Question about medical billing for 2 procedures done during one surgery

[Kassia]

I had minor out-patient surgery done in February (carpal tunnel surgery) and had a trigger finger release done at the same time.  The extra incision for the trigger finger release only took a couple of minutes.

The out-patient surgery center is charging me double because of the second incision.  I was sure it was an error because I only had nursing care for one surgery, one operating room, one IV, one hospital gown, etc.  I called and was told that legally they have to charge separately for each procedure.  The supervisor I spoke with went on to give me an example of someone who went for a gallbladder surgery and ended up having their appendix removed, too - that it would be billed separately.  I don't see how that can be true either.

Anyway, the supervisor I spoke refused to adjust the charge.  She said they would not be compliant with the law if she did so.  I said something about being compliant, but not ethical for collecting money for services not provided and she was silent.  

So, I guess my question really is if she was correct that two incisions during one surgery should be charged as completely separate procedures?  Has anyone experienced this before?  I just can't imagine what it cost the surgery center for me to have the extra incision.  I did pay my surgeon for the two procedures but that was expected and made sense. 

 

[scholastica]

Call your insurance company and ask them. They would have that information regarding both the law and the contract they have with the provider.

[cjzimmer1]

Actually it sounds normal to me.  25 years ago I went in to have my gallbladder taken out laproscopic.  Due to complications, they had to open me up.  Even back then it was billed as 2 different surgeries (and that was even for the same problem).  It sucks because then you have to pay more but it does sounds normal to me.

[Annie G]

If they can charge you twice that stinks!!

ETA: I thought OP meant they charged for two recovery room sessions, etc.  That they charged for two of things where she only used one.  

Edited April 8, 2019 by Annie G

[ktgrok]

I'd think there would be one facility fee, and anesthesia is usually billed by time, not procedure, I'd think. 

[kbutton]

1 hour ago, Kassia said:

I had minor out-patient surgery done in February (carpal tunnel surgery) and had a trigger finger release done at the same time.  The extra incision for the trigger finger release only took a couple of minutes.

The out-patient surgery center is charging me double because of the second incision.  I was sure it was an error because I only had nursing care for one surgery, one operating room, one IV, one hospital gown, etc.  I called and was told that legally they have to charge separately for each procedure.  The supervisor I spoke with went on to give me an example of someone who went for a gallbladder surgery and ended up having their appendix removed, too - that it would be billed separately.  I don't see how that can be true either.

Anyway, the supervisor I spoke refused to adjust the charge.  She said they would not be compliant with the law if she did so.  I said something about being compliant, but not ethical for collecting money for services not provided and she was silent.  

So, I guess my question really is if she was correct that two incisions during one surgery should be charged as completely separate procedures?  Has anyone experienced this before?  I just can't imagine what it cost the surgery center for me to have the extra incision.  I did pay my surgeon for the two procedures but that was expected and made sense. 

 

You had two surgeries at one time. You saved on the nursing care, operating room, etc., because those things were not duplicated, but they were two separate procedures in the actual operating room.

The surgery center is right.

Billing for procedures is very detailed. There are different codes for all kinds of things. Suturing is billed at various levels, for instance, depending on how involved it is--layers of sutures, severity of the wound, length and type of sutures, where the sutures are placed (face vs. on your scalp where it won't be seen), if the sutures saved life, limb, or vital function, etc.

You got a bargain. It's like saving gas money by running multiple errands in one location. You still had to pay for the things you bought at each store, but you saved money by taking one trip to the mall instead of four separate trips with four separate gas expenditures.

[Kassia]

20 minutes ago, kbutton said:

You had two surgeries at one time. You saved on the nursing care, operating room, etc., because those things were not duplicated, but they were two separate procedures in the actual operating room.

You got a bargain. It's like saving gas money by running multiple errands in one location. You still had to pay for the things you bought at each store, but you saved money by taking one trip to the mall instead of four separate trips with four separate gas expenditures.

 

No, my problem is that I didn't get a bargain.  Maybe I wasn't clear in my original post but I was charged separately for each procedure.  So, even though I had expenses for one surgery (operating room, nursing care, etc.) I was charged for two.  

[Kassia]

30 minutes ago, Annie G said:

If they can charge you twice that stinks!!

