Posted by: Heather A. | January 31, 2011

Practice or Business?

Let me begin by saying, I’m the daughter of a doctor and a nurse.  I grew up in a medical family, so I have nothing but the deepest respect for medical professionals and the difficulties they face having to deal with both demanding patients and (adjective censored) insurance companies.  HOWEVER…

This week we faced a situation that has made me SO ANGRY that I can’t think of anything to do but write about it, in the hopes that I’ll exorcise these feelings of rage and maybe help someone else become a better consumer of healthcare.  So be forewarned, MAJOR rant ahead.

Last November, my husband was told he needed shoulder surgery.  As it was the end of the year, our insurance deductible was already satisfied, but we had no money remaining in our Flexible Spending Account.  That meant anything we had to pay would come out of pocket, after tax, but would likely be substantially less than we’d have to pay at the beginning of 2011 when our insurance deductible reset (and incidentally, increased).  So we faced a decision: Do the surgery in November, or wait until January when we’d pay more, but when everything we paid would go towards our new deductible AND would all be reimbursed from the pre-tax funds I put into the Health Savings Account each month.

When the doctor’s office called to schedule the surgery, I explained my dilemma and asked how much the surgery would cost.  I gave them all my insurance information and was told they would check with Aetna and get back to us.  Get back to us they did, with an estimate of $179.  Really?  That sounded WAY too good to be true, so I questioned, as any good consumer would. What did that include?  What wasn’t included?  The clerk told me that was the estimate for the surgeon, and that it didn’t include the surgery center, but that the surgery center “certainly wouldn’t charge more than the surgeon, so you can assume double that estimate.”  Okay, I thought, $400 vs. thousands next year.  Even with after tax dollars, I thought that made sense.  So we went ahead with the surgery.

Two months later, the bills have started to come in, and much to our surprise, the surgeon’s estimate of $180 has turned into a bill for $257.  The surgery center charged our insurance $13,000, more than DOUBLE what the surgeon charged, and we haven’t gotten the bill for that yet, but it’s likely to be around $450.  And we also received a bill from the anesthesia practice for another $250 that was NEVER mentioned when I requested an estimate.

Furious, I called the doctor’s billing department who acted as if there’s no way they could possibly have given us a better estimate than that.  “Well, we can’t know if the surgeon might use a PA (which is why his “estimate” increased).  We can’t know what the surgery center will charge. We can’t tell you what the anesthesiologist will charge.”  REALLY?  REALLY?????  It’s not like I hired you from the Mayo Clinic to come to North Carolina, to a surgery center you’ve never used, and do a procedure you never do.  NO, this is a procedure you do EVERY WEEK, at the surgery center you ALWAYS use, with the same doctors who are always there.  Even if you aren’t responsible for those portions of the bill, you should have standing estimates from those groups or at least you should inform me that in order to receive an accurate estimate I need to call the offices of X, Y, & Z.

Hear me: You didn’t give us an ESTIMATE.  You gave us a FAIRY TALE.  You LIED to us.  And congratulations, you got another surgery out of it.

When Andy told his surgeon about the problem with the so-called estimate vs. reality, the surgeon responded “You know, I hate to say that I don’t know as much about the “business-side” as I should, but I really don’t.”

Well, Dr. Chandler, let me give you some news: I realize you went to medical school to practice medicine, not to run a business, but in today’s environment your practice IS your business.  And your patients are your CUSTOMERS.

And guess what we are?  UNHAPPY CUSTOMERS.

Do you know what happens when customers are unhappy?  They tell their friends.  It’s true in retail and it’s true in medicine.  When friends and family ask us how Andy’s shoulder is doing and who performed the surgery, what do you think we’ll say?  No, don’t guess, let me tell you.

We’re telling people: “You know, Dr. Chandler did a great job on Andy’s shoulder, but watch out for his finance department.  You can’t trust any estimate they give you.  Make sure you multiply that number by at least FOUR.”

Is that what you want prospective customers/patients to hear about you?  Is that how you want your practice represented?  If not, you’d better learn about the “business-side” of your practice and put business processes into place that actually HELP your patients navigate the insurance labyrinth.

You’d better realize quickly that medicine, like retail, is really all about customer service.

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