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Old 03-20-2016, 07:57 PM   #101
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There's a website called walkinlab.com where you can go and order blood tests. They take your money by CC and then refer you to the local Quest or whatever. You don't need your docs prescription to go there as they get around that by having "their doctor" order it.
Another one that I have used is requestatest.com

They will do pretty much any test you want. I have a lab just a couple of miles from where I live, so that's where I go to get it done. Ordering it and paying for it online means they already have your info when you walk in and I've always been back out the door within five minutes. I go online the next day to get my results.
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Old 03-21-2016, 11:28 AM   #102
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Your example is humorous, but with all of your data in their computer, this information should be a click or a finger flick away. With annual per person medical costs in the USA about $9000 per, I think it is past time for docs to know what things cost. Maybe not a tongue depressor but surely an MRI.
Generally, they are bound by their contract not to disclose prices unless you had or are at least scheduled to have the procedure. Each insurance company has thousands of contracts with different pricing. It is not in the insurance company's interest to share pricing, so it won't happen without legislation.

As to getting a huge surprise bill, I looked up what Medicare would pay and offer them that, or nothing. They sent it immediatly to collections when I gave them that choice. I didn't care...I'm not in the market for a loan. Score is still above 800 and never got anything from a collector...maybe they wrote it off.

Everyone should go to HTTP://consumersunion.org/surprise-medical-bills
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Old 03-21-2016, 01:22 PM   #103
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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.
Yes, the system is ridiculous. But, regarding the cost of prescriptions, I just call the pharmacy and ask them the cost of the prescription. They are fine with sharing this info. This goes for the walk-in pharmacy as well as the mail-order pharmacy.
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Old 03-21-2016, 01:29 PM   #104
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...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...
Something sounds wrong. Did you follow up to find out why the insurance paid such a small amount?
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Old 03-21-2016, 01:53 PM   #105
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Generally, they are bound by their contract not to disclose prices unless you had or are at least scheduled to have the procedure. Each insurance company has thousands of contracts with different pricing. It is not in the insurance company's interest to share pricing, so it won't happen without legislation..........
This may be true, but it definitely crazy. You want an new engine in your Lexus? We'll tell you how much it cost when you pick it up.
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Old 03-21-2016, 02:07 PM   #106
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Generally, they are bound by their contract not to disclose prices unless you had or are at least scheduled to have the procedure. Each insurance company has thousands of contracts with different pricing. It is not in the insurance company's interest to share pricing, so it won't happen without legislation.
The market place is so efficient. Only thousands of contracts.
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Old 03-21-2016, 06:06 PM   #107
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Well... I've already given them my insurance card when I made the appointment and when I checked in for the appointment, so they have had that information for some time and should at least be able to tell me what the negotiated charge is for the proposed procedure or test and that it could be lower if I have satisfied my deductible.
The docs can't give the patient that info because they can't get a usable answer from the insurance companies.

The below quote was taken from another thread:

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...My doctor recently told me you wouldn't have any idea how much time is spent on fighting insurance companies to pay for needed services and general paperwork trying to get paid. And this is in a practice that sees no Medicaid patients and only Medicare patients with good supplementary insurance.<snip>
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Old 03-21-2016, 06:46 PM   #108
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As to getting a huge surprise bill, I looked up what Medicare would pay and offer them that, or nothing. They sent it immediatly to collections when I gave them that choice. I didn't care...I'm not in the market for a loan. Score is still above 800 and never got anything from a collector...maybe they wrote it off.
I'd be really surprised if they let it drop, unless you sent them the Medicare amount. If you sent them nothing, be careful- they rarely let these things drop. My first husband ignored a hospital bill (didn't pay anything on it even after repeated requests). They eventually got a judgment against him and, since he was unemployed, got a court order to attach MY wages. We were in the process of divorce and my lawyer fought them off. They got paid after the divorce.

A few years later the hospital called me asking for donations to their capital campaign.
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Old 03-21-2016, 07:15 PM   #109
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You all know the ultimate solution. Just sayin'
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Old 03-21-2016, 09:06 PM   #110
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Yes, I'm slowly coming to the view that the current system needs to be blown up and discarded and a drastic change is necessary... hard to imagine that it could be any worse.
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Old 03-21-2016, 09:20 PM   #111
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I'd be really surprised if they let it drop, unless you sent them the Medicare amount. If you sent them nothing, be careful- they rarely let these things drop. My first husband ignored a hospital bill (didn't pay anything on it even after repeated requests). They eventually got a judgment against him and, since he was unemployed, got a court order to attach MY wages. We were in the process of divorce and my lawyer fought them off. They got paid after the divorce.

