<p>I didn’t realize that, within the emergency room, they sometimes include “consultations” that aren’t part of the emergency room service. Two examples:</p>
<ol>
<li><p>My older relative went into the emergency room when she broke her hip. She was upset, and so they sent a doctor in to talk to her. On her bill, this was listed as a “consultation”, and it was 500 dollars.</p></li>
<li><p>My best friend recently went to the emergency room for psychiatric reasons. A doctor came in to ask her some questions and talk to her a bit. This claim was filed not as part of the emergency room bill, but as a “consultation” again, and it was for 1,000 or so dollars and her insurance didn’t cover it since she didn’t have a referral.</p></li>
</ol>
<p>I don’t understand how this works. In the first case, my relative didn’t want to see a psychiatrist and yet they had her talk to one and added to her bill without alerting her that it was another charge. In the second case, shouldn’t the standard list of questions to someone in a psychiatric crisis be part of the emergency room bill? Apparently these consultations count as outpatient care.</p>
<p>I’m sorry that I’m so ignorant about this. It just seems like an unfair practice.</p>
<p>Emergency room bills cover the hospital’s costs. The doctors that actually evaluate/treat you are usually separate contractors, and bill their time separately.</p>
<p>Typically, the Emergency Room staff are paid through the Emergency Room fees.<br>
These doctors address general care issues.
When the care required is more complex specialists are called.
The services of specialists, psychiatrists and orthopedists, for example, are provided as consultations. Their payments are not covered in the Emergency Room fees.</p>
<p>For your best friend, check to see if she followed her insurance requirements. Many insurance companies must be notified within 24 hours of an ER visit. If the consultation was requested by the ER doctor, is should be covered as a referral if the ER visit was covered.</p>
<p>Her ER visit was covered… anyway, from the emergency room she was placed in a psych ward where she stayed for a week. She didn’t have my number memorized and so wasn’t able to call me the whole time she was there, and so I certainly don’t think she would’ve been able to call her insurance company to alert them. I will link her to your post though so she can check if the consultation was requested by the ER doctor. I didn’t have any good advice about this but I figured you all would.</p>
<p>PhysicsMom,
In the hospital where I work, the registration folks usually verify the validity of the insurance card the patient presents. But ultimately it is incumbant upon the patient to notify their insurance company. For an immediate psychiatric admission, I would suggest she submit an appeal.</p>
<p>I have had the problem when I was admitted to the hospital- by my " preferred" provider and the stay should have been covered, still any Dr who was " consulted" would bill me & if I didn’t have a referral ( since I didn’t even know about it- how was I supposed to do that?), I was billed.</p>
<p>I wouldn’t find out about all the various bills typically long after discharge & it was up to me to chase down the various docs.
Gee thanks.</p>
<p>Then there’s also the situation where an elderly person is in the hsopital – perhaps their last admittance, if you know what I mean – and after their death, all sorts of bills wander in from doctors their loved ones have never even heard of. Medicare winds up paying them in most cases, assuming the patient was over 65 – but I am sure a good portion of those deathbed consultations are bogus.</p>
<p>Exactly. Just like if you have surgery, you will get a separate bill from the hospital and one from the surgeon. It’s this way because the insurance industry demands that hospitals and physicians use two different billing forms with totally different codes. Traditionally, physicians were not hospital employees and the payments for their fees went straight to their offices, not the hospital. This is changing (many physicians are now employed by the local hospital) but the billing systems remain separate. I think it’s stupid also but suspect as health care reform kicks in this will slowly change…hopefully in my lifetime. Even though I have worked in a hospital billing department in the past as well as at a physician’s office, I still find the whole thing to be overly complicated. Can’t imagine how the average layperson copes with it.</p>
<p>Everything is separate. Just like the above example stated… say you h ave surgery… you’ll have a hospital bill, a surgeon bill, maybe an anesthesiologist bill if you are put out, etc.</p>
<p>As people noted, each provider will bill you. In the ER, if the ER physician feels that a specialist needs to be called (say a cardiologist), the latter will bill this as a consult independent of the ER physician’s charge. I’m curious if the ER physician’s bill was paid but the consulting one’s wasn’t because they both belong in the “professional” bill category. </p>
<p>Check two things - see if the reason the consultant’s bill wasn’t paid was because of deductibles. It’s possible that early in the year, there’s a substantial amount that the patient has to come up with, and it would go against the first provider to bill the insurer. Second check the code used for the consult - some of the insurers have discontinued the “consult” codes such as 99241-99245 and may pay for the treatment if a different code is used.</p>
