Diet, Day 19 - Rant About Health Care Costs

Wanna know why health care costs so much? Ask a doctor and he’ll tell you it’s those fucking lawyers and tell you about some shyster that recovered $10 million for a family because a doctor fucked up and killed his patient. Never mind that it was the doctor who committed malpractice; the lawyer still gets blamed.

But the real reason for high medical costs is the doctors themselves -- not only do they sometimes fuck up, they often overcharge. A few weeks ago I went to a dermatologist to have him look at a couple of discolorations on my skin. He did and gave me an Rx for an ointment. He also took the opportunity to check my head for skin cancer and froze a few “benign lesions”. There were no more than a half dozen of them. I paid my co-pay and thought all was fine, but in a week or so I got a letter from the doc’s office saying my insurance hadn’t paid the whole bill and he wanted to collect the rest.

This caused me to examine the bill, and I discovered something known as CPT codes. These are codes established by the US government in connection with Medicare reimbursement. They are the Bible in terms of what Medicare and insurance carriers will reimburse to a doctor for particular services performed. Each number corresponds to a specific service and a specific amount of money that will be reimbursed for that service. You’ve seen these numbers on your doctor’s invoice and probably didn’t pay much attention, because they’re usually just numbers with no explanation of what they mean. There’s a reason they don’t provide an explanation – they don’t want you to know that they’re screwing you or, more accurately, they’re screwing your health insurance carrier.

Here’s what they do, or at least what my ex-dermatologist did. CPT code 17003 is for the treatment of 2 to 14 benign lesions. It pays $6.86. CPT code 17004 is for the treatment of 15 or more lesions and pays the doc $162.72. Which one do you think he billed the insurance company for, even though he treated no more than 6 or 7 lesions? To make matters worse, he also billed under CPT 99202 (new patient visit – 20 min.), which pays $67.57. I wasn’t in the doc’s presence for more than 10 minutes. He should have used CPT 99201 (new patient – 10 min.), which only allows $39.81. The insurance company paid based on the CPT codes and gave the guy $230.29 minus my co-pay. If he’d billed properly, they would have paid only $46.67 – a whopping difference of $183.62! To make matters worse, he billed me even more than the CPT codes allowed, and his letter was to collect the amount the insurance company didn’t reimburse. Upon my calling his attention to the “mistake” in billing, he “graciously” agreed to write off the balance; but he didn’t offer to reimburse my insurance carrier for the extra 180 bucks he’d swindled from them.

Let’s put this in perspective. According to the 2000 Statistical Abstract of the U.S. there were 76,000 practicing dermatologists in the US in 1998 (that number has undoubtedly grown). Let’s assume that a mere 10% engage in this scam and further that each only does it with one patient a day (conservative assumptions without a doubt). That means there are 7,600 instances of improper billing every day. Normal people have about 245 working days in a year after accounting for weekends, holidays and normal vacation times; but let’s give doctors the benefit of the doubt and say they only work 200 days each year. Given those assumptions, there would be 1,520,000 instances every year where a dermatologist fucked a patient’s insurance company. If each screw job resulted in an overbilling of $183.62, as did mine, that amounts to $279,102,400 that insurance companies overpaid in just one year – and that’s assuming only 10% of the dermatologists engaged in the scam and that each one did it to only one of the many patients he or she saw during the day. And that’s only the dermatologists!!!

Word to the wise -- examine your doctor's bill and look up the CPT codes (they can be found on the internet).

By the way, there’s still zero visibility with my dick even though I’ve steadfastly remained true to the diet and have worked out 6 times a week.