I know many have read my previous posts about the charges my LLMD is billing for. The final bill has been submitted since I will NOT be returning there and the grand total is.......
$52,000.00!!!!!!!!!!!!!!

This sounds absolutely ludicrous to me. We are talking desensitization to Rocephin and 56 days of IV therapy......most of which I did at home.

The reason I am writing this is to warn others not to become a victim of this kind of debt. My insurance company was willing to pay for this treatmentwithout any hassle.....that is until they saw the unbelieveable numbers!
They are far off the usual and customary charges.

By this doctor overcharging so much, it is going to make more and more companies deny payment for treatment of Lyme disease.

Please have your insurance companies find out ahead of time what the cost for the entire treatment will be. It can save you a major headache when the prices are gouged!

Needless to say, I won't have anything done in the future without asking exactly how much and where the things are coming from.

BIG BOLD letters on this board

I think that we should make a site and explain what happened to you and give informative links on Lyme.

We cant take this sitting down people.

We have to fight within our rights as americans, with this OLD LYME connecticut diagnosis.

I just posted a reply to your post...

But at the wrong site!

DUH... That's a first for me!

I thought I could fake it.. even though I am tired and it IS nearly 4 AM....

But I blew it.

Could you please see my reply on the link below?

I had gone back to review your old posts about costs... to see if I could help.. and instead of posting my reply HERE.. I posted it there.

Sorry!

Duh me!

Ok.. now I can't get the stupid link to work....

Grrrrrrrrrrr....

Try again...

OK.. got it!

I am headed straight to bed now... not to worry!

hehehe

http://flash.lymenet.org/ubb/Forum3/HTML/011004.html

The 52 grand that I was charged was for the rocephin (not premixed), the infusion (which I did at home with a portable pump) and supplies/drsg.

I did not have a home nurse, went to the office 1-2x/week and my insurance paid for all visits and lab work separately.

I obviously had no clue what was an acceptable price, but the insurance company is insistent that the amount is totally off the mark. Who knows? I just wanted to give others a heads up. Maybe I am the only clueless one in the bunch!

Well, lets hope others take the cost into consideration BEFORE the insurance comapny tries to back out!

IV Rocephin IS expensive but, your bills are a little less than double what mine were. I used the pre-mixed, which is even more expensive than the one you had.

I don't think it is appropriate to post the MD's name online. I thought that was poo -pooed on this forum.

Chances are very good that your insurance co. will renegotiate the price with your LLMD. This is common practice. Why are YOU getting the bill if it has been pre-sertified by your ins. co.? It should go directly to them.

Before you bash the LLMD, see what the ins. co. re-negotiates with him.

I know, this stuff is outrageously expensive.

Mine was $918.00 per week. It came to me premixed and shipped from a pharmacy in Little Rock, 2.5 hours away or 125 miles. Mine included the UPS charges.

If you tack on a CBC and Liver function tests, at let's say a high price of $500.00 per week and tack on another visit to the doctor every week for let's say another high price of $500.00 per week, then that would be $1,918.00 per week.

So take the $6500.00 per week (your cost) and substract $1,918.00 (my cost for drug and tests and doctor's visits) you will get a price difference of $4,582.00 PER WEEK that I think was definitely an over charge.

I used a pharmacy out of Little Rock and they shipped it directly to me. I don't see why anyone with a prescription for Rocephin couldn't get the same thing, but, of course with a probable slight price increase since mine was three years ago this coming up January.

The name of the pharmacy that I used was called United Medical and they are out of Little Rock if any of you would like to call them and see if they will ship out-of-state.

Seriously, I really do believe that when one sees such a price difference as I have detailed above, then there is definitely something wrong with what you've been charged.

I hope that you can work this out and other's are NOT taken in by such gouging of prices. Wow, to think that someone insurance limit could be used up in such a way, turns my stomach.

There are several possibilities:

1. You were overcharged.

2. This is a billing error. I am surprised how often billing errors are made. I no longer assume anything about a bill until it is double, triple checked. Have you contacted the billing person to question this? If not, that should be your first step. If nothing else, a better understanding of the charges will be produced, if not a correction.

3. The bill is accurate, for reasons none of us here could have known.

My IV bills ranged from $1000 to $5000 per week before the insurance company cut it nearly in half, based on their established formulas. The cost depends on the drug(s) used, and the particulars of the administration.

