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Old 04-02-2015, 09:58 AM   #21
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utrecht -
First - sorry to hear you're dealing with back pain issues. And glad to hear they are on the mend.

I agree that the scheduler is not the issue. They are going for the 1 stop shop solution (hospital) as the easiest place to schedule your procedures... It's a lot more work to keep track of charges etc of smaller providers.

On the medical billing vs services front. My husband is getting a colonoscopy today. He tried calling to make sure it would be billed as preventative. The provider referred him to his insurance company, which referred him to his primary, who referred him back to the GI clinic provider. We *think* the procedure will be free... but have absolutely no assurance of this. Earlier this year we had an issue with one of our sons that put him under a series of appointments. He recovered nicely, but the primary provider for his issue kept insisting he continue care. I mentioned we were on a high deductible plan and were paying a lot for each appointment and POOF she changed her tune. She suddenly agreed he didn't need to be seen as frequently and we could monitor the situation a lot less frequently. She was happy to drop the frequency when she realized we were paying the bills ourselves (due to the deductible) but prior to knowing that she was insistent he be seen frequently. Very eye opening that a diagnosis and course of action is 100% insurance plan dependent.

Our medical system is broken. As consumers they make it hard to figure out the balance between adequate care and cost.
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Old 04-02-2015, 10:35 AM   #22
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Originally Posted by imoldernu View Post
All in all, many, many thousands of dollars (mostly medicare or insurance) and many, many hours...that might have been saved with a little more open minded study, and a realization that while doctors do their best, but are not gods.

Had to get this rant out of my system.
Very true, especially when there's so much on the Web. DH has a rare condition (polycythemia) and even though he trusts his doctor, he's found that networks of people who actually have the disease are a great resource. You can get the best doctors, but it's your body and your money and you live with the consequences of whatever treatment decisions are made. Best to be informed.

This discussion spurred me to look into the cost of my upcoming colonoscopy. I was relieved to find that the doc who's been doing mine and the hospital where it's being done are both in-network (I got a private plan after retiring last year). The estimate for in-network on my insurer's Web site is manageable ($1,300-$1,500) even if they don't code it as preventative (could happen with my history). It's still going to take some phone calls to see if the insurer's estimate is right. OTOH, having had a HS classmate die as a result of an intestinal puncture during a colonoscopy, I'm not going to hunt for the lowest bidder.
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Old 04-02-2015, 11:54 AM   #23
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Originally Posted by rodi View Post
On the medical billing vs services front. My husband is getting a colonoscopy today. He tried calling to make sure it would be billed as preventative. The provider referred him to his insurance company, which referred him to his primary, who referred him back to the GI clinic provider. We *think* the procedure will be free... but have absolutely no assurance of this. Earlier this year we had an issue with one of our sons that put him under a series of appointments. He recovered nicely, but the primary provider for his issue kept insisting he continue care. I mentioned we were on a high deductible plan and were paying a lot for each appointment and POOF she changed her tune. She suddenly agreed he didn't need to be seen as frequently and we could monitor the situation a lot less frequently. She was happy to drop the frequency when she realized we were paying the bills ourselves (due to the deductible) but prior to knowing that she was insistent he be seen frequently. Very eye opening that a diagnosis and course of action is 100% insurance plan dependent.

Our medical system is broken. As consumers they make it hard to figure out the balance between adequate care and cost.
I've also been having a very frustrating time with medical billing this last couple of years. I posted about my and DW's issues with our last colonoscopies where we used an in-network facility, doctor and anesthetist and when the bills came through there were lab tests from 2 different labs, one in network and one out of network. The out of network lab costs were $1,500 for the 2 of us and it took a year of phone calls and 2 written appeals before my HI company paid $330 and I paid $60.

A month ago I (after DW persuaded me) decided to have a skin cancer check and went to an in-network dermatologist. I did have a small cyst on my cheek that is a nuisance that I try and shave carefully but do cut from time to time. The doc said it was nothing but I asked what it would cost to have it, recognizing that this was elective and not covered by insurance. $180, which I happily paid and he did a great job a week later, already can't see a scar, took less than 30 minutes for the appointment, stitches out a week later by a nurse.

Today I received an EOB for that visit (I'd already had the EOB for the screening which was a $30 copay). The HI paid up and I only needed to pay a $30 co-pay, so I'll call the clinic in a week or so for the $150 they now owe me. However, to me this is another example of a broken system. No insurance, the cost is $180, but he filed for $555, they paid $380, plus my co-pay and he now has $410 instead of $180. (The cyst was also sent off for a lab test to an in network lab)
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Old 04-02-2015, 12:10 PM   #24
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A month ago I (after DW persuaded me) decided to have a skin cancer check and went to an in-network dermatologist. I did have a small cyst on my cheek that is a nuisance that I try and shave carefully but do cut from time to time. The doc said it was nothing but I asked what it would cost to have it, recognizing that this was elective and not covered by insurance. $180, which I happily paid and he did a great job a week later, already can't see a scar, took less than 30 minutes for the appointment, stitches out a week later by a nurse.



