Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

A doctor has difficulty making sense of medical bills

Manoj Jain, MD, MPH
Physician
May 2, 2012
772 Shares
Share
Tweet
Share

Rarely do people think about medical costs when there is a medical emergency or an urgent need for a test. Recently, I was in such a situation.

A few days after a 22-hour international flight, the calf muscle in my right leg began to ache. If it were not for the recent flight, or if I were not a doctor, I would have just let it pass.

But long periods of sedentary inactivity, whether sitting on an international flight or lying in bed after a hip surgery, can lead to a blood clot in the leg. This clot can then travel up to the heart, pass the valves and lodge in the lungs, causing a pulmonary embolus. More than 300,000 people each year develop a blood clot in their legs or lungs.

In my career, I have witnessed dozens of patients die before my eyes from a pulmonary embolus. So I became concerned, and called my primary care doctor.

I needed a venous ultrasound, a wand-like probe run up and down my leg to visualize the blood vessels, to make sure there was no blood clot causing my calf pain.

But where would I go for my procedure? It was January, and I did not want to take a big bite out of my deductible. So I asked my doctor for the cheapest facility and went there for my test.

When we go shopping for a television or for some clothes, we keep the price in mind and choose accordingly — a dollar store, Wal-Mart or Macy’s. But in health care, we assume costs will be the same. That is not the case.

So after my test, I decided to explore whether I had really gotten the best price. I called local hospitals and outpatient facilities with a simple question, “Can you tell me what will be the cost of an ultrasound of the right leg to rule out a blood clot?”

One hospital operator transferred my call to the radiology clerk, who then sent me to the admissions coordinator, who then put me through to the scheduling clerk. In the process, I got two possible estimates: $313 or $377. Yet this was just the technical fee for doing the ultrasound. The radiologist’s fee was a separate cost for which I had to call the radiology group, where I felt as if the receptionist had never fielded such a call. Then, after consulting a colleague, she referred me to their billing company, which gave an estimate of $84 as the radiology reading fee.

When I called another hospital, the receptionist transferred me to radiology, which then sent me to a billing coordinator, where a voice message asked me to leave a voice message and someone would get back to me in two business days. I decided not to leave a message. I had just about had it with the automated responses: “If you know your party’s extension, please dial it now …” or “Your call may be monitored for quality purposes.”

Then I called the outpatient facility my doctor had recommended. Within a few minutes, I knew the technical and doctor’s fees, $272. This could be lower if I paid cash at the time of the test and was not filing for insurance. We are charged more if we have insurance? Imagine if they did that at Wal-Mart: prices varying by your income status. Now, imagine if I had done my medical-procedure-shopping when I feared a blood clot in my leg possibly floating to my lung.

The problem is that our health care system lacks price transparency. Patients are shy about asking how much a test will cost, and doctors and hospital administrators are not forthcoming about prices for procedures. Sadly, I must confess, I don’t know exactly the charges of the procedures I deliver every day.

At one level, we cannot blame the health providers. In health care, there are thousands of procedure codes, and it’s unclear what will be needed prior to the service. A colonoscopy may be one price, but a colonoscopy with one biopsy or five biopsies may be another. Also, the payment by patients may vary by nearly two- to three-fold if a patient is self-pay, Medicare or commercial insurance.

The lack of transparency becomes a medical mystery when we get our medical bill. Columns with numbers are for “Amount Charged” “Amount Paid” “Amount Adjusted” “Deductible” and cryptic descriptions like “DUP. VENOUS EXT. UNI/LIMIT”

Honestly, even after 14 years of postgraduate education, I have difficulty making sense of medical bills, so before writing a check, I double-check with my wife “How much do we really have to pay?”

There is a bill in Congress, HR4700, which could simplify this process by mandating transparency in all pricing in health care. It has 67 co-sponsors, Rep. Steve Cohen being one of them. But we cannot wait for Congress to act before getting our next medical procedure.

