Doctors Who Prey?

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This time about a year ago, you’d have found me in an aircast and crutches…

I broke a bone in my foot trail running, not fun. In fact, I’d broken the exact same bone on the same trail a year earlier and been in a similar contraption at that time. So, I had a feel for what aircasts or “cam-walkers” should cost. Which is what led to the following email to the doctor’s office manager:

Hello,

I am a patient of Dr. XXXXX’s, who came in for a first visit two months ago and was fitted for an Aircast that day. Your billing system was down, so I did not see the invoice until my next visit a month later.

At that time I realized your office charged me $480 for the Aircast. This struck me as odd, since I had broken the same bone in my other foot a year earlier and a different doctor charged me about $100 for an aircast for my other foot.

I mentioned to the woman processing my payment that it was available elsewhere and online for $80-$100 and she told me the those prices were not for the model I was given. When I returned home, I researched the specific model I was provided by your office (Aircast FP Walker 01F-L) and found that very same model was indeed being sold all over the internet for between $75 and $100.

Below are just a few of the links to major retailers demonstrating this fact, there are dozens more:

[links to 5 online retailers showing $75-$100 price]

With the exception of this incident, the service I have received from Dr XXXX and the entire office has been exceptional and fairly priced.

Charging 600% of fair market price for the Aircast, though, is so out of sync with everything else I have experienced with your office, I am wondering if the price of the Aircast may have been entered into your system incorrectly?

I am happy to pay a bit more for the convenience of getting it at your office, instead of buying it online and having it overnighted. I could see a mark-up to even $150 as being reasonable (even though I paid less than $100 for my last one), because your service has been so good.

But, 6 TIMES the going rate is what most people would call opportunistic pricing.

If I have missed something, please do let me know where I have gone astray. If not, as I mentioned, I have had such a wonderful experience with every other aspect of your office, I trust we can resolve this “system error” quickly and discretely with an adjustment and refund.

Thanks so much for your kind and prompt attention.

I then waited.

11 days passed with no reply.

So, I emailed again, referencing the above email, and got this reply…

Hi Jonathon,

I apologize for the delay in getting back to you. Thanks for forwarding the info to me.

Were you reimbursed by your insurance company? Camwalkers are recognized and reimbursed by all insurance carriers.

I would be more than happy to discount your bill if your insurance company fails to pay. But keep in mind, insurances might deny based on “no out of network benefits” or “medical equipment not covered on your policy”. However, it wouldn’t be based on our fees.

(I’ve never come across an Orthopaedic Surgeon in NYC or Hospital that charged $100 for a camwalker).

Please keep in mind, Medical Facilities come up with fees based on a national database and demographic area.

If you would like to discuss further please call me @ xxx-xxx-xxxx or email.

I’ll try and resolve this matter by next week.

Thanks

I was pretty bothered by the response.

Whether I was reimbursed or not wasn’t the issue (I wasn’t, btw). Nor was whether other doc’s charged what they charged (and as I noted, I paid another one about $90 for a similar product a year earlier). The price of the device shouldn’t be based on who’s selling it to you.

This was about their deliberate decision to charge a patient 5-600% of the going retail rate for an orthopedic device while that patient is in a state of immediate pain, and never let that patient know they had the option of buying the same exact thing online (or getting it from a local supplier, pharmacy or another doc) for a small fraction of the price.

It was about telling me, when I first brought the discrepancy to their attention, that I’d made a mistake on the model. Then backpedaling when I showed them it was the identical model and essentially saying…

“yup, we’re really doing what you’re saying…but so is everyone else, got a problem with that?”

The day I received the reply, I really wanted to mix it up, but I didn’t.

Because this wasn’t any ordinary consumer transaction. I was placed in the very awkward situation of not wanting to burn my relationship with the doctor, because the care he’d personally been providing was excellent. I didn’t know how much more care I’d need from him and I didn’t want to inject bad energy into that element of the relationship.

So, I wrote this simple reply…

Thanks for your reply. I have no out of network benefits, so neither the visit or camwalker are covered. So, yes, I would appreciate an adjustment.

Their response…

Nothing. Not a word. End of transaction.

So, I’m wondering, is what the doc and their office did okay?

  • Is it ethical?
  • Is it slimy?
  • Is it even…predatory?
  • And, with social media now giving everyone a voice…is it just plain bad business?
  • Or, am I just an oversensitive wuss (entirely possible, lol)?

What do YOU think?

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60 responses

60 responses to “Doctors Who Prey?”

  1. […] This post was mentioned on Twitter by johnhaydon, Grant Griffiths, Frank Dickinson, Alex Rinehart DC, MS, Santi Chacon and others. Santi Chacon said: Doctors Who Prey?: This time about a year ago, you’d have found me in an aircast and crutches… I broke a bone in … http://bit.ly/c4iIVW […]

  2. Dennis Baker says:

    No it’s not OK. The issue is the “System”.

    Nobody is accountable or responsible. Who knows where the price of that air cast came from, certainly not the woman you were discussing it with and BTW she has NO ability to change it.

