Cost-Conscious, Self-Managed Care

[redduck]

So did you pay the test costs? At our clinic you literally have to provide proof of current insurance every time you visit. If our clinic dropped our insurance company I would expect to be informed immediately.

What are you basing your expectations on?

 

[ivinsfan]

What are you basing your expectations on?

my expection that the clinic doesn't want to treat us for nothing....at the very least we should hear about it when checking in for lab work or appointments. You have to show your insurance card every time you check-in...

 

[athena53]

Yeah, I think they're starting to get burned enough times by people who had no idea their OOP would be so much and who just plain don't have the money that they'll magically find a way to let you know (and collect) up front.

 

[ExFlyBoy5]

If your insurance company was involved they would have paid just a fraction of that $1000 bill.

This is what I wonder when it comes to being a "cash payer." Reviewing my gallbladder surgery, the original bill was just shy of $26,000. My insurance paid a total of $4100. If I was a "cash payer", I have a VERY difficult time believing that I could get away with only paying 15.5% of the bill unless I actually (and not threatened) filed for bankruptcy. The more and more I think about it, I think this is a rigged game that is difficult to win.

As an aside, about a year ago, my sister-in-law had her appendix burst and she was hospitalized for 5 days. Her OOP wound up being almost $15,000 and the hospital was very hesitant to work with her AT ALL. She *finally* got them down to a little over $11,000 for her "share." The messed up thing was that she presented to the ER the day previous to the burst (and sepsis) and they dismissed her pain as "being on the wrong side." The misdiagnosis (and malpractice in my opinion) directly resulted in her severe complications and yet the hospital STILL billed her!

 

[ivinsfan]

Flyboy5 yes when you have insurance you are billed the negotiated insurance rate. In my opinion that's one of the major reasons to carry the insurance, even with a very high deductible. The discount off a negotiated rate will of course be smaller, but like I said, asking is free.

 

[rodi]

A real life example of how messed up our system is.

DH went into the Dr's for a physical and bloodwork so he could get his statin medicine renewed. He filled the prescription on his way out and was charged $4.57. (Generic statin drugs are cheap, after all).

We got an EOB today. Billed amount $499.54. Allowed amount $4.57.

Yep - they charged 500 bucks for $5 worth of meds... but settled for the $5.

How can a person make rational choices about what care to decline when billing is so completely hosed up.

 

[Big_Hitter]

I had some routine blood work done last year, lipid panel, psa, etc and it was about tree fiddy that I had to pay.

 

[ExFlyBoy5]

A real life example of how messed up our system is.

DH went into the Dr's for a physical and bloodwork so he could get his statin medicine renewed. He filled the prescription on his way out and was charged $4.57. (Generic statin drugs are cheap, after all).

We got an EOB today. Billed amount $499.54. Allowed amount $4.57.

Yep - they charged 500 bucks for $5 worth of meds... but settled for the $5.

How can a person make rational choices about what care to decline when billing is so completely hosed up.

I too am on a daily low cost medicine. If I recall, they cost about .04 per day...and if I bought them outside of insurance, they run about .15 per day. While in the hospital, they were billed at $8 a pop.

 

[jim584672]

Before I left Megacorp I had some basic blood work done. Cost $480, I had to pay a 10% co pay. Absurd.

 

[Trawler]

