Rectal exam cost

I received an explanation of benefits from Medicare today for my annual urologist visit last month.

The doctor billed Medicare $243 for performing a prostate exam, with an additional $15 for urinalysis. Medicare paid $92. I have to pay $18. The entire visit with the doctor took less than 5 minutes.

If I have to pay someone to stick a finger up my ass I would hope it lasted more than 5 seconds lol

I received an explanation of benefits from Medicare today for my annual urologist visit last month.

The doctor billed Medicare $243 for performing a prostate exam, with an additional $15 for urinalysis. Medicare paid $92. I have to pay $18. The entire visit with the doctor took less than 5 minutes.

If I have to pay someone to stick a finger up my ass I would hope it lasted more than 5 seconds lol

$243 prostate exam cost + $15 for urinalysis = $$258 total cost

Medicare paid $92 and you paid $18 =$120 paid

Who paid the $138 difference? Private insurance? Medicare negotiated cost?

I can’t get get a plumber out just to look for much less than $250. It’s not just five minutes of the doctors time. The urologist has a nurse, receptionist, med techs for analysis, liability insurance, accounting/billing, patient history review and post visit summary to write, processing plus loss for no-shows etc - not saying the system is right, but that’s the way it is now, and I doubt it will change. There are layers and layers of BS cost built in.

We have Medicare, wife had a drug infusion and the nurse showed us the invoice around $60,000 just for the drug ( not including the 4 hrs in the transfusion room and staff costs). She said the Hospital settles with Medicare for @ $17,000 total, we paid nothing. Without Medicare, we would have been responsible for the full amount, drugs, transfusion room and nurses. The drug and hospitals don’t strike deals with indiduals like they do with insurance companies

For everyone,

You’re not paying for the time. You are paying for the doctors expertise.

A urologist has 4 years of medical school, 1 year of internship, 2 years of general surgery and 3 years of urology residency. Then any sub specialty fellowships they do.

And this is completely way beyond what you would pay in France even if you paid full fare (no Social security, no complementary insurance).

I went to a private doctor in Austria this summer for my annual check-up (ultrasound of kidneys, bladder, penis, testicles, prostate) and there was a real enema for the TRUS - not a pre-filled enema - and I paid a total of €150. Visit duration for doctor only (without enema): approx. 30 minutes; including enema, I was in the doctor's office for about 1 hour.

I'm not complaining. I just stated the facts. I'm very happy with Medicare. I chose original with a supplement plan.

I always try to remember this humorous joke to rationalize costly experiences like this. It’s not always valid, but it does remind you that there’s always more than just what you pay for.

A supervisor of some factory hears one of his critical machines start making a sound that wasn’t right. Knowing how critical it is to his business, he calls for a specialist to take a look.

The support guy comes, listens for a moment or two, walks around, pokes his hand into a few places, and eventually takes a hammer and taps something which immediately eliminates the strange sound, then gives the supervisor an invoice for $10,000.

“What? All you did was tap a bolt with a hammer, it took you a couple minutes! How could that tapping cost me $10,000?!”

“Oh, the tapping only cost around $50 for my time. The other $9950 was for knowing where to tap.”

So next time… just remember… you’re not just paying for the rectal exam. You’re paying for the doctor to know where your prostste is.

😉

-TYD

@TrustYourDoctor How true, how true! - You're absolutely right!

And I don't regret paying for a doctor's expertise.

I’m not aware that a rectal exam would be billed individually, during a physical exam, with a general doctor. It’s a higher cost if you’re seen by a specialist.

I remember quite a few years ago. I received a bill for 5 USD from my pcp. I called, and they apologized, saying that was for the hemoccult slide during my rectal.

Insurance didn't pay, and they normally wrote the cost off.

BTW, earlier, I noticed a post with all of the items broken out. I noticed one omission. Rent.

With rents averaging at least $1 per square foot per month, that's a major expense.

I don't argue that you're paying for the knowledge, but where do you stop ?

Honestly, ideally, it’s what the market will bear…

This is why our 3rd party payer system had screwed up and totally distorted what things cost and how much they’re worth.

It’s also a question of what a doctor with relationships with his or her patients is willing to offer them as part of the whole package.

When you go to see a doctor for a concern, short of the additional work of running tests, I’d expect them to examine whatever they needed to on thst visit. Rectal exam? Sure. Quick internal exam if it’s a female concern? Yup. Test my reflexes or palpate my abdomen? Whatever.

But by putting costs on every line item, and then being stingy to doctors about reimbursement, insurance companies have trained doctors to be nickel-and-dimers to get reasonable compensation from the 3rd party.

It’s just an awful way to manage all of this.

It’s not the time you spend with your doctor, it’s what’s coded and what they can - and are required - to bill for. If it’s charted, it’s coded. This is driven by the insurance companies, not the medical pros.

Yeah. That's what I said.

It just took me about 3 paragraphs and 7 more sentences to do so.

I prefer @Rigel 's version:

It’s not the time you spend with your doctor, it’s what’s coded and what they can - and are required - to bill for. If it’s charted, it’s coded. This is driven by the insurance companies, not the medical pros.

-TYD

I was poking around my insurance company’s member portal and found that a digital rectal exam for prostate screening is listed under preventative services. The estimated amount my insurer would pay? $34.50. So long as the exam was performed for a preventative rather than diagnostic purposes, I would not be charged anything. My insurance also has no copay for seeing my primary care provider because she is considered an “enhanced PCP” based on metrics the insurer tracks.

All free in uk

I go to my urologist every 6 months. Always does a rectal exam...Bent over the exam table...Medicare covers the costs unless its the beginning of the year I have to pay the medicare deductable

Rectal/prostate exams are always standard procedure and FREE in my clinic. I would be happy to schedule an appointment for anyone needing a thorough exam. 😉