Don't know anything about de-sensitization but that is frequently done in a hospital and can be expensive. So are pumps. If it is pre-mixed, it can be less expensive than if you get the kind that comes with vial and bag attached, but not yet mixed.

So, this is not a cut and dried case of overcharging. First you need to talk to the billing agent.

I wish that people who question bills on this forum would follow up with any explanations, so that sometimes unfounded complaints don't hang around for trolls to use.

Not saying you are wrong, just that we and possibly you don't have all the information yet to judge.

quote:

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Originally posted by beachcomber:
Pitnum:

IV Rocephin IS expensive but, your bills are a little less than double what mine were. I used the pre-mixed, which is even more expensive than the one you had.

I don't think it is appropriate to post the MD's name online. I thought that was poo -pooed on this forum.

Chances are very good that your insurance co. will renegotiate the price with your LLMD. This is common practice. Why are YOU getting the bill if it has been pre-sertified by your ins. co.? It should go directly to them.

Before you bash the LLMD, see what the ins. co. re-negotiates with him.

I know, this stuff is outrageously expensive.

Bc

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I am not bashing this LLMD. I'm sure he is very knowledgable or he wouldn't be doing what he does. My gripe is the pricing. If the doctor is willing to negotiate pricing, then it seems they know they are over charging. Also, I did not post his name on this site....I used his last initial only. If you check back , you will see that others asked for his name, but I did not give it unless it was in a personal email.

If you think I was posting to bash this doc, you are wrong. I am just trying to prevent others from being blind-sided like I was.

A doc/lab/whoever charges a certain price for something, and when the insurance gets it, if they pay, they pay a much lower price. I have seen bills cut as much as 2/3 of the total bill.

But if the insurance company denies it, and you have to pay it, you pay the total price, not the lower price the insurance co pays.

So, it doesn't matter at all if you have the insurance. If that particular bill is denied by the insurance co, it's not the lower rate you get if you have to pay.

So, basically, a lab/doc/whoever gets more $$$ in THEIR pocket if the insurance co DOESN'T pay.

Get it?

This seems terribly unfair. But I contacted a lab once and asked them about it. Told them we didn't have the $$$ to pay all this and I wondered why I could not negotiate down to a lower rate. Explaining that wouldn't it be better to get a lower payment for it rather than nothing if we tried to ignore the bill, go into bankruptcy, etc.

But they told me that it was illegal for them to do this. Some sort of violation of law. And that I had to pay the entire thing or risk credit problems.

I ultimately negotiated a payment plan, and the best they could do is 1/3 of the bill each month for the following 3 months.

But, I didn't know what to make of all this. I just don't get it. How can it be a violation of law? I vowed to look into this, but never did. So don't know any more than I did, and fortunately have not had to deal with that situation again.

But it does bug the Hell outta me that these people make more if my insurance doesn't pay. What incentive do they have to collect from insurance?

All I can say is: the gov't sure doesn't take care of people in a situation such as this. Medical bills can put you in the poor house, but you still have to pay those taxes!!! And you have to pay lots out of pocket before you can take any good quality deductions. What a shame. But the medical vendors get rich nonetheless.

quote:

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Originally posted by ConnieMc:
Another bottom line - which floored me and ultimately cost me lots of $$$ -

A doc/lab/whoever charges a certain price for something, and when the insurance gets it, if they pay, they pay a much lower price. I have seen bills cut as much as 2/3 of the total bill.

But if the insurance company denies it, and you have to pay it, you pay the total price, not the lower price the insurance co pays.

So, it doesn't matter at all if you have the insurance. If that particular bill is denied by the insurance co, it's not the lower rate you get if you have to pay.

So, basically, a lab/doc/whoever gets more $$$ in THEIR pocket if the insurance co DOESN'T pay.

Get it?

This seems terribly unfair. But I contacted a lab once and asked them about it. Told them we didn't have the $$$ to pay all this and I wondered why I could not negotiate down to a lower rate. Explaining that wouldn't it be better to get a lower payment for it rather than nothing if we tried to ignore the bill, go into bankruptcy, etc.

But they told me that it was illegal for them to do this. Some sort of violation of law. And that I had to pay the entire thing or risk credit problems.

I ultimately negotiated a payment plan, and the best they could do is 1/3 of the bill each month for the following 3 months.