Last year had a sleep study done for sleep apnea. The study showed I had apnea and received a certificate of medical necessity prescription for a machine but Insurance declined the equipment because the study did not show I had a bad case of sleep apnea. I appealed this decision and won. I had to go back to sleep doctor to get letter that cost insurer $261 for my visit and letter as I had reached deductible. In the mean time before approval of the equipment the provider that was recommended to me was In Network and quoted me $1800 as in network price. I then when shopping found C-PAP central that was also in network and got a cash price of $560.00 . Called insurer and asked if I won appeal could I be reimbursed thru making a claim they said yes. So I went bought machine and paid the $560. Upon winning the appeal I went to file a claim and was told since I paid the cash price not the negotiated price by law in order to get reimbursed I would have to have the provider bill the insurer at the negotiated rate and have the provider reimburse me for the $560. Furthermore I would then have to rent the machine for 90 days and provide compliance data that I was using the machine. The rent was around $275 a month which they would bill the insurer and once I proved compliance they would bill the balance to the insurer. The total negotiated rate with rent was around $1400 . Also because compliance proof took 90 days I would into next year thus the deductible would start over and I would be on the hook for $1400. What a bunch of hogwash. I get it for $560 thinking I am saving money for me and the insurer and wonder why they cant cut a better deal. The key here is the medical lobby and the law has rigged the system in this case.

 

[travelover]

Last year had a sleep study done for sleep apnea...........

Wow, you couldn't make this stuff up.

 

[pb4uski]

....and stories like this are why I am becoming increasingly receptive to blowing up the whole thing and making some drastic changes. The current system is just too broke to be fixed.

 

[RAE]

A real life example of how messed up our system is.

DH went into the Dr's for a physical and bloodwork so he could get his statin medicine renewed. He filled the prescription on his way out and was charged $4.57. (Generic statin drugs are cheap, after all).

We got an EOB today. Billed amount $499.54. Allowed amount $4.57.

Yep - they charged 500 bucks for $5 worth of meds... but settled for the $5.

How can a person make rational choices about what care to decline when billing is so completely hosed up.

I have had similar experiences. As someone else said, the docs have no idea how much the tests they are ordering cost, nor do many of them seem to care very much. Good luck asking for an estimate of the cost.....I've tried that, and if they even give you an estimate, it often has no relationship to the bill you later receive. And if you question or challenge the bill, you get no response other than just repeated attempts to get you to pay it. The system is so messed up (in my opinion), it is almost beyond fixing.

 

[John Galt III]

Just to throw in a glimmer of hope.... Don't know if you can still do this, but about 10 years ago when I went without insurance for 2 years, I called up several local labs and they gave me cash prices for various blood tests. Some labs were expensive but some were cheap. Example. TSH (for thyroid) test was $145 at one lab, but only $35 at another lab. Both cash, same test. Of course I got the $35 option. Around the same time I got a routine annual physical from my doc for only $45. Not bad. Again, cash on the barrelhead.

 

[Brat]

I am shocked that Group Health would charge that much for tests they ordered. Shortly Kaiser will be taking over their program, I have found Kaiser's costs very transparent.

 

[marko]

My doctor has a concierge type arrangement where we pay a fixed annual amount ($1000) and he doesn't charge/involve insurance at all.

Back when insurance was paying, my usual blood tests (PSA, cholesterol, etc) used to run about $175 each. Now they're included in his fee or at nominal charge ($20 or so).

 

[harley]

DD, who is about 5 months pregnant now, had some genetic screening done for herself and her hubby in order to see what the chances were regarding birth defects and other stuff you can find out about these days. Everything turned out fine, and they pretty much forgot about it until today. She called me, freaking out, after receiving a bill for $33,600.00 for the screening. I scraped her off the ceiling and had her call the company. She called back saying she was told that that amount was what they were charging the insurance company, but if they didn't cover it all she would owe was the $20 copay amount. While I'm glad it worked out for her, that almost seems like insurance fraud to me. How can they justify that kind of charge if they are willing to accept a $20 instead? Something is very very rotten in the medical industry.

 

[ExFlyBoy5]

DD, who is about 5 months pregnant now, had some genetic screening done for herself and her hubby in order to see what the chances were regarding birth defects and other stuff you can find out about these days. Everything turned out fine, and they pretty much forgot about it until today. She called me, freaking out, after receiving a bill for $33,600.00 for the screening. I scraped her off the ceiling and had her call the company. She called back saying she was told that that amount was what they were charging the insurance company, but if they didn't cover it all she would owe was the $20 copay amount. While I'm glad it worked out for her, that almost seems like insurance fraud to me. How can they justify that kind of charge if they are willing to accept a $20 instead? Something is very very rotten in the medical industry.

