Medical Express PSI Overbilling

[TwiceHorn 30,715]

I went to a local doc in the box (City Doc) for emergent/first aid care for a broken collarbone.  It was a positive experience.  Short wait, competent seeming people.  Xrayed, confirmed the diagnosis, gave me a sling and a pretty detailed handout on broken collarbones.

I got billed $70 for the sling from some Austin-based bunch of ripoff artists called Medical Express PSI.  https://www.medexpsi.com/

I can buy the exact sling for $15 from the mfr.  http://store.birdcronin.com/Universal-Arm-Sling-p/5000-0019.htm

Now, I can understand a little markup for inventory, etc. but this is bullshit.  That's an almost 500% markup for those of you who don't do math.

It's little interstitial things like this that make healthcare a fuck.

I have sent emails to both. Any insight on how to deal with this bullshit without a hicky on my credit?

Edited January 23, 2019 by TwiceHorn

[52-80 18,962]

it cost more cuz its medical grade

[Spur08 381]

You wouldn't want to see what we bill..

 

DME (Durable medical equipment) has an absurd markup and it's where large practices make a good amount of revenue.  You're likely going to have to just pay the bill.  Next time something like this occurs, just tell them "thanks, but no thanks" and get your own.

[TwiceHorn 30,715]

I had surgery on a finger.  1100 from the surgeon.  800 from the anesthesiologist.  3300 from the facility. 

This is the first time I have had to go deep in my Obamacare deductible.  It's eye, and ass opening.

I kind of refuse to be complicit in this bullshit.

[jimmyjazz 45,055]

I can top that.  My wife was bitten by something in the yard -- I suspect an asp -- and her foot swelled up like a grapefruit.  I called the neighborhood emergent care facility and they confirmed they billed according to our Humana rates, although we would be "out of network" and so the copay was $500.

Place was empty.  Got right in and doc looks at my wife's foot -- couldn't obviously identify the critter but did the sharpie marks to track the swelling for one hour -- came back in and decided she would be fine.  Gave her a Benadryl.  Sent us home.

Then we got a bill for $3,000.  For a Benadryl.

[52-80 18,962]

28 minutes ago, TwiceHorn said:

I had surgery on a finger.  1100 from the surgeon.  800 from the anesthesiologist.  3300 from the facility. 

 

 

[TwiceHorn 30,715]

20 minutes ago, jimmyjazz said:

I can top that.  My wife was bitten by something in the yard -- I suspect an asp -- and her foot swelled up like a grapefruit.  I called the neighborhood emergent care facility and they confirmed they billed according to our Humana rates, although we would be "out of network" and so the copay was $500.

Place was empty.  Got right in and doc looks at my wife's foot -- couldn't obviously identify the critter but did the sharpie marks to track the swelling for one hour -- came back in and decided she would be fine.  Gave her a Benadryl.  Sent us home.

Then we got a bill for $3,000.  For a Benadryl.

WTF?  I assume you bargained it down?

[TwiceHorn 30,715]

Just now, 52-80 said:

 

Most credible places (CDC) have facilities as the biggest consumer of healthcare dollars.  It was an outpatient place and I had to pay ahead not to pay $7000+.  But, they used a real operating theater and general anesthesia, so I was a little less miffed.  I walked into the OR under my own power and laid down on the table.  That was freaky.

[jimmyjazz 45,055]

10 minutes ago, TwiceHorn said:

WTF?  I assume you bargained it down?

I'm working on it.  My opening salvo was "I'm not paying you more than $5 for a Benadryl".  They didn't bite on that.

Seriously, they can wreck my credit, I don't care.  I'm not paying $3,000 for a pill.

[bernorange 8,336]

I have often wondered about those "consent to care" forms that you have to fill out at every clinic/office you visit for medical care.  How can the industry get away with requiring patients give them carte blanche up front.  I'll give you consent to treat me, but not consent for you to gouge my pocket.  Costs for everything should be disclosed up front.

You go to a hospital for whatever reason and bring your "must take regularly" medications with you.  The hospital says, "you can't take your own pills, we'll provide you with some from our pharmacy".  And hooray, they get to gouge you for it.

and so on and so on and so on

[elfenix 34,000]

every story i hear about this makes me think that this is the dumbest system possible. 

