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Bad news, bad news, good news....
Old 04-03-2011, 04:06 PM   #1
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Bad news, bad news, good news....

The bad news #1 -- a little over a week ago we had to take my wife to the urgent care center of our local hospital because of a kidney stone.

The bad news #2 -- even after the insurance discount, our out of pocket (with an HSA) is over $2,100 for the three-hour visit.

The good news? We've already satisfied the $2,500 family deductible for the entire year. And we've still saved a heck of a lot of money being on an HSA for 3+ years, considering the premiums cost us $1200 a year less and my employer matches $1000 into my HSA each year.
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Old 04-03-2011, 04:17 PM   #2
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Better hit that deductible soon and get your all-you-can-eat healthcare buffet when they start covering 100%. Kidding...
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Disclaimer - I am an independent insurance agent. If the above message contains insurance-related content, it is NOT intended as advice, and may not be accurate, applicable or sufficient depending on specific circumstances. Don't rely on it for any purpose. I do encourage you to consult an independent agent for insurance-related advice if you have a question that is specific in nature.
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Old 04-03-2011, 04:17 PM   #3
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Sorry to hear your wife suffered a kidney stone (and from what I have heard, "suffered" is definitely the right term here). She has my sympathy.

Sounds like this year is the one in which to get all the necessary tests done since you have no more deductible to worry about. Had a colonoscopy? If you are due for one, you could get it for free (or nearly so).
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Old 04-03-2011, 04:20 PM   #4
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Sounds like this year is the one in which to get all the necessary tests done since you have no more deductible to worry about. Had a colonoscopy? If you are due for one, you could get it for free (or nearly so).
That's what I'm thinking in the "good news" part. Seems like the rest of 2011 will be the perfect time to deal with any "deferred" medical issues and tests that hadn't been happening lately... as long as we stay in network, everything else will be covered 85% until we've spent $4000 out of pocket, at which time everything covered in network will be paid at 100%.

Of course, the fear is that a bunch of tests may uncover a new "preexisting condition"...
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Old 04-03-2011, 04:36 PM   #5
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... since you have no more deductible to worry about. Had a colonoscopy? If you are due for one, you could get it for free (or nearly so).
...and that's the good news?

Sorry to hear about your wife Ziggy, I trust she is feeling much better.
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Old 04-03-2011, 04:40 PM   #6
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Sorry to hear about your wife Ziggy, I trust she is feeling much better.
Thanks, and yeah, she's pretty much back to normal now. I suspect the stone broke up and departed on its own a few days ago.
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"Hey, for every ten dollars, that's another hour that I have to be in the work place. That's an hour of my life. And my life is a very finite thing. I have only 'x' number of hours left before I'm dead. So how do I want to use these hours of my life? Do I want to use them just spending it on more crap and more stuff, or do I want to start getting a handle on it and using my life more intelligently?" -- Joe Dominguez (1938 - 1997)

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Old 04-03-2011, 04:48 PM   #7
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Hope DW is feeling better. Give her some extra snuggling and do something to show her how loved, special and beautiful she is.
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Old 04-03-2011, 05:09 PM   #8
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...our out of pocket (with an HSA) is over $2,100 for the three-hour visit.
Wow! This sounded like what I went through more than 15 years ago, back when I did not know what kidney stone pain was like. I have had kidney stones all my life, but thought it was back pain until that time when I had a lot of blood in the urine.

So, I went to the ER for the diagnostic. They tested the urine, and ordered an X-ray after giving me something to induce the kidneys to produce a higher than normal flow. After verifying that the stone did not cause complete blockage of the flow, which could cause kidney damage, I was sent home to tough it out.

After a week of pain, and who knew how much blood loss, I passed the stone. I was on megacorp insurance, and paid perhaps $100 copay or something like that. I was in the ER for about 3 hrs, and the total bill could have been as high as yours too.

Man! Who can afford to be sick anymore?
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Old 04-03-2011, 05:30 PM   #9
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Man! Who can afford to be sick anymore?
Not me! (warning: off topic vent follows!)

