Healthcare According To Ernie – The Waiting Game

billing

It’s been 48 days since I was discharged from Bayfront Medical now and I still have no EOB nor invoice that details for me why they want to collect $2,900 from me.  In the interim I have received EOBs and invoices from two other providers:

Emergency Physicians of St Petersburg submitted a claim for $996.00 which was discounted by BCBS MA by $694.73 leaving $391.27 for me to pay.  This was for “Level 5 physician visit services performed by or supervised by…” and the name of a practitioner was actually given.  What are level 5 ER visits?’  Turns out there are five levels of service and I received the highest – yeah me!  I found a handy reference on the American College of Emergency Physicians website that explains each level.  Level 5 is pretty severe – thinks like blood transfusions and other very invasive and complex services AND one provision which I know is complicated from an administrative perspective but also probably very common – “Coordination of hospital admission/ transfer or change in living situation or site”.

So of course they get to bill the highest level of care because they admitted me to the hospital – very convenient isn’t it?  I looked up a fair market value for this service on a couple different websites and the general opinion is that this should have run me $321 so I paid a little more than the reported national average – not surprising given my experience to date with this hospital.

Inpatient Consults of Florida submitted a claim for $519.00 which was discounted by BCBS MA by $350.13 leaving $168.87 for me to pay.  This was apparently for the privilege of staying in the hospital for 8 hours.  The description reads “Same Day Admit High” and came with a CPT code of 99236.  So I went to my handy-dandy AMA website and plugged that code in and much to my surprise CMS will reimburse $221.47 for this service – much less than I was billed so now things may start to even out.

Regardless, the physicians attached to the hospital seem to have their billing act together – claims in and invoices out in under 30 days.  The hospital however is didn’t get their claim in until after the 30 day mark and time will tell how long before the plan processes it.  I know this sounds simple but I have learned more about this process from Google than I could have imagined.  There is a ton of information out there on the subject and as the key to being an informed consumer is to be just that – informed.

The time to research is now.

You can easily learn what care facilities and care options are in your area and you can even learn a little about the potential cost and quality of care.  Granted, cost and quality information for healthcare is still light years behind other market segments but nothing drives innovation in a space like consumer demand.  If we demand it then it will happen.  They key is in how we demand it.  By standing up for our rights and insisting on co-mingling our physical and financial health conversations with our care givers they will listen.