[Wally Fairway 5,465]

22 minutes ago, jimmyjazz said:

I'm working on it.  My opening salvo was "I'm not paying you more than $5 for a Benadryl".  They didn't bite on that.

Seriously, they can wreck my credit, I don't care.  I'm not paying $3,000 for a pill.

a pill AND a marker

[TwiceHorn 30,715]

One interesting note.  The docs I am using http://www.dallasortho.com/Pages/default.aspx have a self-pay rate that is 30% off and requires payment at time of service.  Turns out, that is slightly better than my Oscar pre-deductible negotiated rate.  They gave me finger splints ($5 for 2) and numerous on-site xrays of finger and shoulder and did not gouge the price on those (<$100 for 4-6 films). 

I feel like they are playing the ACA "self pay" game reasonably fairly.

[HRSchenker 2,215]

3 hours ago, jimmyjazz said:

I'm working on it.  My opening salvo was "I'm not paying you more than $5 for a Benadryl".  They didn't bite on that.

Seriously, they can wreck my credit, I don't care.  I'm not paying $3,000 for a pill.

Just to play Devil's advocate, you didn't pay $3,000 for a Benadryl pill. You paid it for immediate access to an emergency room that is staffed with a board certified physician, tools and equipment that an ER has unlike most urgent cares, and for the physicians knowledge and time spent with you. Or at least that's how it is explained to me by physicians and people who operate these facilities. "You thought you had an emergency, we treated you, and we billed you for it" is a quote I remember hearing on a local story here in Dallas.

But I will tell you this, it is total bullshit that an ER visit can result in 6 or 7 different bills. The only reason it's like that is because Texas law prohibits hospitals from hiring physicians and they have outside companies run their in-house lab room.

[TwiceHorn 30,715]

15 minutes ago, HRSchenker said:

Just to play Devil's advocate, you didn't pay $3,000 for a Benadryl pill. You paid it for immediate access to an emergency room that is staffed with a board certified physician, tools and equipment that an ER has unlike most urgent cares, and for the physicians knowledge and time spent with you. Or at least that's how it is explained to me by physicians and people who operate these facilities. "You thought you had an emergency, we treated you, and we billed you for it" is a quote I remember hearing on a local story here in Dallas.

But I will tell you this, it is total bullshit that an ER visit can result in 6 or 7 different bills. The only reason it's like that is because Texas law prohibits hospitals from hiring physicians and they have outside companies run their in-house lab room.

Counterpoint.  My visit to doc in the box offered the same things, including x-rays and a $70 sling, for a total cost of $220.

Jimmy, was your event at an "emergency room" or a doc in the box?  I kind of assume they are mostly intetchangeable, but maybe not.  By "emergency room" I mean one unattached to a hospital?

Edited January 23, 2019 by TwiceHorn

[jimmyjazz 45,055]

I don't know what you call it -- it's this place:

https://austiner.com/locations/far-west/

 

 

I should have known better.  I should have just waited in line at Seton, etc. but watching my wife drag her new giant cankle around in major pain (and this is a woman who birthed 4 children) freaked me out.  So, I went to the place that I probably shouldn't have.

[Gil Bang 25,507]

6 hours ago, TwiceHorn said:

Most credible places (CDC) have facilities as the biggest consumer of healthcare dollars.  It was an outpatient place and I had to pay ahead not to pay $7000+.  But, they used a real operating theater and general anesthesia, so I was a little less miffed.  I walked into the OR under my own power and laid down on the table.  That was freaky.

ASC or HOPD?

[bernorange 8,336]

jj's place is an emergency care center, not an urgent care center.  They have a page on their website showing the difference:

https://austiner.com/care-billing/urgent-care-vs-austin-emergency-center/

[TwiceHorn 30,715]

I have heard that those private ERs are very bad news on the cost front.

Remarkable thing, I just got a $700 refund from the surgical place.

Gil, I dunno it's this place:  http://www.baylor-surgicare.com/

Appears to be ASC, because it's Dallas Surgical Partners LLC.

Edited January 23, 2019 by TwiceHorn

[Gil Bang 25,507]

That place is Joint Commission Accredited.  That's as good as it gets.  

