Join Early Retirement Today
Reply
 
Thread Tools Search this Thread Display Modes
Cost transparency issue: how to attack?
Old 09-28-2015, 08:38 AM   #1
Thinks s/he gets paid by the post
 
Join Date: May 2014
Posts: 2,989
Cost transparency issue: how to attack?

I had an annual mammogram last month. It was coded as preventative.

The facility offered a 3-D mammo for another $35, payable up front. I accepted that; my mother is a BC survivor so a higher-quality test is better.

Last week I got a bill from the provider (very large hospital) for $200. I checked the Explanation of Benefits from my insurer's Web site, looked up the procedure codes, and found that, while the two procedures for a routine screening mammo (GO202 and 77063) were 100% covered, the $200 they charged for "computer-aided detection" (77052) was not. So, I lose 3 ways here. Since the insurer doesn't cover it, there's no negotiated rate. I pay it 100% out-of-pocket. And it doesn't even go towards meeting my deductible. Last year's mammogram was at the same facility, same insurer (although we moved across a state line so may have slightly different policy provisions), and there was only the up-front surcharge, no surprise bills for procedures not covered by the insurance.

I know I have to pay this if I don't want my credit messed up and, thank God, it won't break the budget- but I'm angry. I feel like either the hospital is padding its bills with separately-coded procedures (sort of like the airlines) or the insurer isn't covering something that should be a part of a normal mammogram. I'm retired and have plenty of time to rattle cages. Where do I start? The hospital billing department (will they give a fig)? The insurer? The state Insurance Department?
__________________

__________________
athena53 is online now   Reply With Quote
Join the #1 Early Retirement and Financial Independence Forum Today - It's Totally Free!

Are you planning to be financially independent as early as possible so you can live life on your own terms? Discuss successful investing strategies, asset allocation models, tax strategies and other related topics in our online forum community. Our members range from young folks just starting their journey to financial independence, military retirees and even multimillionaires. No matter where you fit in you'll find that Early-Retirement.org is a great community to join. Best of all it's totally FREE!

You are currently viewing our boards as a guest so you have limited access to our community. Please take the time to register and you will gain a lot of great new features including; the ability to participate in discussions, network with our members, see fewer ads, upload photographs, create a retirement blog, send private messages and so much, much more!

Old 09-28-2015, 08:52 AM   #2
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
 
Join Date: Jul 2006
Posts: 11,018
Did you ask beforehand whether the 3-D was covered by your insurance? This article clearly states that most insurers do not cover it, and provides some reasons why.

3D Mammograms May Improve Breast Cancer Screening – WebMD
__________________

__________________
Meadbh is offline   Reply With Quote
Old 09-28-2015, 09:05 AM   #3
Administrator
W2R's Avatar
 
Join Date: Jan 2007
Location: New Orleans
Posts: 38,887
I'd call first, tell them that this isn't covered by your insurance, and at least TRY to negotiate to get the rate down if you pay it immediately. Couldn't do any harm.
__________________
Already we are boldly launched upon the deep; but soon we shall be lost in its unshored, harbourless immensities.

- - H. Melville, 1851
W2R is online now   Reply With Quote
Old 09-28-2015, 09:08 AM   #4
Thinks s/he gets paid by the post
 
Join Date: May 2014
Posts: 2,989
I knew that the 3-D aspect was not. That's why they collected the $35 up front. The procedure not covered was "computer-aided detection"- maybe using software to digitally scan the results in addition to a human? Why wasn't that part of the up-front payment if it was a necessary part of the 3-D? I'm a bit overdue for a colonoscopy and this has me feeling even less in-control of my medical costs. It will be coded diagnostic due to previous blips (which is why skipping it is NOT an option) and I have had zero success in finding out what the 2 facilities I'm considering will charge, all-in. The facilities tell me to ask my insurance company. The insurance company tells me to ask the facility. I have a $6K deductible so it's completely out-of-pocket and I'm finding it maddening that no one will give me an answer.
__________________
athena53 is online now   Reply With Quote
Old 09-28-2015, 10:55 AM   #5
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
pb4uski's Avatar
 
Join Date: Nov 2010
Location: Vermont & Sarasota, FL
Posts: 16,428
I would call them and tell them that was not part of the deal that they offered you and that you accepted. They offered you an upgrade to a 3D mammogram for $35 and that is what you accepted and paid for.

