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 ‘œcosmetic 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 ‘œoutpatient’ 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 ‘œOperating Room Service’ to cost thousands of dollars. Who comes up with these billing codes?
‘œPhysician 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.
OMG Nina, that’s insane. One thing I’ve noticed recently is that doctors will not treat you for multiple issues on the same visit. If I have a sinus infection, I have to make one appointment for that. And if I need to schedule a pap smear, my primary care physician will most likely require me to make a separate appointment. All so that they can bill me for multiple office visits. Our system is so ridiculous.
Seeing as how your son lost an important functional and sexual part of his body for no medical reason at your request, I don’t see a problem with the accomplices financially circumcising you. You could have saved a lot of good money by leaving the boy intact. Later on when he turns 18, your son can sue the doctor and hospital responsible for committing this genital mutilation upon him, as William Stowell did (see http://www.cirp.org/news/mndnewswire04-29-03/ ). The boy can at least get some financial compensation for the harm done to him by this physician. He’ll probably get more money back than it is costing you now.
I don’t understand why an insurance company would pay for your son’s genital mutilation in any event. Your pathetic whining because it cost you so much money is pathetic. It cost your poor son so, so much more.
This illustrates the problem with a system where the consumer does not negotiate the price of what he’s buying. You would never walk into a car dealership, pick a car without looking at the price, and just tell them to bill you later – unless you weren’t expecting to have to pay for it. This is the type of behavior that any system of socialized medicine encourages, and why costs always spiral out of control.
Insurance is not the answer. Consumers must be exposed to the price of the procedures they choose. Even minimal exposure like 1% of the purchase price would be enough for people to ask, “How much is this going to cost?” Faced with customers willing to go to a cheaper doctor or facility, price competition ensues. If you negotiate, you can get rates far lower than the reduced prices that the insurance company has negotiated. Here’s one example of this: http://www.cato.org/pub_display.php?pub_id=8304
We desperately need a health care system that brings normal market forces back into play.
Heck, I’d have paid $7,000 for my son not to be circumcised. His body, his choice. If he wants to be circumcised later on (which is safer, less painful and gives better cosmetic results), I’ll pay for it then.
And yes, it is surgery. If you look up the links to some of the complications, you’ll see what can go wrong. The record insurance payout for a botched job is $22.8 million at Northside Hospital in Atlanta, which partly explains why it’s so expensive.
“cosmetic conformity”!?! Only about 1 in 3 boys on the west coast is circumcised.
“cleaner and healthier for him”!?! Women’s genitals are harder to clean than men’s. How would you like it if someone had cut parts of your genitals off to help you keep them clean?
Doctor offices never get paid 100% of what has been billed to insurance, so they upcharge to at least cover their basic costs from what they know insurance will usually cover and the balance wrote off as a business expense. Those that accept government program reimbursements such as Medicare, have set amounts that they are reimbursed for and are always much lower than what insurance pays and wrote off as a business expense. When patients pay cash, they are charged the same fee as what is expected to be covered by insurance and the rest wrote off as a business expense. Patients who end up in collections often get wrote off as another business expense deduction. Also numerous insurance claims are often denied on the first go around, hoping that the claimant will pay and give up asking for the insurance company to cover it. Nature of the beast. Good luck Nina.
We did not circumsize our son but my brother did. This was 9 years ago and it was done at the hospital but the insurance did not pay for it. I think it was around $350 or so. Your total sounds crazy.
Bill, I’m not trying to shut you down. I think you have a valid argument. But how would you negotiate the cost of something if you haven’t been expecting it to happen? For example, when I fell down the stairs last year and broke my leg in 3 places, I went to the ER and was admitted for emergency orthopedic surgery. Thankfully I had health insurance at the time and they picked up the bulk of the tab except the $700 fee for the anesthesiologist. Apparently he was out of network. I don’t know when I would have known I was supposed to shop around for an anesthesiologist, let alone negotiate a price. Would this be before or after my fall? Before or after the ER doc shot me up with morphine?
I agree with the car example – I would never walk onto a car lot without doing me research in advance – but I don’t think it’s a proper analogy. I’m not sure how this applies to medical care.