 

 

[NotActuallyALonghorn 4,956]

Theres a local standalone ER place that I've had to take my daughter to twice when we needed to take her somewhere and her regular doc wasn't available. Didn't get a single bill from either visit. Somehow they manage to get everything covered by insurance. They even picked up breakfast for us once and had a masseuse on staff to give free massages.

[XYZ 2,154]

18 hours ago, TwiceHorn said:

I went to a local doc in the box (City Doc) for emergent/first aid care for a broken collarbone.  It was a positive experience.  Short wait, competent seeming people.  Xrayed, confirmed the diagnosis, gave me a sling and a pretty detailed handout on broken collarbones.

I got billed $70 for the sling from some Austin-based bunch of ripoff artists called Medical Express PSI.  https://www.medexpsi.com/

I can buy the exact sling for $15 from the mfr.  http://store.birdcronin.com/Universal-Arm-Sling-p/5000-0019.htm

Now, I can understand a little markup for inventory, etc. but this is bullshit.  That's an almost 500% markup for those of you who don't do math.

It's little interstitial things like this that make healthcare a fuck.

I have sent emails to both. Any insight on how to deal with this bullshit without a hicky on my credit?

Twice, I can’t tell if you’re being tongue-in-cheek with this post. Massively over-charging for stuff is what the healthcare industry does all the time, and they do it with impunity. From a bandaid to an MRI, medical providers will charge you many times over what it costs them and what people get charged in other developed countries. But, America, fuck yeah.

[XYZ 2,154]

By the way, there’s only a couple of times since I came to the USA over 20 years ago that I refused to pay for something (both times my credit report got dinged but fuck it) and both were for medical services. It literally went like this: go to the ER with a cut from misusing a tool. ER doctor says hey, there’s a doctor roaming the ER right now that specializes in amputations and stuff, want me to bring him in? OK. Some other guy comes in, looks at my finger and goes “nah, you don’t need surgery for that” and leaves. A month later I get a bill from that specialist doctor for I don’t remember how much, but it’s a lot. I call the business office and I’m like “your doctor spent literally one minute with me, I’m not paying a thousand bucks or whatever but I can offer to pay $150”. The answer? Pay what we demand or you’ll get bad credit. Fuck you.

[TwiceHorn 30,715]

Massively overcharging for services or something buried in a bill, sure.  For a single discrete item easily price-shopped and available to consumers, no. 

[deadshank 24,644]

5 minutes ago, TwiceHorn said:

Massively overcharging for services

That's 10 and 5 for each act. Have you really looked at that?  You've got every partner in the firm on overbilling.  

[Quagmire 2,139]

I can top that.  My wife was bitten by something in the yard -- I suspect an asp -- and her foot swelled up like a grapefruit.  I called the neighborhood emergent care facility and they confirmed they billed according to our Humana rates, although we would be "out of network" and so the copay was $500.
Place was empty.  Got right in and doc looks at my wife's foot -- couldn't obviously identify the critter but did the sharpie marks to track the swelling for one hour -- came back in and decided she would be fine.  Gave her a Benadryl.  Sent us home.
Then we got a bill for $3,000.  For a Benadryl.

Lol yep, exact same thing but with my son, had allergic reaction to something late at night , wife freaked , told her the place would screw us, 3k for exam and Benadryl

[TwiceHorn 30,715]

5 minutes ago, Quagmire said:

 

 

Lol yep, exact same thing but with my son, had allergic reaction to something late at night , wife freaked , told her the place would screw us, 3k for exam and Benadryl

I might guess that $3k is their basic initial charge.  Or $2900.

[HRSchenker 2,215]

6 hours ago, TwiceHorn said:

Counterpoint.  My visit to doc in the box offered the same things, including x-rays and a $70 sling, for a total cost of $220.

Jimmy, was your event at an "emergency room" or a doc in the box?  I kind of assume they are mostly intetchangeable, but maybe not.  By "emergency room" I mean one unattached to a hospital?

They are definitely not interchangeable. Insurance companies do not differentiate between standalone emergency rooms and ones attached to a giant hospital. Doc in the box = urgent care = billed as if you were seeing your primary care physician. 

[TwiceHorn 30,715]

1 hour ago, HRSchenker said:

They are definitely not interchangeable. Insurance companies do not differentiate between standalone emergency rooms and ones attached to a giant hospital. Doc in the box = urgent care = billed as if you were seeing your primary care physician. 