But, I didn't know what to make of all this. I just don't get it. How can it be a violation of law? I vowed to look into this, but never did. So don't know any more than I did, and fortunately have not had to deal with that situation again.

But it does bug the Hell outta me that these people make more if my insurance doesn't pay. What incentive do they have to collect from insurance?

All I can say is: the gov't sure doesn't take care of people in a situation such as this. Medical bills can put you in the poor house, but you still have to pay those taxes!!! And you have to pay lots out of pocket before you can take any good quality deductions. What a shame. But the medical vendors get rich nonetheless.

Sorry - VENTING!

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It infuriates me that the medical provider can charge whatever they damn well please and the patient is the one left holding the bag. And the laws allow them to do it. It makes no sense. I have no clue what needs to be done to change this. Seems to me the providers are passing on the costs to people who either don't have insurance at all or have sleezy insurance companies who fail to pay their bills. Insurance is allowed to cut bills, but the patient can't? Seems to me this sets up a huge conflict of interest. Think about it. OK, I will deny this patients' bills, and you can in turn charge them more, and make more, so you turn around and give me a cut of the action by giving me a cut on the bills you do pay.

GRRRRR........

Edit addition...
And we all know that these insurance companies and medical providers are sometimes in bed with one another. It's all about $$$. "You scratch my back, I'll scratch yours."

Sorry about that. I was referring to those who want you to post the LLMD's name. I think that is inappropriate.

Your frustration is justified. I know that my MDs office charges more for the Rx than is reasonable & customary because they know they will have to negotiate down to what is reasonable. Doesn't seem logical but, that's how it works. Fortunately, I do not have to pay the difference.

I get a copy of what is submitted to insurance. I also get a copy of what has been negotiated. I hope you can work it out that you don't have to pay the difference. It does seem like alot. But, maybe the desensitization was expensive?

Don't give up.

If they do, they are required to accept the amount the insurance company sets as reasonable and customary. If they are an out of network provider, as most LLMDs are, then they are NOT required to accept the amount the insurance company says is reasonable.

You should have been informed of this when you started seeing the doctor. You also have to read your insurance policy carefully.

Most policies don't refuse to pay because the charge is higher than reasonable and customary. They simply only pay the amount they would pay to someone they have contracted with. You are responsible for any amount due over what the insurance company pays.

You may need some help negotiating with your insurance company here. My CA Blue Shield turns many things down the first time, even if they are specifically included in coverage.

I just finished filing a grievance complaint for their refusal to pay for a neuropsychological exam. Once I pointed out that it fit the criteria listed in my benefits, they agreed to pay. Because it was done with an out of network provider, I will receive slighly less than half, but I knew that ahead of time.

I would start with your insurance. Find out your policy and your rights, then file an appeal. You may not get the whole thing paid for, but you should be able to get at least some payment.

Check out the info on this website, even if you are not in CA:
Center for Health Care Rights
The Center for Health Care Rights (CHCR) is a California-based, nonprofit organization dedicated to assuring consumer access to quality health care through information, education, counseling, advocacy and research programs.

How was the "desensitization" done?
Do you have a breakdown of the cost for this process or procedure?

quote:

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Originally posted by cbb:
You said the $52,000 was for
"desensitization to Rocephin & 56 days of IV therapy."

How was the "desensitization" done?
Do you have a breakdown of the cost for this process or procedure?

Could this be adding a considerable amt to the total cost?

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I'm sure the desensitization adds some cost to the total, but it is extremely small amounts of the drug that are injected with a syringe. Takes all of 10 secsonds. We are talking a couple cc's , not grams. But, like every thing else, I'm sure the mark up on the price relayed to the patient is high.

For diseases where there are not too many specialists, there should be some kind of price regulations. This would prevent physician's from charging excessive amounts.
Like someone said earlier, most of these docs are not in networks. It is a business, and money takes precedent over patient care.

Maybe it starts with the CDC, who has left the chronically seronegative folks out in the cold, then, maybe Igenex could make their test fees more palatable to insurance co.'s, and then just maybe it would be helpful to teach med students about how complicated and confounding vector-borne illness can be. (Require them to complete a rotation with a llmd)

This all reminds me of the drug companies that create a much needed medicine and then jack the price so that no one can afford it.

It's nothing short of criminal.