Tuesday, May 19, 2009

Invoice for infertility treatment

Yesterday, I went back to my ob/gyn, Dr. M., for a follow up on the breast lump from February (mastitis, from the brief pregnancy then). I'm well, nothing new and the lump is gone except a bruise, and my mammograms compared fine with those from 2004... so no news is good news!

While I was there, I asked my doctor about 2 other issues: 1) the rainbow bruises that I have been getting from nothing special in my behavior, e.g. the file cabinets, and 2) whether I can come to him for my remaining infertility treatment and give Dr. S, the reproductive endocrinologist, the heave-ho.

1) I am fine. It's the low-dose aspirin thinning my blood.
2) Yes! I can give Dr. S. the heave-ho. Which is good (great! Wonderful!), because...

Today I called Dr. S.'s office asking about a bill I received on Saturday. This is the first I have seen of any billing from his office; I have been paying (exorbitantly) for visits, tests, and treatments on each visit sight unseen.

In case you were ever wondering what infertility treatment bills look like, here you go. I have omitted my personal info and of course, the lab tests and other tests done out of office, including those sent out to other cities and labs from this doctor's office. They have run a couple thousand dollars so far.

Anyway, what burns my biscuits about this bill -- aside from its very existence and the threatening look of line items like: BIOPSY OF UTERUS LI, are the following:

1) I am growing dissatisfied with this doctor anyway so I am admittedly cranky. He doesn't give me much information when I ask questions, so that I am forced to play 20 questions, from a position of stunned emotionality and little information going into the conversation. (I am one of those people who has to have information; if I don't know the questions to ask, I have to call back when I do.) In fact, he sometimes seems patronizing (I have a Master's degree and can be spoken to as a responsible adult), and has a perplexing tendency to call me "Madame" or "Milady." I do not want terms of endearment or alternative-lifestyle-esque stylings from my doctors, particularly those who are often looking up my down side. I am confident in his diagnoses and his training, but his bedside manner freaks me out and leaves me feeling insecure after I have had time to reflect. That said, he's friendly and knows his stuff.

2) This office is just dreadful at communication. Nobody ever told me to expect this bill. When I call, I rarely get a call back same-day... sometimes it is a week. Even urgent calls are often returned several days later.

2B) In fact, this bill was mailed first to my address, but in the wrong city. When it was returned it was addressed again by hand and sent out again. See that over 90 days past due column? My credit doesn't need this kind of delay on bills I don't know are coming... and this bill better not reflect, there.

3) Do you see those charges labeled "Report" (I have scrawled "telephone consult" next to them)? Those are billings for telephone conversations. These conversations were never more than 10 minutes in length. That makes them as or MORE expensive at $90 and $70 apiece than the office/outpatient visit that accompanied a biopsy of the uterus lining, ultrasound, anaesthetic and immunocytochemistry. Nobody ever, ever told me he would charge me for time on the phone... and for short calls making up shortfalls in information conveyed during office visits, this is completely infuriating to me. Roughly $10/minute? Really? Without warning? Really?!

4) My insurance will not cover these bills very well because Dr. S. is out-of-network. As an insurance agent, I can tell you that one of the main requirements to become an in-network doctor is charging "reasonable and customary" fees (as adjudged by the insurance company) for procedures. The fees charged by Dr. S. are probably out of that range. I do not know that this is why he is out-of-network but it is likely.

My advice, if you are likely to go through infertility testing, is to know what you're getting into. Don't take the verbal estimate for granted... be sure you have it in writing. This is particularly crucial if your insurance doesn't play nicely with your provider, as is also the case for Dr. S. and not for Dr. M.

Bah. Anyway, I am moving back to my regular doctor. If I need Dr. S., I know where to find him... and I finally have an idea what I will pay to see him.

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