    IMHO – what you have described above IS the problem with our HC system. It too big and convoluted. Insurance will pay for it, so don’t worry about it.

    We need the consumer back in HC. Look at how Lasik eye surgery has come down over that last 5 years. It’s not covered by insurance, so market forces take root and the law of supply and demand rule.

    And there you have it… HC solved, next world crisis please.

  3. Jean Sarauer says:

    I’m really uncomfortable with health care being profit-oriented. How many people are on drugs they don’t even need so someone can make a buck? The costs and quantity of tests and treatments are totally out of control.

  4. Social comments and analytics for this post…

    This post was mentioned on Twitter by jonathanfields: Doctors Who Prey? – http://bit.ly/cif6sk

  5. Jennifer says:

    I think you are 100% justified in being upset. Instead of address in the issue, the doctor 1) figured the insurance company would pay (gee why are premiums so high?) and then 2) said everyone else was doing it too.

    It sort of leaves a bad taste in your mouth. People come for emergency or necessary services to people they trust, medically and financially…Shopping around isn’t always an option.

  6. RJ Weiss says:

    Had a similar situation happen to me. Called three different places for a prescription, one was $100 a month, one was $90 a month, and one was $30 for a three month supply.

    Unfortunately most doctor’s offices assume that everything is covered by insurance and you’re not going to see the bill, whish is different from any other transaction you will ever have.

    I switched to an HRA this year, and the two times my wife and I have vitiated a doctor this year, our bill has been correctly encoded.

  7. Jessica says:

    Absolutely your situation was price gouging. Aren’t there laws about that? I seem to recall that after 9/11 and Katrina, some gas stations raised their prices out of fear and because they could to simply outrageous levels and there was talk about this being illegal. Until we all get together and force these health care providers to bill us correctly and fairly, nothing is going to happen.

  8. Jonathan,

    Great post and an excellent example of what happens when the customer is in essence removed from the transaction (“don’t worry, the insurance company will pay for it”) and as Dennis has noted, a key problem with our health care system.

    No, I wouldn’t call them “slimy” (although their lack of response is incredibly poor customer service, regardless of the price of your airboot). They have one model of how to provide health care, and your email is quite possibly the first one they have ever received asking about prices from the customer’s point of view. I had a similar experience several years ago, and the people I talked to couldn’t even wrap their heads around the concept of “price.” They literally had no answer to my question of “how much will this cost?”

    The new health care legislation that’s been passed will make all this 100 times worse, since there will be no accountability at all. A far better solution would be to create health care savings accounts for each citizen, and allow a combination of personal savings, employer-provided savings, or government contributions (for those who lack the disposable income to seed the account).

    Their lack of response to your last email is also typical, although not “slimy.” Again, you are probably one of the few who have ever contacted them in this way. They very likely lack any sort of “process” to process customer comments/emails, since they have no need to respond. The insurance company is their customer, not you.

    You are not an insensitive wuss (at least not based on what you’ve written!), but simply a very savvy, well-informed customer. You might as well have green skin and horns…you are an unknown species in that doctor’s office! They are light years behind you in terms of understanding customer expectations and possible outcomes of your interaction with them.

    Assuming nothing changes in the recently passed legislation (a far fetched possibility in my mind), the coming clash between
    socialized medicine and social media will be something to watch (although no fun to be the victim in the middle).

  9. My apologies – I should have completed my thought by noting that personal ownership of health savings accounts will drive an incredible advance in health care customer service, lower prices, and better quality. They’re not the total solution (eliminating interstate barriers to selling insurance products is another huge component), but they are a big part.

  10. Tamarisk says:

    Whoa! Our health care system in the UK isn’t perfect by any stretch of the imagination but reading this makes me proud of the NHS – here you just get that stuff as part of the treatment you receive, all free (well…paid for by taxes!)

  11. The main problem is with the insurance. These offices know that they don’t have to compete on price because the insurance company will cover it. The patients never end up paying the price. I think Dennis hit it spot on with the example of Lasik surgery.

    If health insurance could go back to being real insurance, a lot of problems would go away. I think that insurance is meant to safeguard you from a catastrophic loss. When you injured your foot and bills cost you under $1000, then that’s probably not a catastrophic loss and we would be better off if insurance didn’t even play a role in these kinds of transactions.

    The root problem is that people expect insurance to pay for everything. This isn’t insurance, it’s health “pre-payment” and that’s why premiums have risen so much.

  12. Your doctor’s probably a great person, with someone, somewhere in the support staff, who thinks like a mafioso or a contract killer.

    Sorry, this is morally bankrupt. If this happened to me, I’d have a heart to heart with the doctor, and if they thought this was okay, I don’t want that person offering me health advice.

    That’s one bridge I’m willing to burn.

  13. Peter Graham says:

    Ultimately the consumer pays handsomely for the inflated bills presented to the insurance companies. It seems that any time an insurance claim is involved the price for work done is multiplied. It doesn’t matter whether this work is repairing a person, car or home etc.
    To me this practice is unethical but I haven’t a clue what can be done about it!

