What You Pay? (11/13/2007)
Question: Recently, when I went to the doctor for a different problem he talked me into having an age spot on my leg treated with a “dab” of acid. I was billed for a “surgical procedure” and my insurance required I pay co-insurance and part of my deductible for the “dab” of acid. I thought my usual co-pay covered all of the services at the visit. Is this common?
Answer: Unfortunately, yes. A doctor bill is based on what are called CPT codes. The codes correspond to the services they render. If you go for an office visit for an ear infection and he performs a “dab” of acid procedure on an age spot the doctor has performed two different services, the examination for the ear infection and the procedure to treat the age spot. There are two different codes for each and the doctor may bill for both services separately. Many procedures done in the doctor office are not covered by just your co-pay and might require you to pay from both your deductible and co-insurance. Be sure to check your benefits, so you know what you will be responsible for.
Question: Is there a source that I can look up and compare prices for healthcare services?
Answer: Yes, go to the Medicare web site and you will be able to get the prices for most common doctor and hospital services. You can find the link on our archives in the Hospital Pricing Part 2 post. This site is hard to use. Medicare prices are generally 25% to 50% lower than commercial insurance programs. So be sure to add on a factor for your circumstance. We would suggest you try http://outofpocket.com. The content is user generated and is easier to use than the Medicare data. We also suggest http://www.hospitalvictims.org/ as well to determine hospital prices.
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