Guest guest Posted January 7, 2009 Report Share Posted January 7, 2009 You might remember my " why I don't recommend the HPV vaccine " handout that I shared a couple weeks ago. Today a former patient (23 yo female) who had moved out of state last year came to see me while visiting her folks. She told me that she had gotten a pap at a clinic in her new community and while there told that she " needed to get " the HPV vaccine. She further said that she specifically asked if her insurance would cover it and was told " Yes, but if they don't, the state will cover it. " She says it was the doctor himself who specifically made this statement and she believed him and got the first vaccation. Turns out her insurance did not cover it, nor did the state and the clinic billed her $540 for just one of those shots. My first question is: Doesn't that seem high? I thought all three together wasn't much more than that.My second, how much do people get schnookered into paying outrageous costs because of our idiotic convoluted non-system. A friend of mine, who works in a medical billing office-- so she knows a bit about how this stuff works--went a couple weeks ago for a screening mammogram. Her mother has breast cancer, so she tries not to skip. She had gotten a free one at the health dept last year, but this year got the billing job and got insurance. She saw a her PC doc, who scheduled the mamm at the hospital in our end of town (where the vast majority of my patients get their mamms) and my friend went, showed her insurance card and had the screening views, then was called back for additional views and US before leaving. She had a couple extra views, but then put her foot down and said she wanted to make sure the additional views would be paid for by insurance before she went any further. At that point, she was told that her plan would not pay for any of the work (that had already been done) because her plan does not cover mamms done at hospital owned facilities. This hospital DOES par with the insurance plan, so I don't know how the insurance can do this.....but apparently the can....Had she gone down the road to the free-standing breast imaging clinic it would be covered, but since done at hosptial, they handed her a bill for over $500... And it's not like she is completely clueless...she bills for physician services every day and processes payments and denials....she feels really stupid now that she did not call the insurer herself before going, but I am upset that the hospital radiology department, who surely must know that this happens, did not say word one to her before racking up a big ticket.. I just wonder how many times this happens, how many gazillions of dollars people have to pay that they would not have agreed to spend had they known up front.... Crazy-- Annie SkaggsLexington, KY Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 7, 2009 Report Share Posted January 7, 2009 For comparison, I pulled a recent invoice and I paid $1526.88 for 12 doses. That works out to 127.24 per dose. I charge $150 per dose plus the admin fee ($20). I’ve not had any insurances not cover it, except NC Medicaid for those 17 to 21. We have them clear it with their insurance then arrange a visit for administration once they know it’s covered. Reimbursement is about the same as cost, but we usually get the admin fee. Tonya S. Little, MD Tonya S. Little MD Family Medicine 1704 Glendale Dr. Ste C , NC 27893 fax tslittle@... From: [mailto: ] On Behalf Of Skaggs Sent: Tuesday, January 06, 2009 9:02 PM To: practiceimprovement1 Subject: question about Gardasil You might remember my " why I don't recommend the HPV vaccine " handout that I shared a couple weeks ago. Today a former patient (23 yo female) who had moved out of state last year came to see me while visiting her folks. She told me that she had gotten a pap at a clinic in her new community and while there told that she " needed to get " the HPV vaccine. She further said that she specifically asked if her insurance would cover it and was told " Yes, but if they don't, the state will cover it. " She says it was the doctor himself who specifically made this statement and she believed him and got the first vaccation. Turns out her insurance did not cover it, nor did the state and the clinic billed her $540 for just one of those shots. My first question is: Doesn't that seem high? I thought all three together wasn't much more than that. -- Annie Skaggs Lexington, KY Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 14, 2009 Report Share Posted January 14, 2009 Well, it is high. When we were giving it, we only charged $250 (or was it $200) a dose for self-pay. To: practiceimprovement1 < >Sent: Tuesday, January 6, 2009 9:01:47 PMSubject: question about Gardasil You might remember my "why I don't recommend the HPV vaccine" handout that I shared a couple weeks ago. Today a former patient (23 yo female) who had moved out of state last year came to see me while visiting her folks. She told me that she had gotten a pap at a clinic in her new community and while there told that she "needed to get" the HPV vaccine. She further said that she specifically asked if her insurance would cover it and was told "Yes, but if they don't, the state will cover it." She says it was the doctor himself who specifically made this statement and she believed him and got the first vaccation. Turns out her insurance did not cover it, nor did the state and the clinic billed her $540 for just one of those shots.My first question is: Doesn't that seem high? I thought all three together wasn't much more than that.My second, how much do people get schnookered into paying outrageous costs because of our idiotic convoluted non-system. A friend of mine, who works in a medical billing office-- so she knows a bit about how this stuff works--went a couple weeks ago for a screening mammogram. Her mother has breast cancer, so she tries not to skip. She had gotten a free one at the health dept last year, but this year got the billing job and got insurance. She saw a her PC doc, who scheduled the mamm at the hospital in our end of town (where the vast majority of my patients get their mamms) and my friend went, showed her insurance card and had the screening views, then was called back for additional views and US before leaving. She had a couple extra views, but then put her foot down and said she wanted to make sure the additional views would be paid for by insurance before she went any further. At that point, she was told that her plan would not pay for any of the work (that had already been done) because her plan does not cover mamms done at hospital owned facilities. This hospital DOES par with the insurance plan, so I don't know how the insurance can do this.....but apparently the can....Had she gone down the road to the free-standing breast imaging clinic it would be covered, but since done at hosptial, they handed her a bill for over $500... And it's not like she is completely clueless...she bills for physician services every day and processes payments and denials....she feels really stupid now that she did not call the insurer herself before going, but I am upset that the hospital radiology department, who surely must know that this happens, did not say word one to her before racking up a big ticket..I just wonder how many times this happens, how many gazillions of dollars people have to pay that they would not have agreed to spend had they known up front.... Crazy-- Annie SkaggsLexington, KY Quote Link to comment Share on other sites More sharing options...
Guest guest Posted January 14, 2009 Report Share Posted January 14, 2009 Wow. that second one was just unethical because it sounds like they knew her insurance wouldnt cover it, but went ahead w/o telling her. They could have at least said "We dont know if it will cover, and its your responsibilty to find out." Then if she didnt call and find out, hey. But this sounds like they jacked her. To: practiceimprovement1 < >Sent: Tuesday, January 6, 2009 9:01:47 PMSubject: question about Gardasil You might remember my "why I don't recommend the HPV vaccine" handout that I shared a couple weeks ago. Today a former patient (23 yo female) who had moved out of state last year came to see me while visiting her folks. She told me that she had gotten a pap at a clinic in her new community and while there told that she "needed to get" the HPV vaccine. She further said that she specifically asked if her insurance would cover it and was told "Yes, but if they don't, the state will cover it." She says it was the doctor himself who specifically made this statement and she believed him and got the first vaccation. Turns out her insurance did not cover it, nor did the state and the clinic billed her $540 for just one of those shots.My first question is: Doesn't that seem high? I thought all three together wasn't much more than that.My second, how much do people get schnookered into paying outrageous costs because of our idiotic convoluted non-system. A friend of mine, who works in a medical billing office-- so she knows a bit about how this stuff works--went a couple weeks ago for a screening mammogram. Her mother has breast cancer, so she tries not to skip. She had gotten a free one at the health dept last year, but this year got the billing job and got insurance. She saw a her PC doc, who scheduled the mamm at the hospital in our end of town (where the vast majority of my patients get their mamms) and my friend went, showed her insurance card and had the screening views, then was called back for additional views and US before leaving. She had a couple extra views, but then put her foot down and said she wanted to make sure the additional views would be paid for by insurance before she went any further. At that point, she was told that her plan would not pay for any of the work (that had already been done) because her plan does not cover mamms done at hospital owned facilities. This hospital DOES par with the insurance plan, so I don't know how the insurance can do this.....but apparently the can....Had she gone down the road to the free-standing breast imaging clinic it would be covered, but since done at hosptial, they handed her a bill for over $500... And it's not like she is completely clueless...she bills for physician services every day and processes payments and denials....she feels really stupid now that she did not call the insurer herself before going, but I am upset that the hospital radiology department, who surely must know that this happens, did not say word one to her before racking up a big ticket..I just wonder how many times this happens, how many gazillions of dollars people have to pay that they would not have agreed to spend had they known up front.... Crazy-- Annie SkaggsLexington, KY Quote Link to comment Share on other sites More sharing options...
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