  14. Judy Dunn says:

    What happened to you is SO not okay. Because something may be covered by insurance is just a convenient excuse to gouge.

    My husband went to the hospital last summer. He had to stay overnight for observation. ONE NIGHT. The bill was $19,000+.

    We protested and when they found it wasn’t covered by insurance, they sent us an “adjusted bill” for $4,970. There is something morally and ethically wrong with that. You did the right thing to protest. Problem is that the patient has no power.

    Good on you for blogging about it!

  15. Romilly says:

    It goes beyond “they expect everything to be covered by insurance” and into “insurance underpays for things so they inflate the prices so that they can actually get paid what the item costs them.” It’s the system. And it does mean that people without insurance coverage for whatever reason are the ones who get to eat the inflated prices.

    Talk to your doctor about it. It’s one of the main reasons health care in this country is so expensive. I have the same problem with my cpap machine parts. The local company recommended by my doctor charges 5 times what I pay through an internet supply house.

  16. Dave Perks says:

    No. It’s not okay. Further, my wife has worked in the front office of several medical practices and I can assure you that your doctor and the price fixer up front probably have very little interaction. Doctors view front office staff as malcontents at best. Front office staff view doctors as prima donnas. They don’t go to lunch together. So you should handle the problem the way your gut tells you. Don’t accept the crap.

  17. Totally slimy in my book! Sue Lowden of NV has been in the news a lot lately recommending a barter system for our health care which is equally ludicrous!
    I’m all for shopping around – even asking the doctor if what I’m being prescribed has a less expensive alternative, or even a natural option.

    I’m with Joel, I would burn that bridge in a heartbeat!

  18. Barbara D says:

    Have had the same experience with my cat’s vet, who wanted to dispense medication directly that I found out could be purchased from a pharmacy at a fraction of the cost.

    It was accidental — I just happened to mention it to the pharmacist, who tolf me I could get the same medication from them — and I ended up saving hundreds of dollars over the period of time that the maintenance medication was required!

    So beware veterinarians as well as doctors…

  19. Alysson says:

    Your experience is not unique, nor is it an exception to the norm. This is indicative of all that is wrong with the entire health care system in the US. When you hear people speak of Medicare fraud – while you obviously aren’t a part of that system – practices like this are commonplace within the Medicare and Medicaid systems. It’s why comprehensive reform of the entire health care system, not solely greater regulation of the health insurance industry, is absolutely imperative.

    Doctors will charge 5…6…10 times more to those who can or are perceived to be able to pay it. Whether bills are paid out of pocket by their patients or reimbursed by health insurance is irrelevant to them. Many claim to do so, at least in part, in order to account for the services they provide for which they will never be paid – either because insurance denies the claim or patients have no insurance and no means of remitting payment.

    Don’t get me wrong, greed does factor into the equation somewhere for many doctors and they hide behind a veil of plausible deniability if their billing practices are ever called into question. This is the nation we live in. This is the system we’ve built.

    And because people are not in a position to take a consumer’s approach to health care, as seeking care is most often based on immediate need, we’re unable to “shop around” for the most cost effective solution. Why do you suppose hospitals bill, and are permitted to bill, $100+ for a Tylenol?

  20. I would’ve fired the doctor (after I told him off) and then take the cast straight back to his office.

    It’s one thing to tell you what you’re going to pay when they fit it, but to do it after the fact is dirty.

  21. Tim Brownson says:

    Get yourself a new quack man, imho there is no excuse for that.

    I recently had a (at most) 90 second consult with my hematologist. Actually, it was him walking in telling me I’m good to go for 6 months and then asking me how my soccer team were doing on the way out.

    Cost?

    $181 to my insurance company and $30 to me plus half a morning off work. Couldn’t he have just texted me?

  22. I would be annoyed with this too. It feels slimy to me, especially this:

    “Were you reimbursed by your insurance company? Camwalkers are recognized and reimbursed by all insurance carriers.”

    If you were reimbursed, why would you be asking for an adjustment? (DUH comes to mind). Why would you have looked at online prices unless you had nothing better to do than make sure your insurance company wasn’t paying too much? For me, that sounds like “you got your money, didn’t you? Why are you concerned?” It also implies that, if you already got reimbursed, that you’ve actually got the audacity to ask for more money.

    This one: “(I’ve never come across an Orthopaedic Surgeon in NYC or Hospital that charged $100 for a camwalker).

    I know what would be going through my head: “I really don’t care whether you have or not. When was the last time you conducted a survey or had to get one of these yourself? And how often does the price of camwalkers come up at when you’re chatting with all the other ortho surgeons in NYC?” lol

    “Please keep in mind, Medical Facilities come up with fees based on a national database and demographic area.”

    This is probably what she says to anyone who questions prices.

    Maybe you’ll get reimbursed. How long has it been since you heard from the office? Maybe give a call to see how the process is moving along, and, as a reminder, thank her for agreeing to make the adjustment (if I’m understanding properly she did agree that she would).