It sounds like they neglected (intentionally or not) to disclose to you that there would be an additional charge for reading the 3D mammogram. If they had disclosed that to you at the time you decided on the 3D mammogram then you would not have done it and they never got an authorization from you for the 3D reading charge so the fact that they went and did it is on them, not on you.

If you can't avoid the charge, then see if they will settle for $100 paid right now.... if not then file the appropriate complaints and objections and let the process play out.
__________________
If something cannot endure laughter.... it cannot endure.
Patience is the art of concealing your impatience.
Slow and steady wins the race.
pb4uski is online now   Reply With Quote
Old 09-28-2015, 11:19 AM   #6
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
travelover's Avatar
 
Join Date: Mar 2007
Posts: 9,888
I don't have a solid suggestion, but I totally agree with your outrage. It is like getting off a flight and being charged an additional $50 for the peanuts you ate and $100 for using the bathroom.
__________________
Yes, I have achieved work / life balance.
travelover is offline   Reply With Quote
Old 09-28-2015, 11:23 AM   #7
Thinks s/he gets paid by the post
 
Join Date: May 2014
Posts: 2,989
Quote:
Originally Posted by travelover View Post
I don't have a solid suggestion, but I totally agree with your outrage. It is like getting off a flight and being charged an additional $50 for the peanuts you ate and $100 for using the bathroom.
Sssshhhh. You're gonna give the airlines ideas!
__________________
athena53 is online now   Reply With Quote
Old 09-28-2015, 11:31 AM   #8
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
 
Join Date: Jul 2006
Posts: 11,018
Quote:
Originally Posted by athena53 View Post
Sssshhhh. You're gonna give the airlines ideas!
They already thought of that!

Paying to Pee: Ryanair's New Flight Bathroom Fee. Have Airlines Gone Too Far? - ABC News
__________________
Meadbh is offline   Reply With Quote
Old 09-28-2015, 12:09 PM   #9
Moderator
MichaelB's Avatar
 
Join Date: Jan 2008
Location: Rocky Inlets
Posts: 24,455
Quote:
Originally Posted by athena53 View Post
Where do I start? The hospital billing department (will they give a fig)? The insurer? The state Insurance Department?
I think you have to start by disputing the charge with the hospital, to take the complaint elsewhere you should be able to show you made a good faith effort to resolve. Your state insurance regulator is next, along with your health care insurance provider. I would also complain to your state Attorney General.
__________________
MichaelB is offline   Reply With Quote
Old 09-28-2015, 12:48 PM   #10
Recycles dryer sheets
 
Join Date: Feb 2012
Posts: 438
I had something similar happen last month. The heart monitor my dr. ordered was not covered by my insurance. The clinic said I could pay directly at around $200-300. No problem.

Apparently, the $200-300 is the negotiated rate; my rate was $900. Told them I was not paying it and would only pay the $200-300 I was told it would cost. No problem they said, we'll send you the bill. I dealt directly with the company, not the clinic or my insurance co.
__________________
TrvlBug is online now   Reply With Quote
Old 09-28-2015, 12:58 PM   #11
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
 
Join Date: May 2005
Posts: 13,275
First, have you received a bill from the hospital asking for the extra money If not, then do nothing....

When I went in for my colonoscopy they 'required' me to wear these boots that pushed blood from my legs up to my body... they said 'you will be able to keep them'... Why would I need them? I don't...

But, they billed the insurance company $1600 for these things... and then kept disputing the rejection (I know since I kept getting letters saying that MY dispute of the rejected charges did not change their mind)....

I have never heard from the hospital for payment... which if they tried to get the money I would refuse...
__________________
Texas Proud is offline   Reply With Quote
Old 09-28-2015, 04:55 PM   #12
Thinks s/he gets paid by the post
 
Join Date: May 2014
Posts: 2,989
Quote:
Originally Posted by Texas Proud View Post
First, have you received a bill from the hospital asking for the extra money If not, then do nothing....