My colonoscopy was not bad but the bills have been infuriating. I have great insurance. The (outpatient) colonoscopy center where this colonoscopy doctor/surgeon does them, required my entire deductible before the colonoscopy. Having just gone through 2.5 days of hideous prep, I wasn't in any condition to object so I gave them the $350 off my debit card, and got a receipt. Then later, BCBS says that the deductible needs to go to the nurse anesthetist that works every day for this particular doctor at this particular outpatient center (which I believe he owns). So far, so good.

BUT - - it never got to him because the endoscopy center did not apply it correctly. So, a billing service is dinging me for that $350, and when I call the outpatient center they say that they will have to refund it to me and I have to send it to the billing service for the nurse anesthetist. I asked when they would refund it, and they said... "I don't know; it usually takes a very long time so I wouldn't expect anything soon."

So it looks like I will have to pay my deductible TWICE for the same procedure - - $700. (This is not to mention being nickeled and dimed to death to the tune of around $200 in co-pays for every tom, dick, and harry involved in the pathology). I am infuriated. Basically they have accomplished a role reversal because I will be having to extract payment from them, rather than the reverse (and I don't have a billing service to do that for me).
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Old 04-03-2011, 05:41 PM   #10
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By referral from my family doctor, I went to an endoscopy center, where there was just one bill for my colonoscopy. Because my HSA deductible is $10K/yr, of course I had to pay for the whole thing. My wife took care of the bill, so I am not sure but think the whole thing did not cost more than $800.
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Old 04-03-2011, 06:44 PM   #11
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Ziggy...I'm sorry your wife went through that, but sure am glad she's feeling better.

As for health care costs, I can understand the bad news. The costs associated with DH's prostate cancer are mind blowing....well, at least to me.
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Old 04-03-2011, 08:04 PM   #12
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Ouch! I saw my Dad deal with kidney stones. I'm glad she's back to normal.

I just blew through my $2000 in-network deductible dealing with a lump in my breast. It was close to the surface and visible on mammograms so the doctor did a needle aspiration. I was glad to get it taken care of in one office visit and one procedure. But the results came back "undiagnosable" which means that either he missed it or the sample was contaminated with blood. Whatever, I didn't have the answer that I needed.

He suggested waiting 6 months and watching for any change or going for a biopsy under ultrasound or removing it with an outpatient surgery. I went for the biopsy under ultrasound and the results were all negative so I'm done.

But the bills!!! I thought I was done with all the bills from the first biopsy and another lab fee came in last week. Now the bills for the 2nd procedure have shown up online and I'm waiting to see what the insurance pays and what my costs will be. After the $2000 deductible my insurance will pay 70%. Then the hospital for the 2nd biopsy offers a 30% discount on the balance if you pay up front.

I'm glad I have insurance, I'm glad it was not cancer. I hate to have to pay all these bills but this is not the place in life to be stingy. I couldn't put this off because of cost and then look back and say, Gee, I should have taken care of that!

I have a colonoscopy scheduled for June. Our insurance pays 100% if it's preventative/routine which this will be. My mammogram was also paid at 100%. Even though I found the lump they coded it as a screening mammogram which is routine. Sounds just fine to me.
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Old 04-03-2011, 10:21 PM   #13
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Not me! (warning: off topic vent follows!)

My colonoscopy was not bad but the bills have been infuriating. I have great insurance. The (outpatient) colonoscopy center where this colonoscopy doctor/surgeon does them, required my entire deductible before the colonoscopy. Having just gone through 2.5 days of hideous prep, I wasn't in any condition to object so I gave them the $350 off my debit card, and got a receipt. Then later, BCBS says that the deductible needs to go to the nurse anesthetist that works every day for this particular doctor at this particular outpatient center (which I believe he owns). So far, so good.

BUT - - it never got to him because the endoscopy center did not apply it correctly. So, a billing service is dinging me for that $350, and when I call the outpatient center they say that they will have to refund it to me and I have to send it to the billing service for the nurse anesthetist. I asked when they would refund it, and they said... "I don't know; it usually takes a very long time so I wouldn't expect anything soon."

