Last week, I received a bill for $15 from Mount Sinai/Beth Israel. I called United Healthcare (UHC), my insurer, to find out what this extra charge was for. I was on the line as the UHC representative called the doctor’s office. They told her to call Beth Israel’s billing department; we were then passed on to Mount Sinai. The Mount Sinai billing department informed us that this retro-billing for my December visit was a new “facility charge.” They would not say why this charge was not included in the doctor’s bill (which includes my co-pay), which was sent to UHC.
I asked the UHC representative if such double billing to the patient was justified. She put me on hold while she consulted with her supervisor. Then she told me that they did not know why this added charge was not submitted to them initially and, yes, they can bill me above and beyond the co-pay. In other words, they can screw you out of a few more bucks! I asked whether this was because UHC set a limit on what they pay for an office visit and this was Mount Sinai’s way of getting around it. I received no answer.
If one adds my 15 bucks to thousands of other “facility charges” then Mount Sinai is raking it in. A doctor is a necessity of life and I don’t expect to be fleeced with hidden charges. My son, who lives in England, paid nothing when his son was delivered at the hospital. So this is what the revolution got us: a medical system that working people cannot afford and the Electoral College.
The tracking and billing of medical services seem to be a mess and now the government is asking for better measures of treatment and progress. This is causing more consternation and breeding more theories, algorithms, and computer programs to quantify that information.
Medical bills are pro forma fictions since the insurance companies and the government tell the hospital what it will pay. So, it is not important what the hospital actually bills the insurance companies and the government.
We’ve documented in WestView many times what a complicated mess billing is. Even doctors, myself included, don’t understand it and that’s why we have large billing departments in every hospital and healthcare system in the country. It’s also why some of us endorse a single payer system, like Mr. Felix’s son has in England, where you don’t get endless surprise fees. Considering how creative these billings departments are, he’s lucky that he only got screwed out of $15, and, yes, facility fees are usually included in the overall bill and not added on, I think.
—Alec Pruchnicki, MD