Cost-Conscious, Self-Managed Care

[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.

 

[Meadbh]

I don't live in the US, and I don't receive a bill for medical lab tests, but I question recommendations of my doctor and dentist all the time, based on scientific evidence. I hate waste!

 

[LARS]

Well it would certainly have gotten my attention. Must not have been a run of the mill blood test as I've never encountered anything remotely that high. But yes at $600 a pop I think I would pay attention.


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[MichaelB]

When seeing a physician and discussing tests and treatment options I have always said, upfront, either that I have no insurance or I have a very high deductible and all the costs will be out of pocket. This is true and almost always results in a much more productive discussion about which tests are really important and what treatment is more cost effective.

My experience is physicians are very receptive to this and quite knowledgeable regarding the cost effectiveness of the alternatives.

 

[Walt34]

$600 for blood tests would certainly get my attention! We are fortunate to have very good insurance from my former employer and all lab work is covered 100%. I look at the statements when they arrive and don't remember seeing anything near that high though. Maybe yours was something way out of the ordinary?

Within the next two weeks I'm to undergo a cardiac ablation, and frankly I don't care what it costs. I just want it done right. Now, I can say that because of the insurance (after Medicare) that we have, but that's the case. All those midnight shifts are paying off.

 

[FUEGO]

I can believe $600 for some routine tests. I've seen the bills before. $100-200 per test sometimes (and of course the insurance's rate is $1-10 usually, so I pay a percent of that).

 

[meierlde]

Watch adds and so forth for screening test programs put on by local hospitals. Where I live once a month they do screenings tests for $125. Of course you use your credit card to pay for them, and no physician order needed. In addition if you have the test order you can go on the web and shop for lab services as well. Because it takes a couple of months to get paid (versus payment before service) the providers have to jack up the price.

 

[athena53]

Yeah, I've got a $5K deductible and you can bet I carefully evaluate tests and question bills. 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. So, I chose another doc recommended by my PCP, who works in a freestanding facility. They're going to call me a month before my appointment and let me know. Yeah, the info is suddenly available when they want to find out what you're on the hook for so they can make sure you pay it!

I'm hoping things will become more transparent- with deductibles being such a huge % of the average family income, providers are finding that if they just slam them with a big bill after the fact they might not get paid.


DH is on Medicare but we both use clinics such as CVS Minute Clinics for minor things. In a few cases, DH was able to get immediate treatment for a respiratory virus that morphed into bronchitis or pneumonia, stay home (and out of the hospital) and rest for a few days, then see his regular doc to make sure he was progressing OK.

 

[rodi]

Yep - I've learned to ask about everything. Last year was my first year on a HDHP - and I had a lot of issues with kids/sport injuries. I learned to ask, even at the ER, "is this medically necessary - we're on a high deductible plan so we'll be paying out of pocket for this". It raised some eyebrows - but the orders often changed.

 

[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!

 

[audreyh1]

Yes - I question everything that is ordered in any exam.

 

[travelover]

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!

Sadly, docs seem to have no idea what anything costs.
It seems like it would be cost effective to have a person in each office whose only job was to price procedures and drugs real time. $5000 would pay their wage for a whole month.

 

[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

 

[kcowan]

Sometimes I do the opposite. I ask if they would mind testing for other common ailments since they are drawing blood anyway. But if they come up negative i do not repeat for 5 years. Same with urine tests.

(But then I live in Canada where doctors are monitored to prevent ordering too many tests.)

 

[ExFlyBoy5]

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!

My wife has had semi annual MRIs for the last several years and we are acutely aware of the billed amount...and I would guess most folks who have had an MRI know of the cost and are very aware when the doc starts talking about getting another MRI done.

I recently was hospitalized for 3 days to have my gallbladder removed. When the service statement came out, I was shocked at the cost that was billed. I was also shocked to see that the same dose of morphine that was administered never had the same cost. It really made little sense to me...

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[AnIntentionalRoad]

My last blood test was $1,000 and not covered because my doctor office stopped taking our insurance... Yes, I am much more involved now.

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[Ally]

My last blood test was $1,000 and not covered because my doctor office stopped taking our insurance... Yes, I am much more involved now.

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Are you going to stay with them, since they stopped taking your insurance?


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[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.

 

[athena53]

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.

That surprised me, too. I'm typically expected to pay anything not covered by the insurance right up front (an emergency might be different, of course). It's not ideal to find out after you've been fasting all morning and are ready to eat everything in sight what the out-of-pocket will be, but at least you have the choice to walk. I think more places are going to tell people the out-of-pocket amount beforehand because so many people have gigantic deductibles they can't afford.

 

[ivinsfan]

Not only the high deductible, but the providers have to realize that information doesn't flow just one way. If they have to be sure they are getting payed, the patient should have the right to know they won't be fully covered.

 

[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]

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]

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]

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.