    In my experience–mostly with veterinarians–the doctor or office manager doesn’t have much to do with the prices if the practice is at least moderately large. Maybe you can ask who to speak with if this office manager isn’t able to help. I was successful in getting one of my vets to match online prices with something awhile back, but I did have to speak with the business manager behind the scenes and provide lots of proof.

    Your doctor probably has no idea what’s going on with prices. Or good chance, anyway. Sounds like he or she might be open to discussion about it, and might even thank you for bringing it up.

    I said it feels “slimy” but it’s just the way this office manager responded (how people communicate fascinates me but I do get annoyed sometimes). But it could be something going on behind the scenes with whoever sets the prices (assuming there is someone) that’s unethical.

    Definitely check back and see what’s going on. I would. Ouch on the foot–btdt. On a trampoline lol In Germany. Fun! Not.

  23. Tony Grogan says:

    Never been price gouged like that but have been taken to bank by ER doctors. Just recently we took my son to the ER for some stitches due to a baseball injury. Metal cleats and human skin is not a good mix. 7 stitches later and a $100 copay we are out the door and heading home. A month later we receive a bill for ER doctor’s services, $680. For twenty minutes time, a little thread and needle work. Oh did they not tell you, we are not in your preferred network. How can the hospital be in our network, and the doctors that work there not be in our network. Had I known that I would have used Super Glue at home.

  24. I’d say definitely not okay. You might consider reporting the incident to the BBB. That’s a pretty simple case of price-gouging.

    You could also try contacting your doctor directly and inform him of the details. He may not even realize what happened, and might not be very happy finding out what his office staff are up to.

  25. Leif Eriksen says:

    This is just one of the many problems with a U.S. “healthcare” system that scores low on outcomes and high on costs. A good start would be to stop calling it health care and start calling it what it is – medical care (see http://leiferiksen.wordpress.com/2010/03/13/stop-calling-it-health-care/). Then, and only then, can we make rational decisions about its cost.

  26. Liz says:

    Sadly, I had a similar experience this past year. I had been going to a doctor’s office that I picked up while at a previous job because it was convenient. I have since changed jobs and joined the health and wellness industry myself. I tend to focus on prevention before treatment, with the belief that certain illnesses and conditions can be avoided through proper diet, exercise, and lifestyle choices (e.g. diabetes, heart disease, obesity, etc. etc. etc.)

    Long story short, I got charged an exorbitant amount for some pretty basic procedures. As the daughter of a doctor and a nurse, I inquired further into the situation. Based on commonly accepted going rates, this particular office charges me $250 for a $15 procedure, among other things. When I approached the office, they simply explained, “We’re in Soho, we can charge what we want.” Verbatim. You can bet that after settling the bill, I promptly ended that relationship.

  27. Susan Greene says:

    I wonder if the doctor himself is aware of the situation. He likely isn’t. He probably is not the one who set the price. And often you have worker-bees who handle billing, and they really don’t care about a patient’s opinion of their practice or fees.

    I think you should send a letter directly to the doctor and let him know the situation. Or even just send him a link to this blog post, as you spell out the situation very clearly, and the doc can also see the feedback you’re getting. If he’s as decent as you say, then maybe he’ll take action to remedy the situation.

  28. I’m going to play devil’s advocate here any present another point of view. Specifically, I question the premise that “The price of the device shouldn’t be based on who’s selling it to you”

    Say I make a ‘widget’ in my garage and I go sell it at a flea market for $5.

    Then some shop owner see’s it and thinks this widget is a great idea and invites me to sell it in his upscale shop. But he advises me to charge more, to keep with his shop’s image. So I sell it for $50. And it actually sells well!

    But I continue to sell widgets on weekends at the flea market for $5 because I know no one there is going to pay $50.

    Now, who is to blame? Is it the people who are paying $50? Is it the shop owner who is going along with it? Is it me for charging what the market will bear?

    Haven’t you every paid $15 for a margarita in an upscale club that would cost you $7 in a chain restaurant, or 50-cents to make at home?

    We, as customers, all make decisions about what we will pay for. And sellers set their prices based upon their customers make.

  29. Oops, sorry about the grammar mistakes in the previous post (“any present” should be “and present”. And “every paid” should be “ever paid”). I guess I didn’t check my spelling well enough! I’d love to have an edit function here.

  30. ami says:

    I’m with the commenter who suggested a face to face with your doctor. It seems that doctors do everything in their power to avoid having to deal with administrative and billing matters, hiring entire teams of people to process payments, set prices and handle billing. I would not be surprised if your doc had no idea what the actual cost of the cast was.

    That being said – given that the billing team is part of the ‘team’ you sign on with when you choose your doc – might be time to shop for a new doctor. These days, your health service is provided by the entire office and not just the physician.

