This article is specific to the US.
Summary: Over charging is very common by doctors and hospitals. Almost 80% of the bills are over charged. Pay attention to time spent with doctor, tests ordered and services performed. Check against the bill.
CPT (Current Procedural Terminology) codes.
Details:
In the US, we have many reasons for medical costs and therefore insurance to go up lot more than inflation.
Most people know the few reasons:
Frivolous mal-practice lawsuits people and ambulance chasing lawyers which can cause mal-practice insurance to be as much as 30% of an individual physician. It alone contributes to about 2.5% of the US medical cost.
Supply of doctors is artificially kept low by American Medical Association's control over the number of graduates per year. Very self-serving.
Price gouging by drug and equipment makers and hospitals charging 100 times the cost of medication like Tyelenol they give inpatients for example.
So called non-profit hospitals where the profits are pretty much divided as salaries and bonuses to the administrators and top brass to show no profit.
An insurance company provided the following breakup.
Let us take the above graphic for granted for now. Just note than 50% of the cost is hospitals and physicians. Why is that?
Here is what Aetna Insurance said in 2010.
Per Aetna:
Mergers of hospitals were followed by 20% price increase due to monopoly.
About half the spending increase per year is on Medical technology. Doctors are therefore encouraged to order tests which use this equipment.
"The biggest area of excess is defensive medicine, including redundant, inappropriate or unnecessary tests and procedures. Other factors that contribute to wasteful spending include non-adherence to medical advice and prescriptions, alcohol abuse, smoking and obesity."
So, what we can do as consumers of medical care? Do not assume that just because we have medical insurance paid for by the employer, it is cheap to go to doctor or emergency room. Do what we can to stay fit and eat healthy but go get the physical exam and flu shots as a minimum. When we do go to the doctor, have a family member or a friend to take notes of how much time was spent by your doctor with you and what procedures and services were performed. When you get the bill pay attention to CPT codes in the statement.
CPT codes are developed by the American Medical Association to identify codes most often used by physicians rendering services in the medical office. The most frequently used codes are medical Evaluation and Management (E/M) codes.
Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent face-to-face with the patient and/or family.
You can plug in the code and see what it means here.
Doctors think that 61% of the time they are using 99213 wrongly instead of 99214 for 30min.
I beg to differ. Most of the time we go to the doc office for a 30min appointment, we are waiting in the exam room for 10min, nurse 5 min before 5 min after doctor and perhaps 10min with the doctor. It should be 99212 most of the time.
Then pay attention to the tests ordered and other services which can inflate the bill. Insurance companies cannot challenge it. Only consumers can.
Summary: Over charging is very common by doctors and hospitals. Almost 80% of the bills are over charged. Pay attention to time spent with doctor, tests ordered and services performed. Check against the bill.
CPT (Current Procedural Terminology) codes.
Details:
In the US, we have many reasons for medical costs and therefore insurance to go up lot more than inflation.
Most people know the few reasons:
Frivolous mal-practice lawsuits people and ambulance chasing lawyers which can cause mal-practice insurance to be as much as 30% of an individual physician. It alone contributes to about 2.5% of the US medical cost.
Supply of doctors is artificially kept low by American Medical Association's control over the number of graduates per year. Very self-serving.
Price gouging by drug and equipment makers and hospitals charging 100 times the cost of medication like Tyelenol they give inpatients for example.
So called non-profit hospitals where the profits are pretty much divided as salaries and bonuses to the administrators and top brass to show no profit.
An insurance company provided the following breakup.
Here is what Aetna Insurance said in 2010.
Per Aetna:
Mergers of hospitals were followed by 20% price increase due to monopoly.
About half the spending increase per year is on Medical technology. Doctors are therefore encouraged to order tests which use this equipment.
"The biggest area of excess is defensive medicine, including redundant, inappropriate or unnecessary tests and procedures. Other factors that contribute to wasteful spending include non-adherence to medical advice and prescriptions, alcohol abuse, smoking and obesity."
CPT codes are developed by the American Medical Association to identify codes most often used by physicians rendering services in the medical office. The most frequently used codes are medical Evaluation and Management (E/M) codes.
- 99201-05: New Patient Office Visit
- 99211-15: Established Patient Office Visit
- 99221-23: Initial Hospital Care for New or Established Patient
- 99231-23: Subsequent Hospital Care
- 99281-85: Emergency Department Visits
- 99241-45: Office Consultations
Office or other outpatient visit for the evaluation and management of an established patient, which requires at least 2 of these 3 key components: An expanded problem focused history; An expanded problem focused examination; Medical decision making of low complexity. Counseling and coordination of care with other physicians, other qualified health care professionals, or agencies are provided consistent with the nature of the problem(s) and the patient's and/or family's needs. Usually, the presenting problem(s) are of low to moderate severity. Typically, 15 minutes are spent face-to-face with the patient and/or family.
You can plug in the code and see what it means here.
Doctors think that 61% of the time they are using 99213 wrongly instead of 99214 for 30min.
I beg to differ. Most of the time we go to the doc office for a 30min appointment, we are waiting in the exam room for 10min, nurse 5 min before 5 min after doctor and perhaps 10min with the doctor. It should be 99212 most of the time.
Then pay attention to the tests ordered and other services which can inflate the bill. Insurance companies cannot challenge it. Only consumers can.
