Cost-Conscious, Self-Managed Care

[redduck]

Quote:

Originally Posted by pb4uski ...IMO if a consumer has an in-network doc or specialist and an in-network hospital then any out-of-network specialists who perform work should be deemed to have agreed to accept the insurer's in-network rate for the service and no balance billing is allowed (unless specifically agreed to in writing by the patient 48 hours prior to the services being performed so the patient can't be shaken down in pre-op).

Sounds good. Let's clarify ER situations and then we can vote on it.

[simple girl]

Quote:

Originally Posted by pb4uski And my understanding is that states are legislating against these outrageous situations. IMO if a consumer has an in-network doc or specialist and an in-network hospital then any out-of-network specialists who perform work should be deemed to have agreed to accept the insurer's in-network rate for the service and no balance billing is allowed (unless specifically agreed to in writing by the patient 48 hours prior to the services being performed so the patient can't be shaken down in pre-op).

This is the way my insurance works. I called them to make sure specifically before undergoing surgery at my in-network hospital, as I had heard of the "anesthesia out-of-network" issue.

[bmcgonig]

Quote:

Originally Posted by simple girl This is the way my insurance works. I called them to make sure specifically before undergoing surgery at my in-network hospital, as I had heard of the "anesthesia out-of-network" issue.

Who do you talk to? As far as I could tell at my last surgeries no one knew who the anesthesiologist would be on any particular day or hour.


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[Options]

Quote:

Originally Posted by lawman3966 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.

See this:

It's Time to Get a Second Opinion Before Paying That Medical Bill - NBC News

Quote:

The next time you get a medical bill, don't pay it — at least not right away. It pays to check for errors first. Accounts of medical billing errors vary widely. While the American Medical Association estimated that 7.1 percent of paid claims in 2013 contained an error, a 2014 NerdWallet study found mistakes in 49 percent of Medicare claims. Groups that review bills on patients' behalf, including Medical Billing Advocates of America and CoPatient, put the error rate closer to 75 or 80 percent. "Don't pay it until you understand it," said Sara Taylor, health solutions and strategies manager for benefits administrator Aon Hewitt.

[simple girl]

Quote:

Originally Posted by bmcgonig Who do you talk to? As far as I could tell at my last surgeries no one knew who the anesthesiologist would be on any particular day or hour. Sent from my iPad using Early Retirement Forum

I couldn't find out who the anesthesiologist would be. What I did was call my insurance company and ask them what to do to avoid these kinds of charges. They told me my policy had some type of clause or arrangement with their in- network hospitals that required the hospitals to have all providers agree to accept the network rate for all patients under the plan. There was a name for this arrangement, but I forget what it was called.

[redduck]

I went to Cedars-Sinai Hospital Imaging Center today to have a bone-density test done. They already had all the info they needed in their system--but they did confirm some of it with me (including insurance info). They told me the bone-density test would cost approximately $158 and they would first bill Medicare and then bill my secondary provider. They also have checked and, yes, I am eligible for this procedure.

Now, I should probably leave it right here, but there's more good stuff:
I remember this bone-density tech from 6 years ago (and she remembers me).

She tells me to lie on the table and I start taking stuff out of my pockets. She says there's not need to do that, and that she will pull down my pants once I'm on the table. I get on the table real quick-like. She, with one hand, unbuckles my belt, unbuttons the pants button, zips down my fly and then pulls my pants down just a bit. (All this time I'm wondering what my co-pay is gonna' be for all this as I continue to cram one dollar bills in her lab coat). After the bone-density test (how appropriate) is over, she re-dresses me, but for some reason, she doesn't buckle my belt and I have to do it myself. I'm not sure if I should complain to her supervisor or not about not buckling the belt. Any suggestions?

[travelover]

Quote:

Originally Posted by redduck I........After the bone-density test (how appropriate) is over, she re-dresses me, but for some reason, she doesn't buckle my belt and I have to do it myself. I'm not sure if I should complain to her supervisor or not about not buckling the belt. Any suggestions?

<insert happy ending joke here>

[Tadpole]

My husband and I never had problems when we were in MD and on regular workplace insurance. We moved to WA and were on the same insurance at first but rapidly reached Medicare age and went on a coordinated plan between Medicare and my workplace insurance with Medicare as primary. This means that Medicare Assignment determines the price for both. Now, if we need a specialist or lab test, as soon as we show up we are asked to sign a paper that says we will pay any amount our insurance does not cover. It seems like it is every doctor that we encounter. Most of them have been part of Peacehealth, a conglomerate that seems to own most to all the hospitals and specialists clinics and some labs in the area. I asked one facility why, if they accepted Medicare Assignment, they were making people sign these papers prior to treatment. The woman at the desk said "well, we have to get paid, don't we".

