The case of the $1,206 toenail clipping

A patient went to Brigham & Women’s Hospital to get her (potentially infected) foot checked out.  A dermatologist cut part of her toenail off, sent it off to the lab, and sent the lady home.  Her total charges: $1,206.  Here is the breakdown:

Office Visit — $248.00;Biopsy — $182.00; Treatment Room — $328.00; AMB Clinic — $117.00; Pathology Lab — $165.00; Laboratory Services — $166.00; Total — $1206.

Now, I’m not sure how an “office visit” does not also include a “treatment room”, nor how the “pathology lab” fee does not also include the “laboratory services” fee.  Maybe this is because I’m a lawyer, not a medical billing specialist, or maybe it is because our medical billing system is set up so that everything is atomised.  A mechanic will charge for parts and labour, but will not charge you for warehousing the parts, a “garage fee” for putting the vehicle into the shop so that it can be worked on, or two different diagnostics fees.  But Medicare and Medicaid break down every service into a part, then demand the best prices, so the rest of us can’t ask for all-inclusive (and therefore more logical) billing.

It’s a bit odd to head into an ER to deal with this type of thing (a “minute clinic” would be a far better option if her primary care physician couldn’t accommodate her), but it’s also odd to charge people for an “office visit” and to charge $300 for a treatment room.  I could get a hotel in NYC for 21 hours for that price; it’s a bit insane to charge someone that for an hour of sitting on a cot.


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Filed under Economics, MA Health Care

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