  31. Nicki, Dismayed Healthcare Worker says:

    The day someone comes up with a better business model that doesn’t play these kind of pricing games, docs will be out of luck. Future med school students: For God’s sake, take some business classes!!! The old way of doing things is dying, and you need to be ready! Stop saying stupid things like, “I’m a professional, not a salesman.” This type of thinking will make you BROKE! The market is clearly screaming for a better system, and it will find one….with or without you. Just my two cents.

  32. Jeff says:

    Please get in touch directly with the Dr., not the billing or office mgr. I’m pretty sure he’ll be embarrassed about the whole thing and promptly sort it out for you. In my experience w/ Drs, they are seldom directly involved with that kind of pricing decision.

  33. Maggie says:

    I would have informed the doctor’s office that I was returning the aircast for a refund. If they balked, I’d reverse the charges on my credit card, which incidentally I always use for major purchases for that very convenience.

    I wouldn’t take it lying down.

  34. Jim Vickers says:

    Yes, they’re the kind of fraudulent slime-balls that have contributed to our out of control health-care system along with the insurance companies, drug companies, hospitals, attorneys, some patients and now our government. Have I left anyone out? Virtually all of them are corrupted by the “look the other way” ethic that has grown in the past 20 years as our nation has continued to rule God out of the affairs of men. I realize I’m not being politically correct but it’s going to continue to get worse and worse, so we might as well get used to living in the society we’ve “allowed”. Sorry but it makes me sick in the stomach to watch it happening.

  35. Abbie says:

    I absolutely think that the doctor’s office is trying to get more money, and that you have thus far handled the situation very respectably.

  36. bchase says:

    This is one of the pet peeves I have with the health care system. Years ago I was working for a state agency and for a time I had a wellness/copay system. I paid $15 no matter what and the insurance paid the rest. Then the state switched to a deductible plan and I had a $1000 deductible before any fees were covered. I went to the doctor for a procedure I needed, payed the $375 bill and submitted the receipt to insurance for reimbursement. I was told by the insurance that they only paid $125 (or something close) for the procedure and, because I was insured, the doctor could not bill me the difference. I needed to get the difference back from the Dr. I was also told that I should not pay my bills until I saw what the insurance covered amount was.

    I was able to settle the situation with the Dr.s office but it really set a fire in my gut which burns today, because people who have no insurance are the ones least able to pay $375 for a procedure for which insurance will pay only $125.

    There is, to the best of my knowledge, nothing regulating this situation. Insurance companies have clout. Private citizens don’t. Therefore, insurance gets discounts and the rest of us schmucks don’t unless we are insured.

  37. Anne says:

    Unfortunately, poor communication with people who work in doctor’s offices is all too common and has nothing to do (generally) with the doctor. I would continue to push the issue because it will likely not affect your relationship with the doc at all.

    I have the same type of problem with my family practice doc. I love her; she and I are on the same wavelength in so many ways and since she is the doctor I go to for intimate issues, this is hugely important. But the nurse? Forget it. Unfortunately, I deal with the nurse any time I need meds refilled etc. and for some reason I seem to have to explain my situation (re: thyroid meds) every time. The doctor and I have agreed I only need bloodwork once a year but the nurse will hold up my refill (which is not a good thing – thyroid meds need to be taken every day) and then call me, leave a message, I have to call back, only to tell her “no, I do not need to have bloodwork three times a year.” You’d think she’d note it in my file?!

    Anyway, the office staff are the ones you are dealing with…I can almost guarantee the doctor has no clue there has even been a problem. So keep fighting – what they are doing is ridiculous given that you were not told the charge up front.

  38. I agree that the issue is larger than the price of a cast – but stems from the current state of our healthcare system. There is a lack of accountability at almost every level of the current structure: the patient, the doctor, the insurance companies, the pharmas, the med mal companies, the government, etc.

    I also agree that the best hope for addressing the situation in our country is to actually return the power of choice to the consumer. Currently, the average insured American consumer of medical care thinks everything costs $15 – $25 (her co-pay) and many of the uninsured think it’s free (just go to the ER). I love the idea of HSA’s and think they have real potential to help address this issue – but the premiums on the insurance portion of them are unjustifiably high still (I just priced them a couple months ago in NYC).

    I would be surprised if the doctor did not know about your complaint/question – unless it is a really large office. However, to be fair to them, it is rare that a doctor generates a bill and actually gets paid what was billed. The standard process is that the insurance companies have their own negotiated rates and that is all they pay. However, their computer systems (in most cases) pay the LESSOR of the negotiated rate or the billed rate. So I wouldn’t quite call this price gouging – since the billed rates are almost never paid and there is actually a downside to pricing too low, but no downside to pricing too high.

    I am curious to know if they did adjust the bill. It is very common now because of the overhead that medical offices must incur to handle insurance companies (and the games they have to play to get paid) for there to be one fee schedule for cash patients and one for insured patients. More and more doctors are just refusing to take insurance because the overhead to collect is so high.

    The one problem with putting the power back into the hands of the consumers (besides how disorganized consumers are relative to the AMA, pharmas and insurance companies) is that many consumers will not have the confidence or comfort level to confront their doctors on price.