A few years later the hospital called me asking for donations to their capital campaign.
Bad break for you. I have no wages, but if they got a judgement, I might budge. But short of winning a case against me, they don't get a dime until I get a letter saying the agreed upon amount constitutes payment in full.
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Old 03-21-2016, 10:08 PM   #112
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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.
I've seen the other side, and I am in total agreement with the patient's viewpoint. That charge was ridiculous.

On both sides it's absolutely disgusting. The hospitals and labs and doctors charge way too much and insurances and Medicaid and Medicare often pay too little.

I reviewed my aunt's medical bills last year and discovered a charge of $3000 for use of a pre-op room and services and a payment of $30 from Medicaid. Both are completely off the mark, given the staffing and her condition at the time.

I've witnessed what I would call outright fraud as a family member--saw a cardiologist bill my dad's Medicare the highest level visit when he was in the room one minute and the exam was inadequate and only about 15 seconds. But I didn't want to alienate the doctors who were literally keeping Dad alive.

I fought an ER bill for critical care charged for my son with a broken arm--and won-because I asked the physician who saw my son to give me a copy of his ER note (I ran into him at the hospital I worked at and asked him to give me a copy). He was stunned the ER bill was so high. I should have contacted our state insurance commissioner but was too busy at the time.

What I have seen the hospitals and yes, my own colleagues do over the years has made me very angry at my own chosen profession. In the 1990s I lost income and was derided by my partners because I refused to "churn" and "upcode" and so by the numbers I looked less productive than my partners. I left that practice, only to discover the billing/churning issue was systemic and everywhere, on both sides of the country.

A couple of years ago an Amish cash-paying family wanted to decide whether or not to have their son circumcised in the hospital or as an outpatient. They asked for a price. I called our corporate office. I talked to our medical director who was on call with me that day. Two hours later we still could not provide a simple answer to that question. The corporate office said they bill according to the insurance but had no answer for a cash paying patient!

Yes, watching the out and out fraud and lack of transparency in the medical industry over the past 30 years has left me stunned and burned out and appalled.

10 years ago I was involved in a start-up pediatric urgent care that failed miserably. This tiny office did its own basic labs and I saw just how simple it was. The complete blood count that they charge $60-100 for, involves taking a small amount of blood and injecting it in a machine, which prints out the results in less than five minutes. A basic chemistry panel involves the same. The charge could and should be less than $25. Yet the charges are astronomical. With CEOs of health care companies getting millions and some specialists getting a $0.5-3M per year, not to mention all the alphabet soup of organizations and requirements that extract their fees and have massive buildings and massive number workers justifying their own existence, no wonder the dysfunctional American health "system" is a mess. The worker bees, the nurses, the aids, the medical assistants are all underpaid IMO.

Despite my insider knowledge, I could not get an illigitimate charge for a lab that insurance should have covered off my bill last year. And I know the codes! The insurance company claimed I wasn't allowed to know what was coded, which is ridiculous. It's my health for goodness sake! Good thing I switched companies. From now on I will scan the lab slip and pester the doctor for correct coding before I go to the lab. If she doesn't cooperate I am thinking about switching doctors yet again.

Maybe I should write a book...

Now that I am ER, I have the time.
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Old 03-22-2016, 09:52 AM   #113
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I wondered if we could turn up the heat from the customer side by having better information. The possibility was discussed here: Poll: Would you share the price you paid for medical procedures?
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Old 03-22-2016, 08:01 PM   #114
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Maybe I should write a book...
It might turn out to be a best seller, and maybe put you on a level with Ralph Nader and the auto industry.

As I write this I'm in a hospital now after a cardiac ablation, all seems to have come out as expected and I have no complaints. (Nowadays, it's a lousy hospital that doesn't have free wifi for patients.) While on one level what medicine did for me today seems like something out of science fiction, I'm curious to see what the bill is too. I am fortunate to have good insurance though and threads like this make me very aware of how much that matters.

The OR had about five or six display screens in it for the surgeon to look at while he worked on me, and he was able to show me computer-generated images of the ablation areas on his smartphone afterward. Just amazing!
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Old 03-22-2016, 08:11 PM   #115
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Glad to hear that it all went well.

(Are you still moderating, or is this a good time to try to get away with something)?
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Old 03-23-2016, 06:24 PM   #116
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Just using as the above quote as an example of why a doctor can't tell a patient how much medical treatments/procedures may cost.

The doctor would have to know which insurance company you are using (e.g. Blue Cross); which plan (e.g. Gold, Silver, Bronze, etc.); where you are in your deductible; if there are there any medical bills that have not yet been processed; if your policy contains some sort of clause regarding not only a per person deductible but also a family deductible (and many other variables that don't immediately come to mind).