When I went in for my colonoscopy they 'required' me to wear these boots that pushed blood from my legs up to my body... they said 'you will be able to keep them'... Why would I need them? I don't...

But, they billed the insurance company $1600 for these things... and then kept disputing the rejection (I know since I kept getting letters saying that MY dispute of the rejected charges did not change their mind)....

I have never heard from the hospital for payment... which if they tried to get the money I would refuse...

Wow- were they ostrich boots?

Yes, I do have the bill from the hospital. I'm non-confrontational and I hate Voice Menu Hell, but I'm going to call them tomorrow. I'll keep you posted.
__________________
athena53 is online now   Reply With Quote
Old 09-28-2015, 05:15 PM   #13
Moderator
Alan's Avatar
 
Join Date: Jul 2005
Location: Eee Bah Gum
Posts: 21,100
Quote:
Originally Posted by athena53 View Post
I'm a bit overdue for a colonoscopy and this has me feeling even less in-control of my medical costs. It will be coded diagnostic due to previous blips (which is why skipping it is NOT an option) and I have had zero success in finding out what the 2 facilities I'm considering will charge, all-in. The facilities tell me to ask my insurance company. The insurance company tells me to ask the facility. I have a $6K deductible so it's completely out-of-pocket and I'm finding it maddening that no one will give me an answer.
When DW and I had colonoscopies 2 or 3 years ago I made sure that the doctor and facility were both in network and when all the bills started flowing in everything was in-network and covered except 1 of the 2 labs that were used. HI refused to pay, and it took phone calls to the lab plus 2 formal complaints to the HI they finally paid ~$200 of the $1,500 bills (both I and DW) and I paid ~$60. The whole process took about a year to get resolved.

Good luck.
__________________
Retired in Jan, 2010 at 55, moved to England in May 2016
Now it's adventure before dementia
Alan is offline   Reply With Quote
Old 09-28-2015, 05:47 PM   #14
Thinks s/he gets paid by the post
mpeirce's Avatar
 
Join Date: Feb 2012
Location: Columbus area
Posts: 1,590
I find it interesting that my supposedly "crummy" pre-ACA HDHP/HSA health insurance that costs about half what I'd pay on the exchange, totally covered my recent colonoscopy. No co-pay, nothing. It was just included.
__________________
mpeirce is offline   Reply With Quote
Old 09-28-2015, 07:16 PM   #15
Thinks s/he gets paid by the post
 
Join Date: Dec 2014
Posts: 1,661
Quote:
Originally Posted by mpeirce View Post
I find it interesting that my supposedly "crummy" pre-ACA HDHP/HSA health insurance that costs about half what I'd pay on the exchange, totally covered my recent colonoscopy. No co-pay, nothing. It was just included.
Was this a diagnostic or preventative colonoscopy? Typically preventative are completely covered. However, if you go in for a preventative one and they find something... it converts to a diagnostic colonoscopy and you get more work done. Also, more procedures and labs get added. If you had a diagnostic colonoscopy completely paid for without reaching deductible or MOOP would be interesting.

Quote:
Originally Posted by athena53 View Post
I knew that the 3-D aspect was not. That's why they collected the $35 up front. The procedure not covered was "computer-aided detection"- maybe using software to digitally scan the results in addition to a human? Why wasn't that part of the up-front payment if it was a necessary part of the 3-D? I'm a bit overdue for a colonoscopy and this has me feeling even less in-control of my medical costs. It will be coded diagnostic due to previous blips (which is why skipping it is NOT an option) and I have had zero success in finding out what the 2 facilities I'm considering will charge, all-in. The facilities tell me to ask my insurance company. The insurance company tells me to ask the facility. I have a $6K deductible so it's completely out-of-pocket and I'm finding it maddening that no one will give me an answer.
The problem with getting estimates on a diagnostic procedure is they likely don't know all the procedures you will have unless they don't find anything. My insurance company has estimates for procedures by provider. However, it only covers the on procedure you input... not associated ones that may be done. I've had several insurers that had tools like this to compare estimated expenses. My PCP usually points me to reasonably affordable testing facilities.
__________________
bingybear is offline   Reply With Quote
Old 09-29-2015, 07:47 AM   #16
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
easysurfer's Avatar
 
