The $486 Office Visit
September 8, 2009
There are times when it is important to adhere to a policy or procedure. There are also times when it makes good business sense to challenge these same policies when they are costing you money.
There are times when it’s important to understand the scope of your authority so you don’t overstep your bounds when you don’t agree with a policy or procedure. However, there are times when a situation is so out of whack that some action really should be taken.
When my son was away at camp this summer, he injured his foot and had to be taken to an urgent care office. The x-rays showed that he had broken three bones in his foot. The doctor gave him a special shoe to wear to support the foot and told him he would need to be seen by an orthopedist.
A week later, we took him to the specialist’s office. In a matter of five minutes, the doctor looked at the x-rays, examined his foot, and advised us that he should avoid any running or jumping for four weeks. Since that meant no basketball, my son was disappointed, but he was happy that he wouldn’t be wearing a cast. We paid our $20 co-pay amount and left.
Several weeks later, as we were going through the mail, we opened the statement from the insurance company and got quite a surprise. No, we didn’t owe any more money, but the amount billed by the doctor’s office was $486. And it included a charge for surgery!
We were in the office for only five minutes, so I can assure you that no surgery was performed. Clearly, the insurance company was getting ripped off, and I thought they might like to know about it. But I was in for another shock.
The representative at the insurance company informed me that if there was a problem with the bill from the doctor, I would have to call the doctor’s office and have them correct it. Then the doctor’s office could resubmit the bill to the insurance company.
This seemed reasonable, but it would take a good deal of my time and effort to do so. Many health plans have a program where they will pay you a percentage of any overcharges that you bring to their attention. I asked if they had such a program. They didn’t.
So the bottom line was that if I did nothing and let the insurance company pay about $400 too much, my co-pay amount would be $20. If I took the hour it was almost certainly going to take to straighten out the bill with the doctor’s office, my co-pay would still be $20.
The insurance company’s policies prevented them from challenging the bill themselves; they offered no incentive for me to do it, and so if I did nothing, they would be cheated out of $400. I multiplied this by the number of times a day this must happen, and I began to understand why my health insurance premiums increase so much each year.
There are times when it is important to adhere to a policy or procedure. But there are also times when it makes good business sense to challenge these same policies when they are costing you money. Look at your own processes and see if there are some areas that are so out of whack that you really need to take some action. It could save you a lot in the long run.
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