We recently got two bills from Peacehealth. The first was for two services on the invoice which Medicare had denied. When I talked to Medicare and my insurance they said that the doctor had triple billed for the same service and told me not to pay. I called Peacehealth and told them that Medicare and my insurance said that I didn't owe them anything and that Peacehealth needed to deal directly with Medicare and not with the patient. This took time but was easily resolved because I had a copy of the itemized payments and could back out the discrepancy. The next time they sent me a bill, they only sent a code and a number so I couldn’t do an investigation. I determined that they had billed me as soon as Medicare made payment and didn't wait for the payment from my secondary. I checked and the secondary had already paid them the day before they mailed the bill to me. I called Peacehealth and the person on the phone said they couldn't confirm what I was saying (a week later) and if I was sure then I could just not pay the bill.

What if I were 85 and getting a little slow?

There is less and less medical choice in this area as more and more medical choices are bought up by the Peacehealth conglomerate. But it is contagious. The last non-Peacehealth doctor I went to said he accepted Assignment but still had a line on the new patient form that said we would pay anything our insurance didn't pay.

The day of my cataract surgery, we were given a ten page thing to sign. I might be the first person to read it, including the staff of the facility. A comment was made in the document that the facility relied on "contractors". I went to the desk and asked if all the contractors accepted Medicare Assignment. Guess what? - no one knew. A while later one of the receptionist came back and said they had talked to the contractors on my case and they did accept assignment. I left wondering if they accepted assignment if you asked and what they charged if you didn't.

And that is the scary part of all of this. To get medical treatment you promise to pay any amount they pull out of their hat. Little Johnny is starting school at the Richy Rich Academy, Tadpole need to make a donation. There is no price negotiation; just a promise to pay whatever they want or what? – no medical services?-.

[athena53]

Quote:

Originally Posted by Tadpole What if I were 85 and getting a little slow? <snip> And that is the scary part of all of this. To get medical treatment you promise to pay any amount they pull out of their hat. Little Johnny is starting school at the Richy Rich Academy, Tadpole need to make a donation. There is no price negotiation; just a promise to pay whatever they want or what? – no medical services?-.

I agree on the age 85 issue. I'm 63, computer-friendly and numerically literate. I've still found DH's Medicare/Medicare Supplement issues time-consuming to sort out. Most recently, I FINALLY got 40 pages of Medicare claim documentation to his Medicare Supplement provider and got $550 worth of reimbursements last week, even though the hospital's boilerplate on the bills 4 months ago said that all the insurance had been processed. (The Supplement carrier has always been prompt at processing claims so I figured the hospital hadn't submitted them even though two separate employees said they had. I was right.) I'm just glad I have enough brain cells and enough time to get what's ours.

And I'm still plodding through the process of finding out what my diagnostic colonoscopy will cost. I've pried numbers out of the doc and the facility but still need to see if there are separate lab and anaesthesiology costs. Sigh. I hate it, but they need to learn that people who have high deductibles don't write blank checks.

[simple girl]

Not sure if this article has been posted yet or not. Great to see legislation like this being passed:

The Hospital Is In Network, But Not The Doctor: N.Y. Tries New Balance Billing Law | Kaiser Health News

[travelover]

Quote:

Originally Posted by simple girl Not sure if this article has been posted yet or not. Great to see legislation like this being passed: The Hospital Is In Network, But Not The Doctor: N.Y. Tries New Balance Billing Law | Kaiser Health News

My question is why is there a 9X or 10X difference between in network and out of network reimbursements? I can't think of another business where there is this kind of variability.


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[bikeknit]

Quote:

Originally Posted by athena53 It's still virtually impossible to get prices just by asking around here. One doc's office could tell me the self-pay rate for my diagnostic colonoscopy- but not the rate negotiated with my insurance plan and not what the hospital would tack on for use of their facility.

I once spent hours trying to find out what a bone density test would cost me (the insurance negotiated rate, not the sticker price for someone without insurance) and was told everything from "you need to get that info from the insurance company", "you need to get that from the facility", our contract with the insurance company won't let us give you that info"...

Amazingly, they know what it costs after the procedure.

If anyone has had success getting this info from doctors or facilities before the procedure, I'd love to hear how you did it.

[redduck]

To answer your question, bikenit...

The hospital intake woman told me (without my asking) what the cost of my bone density test would be. The whole intake process took about five minutes as they already had my information on file.

Quote:

Originally Posted by redduck I went to Cedars-Sinai Hospital Imaging Center today to have a bone-density test done. They already had all the info they needed in their system--but they did confirm some of it with me (including insurance info). They told me the bone-density test would cost approximately $158 and they would first bill Medicare and then bill my secondary provider. They also have checked and, yes, I am eligible for this procedure.

[bikeknit]

Quote:

Originally Posted by redduck To answer your question, bikenit... The hospital intake woman told me (without my asking) what the cost of my bone density test would be. The whole intake process took about five minutes as they already had my information on file.

