I was recently whisked off to Scandinavia for a couple of weeks courtesy of my wonderful daughter. Unfortunately, I was having a bit of a problem with my sinuses, which necessitated a visit to a doctor in Helsinki. Friends there lined me up to see a doctor at a private clinic. He asked what the problem was, and I started in. Within a couple of seconds he stopped me.

“Look,” he said. “You clearly know what the problem is and I concur.  Let me get the medical business done and then we can chat.” Perhaps more out of astonishment than compliance, I shut my trap and he started typing away. In a minute or so he looked up from his keyboard and gave me the medical spiel – I was getting an assortment of meds to be used as necessary, an EU version of Clarinex, codeine cough syrup, and an antibiotic if things did not clear up on their own in a week. He asked if all was clear, I confirmed, and he hit a button on the keypad.  Then he explained….

He worked for the clinic and he billed based on the amount of time he spent with the client. Materials were extra at cost plus, as were pharmaceuticals. The whole trip to the doc plus the meds ran be $160.  Since he wasn’t pressed with patients at the moment he had time to chat, and there was no reason to bill me for the time he was amusing me with his dry Finnish wit. And that was PRIVATE care!

I mention all this because yesterday I received an EOB (Explanation of Benefits, for those either lucky – or unlucky – enough not to have to deal with them) which indicated that a specialist I see was dinging me and extra ~$30 for lidocaine and a cortico-steroid injected a YEAR AGO. Turns out that the specialist’s office had been billing for an office visit and a surgical procedure (for a total of ~$500) but had neglected to charge me for the contents of the syringe. I inquired when I called to ask about the incremental billing why they weren’t charging me an incremental fee for the needle and syringe.

In this country insurance companies make providers negotiate on a huge range of services – that’s what the CPT codes are about, because apparently we believe that if a doctor gives you a  flu shot, that has a different value then when he pulls a little wooden splinter out of your finger. Same person, doing what he was trained (and insured to do), and yet somehow the doctor is going to get twice the amount for the splinter than for giving the flu shot. No, it does NOT make a great deal of sense.

Lawyers will often debate whether to offer services, say for a simple adoption, as a flat fee as opposed to an hourly. Flat fees in some senses make it simpler, and in a very real sense its a gamble. We call the other side of that gamble, “insurance” – socializing the cost of the risk. Amortizing the risk may in fact be a great idea, but if we are going to do that, it is high time we stopped doing half of it. Otherwise, we might as well go to having doctors bill out their time by the tenth of the hour. The CPR that saved your life? .1 hr at $300/hr is $30; now that’s a bargain!