And, then there's that pesky co-pay along with hospital fees (if applicable) and consultant fees (if applicable).

The conversation goes like this:
Pt. I have sore throat, eight days now.
Doc: Sore throat, huh?
Pt. Yep.
Doc. OK, I'll need to look down your throat.
Pt. What will it cost?
Doc. Well, it might depend if you want me to use a tongue depressor or my finger, but I will need to charge you if you want me to wash my finger. Depending on the plan, it may pay in part for the washing. Also, keep in mind, some plans pay for the tongue depressor, some don't. So, which insurance to you have? Which plan?, etc.

Doc: Okay, now I need to look in your ears.
Pt. What's that going to cost me?
Doc: Want me to look in both ears?
In California, anyway, relief may be on the way for surprise medical bills:

Battle Heating Up Over ‘Surprise’ Medical Bills | California Healthline

Quote:
Have you ever gone in for a medical procedure you knew was covered by your health plan, only to be hit weeks later by a large, unexpected bill from a doctor whose name you didn’t even recognize?

If so, you’re not alone. More than one in five Californians with private health insurance reported receiving “surprise” medical bills at least once over the previous two years, according to a 2015 Consumer Reports survey.

Today in Sacramento, consumer advocates will launch a campaign they hope will eliminate such surprises. Legislation introduced last year by Assembly member Rob Bonta (D-Oakland) is back, after falling just three Assembly votes short of passage in 2015.
Emphasis added
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Old 03-23-2016, 08:48 PM   #117
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A few weeks ago, my Significant Other had a two-day visit at the local hospital. Last week she received a letter from Patient Financial Services. It discussed her medical benefits, her deductible and co-pay situation. It also gave her the name and phone number of her Health CPA Advocate (along with the Advocate's photo (she's amazingly cute--but, I digress). If we want, the Advocate will explain all the medical bills (all the doctor, hospital and lab bills). The Advocate will also review all the bills and make sure that they are correct before the bills are paid.

A few days after the first letter, my S. O. received a Statement of Hospital Services. Nothing was detailed, but there was a list of Description of Services. It showed the amount of the bill (so far) and what the insurance payment pending was. It also said no payment was due from the S. O. at this time.

I don't know how this Advocate service will turn out, but, it sounds hopeful.
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Old 03-24-2016, 04:45 AM   #118
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Another ridiculous-price anecdote: Mr. A. had a colonoscopy, and the Dr. required him to use Movi-prep, which is basically a non-generic batch of cheap chemicals. We are not talking about esoteric pharmaceuticals derived from rare Amazonian botanicals, here. The practice gave us a coupon to get his Movi-prep for free.

Now I am due for a colonoscopy, and Movi-prep no longer gives out coupons. The pharmacy charged me $50.00, which is my BCBS co-pay for the non-generic batch of cheap chemicals. The "retail price" for Movi-prep was stated as $103.00!

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Old 03-24-2016, 09:09 AM   #119
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In California, anyway, relief may be on the way for surprise medical bills:



Battle Heating Up Over ‘Surprise’ Medical Bills | California Healthline







Emphasis added

This is a hot topic for the PA Medical Society too.

The specialists that want to protect their income are ridiculous. They are the ones who have 4 cars, giant houses and also boats, their kids get all the best education without student loans, they are the ones who complain about the lost income the loudest. Not one of them has ever made a house call to a roach-infested public housing project to see how some people have to live.

(See the article).

While us primary care docs got the lowest income, the most regulation, and worked some of the longest hours. Glad I'm basically out of it-just a few days a month and trying to decide my final day to help the old group which is about to fall apart.

I'm pretty disgusted with my fellow doctors and their money grubbing ways. I really want to distance myself from American medicine. It isn't what it could or should be.


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Old 03-24-2016, 09:44 AM   #120
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Another ridiculous-price anecdote: Mr. A. had a colonoscopy, and the Dr. required him to use Movi-prep, which is basically a non-generic batch of cheap chemicals. We are not talking about esoteric pharmaceuticals derived from rare Amazonian botanicals, here. The practice gave us a coupon to get his Movi-prep for free.

Now I am due for a colonoscopy, and Movi-prep no longer gives out coupons. The pharmacy charged me $50.00, which is my BCBS co-pay for the non-generic batch of cheap chemicals. The "retail price" for Movi-prep was stated as $103.00!

Amethyst
Sounds like it's too late, here's a link to a <$10 OTC prep. When I was prescribed the expensive one, I did this sugar-free gatoraid and PEG3350 (on my own). When the doc asked about the prep, I told him what I did, he didn't react at all, as if "everybody does that".
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