I wish that would work for me. I live in Kansas and this was at Kansas University Medical Center. I got transferred to all sorts of offices both at KU Med and at my insurance company of the time, Coventry - and no one ever gave me any hope that they would tell me.

I changed to Blue Cross/ Blue Shield this year and they told me that I should be able to get that information from them. I'll see.

[redduck]

Quote:

Originally Posted by bikeknit I changed to Blue Cross/ Blue Shield this year and they told me that I should be able to get that information from them. I'll see.

I am now on Medicare and have Blue Cross as the supplementary. The only thing so far that I've had to watch out for with medical bills is to make sure that the supplementary has been billed (and paid). I can't imagine BC/BS being willing to help you out with usable information re: upcoming medical costs.

I wish you good luck with them.

[athena53]

Quote:

Originally Posted by bikeknit I once spent hours trying to find out what a bone density test would cost me (the insurance negotiated rate, not the sticker price for someone without insurance) and was told everything from "you need to get that info from the insurance company", "you need to get that from the facility", our contract with the insurance company won't let us give you that info"... Amazingly, they know what it costs after the procedure. If anyone has had success getting this info from doctors or facilities before the procedure, I'd love to hear how you did it.

I'm on the MO side (also KC suburb). It varies. Before we moved last year we were in KS and I had Coventry. When I called the office of the doc who did my last 2 colonoscopies, I got the runaround and was ping-ponged between Coventry and the doc's office (which, as I noted earlier, could give me only the self-pay rate and only for the doc).

I now have BCBS and tried doc #2, recommended by my PCP. They gave me the doc's rate agreed with BCBS and the phone # of the facility, which readily supplied their charge. Then I realized there could be lab fees. I called the doc's office again. The lab fee depends on what they find. Well, I suppose that makes sense. She did tell me the lab was in network. I suppose I ought to verify that. Hey, it's progress.

[MRG]

Quote:

Originally Posted by athena53 I'm on the MO side (also KC suburb). It varies. Before we moved last year we were in KS and I had Coventry. When I called the office of the doc who did my last 2 colonoscopies, I got the runaround and was ping-ponged between Coventry and the doc's office (which, as I noted earlier, could give me only the self-pay rate and only for the doc). I now have BCBS and tried doc #2, recommended by my PCP. They gave me the doc's rate agreed with BCBS and the phone # of the facility, which readily supplied their charge. Then I realized there could be lab fees. I called the doc's office again. The lab fee depends on what they find. Well, I suppose that makes sense. She did tell me the lab was in network. I suppose I ought to verify that. Hey, it's progress.

I'm in Jackson County. When I shopped three years ago it was just BCBS and Coventry in this county. I went with BCBS and have been very happy. Third year zero surprises and I've had too many illnesses, hospitals, and surgeries.

First year of ACA I'd contacted a broker I know and her advice was if you plan on using the insurance(between those 2 in this area) BCBS was superior.

[athena53]

I'm also in Jackson! I dropped Coventry when, after I moved across the state line, Coventry cancelled my KS policy (which I knew would happen) and offered me a MO alternative I "might like". I looked up the details. ZERO out-of-network coverage. What a disgraceful bait-and-switch.

[redduck]

Quote:

Originally Posted by rodi Kaiser Permanente doesn't cover skin tag removal at all. Mine were noted in the record, but I was told removing it would be cosmetic rather than medical. They're happy to give you a list of clinics/dermatologists that will take care of it for you - on your own dime. I'm ok with that.

Quote:

Originally Posted by Brat I think the location of skin tags or 'barnacles' is a factor. I had barnacles on my face and got a referral.

I imagine location may be a factor, but another factor is if it's a medical necessity. So, if your skin tags sometimes cause you pain or discomfort (let's say when you put on a shirt) or they bleed (even a little teeny tiny bit) you should be able to get them removed as it is considered a medical condition.

[rodi]

My husband is still fighting bills for his mother's big adventure last year. She has dementia but two of her sons were driving her to her grand daughters wedding. She had a panic attack and tried to hurl herself from a car... In the middle of no where, in a state that no family lived in. She was taken to the small podunk county hospital by ambulance, then transferred to a larger metro area hospital. (She'd fractured a spine section.)

The podunk hospital is still sending bills and finally, 2 months ago, agreed to submit to the secondary insurance - after being asked after every bill sent... It's looking like that one is finally settled out - 10 months later. The larger hospital had it more together - it only took 6 months to get them to bill the secondary insurance.

My husband spends at least 5 hours/month fighting the bills for his mother - because the providers seem incapable of accurate billing, billing the secondary provider, etc... He's gotten fairly adept at knowing who to call and what to look for on the bills. His mother could not handle it at all - even without dementia....