Reasonable and Customary Charges

[JamieOh]

Eastern Ohio.

This is NOT about malpractice but there is no other category into which it fits.

Where does one go to find the Reasonable and Customary charges for medical procedures in a given geographical area?

My wife recently had three stitches put into a laceration on her face and the charge was $662.00 at the local Hospital (wheeling West Virginia). My wife is a nurse and she was not seen by a physcian at the local emergency room, but by a PA. She told the PA she had a laceration that would require stitches (it was about .6 inches long). the PA looked at the laceration and left the room. Total time with the patient, so far, less than 5 minutes. Some time later the PA returned with a suture kit and placed Three (3) sutures and released my wife. total time with the PA was about 20 minutes. The Bill? $662.00 of whiuch $181.00 was for diagnosis and the remainer was for Physcians Charges. So that puts the PA's cost somewhere in the regions of $1, 443.00 an hour and diagnostice time at something greater than $2,172.00 per hour (when there was no "diagnosis" required).

The rates seem to be a bit over the top and I wanted to try to confirm the customary charges for the area before I initiate a "contest" reply to the charges......

 

[Zigner]

Eastern Ohio.

This is NOT about malpractice but there is no other category into which it fits.

Where does one go to find the Reasonable and Customary charges for medical procedures in a given geographical area?

My wife recently had three stitches put into a laceration on her face and the charge was $662.00 at the local Hospital (wheeling West Virginia). My wife is a nurse and she was not seen by a physcian at the local emergency room, but by a PA. She told the PA she had a laceration that would require stitches (it was about .6 inches long). the PA looked at the laceration and left the room. Total time with the patient, so far, less than 5 minutes. Some time later the PA returned with a suture kit and placed Three (3) sutures and released my wife. total time with the PA was about 20 minutes. The Bill? $662.00 of whiuch $181.00 was for diagnosis and the remainer was for Physcians Charges. So that puts the PA's cost somewhere in the regions of $1, 443.00 an hour and diagnostice time at something greater than $2,172.00 per hour (when there was no "diagnosis" required).

The rates seem to be a bit over the top and I wanted to try to confirm the customary charges for the area before I initiate a "contest" reply to the charges......

ER's are expensive...

 

[ecmst12]

Physicians (and PA's) do not charge by the hour but according to the service provided. The amount of time needed has nothing to do with it. And services provided on an emergency basis are always more expensive then those provided in a regular office setting.

Insurance companies use extensive surveys of prices charged and allowed by medicare and other insurance companies in order to come up with reasonable and customary charges. The resulting data is highly proprietary and not available to anyone outside of that company.

So how did your insurance company evaluate the claim?

 

[barry1817]

medical

Eastern Ohio.

This is NOT about malpractice but there is no other category into which it fits.

Where does one go to find the Reasonable and Customary charges for medical procedures in a given geographical area?

My wife recently had three stitches put into a laceration on her face and the charge was $662.00 at the local Hospital (wheeling West Virginia). My wife is a nurse and she was not seen by a physcian at the local emergency room, but by a PA. She told the PA she had a laceration that would require stitches (it was about .6 inches long). the PA looked at the laceration and left the room. Total time with the patient, so far, less than 5 minutes. Some time later the PA returned with a suture kit and placed Three (3) sutures and released my wife. total time with the PA was about 20 minutes. The Bill? $662.00 of whiuch $181.00 was for diagnosis and the remainer was for Physcians Charges. So that puts the PA's cost somewhere in the regions of $1, 443.00 an hour and diagnostice time at something greater than $2,172.00 per hour (when there was no "diagnosis" required).

The rates seem to be a bit over the top and I wanted to try to confirm the customary charges for the area before I initiate a "contest" reply to the charges......

Insurance companies have tables which give the usual and customary fees for practices and procedures. They use those figures to establish the usual and customary fees.

 

[debtor2008]

should've gone to urgent care facility. it is cheaper and they do just a good a job as an er for stiches.

my son had 3 stiches put in his scalp in MI and was charged about the same..i think around 700$