I'm freaking out over health insurance

[Sarah S]

That was DISCOUNTED Yikes! From what? Any chance that they coded the wrong test? I imagine not as I expect you can see the service in plain English but it just seems wrong that a plain ultrasound is so expensive

 

[daylatedollarshort]

That was DISCOUNTED Yikes! From what? Any chance that they coded the wrong test? I imagine not as I expect you can see the service in plain English but it just seems wrong that a plain ultrasound is so expensive

I just noticed they do not have the actual test name in the services description but instead something generic so I'm going to follow up on that. The initial bill from the hospital was $2K more.

DH pointed out that one of our family members had out patient surgery last year (different hospital) and the hospital bill was about that same, and I negotiated that down a fair bit. So why should a test that took under an hour at one hospital cost in the same magnitude as the hospital costs for surgery that took an hour or two at another hospital? We're going to have to drive further and change our hospital / doctor network to one in a lower cost of housing suburb or we will both be hitting our out of pocket maxes every year even when we're healthy.

 

[CardsFan]

I just noticed they do not have the actual test name in the services description but instead something generic so I'm going to follow up on that. The initial bill from the hospital was $2K more.

Something does not sound right with this billing. DW just had an MRI. The billing charge was about $2,800. The plan allowed amount was about $850. And an MRI should cost a lot more than an ultrasound.

FWIW, this was at an imaging center, but it is operated by a hospital.

 

[Sarah S]

I would start with my insurance. I had a denied claim so I called them of course. It turned out the problem was a miscode both of the service and the diagnosis.

I understand this is different but your insurance may be more helpful and they should be able to tell you both the service billed and the charge allowed for what you really had if they are different. You might want to dig up the relevant codes online to be prepared

FWIW I had an ultrasound ( cardiac echo) at a Boston hospital and the charge for the procedure and the doctor's interpretation ( billed separately) was around 1100 after discount. The original charges were a little over 2000. This was last fall

 

[photoguy]

My doctor recommended that I have an ultrasound test recently. The test lasted under an hour and the bill came to almost $5K.

Was this a specialized/non-standard test? Under Covered California, I thought diagnostic imaging was a flat copay amount.

 

[daylatedollarshort]

Was this a specialized/non-standard test? Under Covered California, I thought diagnostic imaging was a flat copay amount.

I don't think it was anything out of the ordinary. I know it didn't take long because I was running late so I had DH drop me off at the front entrance and then I called him to pick me up, and the call time is on my cell phone. So a little over an hour elapsed from when he dropped me off and picked me up, and in between a lot of my time was spent in admissions and the waiting room.

DH says apparently I was suffering from an enlarged wallet and they had the cure for that.

 

[MichaelB]

I don't think it was anything out of the ordinary. I know it didn't take long because I was running late so I had DH drop me off at the front entrance and then I called him to pick me up, and the call time is on my cell phone. So a little over an hour elapsed from when he dropped me off and picked me up, and in between a lot of my time was spent in admissions and the waiting room.

DH says apparently I was suffering from an enlarged wallet and they had the cure for that.

Hospitals, clinics, and many specialists are billing not based on the services given but instead on what is potentially billable. In other professions that would be called "overbilling". You should check the billing codes, which should be on the EOB, and be prepared to challenge it.

 

[daylatedollarshort]

Hospitals, clinics, and many specialists are billing not based on the services given but instead on what is potentially billable. In other professions that would be called "overbilling". You should check the billing codes, which should be on the EOB, and be prepared to challenge it.

Yes, I will challenge it. I didn't notice the missing test name in the services description until this thread prompted me to look at the EOB closer.

 

[photoguy]

It looks like in CA, the cost of diagnostic imaging can vary from patient pays full cost (bronze) to a flat copay of varying amounts (silver & up):

https://www.coveredca.com/PDFs/2017-Health-Benefits-table.pdf

I had not realized there was that big a difference between bronze and silver.

 

[Fedup]

I wonder what's the difference in yearly price for Bronze and platinum plan. With $5000 for imaging. It might make sense to buy platinum.

 

[FUEGO]

I looked up the prices online and the web sites that have averages for medical services showed the $5K was way out of line with what these kinds of tests normally cost on average in the U.S. I live in a high cost of living area so I would not feel so ripped off at even the high end of the range but what they charged me was crazy high. We're just shocked that I could almost reach my out of pocket annual max over a 45 minute test.

We visited a neonatal cardiopulmonary radiologist (I think I remember the medical specialty correctly ) for a brief consult just before our third kid was born. 10 minutes. $3500.