I suppose hindsight is 20/20, but I’ve found that before we have any procedure done at the doctors office we have their billing department call the insurance company for a full list of whats covered and what isn’t. For what isn’t, at least we have an upfront cost and a negotiating point.
Circumcision is a surgical procedure. Surgical procedures require supplies, time, sterile equipment, staff expertise and so on.
My observation would be that your US insurance system is, frankly, insane, and designed only to make people other than consumers wealthy. Hardly any other nation on earth has such a dysfunctional system. About time you all agitated to change it, in my opinion. It isn’t serving any of you well.
In Australia the procedure, circumcision of a male under 6 months, if it attracts a Medicare (universal free health insurance) benefit has a surgeon’s fee of $42.95. There would be an anesthetists fee of around $100 if there was a local injection of anaesthetic performed by a specialist anaesthetist – nothing if the surgeon did it. There would be an operating room charge of something in the order of $50.
Having said all that, I think there is something very wrong if you are willing to pay for “cosmetic conformity”. Conformity with whom? For what reason? Would you pay for a rhinoplasty for the same reason?
Serena, the link I posted is a perfect example. Certainly, not all medical procedures can be approached this way, but the ones that can are enough to affect pricing across the board. The article also relates how he negotiated down the MRI price after the fact, by finding another imaging place that would have done it for less than half what he was being charged. So not everything needs to be negotiated up front.
But aside from that, just the awareness of consumers price-sensitivity will produce various options. Just as you can shop for food at Whole Foods or at Wal-mart, when you break your leg you should be able to make a similar choice in hospitals. You already have these choices in areas not covered by most insurance, such as cosmetic surgery. You can go to a doctor that moves people through like cattle and pay less, or you can go to a doctor with lots of individual attention and pay more. These choices exist precisely because these procedures are usually not covered by insurance, and so consumers are cost-conscious.
Dwayne, no, patients who are paying cash do not have to pay anywhere near that price – IF they bother to negotiate.
Serena: Many years ago my brother had to have surgery on his shoulder…while not an immediate crisis need it still had to be done rather quickly.
While we were fully insured out father got with the surgeon beforehand and said “How Much In Cash”…same with the Hospital.
What was considered Major Surgery with 3 hours in the operating room came to less than $10,000. Bills totaled $60,000 with $50,000 of “Professional Courtesy” credit applied.
Nina: Not my place on the circumcision but do you remember a while back on MSN an article about “Make Your Child A Millionaire”???
It showed that if you took just under $6800 and put it in a Stock Market Mutual Fund in the Childs name the day they were born and even with paying the taxes due when the account eventually got large enough to have to pay them that at the end of 65 years their should be a Million dollars there.
The article also listed the amounts you would need to put in at different ages both in lump sum and monthly…for a newborn baby its either the $6800 lump or $38 a month from birth to 65.
A constant debate in Intactivist circles is whether doctors continue to circumcise because of the money.
Prominent circumcisionist Thomas Wiswell said in 1987 (hence the low figures) “I have some good friends who are obstetricians outside the military, and they look at a foreskin and almost see a $125 price tag on it. Each one is that much money. Heck, if you do 10 a week, that’s over $1,000 a week, and they don’t take that much time.”
Thanks for the additional evidence.
(And a lesbian couple has their IVF’d son cut for “cosmetic conformity”. Wha…?)
As I noted above, this wasn’t supposed to be a debate about to circumcise or not to circumcise, but I’ll elaborate on the questions about cosmetic conformity… while it was pointed out that only about 1 in 3 boys on the west coast is circumcised, we live in Newport Beach where according to the most recent U.S. Census, the population is 92.2% white and with the majority of white boys still being circumcised… that’s my point about conformity. People can point to the studies about the negatives, but there are studies about the benefits: Here’s one by the Journal of the American Medical Association that found circumcised men seem to be more sexually adventurous than their uncut brethren. We can all make data say whatever we want to hear.
Now about the insurance topic…
Roland: I like your point about what $6,800 could do for Sam by the time he’s 65.
Serena / Bill: Good thread. One of you should turn those thoughts into a Queercents post!
Col: “My observation would be that your US insurance system is, frankly, insane, and designed only to make people other than consumers wealthy. Hardly any other nation on earth has such a dysfunctional system.” Well said!