One website, healthcarebluebook.com provides general information on a fair price for medical procedures in our area. The information can help us know the general price for a procedure and then allow us to cost-compare. Ultimately, this will drive the providers to provide more competitive pricing or, least of all, be price transparent as a start.

Another site, changehealthcare.com provides employees, employers and health plans a tool to compare local prices.

As it turned out, the ultrasound showed there was no clot in my leg. My muscle cramps were likely caused by the higher dose of the statin drug I had initiated a few months earlier. Once I stopped it, the pain went away — leaving me with a medical bill and some important lessons about pricing in our health care system.

Manoj Jain is an infectious disease physician and contributor to the Washington Post and The Commercial Appeal, where this post originally appeared.  He can be reached at his self-titled site, Dr. Manoj Jain.

Submit a guest post and be heard on social media’s leading physician voice.

Prev

What do patients want from the health care delivery team?

May 2, 2012 Kevin 5
…
Next

How single payer can improve the access to cancer care

May 3, 2012 Kevin 6
…

Tagged as: Primary Care, Public Health & Policy, Radiology, Specialist

Post navigation

< Previous Post
What do patients want from the health care delivery team?
Next Post >
How single payer can improve the access to cancer care

More by Manoj Jain, MD, MPH

  • 3 steps to a better health care system

    Manoj Jain, MD, MPH
  • How this physician transitions to becoming an empty nester

    Manoj Jain, MD, MPH
  • Health care in American is on life support, and the future is uncharted

    Manoj Jain, MD, MPH

More in Physician

  • The hidden gems of health care: Unlocking the potential of narrative medicine

    Dr. Najat Fadlallah
  • The dark side of immortality: What if we could live forever?

    Ketan Desai, MD, PhD
  • It’s time for C-suite to contract directly with physicians for part-time work

    Aaron Morgenstein, MD & Corinne Sundar Rao, MD
  • From rural communities to underserved populations: How telemedicine is bridging health care gaps

    Harvey Castro, MD, MBA
  • From solidarity to co-liberation: Understanding the journey towards ending oppression

    Maiysha Clairborne, MD
  • Finding peace through surrender: a personal exploration

    Dympna Weil, MD
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Why it’s time to question medical traditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden gems of health care: Unlocking the potential of narrative medicine

      Dr. Najat Fadlallah | Physician
    • The realities of immigrant health care served hot from America’s melting pot

      Stella Cho | Policy
    • The dark side of immortality: What if we could live forever?

      Ketan Desai, MD, PhD | Physician
    • Lazarus: the dead man brought back to life

      William Lynes, MD | Conditions
    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 5 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Doc Moms, Mind the Gap -- $3M Earning Difference by Sex
  • Clinical Note Writing App Powered by GPT-4 Set to Debut This Year
  • Helping Patients Get Fit -- One Walk at a Time
  • TB Cases Rebound to Near Pre-Pandemic Levels, CDC Data Show
  • Marginalized Groups May Benefit More From Decreasing Air Pollution

Meeting Coverage

  • Switch to IL-23 Blocker Yields Deep Responses in Recalcitrant Plaque Psoriasis
  • Biomarkers of Response With Enfortumab Vedotin in Advanced Urothelial Cancer
  • At-Home Topical Therapy for Molluscum Contagiosum Gets High Marks
  • Outlook for Itchy Prurigo Nodularis Continues to Improve With IL-31 Antagonist
  • AAAAI President Shares Highlights From the 2023 Meeting
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Why it’s time to question medical traditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden gems of health care: Unlocking the potential of narrative medicine

      Dr. Najat Fadlallah | Physician
    • The realities of immigrant health care served hot from America’s melting pot

      Stella Cho | Policy
    • The dark side of immortality: What if we could live forever?

      Ketan Desai, MD, PhD | Physician
    • Lazarus: the dead man brought back to life

      William Lynes, MD | Conditions
    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

A doctor has difficulty making sense of medical bills
5 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...