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    My $4.07 check from an insurer: A sign of the times


    Henry Rosevear, MDHenry Rosevear, MD

    UT Blogger Profile

    Dr. Rosevear is a urologist in community practice in Colorado Springs, CO.


    At a recent party, I had a conversation with an attorney friend about the income professionals like us receive. This lawyer volunteers as a public defender in her hometown and spent most of the party detailing the terrible financial shape that most public defender offices are in. Having seen a few cop shows in my life, I challenged her on this. I reminded her that unlike medicine, the right to an attorney is guaranteed by the Constitution (the Sixth Amendment for those who are curious).

    To support her claim, she quoted an article from The Atlantic that public defenders in New Orleans are paid $9 a case on average. She did admit, though, that the average case takes less than 10 minutes. But she was aghast at the situation, nonetheless.

    I laughed. It probably wasn’t the politest thing I’ve ever done, but having had a few beers already, it seemed appropriate at the time.

    Read: Out-of-control drug pricing requires creative solutions

    I then proceeded to tell her a story of my own. (As always, some details have been changed to satisfy the HIPAA lawyers.) It was about 2 a.m. one recent call night when my pager went off. One of the better ER doctors told me about a 50-something, morbidly obese, diabetic female with a significant heart history who presented with a week-long history of left flank pain. Earlier in the evening, her pain had worsened and she developed a low-grade fever, which brought her in to the ER.

    CT showed an 8-mm proximal left ureteral stone with hydronephrosis. Her white blood cell count was 16, temperature 100.5, and urine grossly infected. Vitals were otherwise stable. The ER doctor had already contacted medicine to admit her. On exam, she had mild costovertebral angle tenderness and her pain was not well controlled despite ketorolac (Toradol) and IV narcotics. She clearly had an infected obstructing stone but wasn’t septic yet.

    By 3:30 a.m., I was in the OR where I placed a stent without difficulty. I rounded on her for the next few days while she was treated with antibiotics before being discharged.

    I billed a 99204 (new patient visit) with a 57 modifier (decision for surgery) and billed the case as a 52332 (cystoscopy and stent placement). I suppose I could have billed the patient for each day I rounded on her, but I didn’t.

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    Her insurance was the Colorado Indigent Care Program, CICP. CICP is a program run by the state of Colorado that is designed to provide health insurance for low-income legal residents of Colorado who are not eligible for Medicaid (annual income limit of $59,625 for a family of four). I always ensure I get a copy of the patient demographic sheet for my billers when I see a new patient in the ER, but I rarely look at it as it really doesn’t matter; she needed surgery and I was on call. 

    Next: "The check was for $4.07. Total. Sum. Finale."

    Henry Rosevear, MD
    Dr. Rosevear, a member of the Urology Times Clinical Practice Board, is in private practice at Pikes Peak Urology, Colorado Springs, CO.


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    • Anonymous
      This scenario happens all too frequently. Working on the outskirts of a major metropolitan city, it amazes me how many people bring family members from foreign countries to the US for care. Once they enter the system by arriving in ER's, they can't be refused treatment. It is an opportunity for our Urology residents to learn but concept of entitlement becomes meaningless when this care is free. I don't think people would expect this from their auto mechanics, plumbers, tree service people, etc. In these cases, it is RARE that I ever get a thank you from people with no insurance. I guess they don't realize (or simply don't care) that we provide this care gratis or for minimal reimbursement. Even if they don't have insurance, a simple gesture of gratitude or card of thanks would be nice.
    • [email protected]
      Henry, welcome to ColoradoCare! I live in beautiful Steamboat Springs but now only practice urology in rural Nebraska. I only do cases that I can walk away from. I work two days a week and am paid for my work based on wRVUs. It is a good model so call me if you are interested.