Cost-Conscious, Self-Managed Care

[Bamaman]

My wife is a Medical Technologist that ran laboratory tests of all kinds (until retiring.) I cannot recall tests costing so much.

The medical world is having a serious collections problems, especially on co-pays and deductibles on patients with O'Bamacare. My hospital discounts any bill 20% if you pay COD.

Most laboratories are paid by insurance companies at negotiated prices, and doctors' just collect the samples and forward them to the labs. Laboratories bill us separately--usually $10-20 for our share of the bill.

Negotiate on any large laboratory bill--telling them you cannot pay them such a bill. You'll be surprised at what you can cut the price down to if you'll pay'em immediately.

And in the future, anyone without great insurance should find out on front end what things cost to keep from being blindsided by ridiculous medical bills. For example, MRI's don't cost $5,000.

[AnIntentionalRoad]

Quote:

Originally Posted by ivinsfan 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.

This was the year that ObamaCare was instituted and they dropped the plan in between my physical and my blood test. I came in in the morning and they said they stopped carrying my insurance and asked if I still wanted the test. I didn't ask how much it would cost, thinking it would be a few hundred dollars. Then I got a bill for $1,000... I learned my lesson!

[AnIntentionalRoad]

Quote:

Originally Posted by Bamaman And in the future, anyone without great insurance should find out on front end what things cost to keep from being blindsided by ridiculous medical bills. For example, MRI's don't cost $5,000.

Ha ha. I paid for 2 $5,000 MRI's last year (one for me and one for my daughter). Are you saying the pice of those are negotiable? Who do you negotiate with?

[ivinsfan]

All test costs vary by region and facility... we are in the Midwest (MSP) as well. Having said that, I no longer would simply pay any large out-of-pocket bill before asking for a price reduction...asking costs nothing. Just because your insurance sends you a EOB saying you owe 5K doesn't mean that's where it ends...I recently opened an HSA and am slightly on the fence about it, because the first thing they do is ask if you have HSA money.

[zinger1457]

Quote:

Originally Posted by AnIntentionalRoad This was the year that ObamaCare was instituted and they dropped the plan in between my physical and my blood test. I came in in the morning and they said they stopped carrying my insurance and asked if I still wanted the test. I didn't ask how much it would cost, thinking it would be a few hundred dollars. Then I got a bill for $1,000... I learned my lesson!

If your insurance company was involved they would have paid just a fraction of that $1000 bill. More than likely the lab would have accepted a lower cash payment offer from you. On my last blood work the insurance company reimbursement to the lab was only 12% of what the lab billed for. The lab I use (Sonora Quest) does list a cash payment discount on their web site for various test that is about 50% of their normal billing rate, still not as good as the insurance negotiated rate.

[redduck]

Quote:

Originally Posted by ivinsfan 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]

Quote:

Originally Posted by redduck 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]

Quote:

Originally Posted by zinger1457 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]

Quote:

Originally Posted by 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.

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]

Quote:

Originally Posted by Trawler 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]

Quote:

Originally Posted by 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.

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.