“what a racket,”

says the surgeon specialists during our last appointment in October.  He wants me to have (another) CT scan, this time of the mandible, (to compare structural stability from six months ago).  Since he is affiliated with NYU (New York University Medical Center), the scans are automatically scheduled at the NYU hospital.  Procedures like this need to be authorized by the insurance company, so the one I use called me to explain that since my deductible is quite high, the scan cost would be out-of-pocket.  Therefore, they said, I might want to consider options for the same scan at other nearby locations were costs are considerably lower.  At NYU hospital the cost is $1,000 for the mandible scan.  Not much, as scans go, but the alternate locations had list prices for the same scan between $200-300.

I had asked the doctor’s assistant prior to our appointment if there was a problem using one of these alternative scan locations and the response was “the doctor prefers the scans done at NYU hospital.”  I also checked to make sure that the scans were equal in quality machine and results.  They are.  And, since spending $700-800 more for the same thing doesn’t seem prudent, I brought this up again at my appointment in front of the doctor and his assistants.  His response, as he shook his head from side to side, was “what a racket.”  I was puzzled by his reaction as I thought the comparable pricing the insurance company gave me was a good service to protect the consumer (from the racket).

I really like the doctor and have known him now for five years.  He’s fairly young, but not too young, and serious.  I’ve been under his knife at least three times so far (unfortunately).  His speciality is head and neck micro-vascular surgery.  Usually during our appointments we talk about cycling and physical fitness.  I’ve shared some good cycling information with him since he enjoys serious cycling as I do.  So when he made the “what a racket” comment, I reacted with, “doc, with all due respect, you want to know what a racket is?  Let me show you your bill from my last office visit when you checked my ear.”

During a trip home in July, GV and I spent a few days at the Connecticut shoreline.  One of those days while GV was out running, I was reading by the surf and a bee flew into my ear.  I could hear the buzzing for a few seconds and couldn’t do anything as my finger could only push the bug in further.  I pounded on the side of my head which was tilted over, but I was alone in the sand and one one could really help me.  I picked inside my ear with a small stick and eventually the buzzing stopped.  When GV joined me about an hour later I asked her if she could see anything in my ear and she could not.  (It’s hard to see inside an ear without proper light.)  I then forgot about the episode as all felt normal again.

About a week later I had a follow up appointment with the doc.  Since he is a head/neck specialist, I asked him to do me a favor and look in my ear.  With his ear light-scope and tweezers he pulled out the body and wing of a dead bee.  “Wow,” he said, “good thing you had wax in your ears or the bee could have gone further in and created a problem.”  He also pulled out a chunk of wax.  The entire procedure took less than two minutes.  I thanked him and was relieved that the bee and wax were no longer in my head.  It didn’t register that there would be an extra cost to this as I assumed it would be part of the cost of the routine visit. I thought wrong.

Itemized on the surprise bill, beside the $400 routine visit cost, were line item costs for; 1) removing impacted ear wax @ $580, and 2) removing a foreign body from ear canal @ $1,457.  In other words, the tweezer operation which took less than two minutes was costing $2,037, or $17 per second.

When I asked him about the exorbitant charge(s), he said he just writes down what he does during the appointments and the billing coordinator makes the invoices from codes.  I chided him and said, “look doc, I thought this was a favor and it took less than two minutes.  Had I known it was going to cost this much I would have gone to a regular ENT as my insurance isn’t paying for this.”  He shrugged his shoulders and told me to duke it out with the billing coordinator, which I’m still doing.

No doubt most of the medical community does great things — healing (what they think) needs healing.  At the same time though, for most, it’s a business — and indeed, quite a racket.