Pregnancy Visit 2 – Data and Commentary

Here’s the data for the 2nd office visit. No lab tests were done, apparently.

	CPT		Rack	Greedy	Net
	Code		Rate	Markup	Cost
Office Visit			240.00	134.00	106.00

Yeah, no posts in a while…

But Quest hasn’t billed me in detail lately, so I don’t have any significant cost data yet.

ER Without the Wait = Crazy, Crazy, Crazy

The Chicago Sun Times has a nice blurb about a new ER at Adventist GlenOaks Hospital. The article is here.

Per the article, ER director Dr. Joe Shanahan has made that important observation that “Time is important” for patients. Hmmm. What a crazy idea — that the patients’ time is valuable. Nation-wide, average ER wait time is 3.7 hours, according to the survey cited in the article. At GlenOaks, patients are seen by a doctor within an hour.

The new ER has no waiting room; instead, patients are checked-in, sent to a private room where the are seen be a triage nurse, fill out the paperwork and then seen by a doctor. This new, private-room setup seems to attract the most buzz.

The private rooms with TVs are nice, but really, the real improvement is getting folks treated faster. For some reason, a lot of people in the health care profession refuse to believe that delivering health care is similar to building a car or checking out in the grocery store. When there is a wait, you need to rethink your process or add staff.

We have some–and all parents will have–some personal experience with the ER. One visit we made to an ER (not the one above) with our toddler (nothing serious, but painful to her) took 3+ hours! And only one other child was in the waiting room and the place seemed dead! 3 hours to spend 5 minutes with a doctor! This is a symptom of a bad process.

Our ER visit went like this… Process 1: Wait to see a triage nurse. Process 2: Wait to see the financial check in. Process 3: Wait to see another nurse. Process 4: Wait to see the doctor. Why couldn’t processes 2 and 4 occur at the same time? Why was process 3 needed at all — step 1 took could have taken care of it?

Good work Dr Shanahan, improving your ER process to make it better for patients.

Pregnancy Visit I – Data

Enough talk. Here’s the data.

	CPT		Rack	Greedy	Net
	Code		Rate	Markup	Cost
Office Visit			240.00	134.00	106.00
Cyto Auto Thin Layer Prep	88142		69.50	44.50	25.00
HPV, AMP Probe	87621		105.00	66.00	39.00
Laboratory Services	83891		3.33	-	3.33
Laboratory Services	83909		15.11	-	15.11
Laboratory Services	83914		347.53	-	347.53
Laboratory Services	83900		30.17	-	30.17
Laboratory Services	83901		196.43	-	196.43
Laboratory Services	83912		2.43	-	2.43
Laboratory Services	81001		40.50	36.50	4.00
Laboratory Services	36415		16.70	11.70	5.00
Laboratory Services	86592		83.00	68.00	15.00
Laboratory Services			312.30	264.30	48.00
(grouped above)	87340		-	-	-
(grouped above)	86850		-	-	-
(grouped above)	86762		-	-	-
(grouped above)	85025		-	-	-
(grouped above)	86900		-	-	-
(grouped above)	86901		-	-	-
(grouped above)	86592		-	-	-
			1,462.00	625.00	837.00

Pregnancy Visit I

UPDATE: If you’re looking for cost data, see my other posts.

Oh, thank you for wising us congratulations. You are too kind.

We had the first doctor visit with our OB. Everything is fine with Mom and Baby #2. Some tests were ordered. The test are where it will get really expensive.

Before our visit, being conscientious health care consumers, we called the doctors office ahead of time and let them know we wanted to talk about costs. That allowed the OB’s office to call our insurance company and learn what coverage we had.

Apparently our health insurance situation was something new to them. They, well, really just the office manager, immedially recognized that our situation would require 1) some thinking and 2) possibly more work, and she visually expressed this to us. Lazy, lazy, lazy. I’ll have to post on some employee management techniques later.

First, we heard that the insurance companies mandate “global billing.” In other words, the doctor normally would bundle up all the costs of the delivery — prenatal care to delivery — and bill the insurance after the baby is born. However, we don’t have that insurance, so we’re about to tread onto on new frontier.

Turns out, after much gnashing of teeth by the office manger, our insurance company would process the bills one by one. No big deal, but change seems to be difficult for the medical profession.

Now, we we went in, the office manager said the visit wound be $240. We said, let’s wait until our insuranc company has a crack at the bill. They did, and the pre-negotiated rate was $134. The differenece of $106 between the “rack rate” and the negotiated rate shall hereafter be referred to has the GREEDY MARKUP.

Some Background on the Data

So where am I getting my data? From my insurance company’s “Explaination of Benefits,” or EOB hereafter, and the medical bills direct from the providers.

My insurance is provided by Blue Cross, a large, mutual insurance company.  Our plan has a deductible of $1,750.  We chose this deductible amount because we didn’t know any better — because we didn’t have any data…

Why?

OK, a first blog post always have to reference that fact that it is the first post. So here goes:

So who am I and why am I doing this?

I’m a married 30-something father with a toddler and another baby on the way. I own my own business, so I buy my own health insurance. We live in a major city in the Midwest. My background is in finance, so I like numbers. Numbers will become the focus of this blog. That and me venting about what a crazy system we have.

We have one of those new, fancy, “high-deductible” health insurance policies that everyone is talking about. Many of the talking heads believe that these high-deductible plans are one of the solutions to the health care crisis, since, the belief goes, consumers will actively monitor the price and value of their health care expenditures.

Which sounds great on paper, but…

There isn’t much comparable data available.

How can I evaluate the value of something when I don’t know a) what it costs elsewhere and b) what its use is? Since I can’t find good data, and I bet other folks in a similar life situation can’t find good data, I thought I’d disclose all the costs we incur for:

1. My wife’s current pregnancy
2. The health care costs up to age two for my toddler.

Hopefully, this data will help you evaluate your health care expenditures, making you a better consumer. At minimum, it will let you know what you are in for–cost wise–so you can plan better.

Enjoy!