Today I received an EOB for that visit (I'd already had the EOB for the screening which was a $30 copay). The HI paid up and I only needed to pay a $30 co-pay, so I'll call the clinic in a week or so for the $150 they now owe me. However, to me this is another example of a broken system. No insurance, the cost is $180, but he filed for $555, they paid $380, plus my co-pay and he now has $410 instead of $180. (The cyst was also sent off for a lab test to an in network lab)

I think the key was it interfered with your shaving. I've had several moles/cysts removed and were paid for by insurance if there was any irritation, or interference with daily routines.
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Old 04-02-2015, 12:16 PM   #25
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This is a least as big if not bigger problem than the whole situation that Obama tried to fix with Obamacare. He tried to give access to healthcare to everyone which is great (no matter what your opinion on how well its working), but fixing these billing issues, over charging and things like that is a massive problem. I should start a health care consultation service that teaches people how to save money on their medical procedures....except I'm retired and dont plan on working again. Someone could make a lot of money.
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Old 04-02-2015, 12:35 PM   #26
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I think the key was it interfered with your shaving. I've had several moles/cysts removed and were paid for by insurance if there was any irritation, or interference with daily routines.
I agree, but the point of my story is that I was told it was not going to be covered so I paid what I expected was the full cost of $180, but by filing he charged $555 and received $410. Just another example of the lack of transparency in costs.
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Old 04-02-2015, 01:19 PM   #27
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My health insurance company is not very good at customer service. They can be clueless and vague, and say things like "just make sure everything is in network, but even then there may be *uncovered expenses* that you will have to pay for, and we can not and will not tell you what they might be ahead of time. Good luck". Argggghh!!! However, I must say their website has a pretty good cost estimator feature. I used it last month to get an estimate for a full body check at dermatologist, along with *destruction of cyst* at the specific dermatologist I was planning on using. The website said it would come out to $89 to $130 my cost out of pocket. It was correct. The actual cost to me was $116. I do not love my health ins co, but at least their estimator is working! Oh, and they do often remind the customer that anything done in a hospital is probably much more expensive than at an independent facility.
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Old 04-02-2015, 01:23 PM   #28
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Hospitals charge as much as they can, everywhere they can, period. The prices of their services are based on value and ability to pay, not the cost of service. This is a business model, to maximize revenue and control cost. Billing complexity, secrecy and obfuscation are strategies and tactics.

This has been underway, and growing, for decades. It is like hardening of the arteries. It happens slowly and over a long period of time, no one notices it while it is developing, and when we finally realize we suffer from it we also discover there is no cure, at best we can only find a way to live with it.
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Old 04-02-2015, 01:53 PM   #29
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Hospitals charge as much as they can, everywhere they can, period. The prices of their services are based on value and ability to pay, not the cost of service. This is a business model, to maximize revenue and control cost. Billing complexity, secrecy and obfuscation are strategies and tactics.

This has been underway, and growing, for decades. It is like hardening of the arteries. It happens slowly and over a long period of time, no one notices it while it is developing, and when we finally realize we suffer from it we also discover there is no cure, at best we can only find a way to live with it.
That's exactly what I thought and what I found out. My doctor has offices in two hospitals. Both are Presbyterian hospitals. Same doctor, hospitals owned by the same people. One is in West Plano which is a very expensive area. The other is in Rockwall which is a very nice area but not nearly as expensive. The doctor charges the same amount either place. The hospital charges double in Plano. People expect to pay more for a pair of shoes in a ritzy mall but I doubt that they expect to pay twice as much for a medical procedure.
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Old 04-02-2015, 02:23 PM   #30
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.... About 2 months ago I hurt my back. Ive had back problems forever and know how to manage it but did something stupid and hurt it badly.
Utrecht, how did you hurt your back?
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Old 04-02-2015, 03:20 PM   #31
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Utrecht, how did you hurt your back?
We retired in Jan and are moving to Florida in June. I have some projects around the house to catch up on in preparation of selling the house. I had some loose ceramic floor tiles and had a box of tiles in the attic. I was trying to get the box down. It was really heavy. There's not enough room to stand up in that area of the attic so I was standing on the attic stairs, leaning over and reaching far back to where the box was. It was stuck on something and I was twisted trying to reach it. I lifted the heavy box while bent over and twisted. Anyone who has ever had a bad back knows that's the perfect storm of back injuries. Ive done such a good job of managing it over the past 20 years that it hasnt bothered me in a while and I got careless. Then to make matters worse, I laid the tiles with an already sore back and that was the straw that broke the camel's back.....pun intended.

Hey, at least I learned a lesson and haven't grouted it. I'm going to teach my 16 year old son how to do it very shortly.
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Old 04-02-2015, 03:34 PM   #32
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Thanks for the reply. By the way, you made it really easy to picture how the injury occurred. I understand exactly what you did (and probably why you did it that way). At my age I try to remember not to do stuff like that. It's very easy to get careless or sloppy or lazy. (Been to all three of those places myself). Over the years I've learned to take my time and maybe would have taken a few tiles out of the box at a time. But, it feels so whimpy and aggravating to do it that way. It's also time consuming.


