Tele-primary care costs during the Coronapanic: $1,220 per hour

by philg

I had called my primary care doc at the end of March to see if something should be done about the 5-week dry cough (Covid-19? Some other Massachusetts plague?).

The bill arrived today for “Phone evaluation and management by physician or other qualified health care provider, 11-20 minutes” (the cruel enemies of medical billing nirvana at Verizon Wireless unreasonably recorded this call as having lasted 10 minutes)

The cost billed to insurance? $305.

I hadn’t seen this doc for a while so they tried to get my old policy to pay, thus resulting in an unexplained disallowance and a bill to me for $305. If we assume that the doctor can do four of these “11-20 minute” calls per hour, that’s $1,220 per hour. A physician working from home full-time solo, therefore, could make $2.44 million per year.

(And, here in Massachusetts, the enterprising child support plaintiff who has sex with that physician, could make roughly $400,000/year, tax-free, for 23 years; no need to target a specialist!)

If you have no familiarity with the U.S. system, you might ask whether I received a diagnosis in exchange for $305. The good news is that I got at least two diagnoses: (1) asthma, (2) some sort of dripping from back of nose down into throat that might go away after two weeks of twice daily pumps (not to say “injections”) of Flonase. I did actually buy Flonase and managed to get in a day or two of treatments before the cough disappeared.

Keep in mind that I am being billed by a not-for-profit enterprise…

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12 thoughts on “Tele-primary care costs during the Coronapanic: $1,220 per hour”

  1. Sounds like a great business opportunity? If your doctor is working remotely, why not outsource to another continent? http://www.PhilGsTelemedicine.com could setup a Zoom Video account, hire doctors in Bangalore for $20/hr, and bill US patients only $1000/hr. Its a win-win for (almost) everyone!

    • JGalt: I’m sure that British docs employed by the National Health Service would have been doing this a long time ago if it were legal for them to talk to a patient here, prescribe a required pill, etc. No Human Being is Illegal, according to most of my physician friends, but thank God for regulations that prevent foreigners from serving American customers!

  2. So how do you understand this, Phil, that is the issue, no? Otherwise what are we supposed to make of this? You had some medical issue and the charge seemed high? So, so what?

    • Jack: The billing saga is just beginning! That the charge to chat with the neighborhood primary care doc is higher than the hourly rate charged by a top patent litigator in Manhattan (well, in East Hampton or Nantucket right now, probably) is only mildly interesting. What is more interesting is that multiple people were involved in trying to bill my old insurance company. And then it will get yet more interesting when we see what the current insurer (Blue Cross) is able to negotiate. And finally it will also be fun when the hardcopy bill for a $25 co-pay or whatever arrives in the mail. It is fascinating to me that Americans would set up a system like this! Or one where, if I didn’t have insurance, the non-profit group of doctors would be able to come after me for 6X what they would charge the insurance company (despite the receptionist never having said, “Are you sure that you don’t want to wait another few days before talking to the doctor. Our fee is $305.”). That the doctor overstated the number of minutes on the call is just a bit of icing!

    • > It is fascinating to me that Americans would set up a system like this!

      Sometimes it amazes me that you can maintain relatively good spirits about it and not become despondent or so bitterly cynical that you just quit looking at it all. I have a fraction of your analytical ability and just looking at these systems, the way they turn out, these massive accretions of thousands of decisions that went into them, producing piles of indecipherable claptrap, drives me crazy. Nature doesn’t build systems this way. They would die instantly.

      My father, who has about 1/2 your innate intellectual ability but was educated during the 1960s in a rigorous engineering curriculum at a very good school, is increasingly tortured in his later years by the extent to which so much of our world has become indecipherably convoluted. The most common refrain he has now is: “Who would BUILD anything like this?” He can’t help himself. He looks at machines, systems, governments, and almost throws up his hands. He has to laugh or he’d go off a bridge. He tells me all the time: “When I started out learning engineering, the hardest part for me was realizing that I wasn’t being taught *what* to think, I was learning *how* to think.

      I’m sure there’s someone out there who studies health care billing who could write a 1,000 page treatise explaining it all in detail. By the time they were finished, half of it would be obsolete, maybe more. These systems are glommed together, a patchwork, a circus of competing interests, resulting from countless rules and prerogatives drawn up by lobbyists, lawyers, administrators, politicians and scores of others who have no business building anything that works. And they don’t.

    • I find this post intriguing in the same way that Alex does:

      “Sometimes it amazes me that you can maintain relatively good spirits about it and not become despondent or so bitterly cynical that you just quit looking at it all. I have a fraction of your analytical ability and just looking at these systems, the way they turn out, these massive accretions of thousands of decisions that went into them, producing piles of indecipherable claptrap, drives me crazy. ”

      I too am in awe of Philip’s intellectual abilities and resilience. He wrote an amazing study of “Real World Divorce.” It documents the epitome of personal and societal insanity. Yet he remains vigorously engaged with the world, intellectually active, and somehow finds fun in the insanity.

      Philip, I’m grateful for all the interesting thoughts you freely share with all persons, documented and undocumented. Yet I beg for more: please tell us your secret for dealing so successfully for with all the crap, idiocy, and mean persons swirling about in the world today!

  3. $1220 is only $12 in last year’s money. We’re utilizin’ the unused productivity. It’ll be paid off with new taxes later. Not inflation because it’s a mutual fund.

  4. Still puzzled about what is interesting about this post. This is the system that Americans have decided that we like. Every time someone wants to change it we label it “socialism” and move on.

    But we have been able to develop a nice medical industrial complex that drives a good chunk of our economy. Other countries have manufacturing jobs, we have insurance billing companies!

  5. For the past two months, my HMO and large group practice has been advertising the convenience and availability of telemed physician visits. On 5/15, I telephoned my primary care physician to schedule a routine annual physical for June 2021. The surly assistant answering the phone gruffly dismissed me advising that no appointments were being scheduled and to call back in four weeks.

  6. My most life-threatening disease (deep melanoma of scalp) was detected by my barber after being overlooked for months by regular dermatologist and GP visits.

    Looking back on the ACA legislation, it was almost totally devoted to getting everybody, including the insurance companies, paid near retail. It did very little to even address costs or methods or other reforms.

    My own medical record system is an online outliner (littleoutliner.io) so I can reorganize occasionally and a copy/paste to simplenote for searching and in case Dave Winer stops the outline server. This is at least 80% of what’s necessary as a record (date, provider, vitals, findings, Rx, next visit scheduled). If this were a doctor’s system, a coupled prescription issuance to my pharmacy would be nice.

    For the lockdown, our insuror has provided an online GP or will pay our existing GP for phone consults. As we enjoy good health for our age (passing 80), these telemedicine sessions plus a thermometer, blood pressure cuff and fingertip pulse oximeter could easily replace office visits.

    Don’t wait for the government, start your own healthcare and just use the existing stuff as sickcare.

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