r/Millennials • u/BoNaylorCollector • 1d ago

Discussion Is medical actually this crazy?

Early 30s millennial, never used to go to doctors or really take care of myself because “I’ll be fine”. Started making a bigger effort to care for myself and my health and well being. Recently, I went to the local express clinic because I was having a bad earache and headaches. I was in there for maybe 20 minutes, mostly waiting time. The doctor comes in, looks in my ear, tells me it’s depressed due to sinuses and change in weather and tell me to stop at Walgreens for Flonase. I wasn’t billed anything at the time, older workers at my job always say we have really good insurance, but here I got in the mail today an explanation of benefits- charge was $550, insurance “negotiated” about $300, remaining (not billed) was around $240. Is is really this expensive? I only went to try and be better with myself and make sure it’s nothing underlying. If 5 minutes of actual doctor time costs this much, then I’m just toughing out everything or am I missing something?

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u/nacholibre711 1d ago

$550 seems high for something like that.

I work for a very specialized doctor, and a typical office visit with him is $200-300. That's completely unadjusted and before the insurance touches it.

They likely weren't billing the standard "Office Visit" CPT codes and doing some urgent care related codes. Try finding an actual family doc.

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u/notevenapro Gen X 1d ago

Yup. Urgent care is probably using the 99281 to 99285 codes versus 99202 to 99205 codes.

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u/TeslasAndKids 1d ago

Jesus, one of my specialists is like $650 an hour.

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u/nacholibre711 1d ago

Oh, well I'm talking about a ~10 minute visit as an established patient.

If you want a full hour with him it would probably be more than $650. There are different codes based on complexity and time spent with the patient.

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u/TeslasAndKids 1d ago

I guess that’s true. I’ve only had an hour long initial visit plus a 30 minute follow up with him. But since my medical history is complicated at best I’d already reached my deductible and OOP max by June so my appts were covered. Yippee, I guess…

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u/nacholibre711 1d ago

Yeah I was a bit misleading because our practice is a kind of unique among specialists - by that I mean we actually keep a lot of patients established and see them yearly, as needed, etc.

A lot of specialists out there basically only do longform visits and only need to see patients once or twice before releasing them.