I had eye surgery and didn't even know it

[ThomasQED]

until I got the bill.

My doctor diagnosed me as having "dry eyes". I tried eye drops for several months and it was an improvement, but still not back to normal. (It's worse than just discomfort - it affects your vision.)

So on a follow-up visit, he suggested getting tear duct plugs, tiny plastic plugs that go into tear ducts on your eyelid. The procedure took about 30 seconds per eye, and including the usual reading of eye charts, looking into my eyes with machines, etc., the entire doctor's visit was about half an hour long.

I just got my Explanation of Benefits from the insurance. He billed it as "eye surgery" and charged about $3,000, plus $300 for the eye exam (which I find out is not covered since I'd had an eye exam at the beginning of this ordeal). So basically he's raking in $3300... that's a LOT of money to earn in half an hour.

I wish some law would address these insane prices.

And yes, I know I'm very lucky to have insurance.

[uncommon]

1. Wtf. That is ridiculous.

Sadly, my brother got an eye exam at a Walmart Vision Center last weekend and it cost $70 - and $38 for glasses, frames and lenses included.

Sounds like your doc is a bit of a grifter.

[Barack_America]

2. I don't doubt that your doctor overcharged for this, but "procedure", "surgery", "operation"

are all used fairly interchangeably these days. I'd also be curious to know what the manufacturer charges for the plugs. You might be surprised by how much they ask for those pieces of plastic.

[ThomasQED]

4. They were $125 each, according to the EOB...

and there's a $150 charge for "medical supply" which must mean the gloves he wore and the tissue I wiped my eyes with afterwards.

[Barack_America]

9. Wow, yeah. Those charges are really excessive then.

Did you insurance pay the full amount? Or did they negotiate it down to $500 or something?

Let's just say that ophthalmology is one of the fields that doctors go into to make bank. It's a profession for the greedy for sure.

[ThomasQED]

12. They negotiated the surgery part down to $2000

but my $300 of course is still $300 (plus the $25 copay I paid at the time).

[flamingdem]

3. Doctors are the new crooked auto mechanics

Rip-off!

[lonestarnot]

7. New?

[Liberal_in_LA]

20. And some dentists also

[MadHound]

5. Part of the problem is that insurance that you're so "lucky" to have

Before the widespread advent of insurance, doctors had to keep their prices within a range that was affordable to their patients, otherwise they would be out of business. With insurance companies, doctors can charge rates that are completely unreasonable and are in no way reflective of their patients' incomes, yet they'll still get paid.

The advent of health insurance is the single largest reason why we've experienced such a dramatic rise in the price of health care.

[uncommon]

13. +1000000000000000000

[Barack_America]

17. Insurance isn't the problem, insurance companies are.

One of the advantages of insurance that you're overlooking is what the ability to pay more means for medical technology. If no one could afford to pay the thousands of dollars for diagnostic tests and procedures, there would be no MRI, PET-Scans, catheterizations, etc. MRI machines and PET-scanners cost millions of dollars (I toured a nuclear medicine facility last week and nearly choked when I found out how much some of the machines cost). There's simply no way a hospital can recoup those costs charging $200 per scan. Without an insuring body to pay those costs for the majority of patients, hospitals would simply cease to have them. I doubt you would argue that is in patients' best interests. One of the big reasons medicine was so affordable "back in the day" was that doctors had so little to offer patients. The insurance COMPANIES have certainly brought our healthcare system to its knees with their profit margins, but the concept of insurance has done wonders for our medical system.

[ananda]

6. I had dry eyes and went to the eye doctor.

He told me to change soaps and that worked.

[Warpy]

8. The company probably charged him $300 for those tiny plugs

that have to be manufactured to within a thousandth of an inch, sterilized, packaged so they stay sterile, blah blah blah.

As for the doc, refer to this story:

A company had a hugely expensive piece of equipment on the production line. One day, the machine simply stopped working, shutting down the whole line. After two weeks of trying to fix the machine and restart it and thousands of dollars lost, the company contacted the engineer who built the machinery. He arrived, climbed way inside it, pulled out a little hammer, gave it a whack, and restarted it.

He presented the company with a bill for $5001.00. The manager was outraged, "You just whacked it with a hammer!" The engineer replied, "The dollar was for whacking it with a hammer. The $5000 was for knowing where to whack it."

