Cost-Conscious, Self-Managed Care

[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]

Quote:

Originally Posted by 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.

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]

Quote:

Originally Posted by FlyBoy5 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]

Quote:

Originally Posted by ivinsfan 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]

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.

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]

Quote:

Originally Posted by ivinsfan 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]

Quote:

Originally Posted by 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.

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.

[SteveNU]

Quote:

Originally Posted by 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.

As the saying goes, If you think health care is expensive now, wait until it's free....

I think most people could care less how much it costs since the insurance company is paying the bill. I doubt many people even ask about cost, I know I almost never have in the past.

Probably another driving factor is the use of the Internet to self diagnose every little ache and pain which leads to people asking for unnecessary tests.

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[athena53]

I've used the Internet for the opposite- it keeps me from unnecessary trips to the doc. I diagnosed a case of frozen shoulder 2 years ago and got rid of it with exercise- found it all on the Internet.

I agree, though, that when it's "free", most people don't assess whether something is worth it. Interesting that in an earlier post, someone mentioned a doc cutting back on tests ordered after finding out that the patient would be paying it all out of pocket. Makes you wonder how important the eliminated tests were.

ETA: DH was getting weekly treatments for a leg ulcer (now healed nicely) and when he asked the practitioners what a visit cost, the answer was, "It should be covered almost completely by your Medicare policies". What kind of an answer was that?

[pullmyfinger]

Yes, we definitely need to be aware of out of pocket costs. I also have a Group Health plan in Washington and mine is a bronze high deductible plan with a $4500 per person deductible. I was planning to go in for a preventative visit which is supposed to be covered in full prior to the deductible, to establish care with a new PCP in January. I did some research and found that if there is ANY mention of a pre-existing condition during a "free" preventative care visit the visit is no longer "free" and the patient will be billed. So what is the point of going in if you can't talk? And then if they order any tests how will you know what you are responsible for?

I am also not impressed by the billing and general record keeping of GH. We have had this insurance since last April, and almost every month we get a statement that we are delinquent. We always pay our premium on time. So each month I sit on hold for customer service and they confirm that we are paid up and say that many people have had problems with the billing. They have also sent us 3 sets of insurance cards since January, all the same. Doesn't inspire confidence.

This situation forced me to investigate care at the VA which I have been entitled to, but never used before. For DH, we're hoping that he doesn't need any care this year.

[imoldernu]

Quote:

Originally Posted by Amethyst I check with BCBS Federal before we go for any new procedure. The rules for co-pays seem very plain, but the devil is in the interpretation. For example, even the tiniest intentional scrape or cut by an in-network Dr. counts as "surgery" at $150 a co-pay. So, removing 5 polyps or skin tags (say) would be 5 x $150. Getting a cast on my wrist was considered "surgery." So far, we haven't needed to see an out-of-network Dr. but it could happen. In that case, you can bet I'd ask a lot of questions! Amethyst

+1
I treasure my "brown spots"... @ $150/per, could pay for the Dr's new Tesla.

[travelover]

Quote:

Originally Posted by pullmyfinger ............I did some research and found that if there is ANY mention of a pre-existing condition during a "free" preventative care visit the visit is no longer "free" and the patient will be billed. So what is the point of going in if you can't talk?...........

This sounds crazy. I just had my annual physical and most of the time was spent talking about ongoing health concerns and medications that I am taking to control those conditions.

[rodi]

Quote:

Originally Posted by Amethyst I check with BCBS Federal before we go for any new procedure. The rules for co-pays seem very plain, but the devil is in the interpretation. For example, even the tiniest intentional scrape or cut by an in-network Dr. counts as "surgery" at $150 a co-pay. So, removing 5 polyps or skin tags (say) would be 5 x $150. Getting a cast on my wrist was considered "surgery." So far, we haven't needed to see an out-of-network Dr. but it could happen. In that case, you can bet I'd ask a lot of questions! Amethyst

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.

[r2021t]

Quote:

Originally Posted by marko 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.

I don't disagree with your main point. Tort reform needs to be an important part of this. But the doctor has insurance for errors he makes or is alleged to have made. That young woman should not be out of pocket 5k because the doctor wanted to "CYA".

Honestly, I'm inclined to believe that was not a part of his thinking. It is probably as simple as the poster stated. He was just confirming his final diagnosis/treatment regiment. It was a thoughtless act. Nothing more. He, like many doctors, haven't caught on that Obama Care is not free and it is costing real people real money. Mine certainly hasn't. So much so that I'm considering shopping for a new one.

[pb4uski]

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.

DW removed a couple for me last week. Cleaned the area and a sharp pair of scissors with alcohol and then snip-snip.

[athena53]

Quote:

Originally Posted by r2021t He, like many doctors, haven't caught on that Obama Care is not free and it is costing real people real money. Mine certainly hasn't. So much so that I'm considering shopping for a new one.

Except it always did cost real people real money- when there were no or low copays or employers bore most of the premiums, it just didn't cause as much pain to the individual patient. It's about time providers figured this out.

[travelover]

Quote:

Originally Posted by athena53 Except it always did cost real people real money- when there were no or low copays or employers bore most of the premiums, it just didn't cause as much pain to the individual patient. It's about time providers figured this out.

Exactly. It pains me to hear people act like paying for medical care started with the ACA.


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