    Whatever happened to the local family doctor who didn’t get rich and buy 3 houses and 4 cars from helping people get well and stay well? I’m really curious to know what triggered that shift. I think it happened in the last 50 years….

    PS – Dude – you’re awesome 😉 (couldn’t resist….)

  39. Nicki, Dismayed Healthcare Worker says:

    No, no, no. If the doctor is in private practice, (S)HE sets the prices. If it is a group practice or hospital, then a corporate-manager / executive sets the prices. Staff simply do as they’re told (they don’t dare tell a doctor what to charge & earn). A doctor, however, can override a policy at his/her discretion.

    Were I you, I’d have a one-on-one with the doctor. Why? You are #1 a returning patient (repeat business, not new) and #2 a potential referral source (and the most effective type of advertising around).

    Again, doctors, the old-school wacky HC business model will change. The market demands it. Who’ll be left standing? That’s up to you…

  40. No one has mentioned a simple fact: doctors are offering a service like other service providers. Their prices are negotiable. They just haven’t come to grips with that yet. Doctors have been on a pedestal for years and patients have meekly gone along with recommended treatments — and prices. But the internet now offers transparency that never existed before. That is why the price of the aircast is negotiable — because we can check comparables and actually buy the device online. It is also the patient’s responsibility (unless unconscious) to ask the cost of a service or product in advance. Doctors provide an invaluable service, but patient’s have rights, too. The problem is these discussions are so uncomfortable for both doctor and patient, because money was never part of the relationship before.

  41. caitlyn says:

    I know Canada’s health care system has its own problems, but what you describe is less likely to happen in a doctor’s office – although, once you get to choosing which crutches you would like and such, there are the “free with a deposit” and the cadillac versions – and more likely to happen with dentists.

    Unionized Canadians and those in large enough companies to have group health insurance are generally covered for basic dental costs of cleaning, check-ups, occasional x-rays, and fillings. If you need a crown or something more specialized, you pay out of pocket. The reality is two-prices, the discounted one for those without insurance, and the regular fee for those with insurance. Fair enough – in most cases, the difference is not that great.

    My general practitioner, who has never charged me for anything in the 10 years I’ve been seeing her, says the most difficult part of her job is her office staff. Over the years, they’ve come & gone. Some have been rude, others inefficient, most are just there for the paycheque. The doctor must have people with medical terminology training and billing experience, at the very least, and these skills are at a premium.

    I agree with the person who made the comment that suggests speaking directly to the doctor. I know my doctor appreciates feedback on what is happening in the waiting room & reception area; without it she doesn’t know how things are being done.

    In your shoes (cast?) I’d be ready to punch someone out and be using all my formidable interpersonal skills to make it through the exchange with my integrity intact (and all the parts of the other person intact, too.)

    Should I admit that a recent post at http://ImaginingBetter.com is titled “The Courage to Beat Your Kids”? Really I’m not like that. I abhor violence, really.

    And, Jonathan, good on ya for keeping your cool.

  42. Dale says:

    Thanks for sharing your experience of YES bad business tick the boxes for slimey, unethical and predatory. The key word here is BUSINESS, what you have participated in is a business transaction and it looks like there were a few things missing: a pricelist for you to compare, and agreements for the way in which the business is conducted. IE, we will respond to issues/queries/complaints within x amount of days in compliance with our policies and procedures – do they have any?

    I’m with the suggestions for you to meet with the doctor coming from a business perspective. (oh, and if the doctor’s name is on the invoice and he is NOT aware of the price invoiced, I would also point out the illegality of that action). Take the prices you’ve researched, request to see his business practices charter, and a print out of the responses you’ve gathered here. Invoice him for YOUR time for your research and settle your mind, the transaction and the account.

    Alternatively tick the other box that says oversensitive wuss. OUCH, sorry for that little conclusion, bit like an unsettled invoice that weighs on your mind!

    Seriously, thanks for sharing your experience.

  43. Witold says:

    I have just returned home from a dental consultation . At reception I had to wait for the dentist to enter the amount I had to pay into his computer so the receptionist could see it on her computer . I doubt that doctors are unaware of prices being charged for hardware items as HC is a profit making business .

  44. Eugene the old Yogi says:

    I agree with Joel’s thinking earlier. If the doctor is willing to price-gouge for an aircast, I would be skeptical about seeking further medical advice from him. If he’s the only surgeon in town, then you have to deal with him; but there are lots of good doctors around. Often, they work under a corporate umbrella of some sort, and herein lies the problem: the health care business is too often more about making money than dispensing health care.

  45. Health care should never be profit oriented. People should give of themselves freely because they know it’s the right thing to do. It shows how much work we all still have left to do here.

  46. […] Doctors Who Prey? Medical Profession or Predatory Syndicate? […]

  47. Jonathan Fields says:

    Hey guys,

    Great conversation, as always. I’m digestifying everyone’s thoughts. A few more facts…

    1 – This particular doc is a top ortho surgeon in a busy NYC office with a big practice, I have a lot of trouble believing he doesn’t know from whence his P & L comes.

