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Does provider-based billing provide hospitals and doctors with the opportunity to double bill, gouging patients along the way?

Provider-Based Billing: Give Me Your Sick (and Bill Them Twice!)

A young man, who lives in a college town,  went to the doctor a couple of months ago. The doctor’s office happens to be located in the local hospital, Carle, in Urbana, Illinois (home of the University of Illinois). It was simple visit, and nothing but a blood pressure measurement was taken. The visit lasted about half an hour, and he left with a prescription in hand.provider-based billing gouges patients

He received a bill (not a small amount for a short visit), which was submitted to his insurance. The remainder to be paid by him. Okay. With me so far? Good. Then last week, he received another bill, this one for nearly the exact amount (more than $400). But instead of coming from the physician, it came from the hospital.

I’ve been going to doctors’ offices for many, many years. Sometimes there’s a co-pay; other times an amount not covered. But never, whether the physician’s office was on the second floor of a bank building, in an office complex, a strip mall–or within the grounds of a hospital have I gotten a separate bill from the owners of said property. Until now.

Surely, this must be a mistake, I thought. Why would a half hour office visit to a physician (no procedures, no equipment used beyond the blood pressure cuff, etc.) cost more than $800.00? Yikes. Double yikes.

But such is the way of “provider based billing.” Welcome to hospital price gouging 101. Not bad enough that when you undergo a real procedure, you are assessed fees for every scalpel, tray and band-aid used (which I suppose is reasonable when you are charged a dollar or two for the band-aid and not $25.00), but now, it appears, under this new and improved model, just walking in through those fancy hospital front doors costs you.

I get that hospitals need to recoup “technical costs”: maintenance, equipment, etc. But more than $400 for a half hour visit, essentially doubling the cost of the visit??? If this young man had gone to a doctor not in the hospital, but in a space rented from a property owner, say in an office building, the same equipment would have been used, but the amount absorbed by the physician. So, if the hospital is picking up the “technical costs,” let’s call it overhead, then logically, the physician’s charges should be lower than if he were housed in a different location, right? It should all balance out as shown in the graphic above.

Something here is not right. Either the hospital is still charging the doctor for facility and equipment use, in which case those costs would be passed on through his charge, or the hospital is picking up those costs, which would suggest the need for two bills (but still not such a huge amount for a simple visit). Someone, somewhere is gouging the patient, the insurance company (or both).

In any event, a lesson has been learned by this young man. He will no longer see a physician in a hospital setting unless he needs to be in-patient or requires the specialized equipment that only a hospital can provide, for example, when he recently needed a CT Scan. What has been your experience either with Carle or other hospitals? Let me know in the comments below!

About Barbara Barnett

Barbara Barnett is Publisher/Executive Editor of Blogcritics, (blogcritics.org). Her Bram Stoker Award-nominated novel, called "Anne Rice meets Michael Crichton," The Apothecary's Curse The Apothecary's Curse is now out from Pyr, an imprint of Prometheus Books. Her book on the TV series House, M.D., Chasing Zebras is a quintessential guide to the themes, characters and episodes of the hit show. Barnett is an accomplished speaker, an annual favorite at MENSA's HalloWEEM convention, where she has spoken to standing room crowds on subjects as diverse as "The Byronic Hero in Pop Culture," "The Many Faces of Sherlock Holmes," "The Hidden History of Science Fiction," and "Our Passion for Disaster (Movies)."

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