Yeah my mistake there. I suppose there is something to be said for being ready to deal with GSW or head trauma or heart attack.  You go there with a sprained ankle, you've still used the resources, even if you didn't make use of their capability.

 

Edited January 24, 2019 by TwiceHorn

[CooterBrown 17,695]

The best fuck you move is when you’re in the hospital and the doctor working the overnight shift bills you for sticking his head in the room. They’re inevitably out of network so they’re 3x more out of pocket and you had no choice in the matter.

[Nice Guy Eddie 13,268]

https://www.tdi.texas.gov/consumer/cpmbalancebilling.html

https://www.houstonchronicle.com/business/medical/article/In-mediation-doctors-reduce-billed-charges-by-12519873.php

Might be worth a shot to try the state when it comes to lowering your bill.  From what I can tell, the first step is mediation with the doc over the phone, and if the consumer is not satisfied, a formal hearing.  What doc is going to want to go to a hearing or send a rep.  I bet any charge gets cut in half easily during the phone call.

Also don’t be afraid to tell the high charging facility you are reporting them to the local consumer affairs reporter.  They might lower the bill by $500 just to prevent the reporter from showing up outside.

unfortunately telling a doc or facility that you’re not paying and to ding your credit does very little but make you feel better and they ding your credit. 

Edited January 24, 2019 by Nice Guy Eddie

[Updawg 2,239]

Wife once took our daughter to one of those clinics for an ear infection on a Saturday. The placed billed us like it was a visit to a trauma center- deductible etc I called and bitched and they said it was correct and there was a sign upfront indicating it was a level 3 er or something. I called my insurance and they noticed they coded the visit as a regular visit and it was over billed. So I called Seton? who owned the place and they agreed but I had to talk to a certain lady to get my money back. Eventually after weeks of tracking down this lady who is never around she agreed and corrected it. I asked her what they do with all the other people who don't do or know how to do this much work and she said every one calls and gets it corrected.

No other industry is this fucked up. They have a license to rip you off basically

[Updawg 2,239]

The best fuck you move is when you’re in the hospital and the doctor working the overnight shift bills you for sticking his head in the room. They’re inevitably out of network so they’re 3x more out of pocket and you had no choice in the matter.

When my daughter was born some random Dr tried to bill like he was in the delivery room as well. I was there and never saw the fucker. Eventually they removed the charge. It's ridiculous. I'm all for dr,'s getting paid and understand they are getting squeezed but the system is a joke. Insurance and hospital systems are just a fat middle man it seems

[CooterBrown 17,695]

Just received a robo call saying I had a balance due with a 3rd party company that bills separately from the hospital and to go online and pay the balance.  I had remembered paying a bill to this services company a few months ago. I couldn't make out the URL on the call, so I google the company and call them. There's no balance due and they don't do robo calls. It appears the phishers have found another pool of potential marks. Somehow they knew I had been billed by this company. I can only assume the URL on the call was to a fake site.

 

 

[Spur08 381]

https://www.tdi.texas.gov/consumer/cpmbalancebilling.html
https://www.houstonchronicle.com/business/medical/article/In-mediation-doctors-reduce-billed-charges-by-12519873.php
Might be worth a shot to try the state when it comes to lowering your bill.  From what I can tell, the first step is mediation with the doc over the phone, and if the consumer is not satisfied, a formal hearing.  What doc is going to want to go to a hearing or send a rep.  I bet any charge gets cut in half easily during the phone call.
Also don’t be afraid to tell the high charging facility you are reporting them to the local consumer affairs reporter.  They might lower the bill by $500 just to prevent the reporter from showing up outside.
unfortunately telling a doc or facility that you’re not paying and to ding your credit does very little but make you feel better and they ding your credit. 

Lulz at this guy thinking a doc handles his own billing and would need to personally go to a hearing.

/I'm out of network. Fupm

[Nice Guy Eddie 13,268]

6 hours ago, Spur08 said:

Lulz at this guy thinking a doc handles his own billing and would need to personally go to a hearing.

/I'm out of network. Fupm

That’s the point.  The doc isn’t going to want to send someone to fight over a $1000.  It’s not worth it.   The doc is hoping everyone will be sheeple and just pay the bill.