ETA: I thought OP meant they charged for two recovery room sessions, etc.  That they charged for two of things where she only used one.  

 

They won't give me a breakdown of charges but I suspect that's what happened - I was charged double for everything involved with the surgery (operating room, recovery room, nursing care) because I had a second incision on the same hand.  

[Kassia]

2 minutes ago, happysmileylady said:

There should be a financial office or billing office that you can talk to, I think they are supposed to break down all the charges if you ask for it.  

Your EOB might have that also, do you have that to check on it?

 

The EOB just showed the two surgeries - no breakdown.  And the billing office had the same info as the EOB.  But I'm not paying it until I see an itemized bill.

[Jean in Newcastle]

Call and ask them for a line-item bill.

Call your insurance company and explain the situation to them.  It is in their best interest to have costs lower than higher. 

Call your state's insurance commissioner and explain the situation to them. 

[TechWife]

18 minutes ago, Kassia said:

 

They won't give me a breakdown of charges but I suspect that's what happened - I was charged double for everything involved with the surgery (operating room, recovery room, nursing care) because I had a second incision on the same hand.  

Tell them if they don’t give you a breakdown in charges, you won’t be paying. It’s a legitimate and common request. 

[kbutton]

42 minutes ago, Kassia said:

They won't give me a breakdown of charges but I suspect that's what happened - I was charged double for everything involved with the surgery (operating room, recovery room, nursing care) because I had a second incision on the same hand.  

I took your original post to say the opposite. Sorry.

23 minutes ago, TechWife said:

Tell them if they don’t give you a breakdown in charges, you won’t be paying. It’s a legitimate and common request. 

I agree.

I would expect to get two surgery (incision/procedure) bills, but NOT double charges for the same nursing, etc. I would expect that it might be a higher charge than for one, but not double. 

[Garga]

100% call the insurance company.  They will fight it for you because they will not want to pay double!  There’s no reason to pay for 2 operating rooms and nursing, etc.  

[Bambam]

We've called the hospital and surgery center and asked for a detailed line-item bill. They will send it to you. Then you can see if they did or not. 
Personally, I was shocked by the amount of the charges for every thing. 

[J-rap]

We were in the same situation a couple years ago.  My dh was having a quite major surgery and we were looking into having a minor elective surgery done at the same time.  (And because it was elective surgery, we'd pay for it out-of-pocket.)  It was in the same area on the body, would be the same surgeon, was very, very minor.  We thought as long as my dh would already be under general anesthesia and having extensive surgery, the surgeon might as well do this one other small thing (and fairly quick too -- compared to the main 5 hour surgery going on) at the same time, and the surgeon himself said he'd be happy to do it...no big deal.  To our surprise, it would have cost us thousands of dollars more -- they were adding in the cost of anesthesia again, room cost, nursing staff, etc.  It didn't make any sense to us.  Needless to say, we declined.  

I'll be curious to hear what you find out as you look into it more.  

[Garga]

This is odd to me.  Now, granted, I haven’t worked for the health insurance company in 16 years, but waaaay back in the olden days, 16 years ago, we would pay for the primary surgery at 100% and the secondary surgery at 50%.  This was the bill for the surgeon.  The idea was that the patient was already in the room, already under anethesia, the incision was already made, etc.  

Now, there might have been cases where we paid for both surgeries at 100% if there were two surgeons.  The details are blurry. 

I do not ever recall paying for two full anesthsia bills—it would be one bill with a flat rate and then amounts above the flat rate for the length of the time of the surgery.  We wouldn’t pay for two rooms in a hospital (if it was inpatient.). 

Maybe things have changed, but I wonder if the OP and the person on the phone were misunderstanding each other?  Like, maybe the person on the phone thought the OP was trying to get an entire surgery for free?  It sounds like the person on the phone was talking about charging for both surgeries, but the OP was talking about double charging for all the other care and the person on the phone didn’t get that.  It could very well be a billing error.

I still say to call the health insurance company.  This is one of those times where their miserliness is in the patient’s benefit: they’re NOT going to let a surgery center charge double unless it’s really, honestly, legally the way it’s mandated to be.  

Edited April 9, 2019 by Garga