Result: "medically unremarkable" which means things are normal I guess. $3500 for 10 minutes of work is nice if you can get it. Of course they probably spent an hour or two behind the scenes making notes to protect against a medical malpractice lawsuit, and filing with the insurance, and fighting to get paid by insurance. So on second thought, the money isn't that great.

I can't remember the negotiated discount and what we paid but it was shockingly high for such a short visit. We thought it was at a regular doctor's office but it was next door to the local hospital, so I assume they charged as a hospital.

 

[Meadbh]

We visited a neonatal cardiopulmonary radiologist (I think I remember the medical specialty correctly ) for a brief consult just before our third kid was born. 10 minutes. $3500.

Result: "medically unremarkable" which means things are normal I guess. $3500 for 10 minutes of work is nice if you can get it. Of course they probably spent an hour or two behind the scenes making notes to protect against a medical malpractice lawsuit, and filing with the insurance, and fighting to get paid by insurance. So on second thought, the money isn't that great.

I can't remember the negotiated discount and what we paid but it was shockingly high for such a short visit. We thought it was at a regular doctor's office but it was next door to the local hospital, so I assume they charged as a hospital.

A neonatal cardiopulmonary radiologist (who in my experience is usually a pediatric cardiologist) has years of very specialized training. Imaging and interpreting the anatomy of a thumbnail sized fetal heart through the mother's abdominal wall is a completely different level of complexity from interpreting the anatomy of an adult on ultrasound (the OP did not state what part of her anatomy was examined).

 

[marko]

Of course they probably spent an hour or two behind the scenes making notes to protect against a medical malpractice lawsuit, and filing with the insurance, and fighting to get paid by insurance. So on second thought, the money isn't that great.

.

And that's why my PCP dropped taking all insurance and can now charge a flat $995 annual fee instead. He got rid of 3-4 people who chase insurance all day long and then fight to get paid and has no "15 minute" insurance limit.

He now has one receptionist, can see me within hours and can spend as long as he needs with me. My last visit he spent over 45 minutes with me.

 

[ShokWaveRider]

I think people mention single payer for everybody and not just Medicare age. And that was what I was referring to. Everywhere you read on the internet, especially on some forums, people keep mention we need single payer. We already have Medicare which is a single payer for 65 and over. If that's what they refer to, I'm sure there is no need to say we need single payer. We already have single payer like VA and Medicare.

How about "Single Payer" for all. Currently it is only for a select few.

 

[ShokWaveRider]

I found that hospitals are the Most expensive place to have any form of testing done. I recently shopped around for a stress test and it was $185 at a non hospital facility, it was $7k at the local hospitals. Blood Tests are 10x what they are at independent facilities. A Halter Monitor was a fraction of the hospital costs. My last ultrasound was $15 CoPay.

I have had to train my cardiologist as he just orders the test from the most convenient place (for him)..... the hospital. Now he just gives me the order and/or asks where I want it done. But I also changed my Cardiologist to one that works out of an independent facility. Not because I did not like my original one, but because of the facility, I really like the cardiologist. He also has MRI, CT, XRay facilities too if ever I need them. Now all tests are a sensible price and covered by insurance.

Over my lots of traveling years I have learnt not to be married to your doctor. I honestly do not care who they are as long as they do their job. I honestly see them so rarely. Cardiologist 1 time per year, GP 1 time per year. Regular tests because of my pacemaker 2 times per year for the testing technician. Blood Tests 2 times per year.

The other thing I noticed is the hospitals estimate of what the services will cost is never accurate at all. I learnt that the hard way and prompted me to do a little research. within 30 minutes, I had found 10 alternatives.

Perhaps if we used hospitals for what they were designed for, they would be more economical.

 

[travelover]

A neonatal cardiopulmonary radiologist (who in my experience is usually a pediatric cardiologist) has years of very specialized training. Imaging and interpreting the anatomy of a thumbnail sized fetal heart through the mother's abdominal wall is a completely different level of complexity from interpreting the anatomy of an adult on ultrasound (the OP did not state what part of her anatomy was examined).

So, given the skill required, that $3500 charge was reasonable.

 

[Fedup]

How about "Single Payer" for all. Currently it is only for a select few.

You should read my post. There is only a few countries have them. Last I've heard the VA system was not so hot.
But I try to refrain from making political comment. But how about giving back all your wealth for free healthcare?

 

[ShokWaveRider]

You should read my post. There is only a few countries have them. Last I've heard the VA system was not so hot.
But I try to refrain from making political comment. But how about giving back all your wealth for free healthcare?

I am a Canadian Citizen and a UK Citizen. Whatever you call those systems. They work, ours here does not (Based on the numbers of completely covered US citizens and those with no coverage at all. Cost in Canada at my income level is between $150 and $182 per month for me an DW No Deductibles no Copays. Depending on the Province. This covers basically 100% of Canadian Citizens, AKA a working System.

