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Old 06-21-2013, 03:44 PM   #21
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Yeah, I got it.

My deductible is $4k, so $10k won't apply for me. For Mulligan... it is different. I think his is real high.

It doesn't matter what I pay. Someone pays, and that's where the abuse is happening. But abuse is a relative term since there are so many players in this crazy process (doctors, insurance, lawyers and government).

P.S. To be clear, I don't think polyp removal is abuse. Now if you talk about the charge for it, yeah, I get it.
Joe, one thing is for sure which I have learned through this forum, is on top of all of it now, you have to be an expert in understanding billing coding. I will have to make sure I know the right questions to ask and prove they answered them correctly. Punching in an unfavorable code, can evidently hit a person in the wallet hard.
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Old 06-21-2013, 04:19 PM   #22
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Joe, one thing is for sure which I have learned through this forum, is on top of all of it now, you have to be an expert in understanding billing coding. I will have to make sure I know the right questions to ask and prove they answered them correctly. Punching in an unfavorable code, can evidently hit a person in the wallet hard.
Thanks. You know, I've read about the code thing here and elsewhere on this board, and forgot about once I was in the office. Well, it had a passing thought, but I let it go figuring I could worry later. My focus was on the doc and the issues at hand.

However, I probably should have brought up the billing ahead of time. Now I have to wrangle with this post-billing and that's hard.

Got to keep this in mind for the next procedure, but it is so darn hard. I worked in medical billing in the early 80's and it was tough then. (I was the guy on the other side of the phone getting yelled at.) It has just gotten worse and worse and what I did then does not really apply to today's madness.
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Old 06-22-2013, 09:45 AM   #23
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Thanks. You know, I've read about the code thing here and elsewhere on this board, and forgot about once I was in the office. Well, it had a passing thought, but I let it go figuring I could worry later. My focus was on the doc and the issues at hand.

However, I probably should have brought up the billing ahead of time. Now I have to wrangle with this post-billing and that's hard.

Got to keep this in mind for the next procedure, but it is so darn hard. I worked in medical billing in the early 80's and it was tough then. (I was the guy on the other side of the phone getting yelled at.) It has just gotten worse and worse and what I did then does not really apply to today's madness.
I agree, as I basically handled it the way you did a couple months ago when I went in for my annual physical that was three years late. My doctor works at a hospital facility and just sent me downstairs to do the blood work. All the way down I was thinking I am going to get screwed on this. I should go to an offsite facility somewhere. But l just kept walking toward the directed site like drone because it was too convenient. The bill was a little over a $100, which I guess wasn't too bad, except I did it on my own at a health fair at a nearby hospital a year ago for $10 that spit out the same results....Then I have read recently about concierge doctors bragging about getting their patients cholesterol checked for $3 by bypassing all the middlemen and paperwork costs....
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Old 06-22-2013, 11:02 AM   #24
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If we can learn one thing from Michael's initial post, it may be that we should do a lot of research before undergoing any kind of test or procedure.

The link to the PPACA information points up the reason that Healthcare is a 24,000 page package, and reading the "specifics" is so important. Naturally no one will ever "know" what's in the healthcare laws, but when it comes to the details, the time spent "Googling" the details, could pay off big time.

As a colon cancer survivor, this particular issue is very interesting.

We begin everything that has to do with health... by researching on-line. Before a doctor visit for any reason, we spend as much time as necessary (hours sometimes) researching the reason(s) we're looking for help. No one knows your body better than you do, so looking up symptoms, or following through on suspicions online, gives the doctor a jump start, and saves time.

Researching procedure costs by searching "cost of lumpectomy" (for instance) often brings up interesting results, such as whether a procedure or test can be done in a clinic or as an outpatient.

The maze of government regulations is usually there for a reason. Without regulation we are all subject to being overcharged. Those who suggest that regulation is always "too much" should consider what living in an uncontrolled society might be. We have a chance of staying ahead of the game, by looking before we spend.
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Old 06-25-2013, 05:52 AM   #25
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imoldernu- I might agree with that but a procedure which cost me nothing before, when market factors ruled the pricing structure now will cost me a substantial amount. IMO the government seems incapable of simplifying anything but constantly adds overhead to the cost. Insurance companies are for profit entities and as such, if you take away one revenue stream they will find another. It might be my libertarian bent, but this ride is going to be far bumpier than anyone wants to admit.

Mulligan - the concierge doctors are going to be a big part the health care of the future. My own doctors are saying they may change to a pay up front though they will help with getting reimbursement for me. SO now I can deal with the Insurance and federal bureaucracy.
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Old 06-25-2013, 09:41 AM   #26
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Originally Posted by imoldernu View Post
If we can learn one thing from Michael's initial post, it may be that we should do a lot of research before undergoing any kind of test or procedure.

The link to the PPACA information points up the reason that Healthcare is a 24,000 page package, and reading the "specifics" is so important. Naturally no one will ever "know" what's in the healthcare laws, but when it comes to the details, the time spent "Googling" the details, could pay off big time.

As a colon cancer survivor, this particular issue is very interesting.

We begin everything that has to do with health... by researching on-line. Before a doctor visit for any reason, we spend as much time as necessary (hours sometimes) researching the reason(s) we're looking for help. No one knows your body better than you do, so looking up symptoms, or following through on suspicions online, gives the doctor a jump start, and saves time.

Researching procedure costs by searching "cost of lumpectomy" (for instance) often brings up interesting results, such as whether a procedure or test can be done in a clinic or as an outpatient.

The maze of government regulations is usually there for a reason. Without regulation we are all subject to being overcharged. Those who suggest that regulation is always "too much" should consider what living in an uncontrolled society might be. We have a chance of staying ahead of the game, by looking before we spend.
+1
Well stated. After some initial surprises, we also take this approach.
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Old 07-16-2013, 09:32 AM   #27
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Joe, one thing is for sure which I have learned through this forum, is on top of all of it now, you have to be an expert in understanding billing coding. I will have to make sure I know the right questions to ask and prove they answered them correctly. Punching in an unfavorable code, can evidently hit a person in the wallet hard.
I made the mistake of not asking any questions before the procedure, and being too quick to get out of there. But I got lucky...

So, it turns out the good doc's office knows what they are doing and pressed the right buttons to spit out a correct billing code to my insurance. Despite the fact that doc snipped a polyp, insurance covered it 100%. This was even after I called my insurance earlier and they warned I might get an extra charge for the snip. I am still awaiting pathology which I know I'll be charged for. That's OK.

Overall, I'm very surprised and pleased.

However, since I'll have follow-ups to deal with, I'll be paying for those under my high deductible plan. It is OK, maybe in the neighborhood of $1k. I just consider it like a car repair. Like I've said before, I see too many people put out huge bucks on their car repair but refuse to go to the doctor because they "may have to pay."
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Old 07-17-2013, 07:10 PM   #28
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I went for initial consult today, I have individual 10k deductible policy, and by there own admission, if they remove a polop, proceedure turns diagnostic and not 100% covered, but a call to supposedly informed person at place doing procedure got me little info, seems it is impossible to nail down what cost will be. They did say I would be billed at a percentage of agreed to rates (Aetna).
Let to me to believe will be under $1k. I had thought of waiting till next year, assuming I am forced into a more expensive better plan, but at 55 and never had it done before, i just want to get it over with.
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