Tuesday, March 15, 2011


In my never-ending quest to get rid of the clutter and keep my life semi-organized, I sorted through several months of EOBs (Explanation of Benefits) last weekend. I typically don't pay much attention to the EOBs because 99% of them are for Jack and we have Medicaid as secondary, so I don't need to worry too much about what is or isn't covered or what is or isn't billed correctly.  However, I took some time to read through the stack and I was absolutely floored with what doctors/DMEs/nursing agencies charge and what insurance companies pay.  The numbers are astounding.

Here are a couple of examples that caught my attention:

Trach Tube
Submitted Charges:     $3,448.00
Negotiated/Allowed:   $56.38

I don't know which is more shocking, the amount billed or the amount paid.  I'm thinking a trach is worth somewhat less than thirty-four hundred dollars and somewhat more than fifty-six.

Nursing Care in the Home
Submitted Charges:    $562.50/day
Negotiated/Allowed:  $486.70

I remember when I thought daycare for my typical kids was expensive.  $2800/week - now, that's expensive!

Submitted Charges:     $1,282.31
Negotiated/Allowed:   $194.75

My DME company charges over a thousand dollars a month to RENT a pulse-ox machine.  I'm okay with the amount actually allowed on this one.

Dr. W
Office Visit - submitted charges                      $258.48
X-ray of Knee - submitted charges                 $46.83
Treatment of fracture - submitted charges    $1,286.40

These charges by Jack's orthopedic doctor make me mad.  When Jack suffered his broken leg in January, we took him to the doctor's office rather than the ER.  Not only did the doctor charge for an office visit, he charged for "treatment of fracture".  Let me tell you what his "treatment" consisted of --- he took a knee immobilizer and bent it to accommodate Jack's contracted knee and then he handed it to me to put on Jack!  For this, he billed insurance twelve hundred dollars.  Unbelievable!  I like this guy, but I'm extremely disappointed in him for this.

Dr. S
Office Visit - submitted charges     $536.00
Negotiated/Allowed                       $219.47

This charge infuriates me!  You may recall that I posted awhile back about how the State was requiring some kids who have Medicaid to switch to a different program (called Children's Rehabilitation Services).  As part of this switch, your child had to be seen by the CRS doctor to officially get into the system.  So, I jumped through the necessary hoops and made the appointment.  This Medicaid doctor then proceeded to charge my private insurance over five hundred dollars for a visit Medicaid required.  Total B.S.  This charge pissed me off so much that I was going to call them on it.  But, time got away and my anger subsided and I never got around to making the call.  I also found out that we do not have to become part of the CRS program and can stay with the program we have been with all along because we have private insurance and Medicaid is our secondary.  Good thing, because if I had to see that doctor again, I'd probably have a few words for her.

Finally, I offer this one because it's so ridiculous, it's almost funny:

St. Louis Children's Hospital
Ophthalmic Exam - General Anesthesia
Submitted charges                                        $583.15
Negotiated/Allowed                                     $4,198.90

So let me get this - they bill you five hundred and you pay them four thousand?  Nothing like being paid more than seven times what you billed.

Insurance companies rank right up there with the government for being run with a complete lack of efficiency, accountability and responsibility!


Stay tuned ... Mary's 18th birthday is later this week and I promise my "All About Mary" post I promised a year ago.  I figure if I tell you I'm going to post it, I will have no choice but to write it!


Justin and Victoria Nelson said...

man oh man, you don't want to get me started on this subject...i'm right there with you!

Christy said...

I can't help but wonder if what the docs charge is driven by what they are paid. So, if they charged something more reasonable, would they get paid way less?

I do think the whole thing is out of whack. It is scary to think about. So, I try not to. I barely glance over the EOBs and put them in a binder. How long do you save them? I'm ready to chuck them all.

worthy said...

Wow, staggering! This isn't something we see in the uk - unbelievable!

Katie said...

Grrrrr that irritates me as well. It sure is interesting isn't it...
Kind of like Mayo charging us $500 for a in room trach change-when it was OUR trach and I did the change!! The RT just stood there!


Alicia said...

And people wonder why we have a healthcare crisis in this country! Unconscionable!

Susan said...

It IS all a little crazy. And they pile up. I've been keeping them and have a foot high stack I don't know what to do with.

It is good to look at them though. You remember the time we were overbilled by the hospital for some titanium screws. $50,000+ worth. (It did get fixed.) I often wonder how many small overbillings go on every day.