After my doctors appt., The nurse just came in and handed me my medical boot after my first post surgical appt. she didn’t say I was going to be charged for it, I just left with it. A month later I get the bill in the mail. They charged $300 to insurance, which discounted it $100. I had to pay $200 out of pocket. I looked the exact same boot up yesterday and it costs $68 on Amazon, and the same price on another medical supply company. I am incensed. What a ripoff. I’m thinking off calling today and complaining. I don’t mind paying for the doctors expertise and office visits…but I’m mad About this. Would you say something or just let it go? I have lower premiums, higher deductible, so this came right out of my pocket. And the doctors get mad at insurance companies…,this type of shenanigans doesn’t help!
I would call your member services department and say that you should have been advised that insurance might not cover the cost and that you should have been given the option to buy it elsewhere. I would also mention that it’s $68 at two other places!
Welcome to our new healthcare. Many say this is better.
@Madison85 …why call the insurance and not the Doctors? The doctor is the one that Is overcharging 10 times their cost to the insurance company. (if you consider the boot probably cost them 50% of retail). Maybe some people had the entire amount covered due to their type of insurance, deductibles, etc. it just happened I did not. Is there something I don’t know that insurance can do? Seems the doctor should be reimbursing me. I’m sure they won’t, just don’t know if others would complain or not.
@conmama your insurance paid your bill. They could have reduced the cost to $0.
Would you have known what kind of boot to order…in advance?
I share your frustration with many aspects of health care billing, and am often dismayed to read through my EOB’s (Explanations of Benefits). (I have several medical conditions and am a heavy user of health care.)
However, in this case, while clearly your doctor’s office makes a profit on the boot, I wonder if it is worth protesting. If you have a high deductible plan, and the $200 went towards the deductible, I figure that is money that you would eventually have “out of pocket” at some point anyway – assuming you will incur other medical charges during the year, enough to “satisfy” your deductible. (LOVE the terminology!) Especially as it is still early in the year, this may well be the case, depending on your usage and the amount of the deductible.
But I am assuming the $200 out of pocket was due to the deductible, which may not be the case here.
Just a thought.
She probably has some sort of limit, also, on medical equipment.
I have to say…when my kid had surgery, we never saw an itemized bill for any of the durable medical equipment. It was part of the procedure bill, I guess. And she had a high deductible plan.
@conmama what kind of insurance do you have?
I have Anthem. It’s through DH, which although it’s a group reduced rate, the company does not subsidize. I have an individual $6500 deductible because we went with the lower premiums. I have under $1,000 left to be meet the deductible due to the surgery, The boot is included in the deductible. I knew I would have a boot, but not what kind. And naive ad I am, I thought when they just gave it to me, and didn’t charge me, it was just part of the fee I had paid the doctor. I should have asked, I know. Lesson learned.
There is absolutely nothing new about this. This kind of rip off stuff has been going on forever. I grew up with a chronically ill family member, and there weren’t other options like buying online in those days, so it was more opaque. Nothing new under the sun. I ask now about the charge of anything. I am sure you will too!
Unfortunately, we have a system where you have to ask about everything, every time. Two of my Ds have had painful lessons that way. $900 for an allergy scratch test, $200+ to give a shot (that she had brought with her).
You can’t really compare amazon pricing to doctor pricing. Look at what they “charge” for Tylenol. If you bought from amazon it wouldn’t have become part of your deductible. That was a negotiated rate by your insurance company so there is probably little you can do.
I would absolutely complain to the doctor’s office. They could have at least mentioned the options to you. This isn’t about insurance, it’s about a single doctor choosing not to offer a better priced alternative to a patient… who could very easily shop around for a different doctor.
I have found that if you make it clear to the doctor up front that cost is a concern to you because of a high deductible, that the doctor is more likely to give you options and/or take that into account when deciding on a course of action.
I suppose the question was partly whether the boot was something you had to leave the office wearing. And also whether it is something that has to be fit in a really specific way. From your description, neither was the case, so they COULD have told you in advance that you would need a boot in such and such a size, and they could supply it or if you wished you could find it more cheaply elsewhere and bring it in with you to the visit to be checked.