You're not paying for the total time. You're paying for the expertise of knowing what to look for and how to treat it, along with the huge amount of student loans he had to take out to get that expertise and the interest on those loans.

Yes, it's outrageous, but it's another example of why we need national health insurance. No industry is as far out of whack as medicine is.

[ThomasQED]

15. I know, but...

at $2300 per half hour (which is what he will eventually get), he can work 3 hours a day and make over $55,000 a month... that will pay off those student loans pretty quick, even after paying rent, employees, equipment, etc.

Obviously not every half hour will be billed that high, but that's just 3 hours a day... leaves him 4 or so to charge lesser amounts.

[Warpy]

19. He also spent time documenting everything in longhand,

so he spent much longer than half an hour on you. He also coded the procedure to send it to his paid staff to bill to insurance. Chances are he also had to call your insurance company to get the procedure approved.

In any case, the insurance company didn't pay him $2300 for it, they paid considerably less. That price is only for uninsured people like me.

[ThomasQED]

23. True.

So say 1.5 hours. Still a steep price.

Assuming the insurance company paid what is on the EOB, he will get about $2000 from them and then $300 from me. Or are you saying he may pay less than is on the EOB?

[unblock]

10. but after $100 to run the office and $3195.87 for malpractice insurance, he's making minimum wage!

kinda makes you want to vote for tort reform, doesn't it?

:sarcasm:
:sarcasm:
:sarcasm:

[Ozymanithrax]

11. Before Unions pushed management into supplying health care...

most of the workers and their families had none.

In the 60's and 70's, my grandfather (a union man) used Blue Cross Blue Shield, provided by the union contract, otherwise they would never have had medical care.

Countries like Germany have both national health care and health insurance companies, because they regulate the industry to keep prices down.

It is the failure of regulation that allows these shoddy practices to continue, not some inherent vileness in Health Insurance. The lack of health care for the working poor and the middle class was common before Health Insurance Companies. Unless a government actively regulates and monitors hospitals, health insurance companies, and even the pricing practices of individual doctors for the benefit of its citizens, health care will remain a privilege of those who can afford it.

[Love Bug]

14. You should call your insurance co to make sure this was coded properly

All they know is what was submitted to them, so if your doc's office used a different, more lucrative procedure code, well, happy payday for him. I'm not saying there is fraud involved, but you really should investigate this to make sure. He wouldn't be the first doctor to stick it to an insurance company, counting on the patient not knowing enough to ask the right questions about charges.

[ThomasQED]

16. I have considered it

but first I want to try to negotiate a better price for the exam since I will have to pay extra for that.

[eppur_se_muova]

18. I got plugs years ago ... tried two different types.

I don't even remember what the bill was, so it had to be well under $100.

[ThomasQED]

22. Wow.

Do you remember what kind of place it was?

[eppur_se_muova]

24. Private practice -- one doctor. My *favorite* eye doctor.

Sorry that doesn't help at all. :(

[Cleita]

21. This is why we need a single payer Canadian style health plan.

The provincial authorities standardize the prices for each visit and procedure with the approval of the doctors. So each eye surgery performed in that province will cost the same until the price is renegotiated again, usually on a yearly basis. Sure some doctors don't like it because they want to be able to overcharge on the open market, but most are satisfied as are the patients and the govt. agency that pays the bill.

[jmowreader]

25. This is how it works

The doctor considers $500 to be a reasonable price for this procedure...he's got rent on his office, student loans, malpractice insurance premiums, employees, etc., etc., etc. Of that $500 he will put $50 in his bank account. The eye exam is worth about $50, and of that he'll get lunch at Subway.

The doctor also knows your insurance company is going to negotiate him out of five-sixths of whatever he charges, so he multiplies the number he really wants by six and submits his claim.

When the bill gets to the insurance company, the MBA who decides what procedures to cover and how much to pay says this is totally outrageous, they'll only pay $550 for the whole bill. They cut a check for $550, put a note in the envelope that says "you're a dirty crook, you know that?" and throw it into the mailbox as hard as they can.

At the doctor's office, his secretary runs the insurance company's envelope through the letter opening machine, pulls out the check, hands it and the dirty note to him, and smiles...because it's exactly what he wanted in the first place.