Medical Insurance - $14 Million for 1 Salaried Doctor

I have medical insurance through Blue Cross and I have read my policy and I always review the benefit statements for medical services processed on my insurance. A few months ago I had a routine screening colonoscopy because of my age and everything was fine until I received the bills.

Since I have a private policy, i.e. not a group policy, I have a fairly high calendar year deductible. However, I was aware that my policy pays 100% of the allowed charges for a screening colonocsopy every 10 years which is to say that Blue Cross waives the calendar year deductible and should pay everything. The allowed charge is the price that Blue Cross negotiates as payment in full with a service provider.

When I received my benefit statement, I noticed that there were two charges for anesthesia - one with a list price of $602 and an allowed charge of $133 and the the second with a list price of $595 and an allowed charge of $133. Thinking this was a billing error and a duplicate charge, I called the doctor's office who explained that the $602 charge was for an anesthesiologist who prescribed the anesthesia and was available in case there was a problem, the second charge was for the anesthesia nurse who actually administered the anesthesia and monitored my vitals and that I was only charged for the actual time that they spent with me which was 22 minutes. First, I spent about 3 minutes with the anesthesiologist who asked my weight, whether I had any allergies and then presumably wrote the prescription for the anesthesia. Based on the number of procedure rooms, I would estimate that this anesthesiologist supervises 6 anesthesia nurses. One of my 1st thoughts was how could the anesthesiologist accept such a significant discount for Blue Cross patients? But then I did the numbers. Assuming that the anesthesiologist works 50 weeks per year, 8 hours per day, supervises 6 anesthesia nurses who each perform 2 colonoscopies per hour, then the total annual billing for her services at $602 per procedure would be $14.4 million! Even at the lower negotiated rate of $133 per procedure, the total annual billing would be $3.2 million. Note that there was also a facility charge at $1,295 and the doctor who performed the procedure billed separately. $14.4 million per year in charges for 1 doctor's time is outrageous. For the anesthesia nurse, using the same assumptions, the total annual billing would be at least $2.4 million at the list price or $532K at the Blue Cross price. I know that nurses are paid well but again this is ridiculous.

Getting back to the benefit of knowing what is in your policy, as I explained above, per my policy I was only responsible for the allowed charges (not the list price) and Blue Cross waived the deductible for this procedure so I was surprised that I received a $250 bill for the Outpatient Surgery Center where the procedure was performed and another bill for $200 for the doctor who performed the procedure. After a number of questions, it turned out that the doctor coded the Blue Cross claim incorrectly, he corrected the claim and Blue Cross paid him the additional amount that he had billed me for. The 1st Blue Cross claims representative said that the Outpatient Surgery Center charges were not part of the Colonoscopy and that I was responsible for the $250 co-pay. I called back again, spoke to another rep who agreed with me and setup the paperwork to refund the $250 co-pay that I had already paid. If I hadn't read my policy I would have paid $450 more so reading the policy was time well spent.