Is this for real? The EOB from RMHP shows that I’ve been charged $511 for what I thought was an annual physical at Primary Care Partners. It was a pleasant 45 minutes spent with someone that I hoped would become my primary care physician – someone who might come to know my health history and help me make informed decisions regarding my health.
I contacted my PC Provider, and PCP billing to let them know that I’d been double charged – $291 for “initial comprehensive preventative medicine E&M of new patient” and $207 for “E&M of new patient which requires 3 key components, typically 30 minutes”. The $291 will come out of my $482 monthly insurance premium, but the bill from PCP for $207 arrived promptly on the heels of the EOB. The PCP Billing department’s questions: “well, did you get a prescription written? and statements: “that’s the way that we bill” are not promising a satisfactory outcome. We will see how this goes.
I have several concerns:
1. How can a 45 minute office visit possibly cost $511? I’m pretty sure that the care I received (although it was satisfactory) didn’t approach that value.
2. How could I have known what the charges would be? I asked for an “annual physical” which I knew to be an essential benefit, covered under the insurance premium, but I was charged for things that I didn’t know existed, and couldn’t have predicted from any information available on the website, or provided to me prior to my visit.
3. I left the care of a popular local doctor who last year decided to quit working with insurance companies. His annual “all the primary care you can use” charge of about $1000 per year could have been half paid for in this single 45 minute visit. His ‘membership’ model looks like a pretty good value compared to PCP, right now.
4. I decided to look to Primary Care Partners for a new PCP because I have been favorably impressed by Dr. Michael Pramenko’s vocal advocacy of innovative methods of providing health care (and, I thought, of keeping health care costs within reason). Yet here is an absolutely egregious example of “fee for service” abuse. Can’t PCP practice what they preach?
5. See the previous post. In 2016, I anticipate that the least expensive health insurance policy available in Grand Junction will include a PPO with Primary Care Partners at the center. I am very afraid that the $5000+ annual deductible will be quickly claimed by the physicians and hospitals in the “Monument Health” network should I make contact with them for any reason.
“Even in Grand Junction, Michael Pramenko told me, “some of the doctors are beginning to complain about ‘leaving money on the table.’ ” Atul Gawande, The Cost Conundrum, The New Yorker, June 1, 2009.
Update: Spoke with the billing coder. She tells me that they use “Private AMA guidelines” to bill which say that anytime an acute or chronic condition is discussed, it’s billed in addition to the physical. In my case, I think it was my “chronic” high blood pressure which required sending a prescription to the local City Market. She said however, that the claim was incorrectly processed and that the ‘corrected’ bill will be for $143 rather than the $207 originally billed.
Further – if meds are discussed in an office visit (next year, possibly?) then the bill might fall within a range of $122 (99213), and $244 (99215), with a mid range of approximately $181.
OK – so it wasn’t $11.36 per minute. It’s going to be closer to $10 per minute. But still…..