    2 – Even if he didn’t know, that’d fall under something I’d call “not wanting to know.” Lawyers call it reckless indifference. Isn’t it his job to know?

    3 – His office DOES NOT TAKE INSURANCE. It’s all out of pocket, so this was not about them padding the bill so they could get paid more. All of their patients pay them the full amount of the invoice directly, on the day of the visit (except when if rains and their systems go down, lol)

    4 – If this were a straight up consumer/retail transaction, I would’ve made more of a fuss, but, as I mentioned, when you insert the dependence/reliant nature of the physician patient relationship and the care is congoing, it becomes a much more complex decision.

  48. Hey Jonathan,
    Slimy at best, predatory at worst. The deafening silence after your last request leads me to believe that they know exactly what they are doing. I also believe their “we will charge a mint because insurance is paying anyway” attitude is unethical. Those costs come back and are borne by all of us. I would speak directly to your doctor. He may not be aware of these practices but as leader of his practice are responsible for them nonetheless. ~ Sharkman

  49. g says:

    I work in a Family Practice office. The Health Care system is broken: a primary care doctor gets about $50 from Medicare for a 45 minute visit where he/she might adjust meds for your multiple chronic diseases, maintaining your quality of life and keeping you out of the hospital; in contrast, cleaning your ears or removing a suspicious mole, that might take 15 minutes, pays significantly more. Obviously, Surgeons have a better lobby.

    To some extent there IS a federal system that ‘sets’ the relative value of each type of service, but each practice decides what ‘conversion’ factor to use. Keep in mind too, that prices (relative values) are affected by actuarial data: a surgery is more expensive because it includes, in effect, a surcharge that covers potential complications.

    The practice described seems to be one that is profit-driven, and if they are The Best, they can charge what the market will bear. Not all practices are like that. Our practice charges $50 for an ankle air splint, $200 for a walking boot, but that is based on our cost (no mark-up). Even then, we often do not get paid for them and have to absorb the loss. Some patients seem to figure we can afford to write it off, and just ignore their bill – but they’re the same ones who always pay the Pharmacy (because the Pharmacy will withhold the medications while Drs are not allowed to withhold services).

    Our philosphy is treating out patients the way we would want to be treated: fairly and respectfully. This won’t make us killer profits, but we can look ourselves in the mirror and hold our heads high, knowing we provide good service at a reasonable rate.
    Hope this sheds some light.

  50. Jean says:

    The problem is that NO ONE — not the patient, not the medical provider, not the office staff–know what the total cost to treat that patient on that day is. Health care costs are obscured by co-pays, insurance submittals, use of third parties for tests, and negotiated prices between practice groups and insurance companies.

    I had a parallel experience to Jonathan’s where I was sent to a physical therapist and received a balance and hearing assessment from two therapists that included standing on one foot with my eyes closed, or watching the therapist move a yellow stickie note back and forth in front of my face, for which I received two weeks later a Notice of Submitted Charges in the amount of $1,600! I received this notice on Friday, called first thing Monday morning to strenuously object to the outrageous charge and was told it had already been paid by my insurance company. When I called the insurance company to vociferously object they told me that the fees charged by the physical therapist were within the range negotiated between the insurer and the provider. Unless I could demonstrate that the provider engaged in fraudulent billing (namely for services not provided), the insurance company would not withhold payment.

    It is time we the consumers insert ourselves in this runaway money-eating machine we call the health care industry.

    I propose a citizen movement where each of us demands an estimate of costs BEFORE the health care provider prescribes or undertakes any procedures. This may seem an outlandish proposition, but it occurs every day in the veterinary field. When I take my pets to the vet–even (especially) for emergency care–immediately following the initial exam and before any further procedures are undertaken, the vet will prepare and present to me a written estimate of services, including identification of various levels or degrees of care, e.g. the cost of 2 versus 4 x-ray views. If we need to go to a specialist, that provider will also give me a written estimate of costs. The provider also requires I sign and agree to the costs before services are rendered.

    Some may think this a needless exercise, but I think it goes to the heart of the problem. For the very first time, each of us would see, in advance, what our care really costs.

    I suspect that the most serious impediment to this approach is that our frontline health care providers could not actually produce such a document for us during our visit because they do not know themselves! As in Jonathan’s case–the cost depends. It depends on what the insurer will accept to pay.

    However, when we all can see and make choices about (1) the amount of health care we are actually willing to pay for (right now it is very easy to schedule a quick visit to the doctor for a bad cold or cough because we never see that this throw-away visit (which netted nothing except an over-the-counter cold medicine or an antibiotic) actually cost hundreds of dollars, and (2) who we patronize to provide these services (most of us spend more time price-shopping cell phones and MP-3 players than our health care providers), then the real revolution in our health care system will occur.

