Choices

When more than one doctor can be seen for a problem, deciding which one to call can be tricky.  What matters most?  Skill?  Bedside manner?  Convenience?  Cost?

It probably depends on the situation.  In this case, I need a cortisone injection.  Okay, I’m not a doctor.  Maybe I’m not qualified to make such a decision.  In the past, though, when my shoulder has felt like this, I’ve gotten a steroid shot, and it’s helped.  Whom should I call?  Rheumatologist, orthopedist, or family physician.

My rheumatologist might be able to do it at my next appointment.  That would be simplest.  No extra appointments, no extra time required.

Another option is to see the orthopedist.  Last summer he said that he suspects I’ll need surgery on the shoulder within a year.  I’d like to prove him wrong.  If he’d said he could fix my shoulder, I might be interested, but that’s not what he said.  There’s only a 50/50 chance of surgery helping, and those odds aren’t nearly good enough.  A better plan is to resume the exercises that have helped in the past (and not stop once my shoulder is better).  Steroids would make the PT exercises a lot more doable.

I’d rather have my family physician do the injection.  His cortisone shots seem to work better and hurt less than steroid injections I’ve gotten elsewhere.  I don’t know if it’s individual skill, or if it’s the fact that he uses kenalog and everyone else has used depo-medrol on me.  It doesn’t matter.  That’s where I’d prefer to go.  The drawback is that if I go see him about my shoulder, he might tell me to go back to the orthopedist.

That’s my choices of whom to see.  Then there’s the financial aspect.

My old insurance policy covered injections at 100%, so cost wasn’t really a factor.  New insurance only covers 80% so expense is now a consideration.  Add in the fact that under this will be entirely out-of-pocket since I haven’t yet met my annual deductible.

Steroid injections vary widely in price.  Looking back through my old EOB’s, I found:

  • My rheumatologist charged $172 when I got a depo-medrol injection from her.  Insurance allowed $128.51.
  • My orthopedist charged $269 for the exact same thing.  Insurance allowed $168.33.
  • My family physician has charged $134 for the kenalog injections (plural) that he’s given.  Insurance allowed $41.18.

That means I can pay $128.51 for the convenience of getting a cortisone injection at my next rheumy appointment, or I can pay $41 plus a $30 co-pay and get the shot from my PCP.  Although this reduces my costs, my insurance company will be out an extra $70 since they’ll be stuck with the tab for an extra office visit.  For a savings of $57, it’s worth making an extra appointment to have my PCP be the doctor jabbing a needle into my shoulder.

When you have a choice, how do you choose?

What Does A BUN Test Cost?

Edit to add, for those who found this post googling “What does a BUN cost?”: it should be less than $20.  Pre-paid labs currently charges $11.85 (plus admin fee).

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Perhaps I’ve mentioned it before, but I’m one of those people who actually reads their EOBs when they arrive in the mail.  Then I compare the EOB with my notes of where/when/why of the appointment, and check all of that against my bill.

It’s kinda nice, because I’ve been able to figure out what the charge is for many of the labs that have been ordered, and compare prices.  In theory, if one lab charges significantly more than another, I could choose to get my blood draws done at the place that’s most economical.

Today, then, an EOB arrived showing that my daughter’s labs done at Children’s Hospital were $477.

Um. No.

  1. No labs were done at Children’s.  Her labs on the date in question were done at the local lab, fifteen minutes from my house.  I had my blood drawn at the same time, and the EOB for my labwork looks perfectly normal.
  2. There’s only test she had that I don’t have a dollar amount on.  If I had to guess, I’d put it in the $10-$45 range.  Some tests are a bit more than that, but I seriously doubt that a BUN test costs $243.

Local lab might be interested to learn that their billing company is giving their money to a different provider.  My insurer might be interested to know that they’ve been billed inaccurately. 

I’m very impressed with the care we’ve gotten at Children’s Hospital, but they are seriously deluded if they think I’ll be paying them for work they didn’t do.  And now that I see their fees, I know that we’ll never have labs drawn at Children’s.  We’ll bring their lab slip to a different local lab and see if the billing company can keep things straight.

I’m in shock that there can be such a significant difference in what labs charge.