Circumcision: A Lesson in Insurance Billing
Our newborn son could not be circumcised after his delivery because the birthmother was on Medi-Cal, the Medicaid program here in California and from what I understand, Medi-Cal no longer will fund these procedures.
When we returned to Newport Beach, our pediatrician referred us to an urologist that performs infant circumcision at his office associated with Cedars Sinai Hospital in Los Angeles. Before readers start commenting on whether our son should or should not be circumcised… you’re too late to weigh in. Sam was circumcised. We did it primarily for social reasons; our desire for his “cosmetic conformity” but also our belief that it will be cleaner and healthier for him. You don’t need to comment on the pros and cons, the research, the policy statement from the American Academy of Pediatrics or how inhumane and unnecessary circumcision is. It’s done. That’s not the point of this post.
The point is how can a 20-minute procedure cost nearly seven thousand dollars? The answer comes from our screwed up insurance system.
We received two bills:
- One from the hospital for Operating Room Services. Total charge = $6195.
- The other was for Physician Services. Total charge = $745.
The “outpatient” procedure took place in the urologist’s office and seriously, it took all of twenty minutes. Four little pricks in his penis to localize the area, then a clamp and a quick slice to remove the foreskin. I watched. Jeanine turned away.
The doctor is also a physician-mohel… the person at a Bris ceremony that functions as a Jewish religious officiate and surgeon. He probably does three circumcisions per week and most are done in the living rooms of Jewish families with sons that are 8 days old. I searched around on the Internet to find the going rate of a physician-mohel and it appears to be a few hundred dollars… the equivalent of what a Protestant couple might pay a minister to marry them.
The point I’m trying to make is that it’s not rocket science. And it certainly did not look like surgery, but that’s how it was allowed to be billed. Apparently, the system thinks it’s fair for this “Operating Room Service” to cost thousands of dollars. Who comes up with these billing codes?
“Physician practice is aligned first and foremost with insurance billing codes, not best practices or patient’s rights.”
At least this is what I discovered with Sam and his billing code…
I’m still in a dispute with the insurance company about how much they’re going to cover which will likely be part two of this post. In the meantime I’m wondering what health care procedures you have seen bill at a suspiciously high rate?
Photo credit: stock.xchng.