Anyhow, I hope you find the best course of treatment for your back. Hope your retirement to Florida is the best (or at least one of the best) moves you ever made and hope that your son enjoys grouting.
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Old 04-02-2015, 04:24 PM   #33
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Thanks for the reply. By the way, you made it really easy to picture how the injury occurred. I understand exactly what you did (and probably why you did it that way). At my age I try to remember not to do stuff like that. It's very easy to get careless or sloppy or lazy. (Been to all three of those places myself). Over the years I've learned to take my time and maybe would have taken a few tiles out of the box at a time. But, it feels so whimpy and aggravating to do it that way. It's also time consuming.


Anyhow, I hope you find the best course of treatment for your back. Hope your retirement to Florida is the best (or at least one of the best) moves you ever made and hope that your son enjoys grouting.
Thanks a lot!
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Old 04-02-2015, 05:03 PM   #34
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+1 I find it infuriating that medical professionals have no idea of the cost of the services that they recommend and no apparent inclination to find out. It also seems like a missed opportunity for insurance companies to have a referral service to send patients to the most cost effective facility for a given procedure, when literally thousands of dollars can be saved for a few minutes research.

When you are an employed physician you lose control over what you charge. Each insurance company contracts with you to provide services and each contract has a different reimbursement amount for each service.

I spent an hour once trying to find out what our parent company has us bill for a procedure in order to provide that information to a cash paying patient. It was maddening.

Most doctors are now employed and not independent, since they are now required to purchase electronic medical record systems that cost 6 figures. It us much more difficult to know what you charge when you are kept far away from billing.

So the answer to the cost of each procedure is "it depends". We can thank insurance systems and the rise of billing insurance companies directly half a century ago for the current state of things.

The insurance companies pay the contracted rate, then what the patient pays depends on their particular plan. If both facilities are in-network, then you really should be paying only your portion of the allowed amount, as balance billing is not allowed when you are in-network.


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Old 04-02-2015, 05:38 PM   #35
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When you are an employed physician you lose control over what you charge. Each insurance company contracts with you to provide services and each contract has a different reimbursement amount for each service. <snip>
Thank you for a knowledgeable explanation.
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Old 04-02-2015, 07:36 PM   #36
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I have had the ESI in my lower back a few times. It was always done in the doctor's office. The only medication I had was lidocaine to numb the injection site. No sedation was necessary as it only takes 5 minutes.
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Old 04-02-2015, 08:05 PM   #37
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When you are an employed physician you lose control over what you charge. Each insurance company contracts with you to provide services and each contract has a different reimbursement amount for each service.

I spent an hour once trying to find out what our parent company has us bill for a procedure in order to provide that information to a cash paying patient. It was maddening.

Most doctors are now employed and not independent, since they are now required to purchase electronic medical record systems that cost 6 figures. It us much more difficult to know what you charge when you are kept far away from billing.

So the answer to the cost of each procedure is "it depends". We can thank insurance systems and the rise of billing insurance companies directly half a century ago for the current state of things.

The insurance companies pay the contracted rate, then what the patient pays depends on their particular plan. If both facilities are in-network, then you really should be paying only your portion of the allowed amount, as balance billing is not allowed when you are in-network.
I understand how it works and don't take this personally, but it is a big deal to a patient if a drug costs $4 a month or $1000, especially if they have a high deductible policy. Similarly, sending someone off to get an MRI or similar procedure with no guidance can cost them thousands, as has been highlighted in other posts here. It might not be reasonable for docs to know exact pricing for everything, but they should be generally aware of what is expensive and what is likely not covered by most insurances. That way patients can make informed choices.

I like my docs and they work hard, but my observation is that they seem to live in a somewhat academic world compared to the cost effective world that I worked in. It is frustrating, and with medical care at $8000+ a person per year, unsustainable.

Rant off.
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Old 04-02-2015, 08:16 PM   #38
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I have had the ESI in my lower back a few times. It was always done in the doctor's office. The only medication I had was lidocaine to numb the injection site. No sedation was necessary as it only takes 5 minutes.
Me too, but a long time ago. How long ago were yours?
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Old 04-02-2015, 08:18 PM   #39
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I like my docs and they work hard, but my observation is that they seem to live in a somewhat academic world compared to the cost effective world that I worked in.
I don't disagree but I'm also (very slightly) aware of how hard it must be for a physician to stay current with medicine and all the rapid advances even if they specialize in a narrow field. Frankly I'd prefer they spend their limited "study time" on medical stuff and not insurance stuff.

There really isn't a perfect answer. Every system in every country has advantages and disadvantages.
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Old 04-02-2015, 10:58 PM   #40
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You would think that the insurance companies would know the costs and would encourage their customers to use the services of the cheaper places.

I have been getting ultrasounds for the past 3 years at the hospital that my doctor's office suggested. I never even thought that other places could do them for less. I need to keep this in mind for the next time.
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