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Old 11-25-2011, 10:07 PM   #21
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There shouldn't be any loopholes, but the $7.5K MOOP covers eligible expenses.
+1

I'm curious to see how much that $33k bill will be reduced by the insurance company. I wouldn't be surprised to see the amount cut by 30 to 50%. Unfortunately I don't think that will have any impact on your $7,500 out of pocket amount.
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Old 11-27-2011, 02:54 PM   #22
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+1

I'm curious to see how much that $33k bill will be reduced by the insurance company. I wouldn't be surprised to see the amount cut by 30 to 50%. Unfortunately I don't think that will have any impact on your $7,500 out of pocket amount.
+1

The year I had back surgery I hit my MOOP of $5k. Later that year DW had to have surgery and when I arrived the day after to bring her home they insisted I pay the full 20% co-pay of approx $5k before they would release her. I told them I should be paying zero, and why, and to contact my insurance. They called but it was a Saturday, so I had to pay to get her out.

The insurance paid the full amount and after a few weeks I called the hospital to ask about my money. They confirmed I had a credit of $5k but were just going to leave me in credit for the next time we needed care I asked them for my money and they sent a check.
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Old 11-28-2011, 01:33 PM   #23
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But, at the bottom, it says "PAY THIS AMOUNT 0.00." So my guess is that they are telling us not to pay this now, and wait for the insurance company to be billed.
We get those kind of bills too from the hospital where DW's labwork is sent.

And you will probably get other bills from other medical service providers at the hospital. Surgeon fees, forensics, pathology, hematology, lab work, radiology, anesthesiology etc.

A note on the max out of pocket - it will usually include all the stuff that you are paying a percentage on, but not include your co-pays. So if you paid $400 for various copays throughout the year, then that will not add to your Max out of Pocket amount. Of course you may have a High Deductible plan, in which case you aren't paying copays just the large deductible then coinsurance.
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Old 11-28-2011, 02:30 PM   #24
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I hit my MOOP of $10k every year and have for the last 7 years and my RE budget assumes it.

If my wife gets better or off of the expensive medications then Whoopee!
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Old 11-28-2011, 02:43 PM   #25
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I have never heard of a hospital that could hold a patient hostage until the bill was paid!!! I think I would file a complaint with the state agency that licences your hospitals. If you are on Medicare I would file a complaint with them too.
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Old 11-28-2011, 03:00 PM   #26
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I have never heard of a hospital that could hold a patient hostage until the bill was paid!!! I think I would file a complaint with the state agency that licences your hospitals. If you are on Medicare I would file a complaint with them too.
I had turned up to collect her and was told I needed to go down to the cashier to get a release. When I got back to the ward, DW was still waiting in a wheel chair with the nurse on the ward. After I told her why it had taken so long she was pretty ticked at me for haggling over payment as she was ready to get back home.

This was 1990, less than 3 years after we moved here from England, so I didn't really know what was normal for the USA. I certainly don't recall having to pay on release when I had my back surgery earlier that year in a different hospital. It is very strange looking back on that Saturday morning arguing with the cashier in the hospital to release my wife.
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Old 11-28-2011, 03:24 PM   #27
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This was 1990, less than 3 years after we moved here from England, so I didn't really know what was normal for the USA. ... It is very strange looking back on that Saturday morning arguing with the cashier in the hospital to release my wife.
Now you know the proper thing would be to call 911 and report a hostage situation...
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Old 11-29-2011, 12:13 PM   #28
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The hospital here in Bellingham WA pre-bills the patient a certain amount which is non-trivial. They claim they talk to the insurance company to arrive at an estimate of what the patient's obligations will be. Until recently I believed them but now I am not so sure. We recently ran up substantial medical bills and before the last hospital stay were near our catastrophic limit. The remaining before the limit was reached would depend on how the bills went through and it was possible we would exceed it on doctor bills alone before the hospital bill went to the insurance company. Nevertheless we were required to make a pre-pay of $1240 before we could be admitted. I am just waiting to see what is going to happen since the insurance company seems to be resolving the smaller bills first with my approach to the limit becoming likely. All the hospital bills are in negotiation (progress).
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Old 12-26-2011, 10:34 AM   #29
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+1

I'm curious to see how much that $33k bill will be reduced by the insurance company. I wouldn't be surprised to see the amount cut by 30 to 50%. Unfortunately I don't think that will have any impact on your $7,500 out of pocket amount.
The $33,000 bill was reduced to $3,000. We're up to $5,286 total payments for this year. Maybe we won't hit the max out of pocket, which will be nice, since I've been figuring a $7,500 hit this year.
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Old 12-26-2011, 10:39 AM   #30
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Wow, the bill was reduced by 91%. My 30 to 50% guess wasn't far off was it?

Nice Christmas present!
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Old 12-26-2011, 11:56 AM   #31
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Meanwhile, people who have no insurance coverage would be faced with the full $33,000 bill, instead of the $3,000 which seems like what the real value of the services is. What a broken system. Glad your insurance worked so well for you.
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Old 12-26-2011, 03:36 PM   #32
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The $33,000 bill was reduced to $3,000. We're up to $5,286 total payments for this year. Maybe we won't hit the max out of pocket, which will be nice, since I've been figuring a $7,500 hit this year.
That is steep. Like REWahoo, I thought 30 - 50% because that mirrors our experience. The only expenses I see cut by 90% are LabCorp.
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Old 12-28-2011, 10:43 AM   #33
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Meanwhile, people who have no insurance coverage would be faced with the full $33,000 bill, instead of the $3,000 which seems like what the real value of the services is. What a broken system. Glad your insurance worked so well for you.
Actually, it depends. In many cases, the hospital has to write off the WHOLE bill as the patient can not pay it (blood from a turnip sort of thinking). IOW, those who can afford insurance, (usually) have it and get the negotiated price. Those who can not afford insurance often can't pay their full-ride bill at all.

I agree that the system is broken.

Guess who actually pays in the end.
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