So it looks like I will have to pay my deductible TWICE for the same procedure - - $700. (This is not to mention being nickeled and dimed to death to the tune of around $200 in co-pays for every tom, dick, and harry involved in the pathology). I am infuriated. Basically they have accomplished a role reversal because I will be having to extract payment from them, rather than the reverse (and I don't have a billing service to do that for me).
Call BCBS and complain about the provider's billing practice. They may be able to intervene.

Then call your state's attorney general's office of consumer protection and find out what they can do about speeding up your 'refund.' There may be some rules around this.

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Old 04-03-2011, 10:25 PM   #14
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Ziggy, I hope Mrs. Z is feeling all better and has no recurrences any time soon. I hope your HSA balance is still healthy too
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Old 04-03-2011, 10:38 PM   #15
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Hope Ms Z is doing good.
I dread the day I may have to deal with any kind of stones or catheter's in my life time.
My Dad just went through the catheter thing (84yrs old), In and out several times. Not pretty.
One of the nurses said, this is what you have to look forward to. Older women can't stop peeing and older men can't pee. Didn't sound worth a damn to me, either way.
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Old 04-03-2011, 11:38 PM   #16
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Call BCBS and complain about the provider's billing practice. They may be able to intervene.

Then call your state's attorney general's office of consumer protection and find out what they can do about speeding up your 'refund.' There may be some rules around this.

-- Rita
Rita, thanks. I tried calling BCBS using the phone number they gave me and that is imprinted on the back of my card. I spent over an hour going through a computerized voicemail system, and finally managed to get a human being. She apologized and said she could not pull up my records herself, so she would have to put me on hold for someone who could. An hour later I gave up.

Thanks for the advice. I found the Louisiana Attorney General's office of consumer protection and where to send complaints on the internet. So maybe that will result in something.
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Old 04-04-2011, 02:49 AM   #17
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....colonoscopy center where this colonoscopy doctor/surgeon does them, required my entire deductible before the colonoscopy.
So, the 2 days prep failed to extract everything then


Quote:
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I am infuriated. Basically they have accomplished a role reversal because I will be having to extract payment from them, rather than the reverse (and I don't have a billing service to do that for me).
Not much has changed in 20 years then. In 1990 I had back surgery and my out of pocket costs exceeded my annual out of pocket max. Later that year DW needed surgery, went in Friday and had to stay overnight. I went in to pick her up on Saturday morning and went to the ward to pick her up. I was told I had to go pay first and come back with a receipt. When I went to pay I was told I owed $5,200, which was the 20% co-pay. I explained that I had exceeded my annual max and that the insurance company would be paying 100%. They said that was not what the insurance company rep had said the day before when they called. I insisted they call again which they did but as it was a Saturday the office was closed.

I then stumped up the money (Credit Card) and took the receipt for my wife up to the ward - she was a bit miffed at how long it had taken and that I had argued with them rather than simply paying. It took the usual many weeks for the EOB's to come through, and the insurance company paid 100% as expected. No refund came back from the hospital until I called them, and the accounts person seemed surprised that, after she confirmed that I was in credit to the tune of $5,200, I actually wanted them to pay me back rather than leave my account in credit.
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Old 04-04-2011, 10:26 AM   #18
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Rita, thanks. I tried calling BCBS using the phone number they gave me and that is imprinted on the back of my card. I spent over an hour going through a computerized voicemail system, and finally managed to get a human being. She apologized and said she could not pull up my records herself, so she would have to put me on hold for someone who could. An hour later I gave up.
Letter writing may be in your future!

Every BCBS plan is managed differently. You will/should find an address in your benefit booklet. Think about writing a letter outlining the issue. They have to log the letter and respond.

Then do the same thing with OPM -- in this one indicate the lack of customer service you received with BCBS. The reason for this is that each plan is assessed annually by OPM, and if they don't measure up they are removed from the program. The good plans earn a bonus annually that has to be split among all the employees (but not management) who serve the federal employees.

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