Well, they won't cover the full amount anyway. They will pay the amount that is contractually required and that will be it. She will have to pay the $20 no matter...it won't be an "either/or" situation. And whatever the insurance won't cover, she won't be responsible since she can't be "balance billed." Now...if it out of network or not authorized, then well...watch out!

 

[harley]

Well, they won't cover the full amount anyway. They will pay the amount that is contractually required and that will be it. She will have to pay the $20 no matter...it won't be an "either/or" situation. And whatever the insurance won't cover, she won't be responsible since she can't be "balance billed." Now...if it out of network or not authorized, then well...watch out!

Well, I would hope that the company that was doing the test might mention something like "if this isn't covered by your insurance, you're going to owe $33K." That's the kind of thing that might be important to consider before having a test done. I doubt she ever gets anything done again without asking the price, so maybe a good learning experience.

 

[Amethyst]

A relative whose spouse needed a liver transplant (which unfortunately never materialized, and the spouse died - long horror story in itself - first it was "not quite sick enough," and a month later "you're too sick" for a transplant), got the whole procedure itemized in advance: roughly $750,000.00.

Fortunately, there was military retiree insurance and the out-of-pocket was going to be almost nil.

 

[48Fire]

This reminds me of my young niece with a high deductible. Had a neurosurgeon run a test (MRI) over an issue that was resolved several years ago.At her appointment he made the mistake of saying..I was sure it's no longer a problem I ran that test just to confirm my thinking. Apparently she looked right at him and said. You F#$%@r that cost me over 5 thousand dollars! She's a very outspoken young lady!

Haha good for her! He should have paid for it. Can you imagine if your auto mechanic does this?

 

[48Fire]

I had two blood tests with Grouphealth in Washington, and was stunned to discover that my share of the bill was $600.

Some of the tests were central to treatment I was receiving, but others seem to have been just thrown in. I was not warned of the cost of any of these procedures, and the GH customer service rep told me that the doctors likely don't know what the costs are upon ordering the tests.

Going forward, I now intend to learn what blood tests are slated to be conducted with each blood draw visit, and what each of them costs.

This experience prompts me to ask whether anyone else has opted to participate more in their health care decisions to avoid costs of this magnitude for services that may not necessary.

And it's not just the financial costs. My FIL was literally tested to death. And we are trying to avoid that with MIL currently.

 

[marko]

This reminds me of my young niece with a high deductible. Had a neurosurgeon run a test (MRI) over an issue that was resolved several years ago.At her appointment he made the mistake of saying..I was sure it's no longer a problem I ran that test just to confirm my thinking. Apparently she looked right at him and said. You F#$%@r that cost me over 5 thousand dollars! She's a very outspoken young lady!

Of course if there had been a problem and he hadn't requested the test, he might've been sued for malpractice.

A lot of these 'double check' tests are CYA due to fear of lawsuits.

 

[rodi]

I am shocked that Group Health would charge that much for tests they ordered. Shortly Kaiser will be taking over their program, I have found Kaiser's costs very transparent.

The above quote was from my husband's carrier, Sharp (a San Diego local hospital/insurance system). But I would not say Kaiser is super transparent... We're on a high deductible plan - and the EOB's still have crazy charges and much lower allowed charges... Plus they use contractor docs at times (especially in the ER) and that ends up being a separate billing. The billings for xrays, casting, splints, etc... very confusing. (Thinking back to my son's broken elbow followed by his broken wrist on the other arm last year.)

It was much easier and less confusing when I was on the copay, no deductible plan through work.

 

[MichaelB]

It could be that one factor that has led to such high use of tests is that so many consumers had low or no deductible health coverage from work. Combine this with our obsession to reduce or completely eliminate uncertainty, especially in the physicians office, and this would explain a great deal of the excessive testing that goes on in the US.