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Old 08-27-2009, 06:02 PM   #21
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We are paying near $400/month for an HSA for a couple of 52, plus a son in college of 20. My daughter has a job with her own health benefit. The annual deductible is $10K for all 3. I think they pay 100% after that, but I am not sure (I haven't bothered to remember because if we get up there, I'd have more to worry about than whether it's 100% or 80%).
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Old 08-27-2009, 07:21 PM   #22
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We've seen the same "discounting" with our insurance. But you'll find better overall odds of getting a reasonable financial outcome at a casino . . .

My wife went in for a routine physical. We called the insurance company beforehand to make sure that it was 100% covered and that the physician was approved. The insurance company gave us the OK on both. Afterwards we get billed $200 from the physician who was trying to charge for an "office visit" in addition to the routine physical. And then we receive a bill for $600 because the lab work was done by an "out of network" provider even though she went to an in-network physician for the physical. They're trying to get $800 from us for something we were told in advance wouldn't cost us a thing.

Any other company pulling that kind of crap would be shut down for fraud.
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Old 08-27-2009, 07:25 PM   #23
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But colleges can give you a price quote that is probably pretty close, yet dr's can't do that.
That's why the whole HSA thing is kind of a joke. Anytime we ask "How much is this going to cost" the doctor looks at us like he's never before heard such a ridiculous question.
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Old 08-27-2009, 10:17 PM   #24
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We've seen the same "discounting" with our insurance. But you'll find better overall odds of getting a reasonable financial outcome at a casino . . .

My wife went in for a routine physical. We called the insurance company beforehand to make sure that it was 100% covered and that the physician was approved. The insurance company gave us the OK on both. Afterwards we get billed $200 from the physician who was trying to charge for an "office visit" in addition to the routine physical. And then we receive a bill for $600 because the lab work was done by an "out of network" provider even though she went to an in-network physician for the physical. They're trying to get $800 from us for something we were told in advance wouldn't cost us a thing.

Any other company pulling that kind of crap would be shut down for fraud.
Frequently happens with most health insurers it seems. I've started calling it the insurance companies F...K you panel.
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Old 08-28-2009, 09:49 AM   #25
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We've seen the same "discounting" with our insurance. But you'll find better overall odds of getting a reasonable financial outcome at a casino . . .

My wife went in for a routine physical. We called the insurance company beforehand to make sure that it was 100% covered and that the physician was approved. The insurance company gave us the OK on both. Afterwards we get billed $200 from the physician who was trying to charge for an "office visit" in addition to the routine physical. And then we receive a bill for $600 because the lab work was done by an "out of network" provider even though she went to an in-network physician for the physical. They're trying to get $800 from us for something we were told in advance wouldn't cost us a thing.

Any other company pulling that kind of crap would be shut down for fraud.
Glad to see I'm not the only one shocked. Shocked that I would be billed for the extra office visit, and then shocked that the insurance companies don't bat an eye at the extra office visit charge.

I have now come to expect a little overage every time we go to the dr for some kind of non-covered charge or some out of network thing. Luckily our primary physician uses an in house lab company that is in network. But occasionally we get these "this lab service is not included in a physical" notes that mean we pay the negotiated rate on the "extra" lab services (10-20% of the list price) - usually $10-20 bucks out of pocket max.


Quote:
That's why the whole HSA thing is kind of a joke. Anytime we ask "How much is this going to cost" the doctor looks at us like he's never before heard such a ridiculous question.
I have never really tried to get a price quote, but figure it would be met with strange stares. I like the walmart/drug store "minute clinic" price charts that tell you what it will cost ahead of time. I think the high deductible plans do bring some level of price sensitivity to the patients, since I am more likely to tell the dr that I'm on a high deductible plan, so don't run tests or refer out unless it is necessary. There are probably times when it is a close question between an extra test, or a referral, and if "wait and see" won't be detrimental to health, I'd rather take that option.
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Old 08-28-2009, 04:37 PM   #26
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We've seen the same "discounting" with our insurance. But you'll find better overall odds of getting a reasonable financial outcome at a casino . . .

My wife went in for a routine physical. We called the insurance company beforehand to make sure that it was 100% covered and that the physician was approved. The insurance company gave us the OK on both. Afterwards we get billed $200 from the physician who was trying to charge for an "office visit" in addition to the routine physical. And then we receive a bill for $600 because the lab work was done by an "out of network" provider even though she went to an in-network physician for the physical. They're trying to get $800 from us for something we were told in advance wouldn't cost us a thing.