That is the fallback, but it is too cold up there. .

ACA worked for us. This year it is $145pm for me a DW + $4000 OOP no Deductible. I am happy with that.

 

[pb4uski]

Yes, I will challenge it. I didn't notice the missing test name in the services description until this thread prompted me to look at the EOB closer.

Given the amount involved, unless you think you can make a lot of progress on your own it may be worth getting one of those medical billing advocates involved to make sure that the bill is correct and you are paying the least amount possible.

https://www.nerdwallet.com/blog/hea.../patient-advocates-medical-billing-advocates/

I have not yet used one, but I wonder if any others on the forum have and would be willing to share their experiences.

 

[Fedup]

I am a Canadian Citizen and a UK Citizen. Whatever you call those systems. They work, ours here does not (Based on the numbers of completely covered US citizens and those with no coverage at all. Cost in Canada at my income level is between $150 and $182 per month for me an DW No Deductibles no Copays. Depending on the Province. This covers basically 100% of Canadian Citizens, AKA a working System.

That is the fallback, but it is too cold up there. .

ACA worked for us. This year it is $145pm for me a DW + $4000 OOP no Deductible. I am happy with that.

But the U.K. And Canada people have been paying them all these years with very high tax, same with other countries in Europe. In fact from what I've read, if the U.K. were to start single payer today they can't afford it. Lately, what I've read is the U.K. is going to increase tax on inheritance to fund NHS. My husband said he still has a full set of teeth while his sister doesn't. He prefers the US system.

 

[Alan]

Lately, what I've read is the U.K. is going to increase tax on inheritance to fund NHS.

Where did you hear that because they have just decreased inheritance tax income, beginning this tax year by excluding part of the value of the family house. Inheritance tax in total amounts to less than 1% of tax revenues and even the record high in 2016 of inheritance tax revenues was less than £5B (NHS spending is about £120B)

Tax revenue sources in UK | Economics Help

http://www.thisismoney.co.uk/money/...boom-inheritance-tax-revenues-five-years.html

 

[ivinsfan]

But the U.K. And Canada people have been paying them all these years with very high tax, same with other countries in Europe. In fact from what I've read, if the U.K. were to start single payer today they can't afford it. Lately, what I've read is the U.K. is going to increase tax on inheritance to fund NHS. My husband said he still has a full set of teeth while his sister doesn't. He prefers the US system.

YMMV, I have a cousin in the UK that suffered with intense sciatica pain starting in the Spring of 16. When I saw her November she was just starting to be able to get around without pain .I got a note from her saying she had been to a pain management clinic on April 20 2017...that's how long it took her to get in... one year. Ironically her pain is gone but she went to the clinic in case she had a flare up sometime. She told me that's just the way things work over here.

 

[Meadbh]

So, given the skill required, that $3500 charge was reasonable.

I didn't necessarily say that. I said that this is a relatively complex diagnostic test in terms of expertise. In the US healthcare marketplace it could be highly priced. in Canada, the physician would be billing a couple of hundred dollars.

 

[LARS]

The healthcare equation in the United States is seriously screwed up. And from what I can tell no politician is truly focused on the real issue.

Indeed, the current Healthcare debate, like much debate in this country, is akin to discussing the placement of the deck chairs aboard the Titanic.

The US spends approximately 17% of GDP annually on healthcare. According to data from the World Bank other industrialized high income nations (like Canada, France, Finland, Germany, Australia, etc.) spend approximately 12%.

If we could reduce the difference by half (or approximately 2.5% which would still leave the US spending 20% more than the average) that would equate to a savings of $500 billion annually. The CBO estimates the cost of ACA at $136 billion a year as a referendum point.

The real discussion ought to be how to increase efficiency, and eliminate waste, in the Healthcare delivery system. We, as a nation, need to understand the reasons why the US spends 42% more on healthcare compared to comparable countries. And using average life expectancy as a proxy suggests the US is not getting its money's worth.

 

[Fedup]

Where did you hear that because they have just decreased inheritance tax income, beginning this tax year by excluding part of the value of the family house. Inheritance tax in total amounts to less than 1% of tax revenues and even the record high in 2016 of inheritance tax revenues was less than £5B (NHS spending is about £120B)

Tax revenue sources in UK | Economics Help

UK Treasury sees 70% boom in inheritance tax revenues in five years | This is Money

My husband said it's from the Economist. But I don't know if I can find the link. I found it, but there are other links out there for the same article, so it's not far fetching idea.
http://www.economist.com/news/brita...ocial-care-paid-order-bolster-national-health