  51. LisaG says:

    Had a similar price gauging situation last year when our daughter spent 7 days in the NICU after she was born – our insurance was billed $13 for a freakin’ pacifier. No it was not gold plated. Even had the website on it if I wanted to order more. Would have only cost me $1.25 to get one of my very own. They also billed our insurance $255 for a breast pump kit that retailed for $50. Diapers were similarly insanely priced. And paying a NICU Dr. $2,200/day for MAYBE 10 minutes of his time…….grrrrr

    My problem with health care is that when you need it, you’re typically not in a position to price shop. So yes, while I may be more than willing to pay $15 for a margarita at some high end bar/restaurant, that’s a choice I made. Price shopping my daughter’s NICU stay – not gonna happen. In my mind, that’s what makes it unethical – taking advantage of people in a vulnerable position.

  52. As you know the cost is usurious and that’s wrong. But I’m more bothered by their response, or lack there of. My wish would be that you post this again with the office’s name. I understand you received excellent care from the doctor and you’ve made sure to say that. Maybe he or she doesn’t even know about the degree of mark-up, and I would bet that s/he definitely doesn’t know about the response you received. If you post the office’s name s/he will.

  53. Mick Morris says:

    Is it ethical? not by any ethical standard that I am aware of nor would want to participate in.

    Is it slimy and predatory, most definitely. It stinks of a lack of transparency and respect in the first instance and then only gets worse when they try to “explain” themselves.

    Is it bad business given the social networking… well that is an interesting question, why? because I note that you have been careful not to name the Dr or medical practice (probably a sensible thing to do to prevent legal action for slander/defamation) so unless someone is going to name them…. probably will have NO effect on their business.

    Are you being overly sensitive…. hell no… none of us like to be blatantly ripped off like that.

    and then for the kicker….. and I will say this is coming from someone in a country with universal health care… what difference does it make if it is being covered by an insurer…. If I was the insurance company and getting a bill with a 600% mark-up on a product.. I would be considering pursuing the Dr for fraud.

  54. As usual, I came at the end of a gazillion comments which I haven’t read so I may be redundant.

    Welcome to the wonderful, wacky world of health care.

    There are two things at work: 1) health care providers charging enormous fees in the hope of receiving a small portion of said fee from insurance companies and 2) the fact that they are charging what the market will bear.

    It is a shame that health care providers must pump up the cost of some things like your Aircast when you are in the most vulnerable position (i.e., a lot of pain). However, they would say that many items are under priced or go unpaid for by indigents and deadbeats and the cost of filing for insurance payments, the carrying costs of waiting for payments, overhead for equipment in the office, overhead for staff, etc. etc. justifies high prices where they can charge them and get away with it (what the market will bear).

    If this had been my experience, I would e-mail the doctor telling him I would no longer be using his services for anything and would be warning off anyone who would listen from using his services.

    Don’t worry. He won’t lose a wink of sleep over it.

  55. Katherine says:

    Hi,

    I just stumbled onto your site for the first time today and noticed this post – I happen to work at a large hospital handling patient letters that come in – coincidence ;).

    1st of all, way to go writing to your doctors, most people dont even do this when they are shorted. You should know that CMS (Centers for Medicare and Medicaid Services) require all doctors offices and hospitals respond to each patient letter and appeal letter recieved WITHIN 30 DAYS. If you have not recieved a response by 30 days from the date of your initial letter, they are in voilation of CMS and you can report them. I would keep writing, I have seen bills be waived simply because the patient refused to give up.

    Good Luck!

  56. Erik says:

    The system is just as screwy up here in Canada

    I have to sacrifice a morning’s worth of billable work just to be told that “everything’s okay”.

    I’m handed a bill for uncovered services, but I can’t invoice my 3 hour wait because the doctor was overbooked and running behind.

    If I know I have a foot problem, I can’t make an appointment with a foot specialist until I make an appointment with my family doctor first for a recommendation….which means waiting another 3 hours for a signature.

    There *has* to be a better way to run health care.

  57. Ann Tellez says:

    The podiatrist I had operate on my achilles tendon did a great job. The problem is, he stocks splints, boots, knee rollers in his office and EVERYBODY he treats, he SELLS them these things at 600% markup. Oh,no, you can’t borrow a wheelchair if you are to be non weight bearing. You have to have a knee walker..for 800.00 and he makes sure you sign a paper agreeing to pay for it if your insurance doesn’t cover it and most times he knows your insurance company won’t cover it.
    He sells a 595.00 walking boot to every patient for a surgery that doesn’t require the boot. His business of selling these things nets him more money then the surgeries he does!. I’m appalled at this behavior and though he does good surgery it doesn’t excuse this sleazy behavior.

  58. Ann Tellez says:

    P.S. I will never go to this doctor again. There are other good podiatrists here.

  59. Ed Esco says:

    Jonathan; I empathise with you completely you are not a wuss lol… This is wrong I know I can be uncomfortable to talk about money matters with your doctor but in this case it is a necessary evil speak up, stand up for yourself if you don’t then you may feel like a wuss later lol.. seriousley change only comes through invividuals like yourself who have the courage to stand up for whats right. keep up the good fight — hey stay off that trail.