Dwayne: Great point about the write-offs. Yes, the “hospital discount to patient was $3,283.” When I asked how they arrived at the “actual charge” of $2912, the doctor’s office indicated that this was all they’re allowed to bill my insurance company. I’m still disputing what I’ll have to cover out of pocket but the system is truly broken. It’s a crock and just a numbers game…
1) There will be other intact white boys in your son’s class, but is it really acceptable to cut part of a child’s penis off just because other people do it? That’s one of the reasons it’s hard to stamp out female circumcision, because “everybody does it”. I know, I know, the extreme forms of female circ are truly horrific, but the forms practiced in Egypt and Malaysia are very close to male circumcision.
Are you aware that the USA also used to practise female circumcision? Fortunately, it never caught on the same way as male circumcision, but there are middle-aged white US American women walking round today with no clitoris because it was removed. Some of them don’t even realise what has been done to them. There are frequent references to the practice in medical literature up until the late 1950’s. Most of them point out the similarity with male circumcision, and suggest that it should be performed for the same reasons. Blue Cross/Blue Shield covered clitoridectomy till 1977.
2) I’ve seen that JAMA study quoted as a drawback to circumcision, as it suggests that intact men are happier with regular sex. It’s not like they’re queuing up to get cut.
3) $7,000 for an infant circumcision does seem very high. Figures I’ve seen quoted before are usually around $600-800. Something seems very wrong with the figure you were given, though personally, I’d be glad if it really were that expensive. It seems entirely possible that they made a mistake with the billing.
The only other explanation I can think of (apart from rampant greed), is that maybe there was a big insurance payout due to circumcision at that hospital. I’ve heard of at least two hospitals that stopped performing infant circumcision solely because of an insurance payout (one in Canada, one in Australia).
It’s worth remembering that we wouldn’t even be having this discussion if it weren’t for the fact that 19th century doctors thought that :
a) masturbation caused various physical and mental problems (including epilepsy, convulsions, paralysis, tuberculosis etc), and
b) circumcision stopped masturbation.
Both of those sound ridiculous today I know, but if you don’t believe me, then check out this link:
http://www.noharmm.org/docswords.htm
I don’t think this cost is very much out of line. Cosmetic surgery to amputate sexual tissue from non-consenting minors carries a small risk of a very large lawsuit. Your son could, one day, sue you and the circumciser, and had his surgery resulted in serious injury, as it sometimes does, you would now be suing the circumciser. When the amputation is done in a hospital, the cost and risk is spread out. Given that you were so anxious to have him cut that you forgot to ask about the fee, you don’t have any standing to complain.
I think you should pay every cent of that price for needlessly cutting off a part of your helpless child.
Normally, I agree that prices in the US for routine medical procedures are too hight. However in this case you deserve it.
Conformity? Why on earth should a lesbian woman worry about conformity? Your very relationship and family is an exercise in non-conformity, an experiment showing that different is good, a thing to be proud of.
Your son won’t necessarily always live in Newport Beach. He won’t necessarily always be around white people. (As if race should be a factor in these type of decisions!) As the tide continues to turn against circumcision – and it will if moms like me have anything to say about it – your son will be in the minority. So much for conformity!
I know, I know, it’s too late, it’s over and done with. Pay your seven grand, it’s the least you could do for making such a bad decision. If it weren’t for the other excellent posts on this site, this would completely turn me off of Queercents. As it is, I probably will not be recommending this site anymore. A shame.
Wow, that’s an outrageous bill. But I am glad to hear that you had to pay out the nose for a totally unnecessary procedure. If all insurance companies refused to pay we would save so many more little boys from this terrible tragedy. I am ashamed that we are both lesbians and that you feel so little respect for your sons basic human rights. Human rights are what we as queers have been fighting for and you are a disgrace to the cause.
You have lost at least one reader!!! Give your sons my condolences.
Good. I hope they send you to collections for every nickel. Call it karma for inflicting such a thing on your son…for what? You mutilate your own child, for “cosmetic conformity” and saving a bit of extra work in the shower? How could you conceivably do such a thing?
I seriously doubt your MD charged $6195 for a circumcision, if so that’s insane. My office charges $519.00 when we perform them. I tend to believe the $6195 bill is the physicians bill for delivering your baby, not for a circ. $6195 is fairly close to the fee my offices charges for delivery.