That would have been a more thoughtful approach. On the other hand, I can see that it could mean more hassle for them: people who didn’t buy it in advance or bought the wrong thing and refused to take theirs, risking a bad outcome, etc. Even if they established a policy that patients could not leave the post-op visit without an appropriate boot, they could still get a huge hassle from some people.
I would never accept a medical device thinking it would be of no cost. Not in these times.
That said, I hope you can recover some of the cost.
When you buy something through a service provider, there is typically an additional markup, or you may pay full MSRP instead of a discounted price that you can commonly find on web retailers. So this incident is not unusual, though since medical stuff is commonly insurance-paid, providers have even more of an incentive to inflate prices.
lesson learned for me. But I think it’s really unethical for him to be marking it up like that. Doesn’t matter who pays, insurance or the patient.
Yea, I paid for the medical boot that I later learned was too short and the ortho urgent care never charged me for giving me the taller boot. I also was very annoyed that I paid several times more than the online price for this wrong boot. When I complained to insurer, they said it was fine and said they’d also pay for their share of the correct taller boot. Fortunately I was never charged for the 2nd boot.
I’m in a similar boot right now. I just checked my insurance portal - I’ll be getting a bill for $290 for said boot - durable medical equipment that counts towards my deductible. When I look at the whole bill though - the provider is being paid around $210 for my visit, which included x-rays, an examination, fitting of the boot (they tried several on) and instruction on proper gait and use of crutches. I’ll end up paying that $290 one way or the other - the fact that the doctor also opened her office early to examine me (a new patient) as an emergency at no additional charge - well, I’d rather she makes some money instead of LabCorp or some other faceless entity.
Not sure why it is “unethical” for Dr to mark something up. The US wants a for-profit health care system this is what you get. Vote accordingly if you want change.
Well, consider me triggered…
DS broke his arm many years ago. The Urgent Care insisted he needed a sling before sending him to the ER because they couldn’t handle resetting the bone. The sling (15+ years ago) was $200. When I blew a gasket I was told that…the supplier for the slings to this in-network facility was…not in network. Therefore, I was being billed the out of network cost for medical equipment. That was the deciding factor in leaving that provider and going to another group of practitioners. They billed the same amounts but their negotiated rates were about 1/2 the billed amount.
Sadly, that lovely and independent group got eaten by the big bad overcharges (BBO) on Jan 1, 2018. We also have a high deductible plan. H had three doc appointments. One where they said he was fine, it was just irritation from a long plane flight. The second - 20 hours later - where they said - heck you have pneumonia and ran a strep (? HUH) influenza (yup - got that too) and bacterial test. The OOP costs for those visits…$706 ! BBO’s billed rate IS their contracted rate and they have a gag clause on those rates.
The third visit was to his PCP. Blue Shield suggested H get a few tests. He met with his PCP. They discussed things. That bill - $420. Why… because there were 6 different diagnoses so it was a ‘medical visit with high complexity’. Grrr… really. If you mention a hang nail - its a diagnosis, if you mention a skin tag it’s a diagnosis, if you mention your knee hurts it’s a diagnosis, if you mention your arm has the same pain as the knee - yup another diagnosis.
So, we are out $1178 for three basic office visits. Just for fun, I looked up the Medicare reimbursement rates for these CPT codes. Provider would have received a grand total of $365. Oh and Medicare wouldn’t have covered the strep test because it is not medically indicated. If one is exhibiting flu symptoms during flu season - think flu, not strep. But hey, BBO threw it in for good measure.
H goes on Medicare at the end of the year. BBO has to take him because they just acquired his PCP- hahahahaha
I will keep a footprint with my PCP - now also with BBO. I will see other docs in my network but not with BBO for everything else. Then, when it’s my turn BBO has to take me as a Medicare patient.
This is a mess.
Sorry…like I said…I just got triggered