O/T - Doctor's office jacking up med prices - SO ANGRY!

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O/T - Doctor's office jacking up med prices - SO ANGRY!

Postby weisssoccermom » Tue Jul 11, 2017 4:30 pm

I am SO angry at what is happening with this doctor's office. My old ortho retired last year and I was forced to find a new one. Nowadays, it seems that every doctor is affiliated with a large medical group and it is so frustrating. So, I asked the PT for his referral and he gave me a local ortho who is with one of those big, multi city medical groups. Honestly, the doc was great.....and he ordered lubricant shots for my knees.....initially Euflexxa. For the next 6 weeks, I had to basically hold the hand of the office preapproval person to get the approval from my insurance company. Honestly, the insurance company was NOT the problem. I spent numerous days on the phone with the office manager complaining that nothing was being done. Fast forward....insurance company approved a different drug (no big deal to me....they are all basically the same and I've had good results with Hyalagen so I was fine with that). The drug was approved and I 'purchased' it from our insurance company's pharma....CVS/Caremark and they sent it to the doctor's office. Had my first shot on 6/22 and when I went it, I was emphatic that the staff find MY pre-filled syringes that were sent to their office. Next visit on 6/29....I did the same thing. Now, backtrack a minute.....when I talked to CVS/Caremark to give them my credit card info....they told me for 10 syringes (both knees), it would cost me a flat $200....without insurance it would have cost a little less than $900 (or slightly less than $90 per syringe).

The other day, I went on my insurance website to check on the claim and while the EOB isn't up yet, the 'claim' was.....and it was broken into two parts. One was for $390 and the other was for $1360. Today, when I went in for my third set of shots, I asked billing what the claims (now there are two being worked on) were for.....could they explain the two components of the claims. She said that the $390 was for the PA to administer the shots and the $1360 was for the two syringes. I was so totally TICKED off. After everything I had gone through, isn't the office competent (guess not) to realize that I had the SYRINGES SENT TO THE OFFICE??? We finally got it straightened out but....then I started to realize that the office was charging $680 a syringe!!! OMG! That's 7.5 times more than the CASH cost of the pharmacy.

CVS/Caremark cash price was just under $90...and here the doctor's office jacks up the price to $680 for the exact same (same brand...no generic available)thing! No wonder our insurance premiums keep going up and hello, no wonder why my insurance 'rewards' me with a flat copay if I purchase the meds through them instead of 'purchasing' the meds at the doc's office!!!

Total out - of -pocket cost for 10 syringes (5 per knee) = $200 (or $20/syringe)
Total CASH price for 10 syringes = $900
Total billed price for 10 syringes from doc's office - $6800

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Re: O/T - Doctor's office jacking up med prices - SO ANGRY!

Postby betsydoglover » Tue Jul 11, 2017 7:22 pm

Ridiculous and I'm glad you got it straightened out. Regardless, my oncologist once told me that she had no idea where the "Billed amts" came from. Guess they are greater than any insurance co would pay, and they accept ins pymt. Where does that leave folks without ins? Screwed! (sorry if the language offends you.)

On another topic, had my rt knee replaced in 10/15 and it was the BEST thing I have ever done for myself.
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Re: O/T - Doctor's office jacking up med prices - SO ANGRY!

Postby MissMolly » Tue Jul 11, 2017 9:45 pm

Ridiculous and outlandish.

The lack of pricing transparency in health care is pervasive and troubling. You go into a restaurant and order from a menu with prices listed. You go into a doctor's office or hospital and have no earthly idea of the charges and fees for service.

I am on a prescription narcotic and have to abide by routine drug screening, which consists of a urinalysis. My insurance company has typically been billed $300, which seems somewhat reasonable to me. My insurance company was billed $2,500 for the latest urinalysis drug screen.

My jaw dropped 5 feet when I opened the explanation of benefits letter. $2,500 for a basic urinalysis drug screen.
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