<p>Look into these also - even if a physician bills x dollars for a service, as long as he’s a participating physician with the insurance, he can only collect the fee specified by the insurer. eg. a physician bills $300 for a level 3 consult, but the insurance company’s fee schedule lists an amount of $200. In this case the physician has to settle for $200 either through the insurer or the patient, or a combo. In some cases, if the service billed for is “not covered”, then the physician may demand the full amount, so it’s imperative you find out whether the physcian billed the right code for the service provided. Once you find out the code, get a copy of the documentation to verify that what was billed matches what was documented. What I mean is that if a level 5 is billed, there are x different things the physician has ot have documented that he did, and if he didn’t, the service has to be lowered to a different level. </p>
<p>I realize it’s difficult for a layman to know all the intricacies of medical billing, but try to get someone in the medical documentation and billing area who is a family friend, or if you don’t know of any, try the patient advocate at the hospital (less optimal, of course, but better than nothing, especially if the hospital is a non-profit). </p>
<p>Last resort, negotiate the amount directly with the provider’s office - it’s not unusual to get a break if you are willing to pay up right away.</p>
<p>1) Try to make sure that you are paying what an insured person would have been billed. Typically the uninsured are billed up to twice as much for the same service. On the other hand, SOME providers have uninsured discounts. </p>
<p>2) You can usually arrange to make smaller ongoing payments over time, rather than paying a big bill right away.</p>
<p>We are in Canada. Healthcare here has it’s own issues, to be sure, but gosh I’m so so so glad we don’t ever have to see any medical bills, let alone think about costs. I went in last year to ER with pain in my chest, spent quite a few hours there running tests, being checked out and monitored by a doctor…all was fine in the end, but they took it extremely seriously. I was sent home without seeing a bill. </p>
<p>Spouse went in with sudden intense pain and vomiting about six months ago, had amazing care by numerous people…determined it was a kidney stone, exactly where it was located and what to expect, was put on meds, walked out. End of story. I can’t say enough about the first class service we received. No idea about the cost involved.</p>
<p>Civilized. And works, too. Two people in the Canadian office of my old publishing house are now in their early 60s. One has Parkinsons - and all his office visits, treatment, drugs, (and alternative treatments) are covered - he doesn’t see a bill. The other one has lupus - same story. Never have a delay in seeing a specialist of their choice.</p>
<p>For a smart country, we sure can be mind-numbingly frustrating. The above is what we could have, and yet for reasons i’ve never understood, we run screaming in the opposite direction, imaginary threats chasing us away. It is a puzzlement.</p>
<p>As a physician I have been frustrated by our health care system as much as everyone else- I get my hospital X-ray bill plus the radiologist’s bill as well. It would be so much simpler for that to be lumped together. Another pet peeve is separate fees to draw blood/collect samples in addition to the lab test charges. A face to face consultation is different. Unfortunately in ER situations patients often don’t have the luxury of time to think over whether they want to see the specialist, nor the clear thinking to be sure to jump through all of the required hoops. </p>
<p>Health care reform- don’t get me going (too late- had to vent)… Back when the Clintons (Hillary was involved) made attempts physicians were kept out of the loop. Insurance companies defend their monetary interests, as do pharmaceuticals and other manufacturers- the politicians worried too much about physicians being greedy and not about others whose sole business is to profit from healthcare, unlike medical personnel. Hopefully the current steps will be able to evolve to a better system- it’s not perfect, but a start.</p>
<p>The difference between insured patient charges and posted before the deduction charges is amazing- reason enough to be sure your young, healthy adult children have health insurance, even with a high deductible.</p>
<p>And some of those are running into economic problems with their high levels of socialization, and medical care rationing occurs (we often get instant gratification here- not some of the wait times in other countries). It’s an imperfect world. We do have socialized medicine- for the elderly. That’s another rant… how the government keeps trying to check costs by keeping the level of services (actually expanding, increased tech and population) but lowering payments to below costs of some providers (eg service such as hospitals and physicians, not goods providers).</p>
<p>Medical care is rationed in this country as well. It’s rationed based on ability to pay, which boils down to whether or not you have decent insurance. And as you know, decent insurance is becoming a luxury.</p>
<p>I wish as much as you do that doctors were in the loop when insurance reform was attempted. Doctors and other providers are the only players that I trust in this system. Unfortunately, it looks to me like insurance companies are running the show.</p>
<p>I absolutely trust doctors when it comes to taking care of me. Unfortunately, I’ve had experiences where a few doctors have run a test or sent me to a specialist in order to maximize the $$$ they can get out of me or my insurance company. By no means am I lumping all doctors into that; most doctors are interested in taking care of the patient and do well enough without trying to game the system. But I have been involved with some physicians who just want to maximize their income and think that the passive, uninformed patient will just go along with it.</p>
Even though I have worked in a hospital billing department in the past as well as at a physician’s office, I still find the whole thing to be overly complicated. Can’t imagine how the average layperson copes with it.</p>