Any other company pulling that kind of crap would be shut down for fraud.
Been there, done this, survived the walletectomy.

I used to have PPO coverage through United Healthcare. Then, coincidentally right after their last CEO left with a 1.5 gigabuck golden parachute, they decided to get a little more... competitive. They dropped what they were willing to reimburse physicians and labs. Our doctor of over 20 years told us he couldn't accept that insurance any more, so we had to find a new one.

The only doctor within 15 miles that would take UHC had his office in a strip mall, where he saw his mostly Medicare clientele. Call him Dr. Nick... He worked with Quest Diagnostics for lab services, which was handy because they had a walk-in facility four doors down. Guess what major lab service just stopped working with UHC?

So, now we had to find a lab service that Dr. Nick could work with, and that would work with UHC. I learned way too much about medical labs and processes, and eventually identified the Stanford Clinical Lab as one that would work. They were convenient to... well... nowhere. Only a 2 hour drive. Each way. Dr. Nick would draw the blood and write up the paperwork, then I'd pop it in my little cooler and go for a drive.

I heard similar stories from others about hospitals. That is, the hospital was in the plan, the physician or surgeon was in, but the hospital's lab (Quest managed) and anesthesiologist were out.

During the next open enrollment period I switched to the top-rated HMO. This whole do-it-yourself thing was a little too much for me.
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Old 08-28-2009, 04:58 PM   #27
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This is the situation I see myself in in about 10 years (except just high net worth, not "very"). Self insuring the occasional $30,000 to $100,000 procedure/illness wouldn't necessarily break the bank, but paying $20k-30k EVERY year for insurance might.
A word of caution here. The above might apply to a simple operation or even a more serious operation that fixes your problem, but not if you get cancer. I calculate the outlay by medicare since my diognoses in 2007 has run close to $400,000, and when it comes back, it will spiral upwards again. So conceivably up to $1,000,000 if I were to have a transplant next.

So I guess if you have $5,000,000 to 7,000,000 your statement might be correct, but if your nest egg is a comfortable $2,000,000, you might be in for a surprise. Wouldn't you just love having to spend half of your life savings for retirement on medical bills? So,I sincerely hope you reconsider your position and at least opt for a catastrophic policy with high dedutable. No one thinks it's going to happen to them.
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Old 08-28-2009, 11:02 PM   #28
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So I guess if you have $5,000,000 to 7,000,000 your statement might be correct, but if your nest egg is a comfortable $2,000,000, you might be in for a surprise. Wouldn't you just love having to spend half of your life savings for retirement on medical bills? So,I sincerely hope you reconsider your position and at least opt for a catastrophic policy with high dedutable. No one thinks it's going to happen to them.
I plan to have some kind of coverage, mainly for the negotiated discounts. But if for some reason I really needed coverage and was facing the inability to continue paying for coverage, there's always the "get a job" option (for me or DW or whoever is medically able). I'm guessing it is a moot point for me, since I have 10 years on the FIRE clock, and I expect some form of Obamacare to be in effect by then that would cover catastrophic illnesses.
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Old 08-29-2009, 06:57 AM   #29
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That's why the whole HSA thing is kind of a joke. Anytime we ask "How much is this going to cost" the doctor looks at us like he's never before heard such a ridiculous question.
If you were to ask an IBM programmer how much their software costs, they
give you the same look. The doctors are just a cog in the machine, you
go for an operation, you have far more than just paying the surgeon.
The other problem is health care does not fit into the free market economy
model, because unlike buying a car, you can't choose NOT to have it.
HSA is great if you are reasonable healthy, but I don't think it lowers costs.
It may prevent some people going to the doctor because they sneezed,
but they probably wouldn't buy an HSA anyway.
TJ
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Old 08-29-2009, 02:10 PM   #30
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Would you call the insurance company and tell them they might be paying more than they should?

And I'm not just asking about this specific set of circumstances, but if there was a big overcharge on a medical bill that did not change what you paid, but the insurance co's payment, would you squeal?
I tried this. I called and faxed the insurance company many times.

They don't care.
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Old 08-29-2009, 02:42 PM   #31
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If you were to ask an IBM programmer how much their software costs, they give you the same look.
But I don't buy software from the programmer. I typically buy it from a store where the price is listed on the box. If I were to solicit IBM to write a custom program for me, they would give me a price estimate.

There is absolutely no reason most medical services couldn't come with a listed price. Other, more complicated procedures, should at least have an upfront cost estimate.
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