Join Date: Jun 2008
Posts: 7,888
Quote:
Originally Posted by mpeirce View Post
I find it interesting that my supposedly "crummy" pre-ACA HDHP/HSA health insurance that costs about half what I'd pay on the exchange, totally covered my recent colonoscopy. No co-pay, nothing. It was just included.
My thought is that whether a doctor is in-network or not trumps the "crummy" or "not crummy" insurance. A couple of years ago, for my physical I was surprised to see that the cost of my physical with my doctor was not covered. I thought all preventative procedures were covered post ACA, but apparently not as he wasn't in-network.
__________________
Have you ever seen a headstone with these words
"If only I had spent more time at work" ... from "Busy Man" sung by Billy Ray Cyrus
easysurfer is online now   Reply With Quote
Old 09-29-2015, 08:26 AM   #17
Thinks s/he gets paid by the post
 
Join Date: May 2014
Posts: 2,989
Quote:
Originally Posted by bingybear View Post
The problem with getting estimates on a diagnostic procedure is they likely don't know all the procedures you will have unless they don't find anything. My insurance company has estimates for procedures by provider. However, it only covers the on procedure you input... not associated ones that may be done.
Yeah, that's a good point. In each of the previous tests they found something that needed to be excised. I can see how that isn't predictable. From one doc's office, though, all I could get was the self-pay rate for HIS fees. Costs for the hospital where it would be done? No, they couldn't tell me. The other doc operates in a free-standing facility so I may have better luck there, but I sent a question to their informational e-mail address and apparently no one answers e-mails.
__________________
athena53 is online now   Reply With Quote
Old 09-29-2015, 09:25 AM   #18
Thinks s/he gets paid by the post
 
Join Date: May 2014
Posts: 2,989
A hopeful update: I called the hospital and the young man who reviewed the file said that this is a "known issue" and he's registered my objection and sent it somewhere to be resolved. The fact that he said it's a known issue gives me some hope they'll waive it.
__________________
athena53 is online now   Reply With Quote
Old 09-29-2015, 10:07 AM   #19
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
Brat's Avatar
 
Join Date: Feb 2004
Location: Portland, Oregon
Posts: 5,914
In today's news there is a mention of a study about the utility of computer assisted mammography vs not computer assisted mammography. The computer assistance did not find more breast cancers. The other interesting fact is that 90% of mammograms are computer assisted and cost more. Computer-Aided Mammograms Bloat Costs, Don't Save Lives: Study - NBC News Doubtless the health care industry will question these results loudly.
__________________
Duck bjorn.
Brat is offline   Reply With Quote
Old 09-29-2015, 12:07 PM   #20
Give me a museum and I'll fill it. (Picasso)
Give me a forum ...
Lsbcal's Avatar
 
Join Date: May 2006
Location: west coast, hi there!
Posts: 5,686
Another terrible defect in our health care system: not knowing costs ahead of time and not knowing whether insurance or medicare will cover it.

Had a $1700 bill recently that fell into this category.

Grrr...
__________________

__________________
Lsbcal is offline   Reply With Quote
Reply


Currently Active Users Viewing This Thread: 1 (0 members and 1 guests)
 
Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts

BB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Trackbacks are Off
Pingbacks are Off
Refbacks are Off


Similar Threads
Thread Thread Starter Forum Replies Last Post
Lack of Transparency Still. Blood Tests. Rant. John Galt III Health and Early Retirement 25 02-17-2014 11:59 AM
New Issue and Reopened Issue Bonds CaptainO FIRE and Money 15 08-22-2013 11:16 AM
Heat Attack Grill Spokesman Dies of Heart Attack easysurfer Other topics 1 02-13-2013 04:55 AM
Purchase Research Transparency RonBoyd FIRE and Money 0 08-31-2009 01:36 PM
Transparency of risk, complexity, Overseas investing free4now FIRE and Money 13 10-22-2008 03:52 PM

 

 
All times are GMT -6. The time now is 10:41 PM.
 
Powered by vBulletin® Version 3.8.8 Beta 1
Copyright ©2000 - 2017, vBulletin Solutions, Inc.