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Old 04-02-2015, 11:24 PM   #41
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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.
It will be cheaper at an imaging center than at a hospital. My doctor offers an even less expensive option - he has an ultrasound technician come in every Friday and do the scan in his office.
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Old 04-03-2015, 09:33 AM   #42
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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.
I'd agree if it is an either or choice.

This is simplistic, but as an example, in our engineering department, we went through a lot of very expensive test equipment. I had a tech who maintained and replaced this equipment put a label on each piece showing how much it cost. Engineers were shocked to see that a single accelerometer cost $1000. This greatly reduced lost and damaged equipment, just from a heightened awareness.
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Old 04-03-2015, 10:48 AM   #43
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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.
Thanks for this clarification. When I checked my health insurance company's site (Coventry) for estimated costs of procedures, they had something like 30 plans- and that, I presume, is just our state. I can see that the same doctor might have agreed to a different reimbursement rate for each plan- and that's only one insurer. (I know my primary physician accepts my Coventry plan but not the one bought from the Exchange.)

I'm not due for a colonoscopy for another 3 months but I may need that much time to get answers!
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Old 04-03-2015, 02:22 PM   #44
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utrecht - I hope you feel better soon.
There are doctors who do spinal epidural injections in the office. Look for pain management specialists or physiatrists.
I used these guys before (but injection did not help): Non Surgical Alternatives - Peachtree Spine
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Old 04-03-2015, 08:31 PM   #45
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It will be cheaper at an imaging center than at a hospital. My doctor offers an even less expensive option - he has an ultrasound technician come in every Friday and do the scan in his office.
Exactly. If your insurance company doesn't offer an estimator application, select a location that is not required by law to treat anyone that shows up, irrespective of having insurance or ability to pay (ie a hospital).
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Old 04-04-2015, 12:41 AM   #46
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My wife has spinal stenosis, and went on disability at age 50. The following is our experience in dealing with her bad back:

1. Since your back problems are chronic, you should choose health insurance plans with lower deductibles. Your condition will be very expensive to manage in the future.
2. Doctors will always prescribe physical therapy--time and time again. Expect it.
3. Look for a physician in a Pain Clinic that's an anesthesiologist with a fellowship in Pain Management. We also prefer to deal with neurosurgeons rather than orthopedic surgeons.
4. And ask if the doctor is willing to manage your condition medicinally--rather than just shooting you up with steroids. Just shots don't work--meds are required.
5. Steroid injections must be done by flouroscope. Never let a doctor inject steroids by "feel" as it's a waste of time.
6. Injections are best when done in series of three--a month apart. Often, it's the third shot that puts you over the top.
7. Don't be ashamed to be managed medicinally. With proper medicines, chances are that you'll be capable of living a decent life. It beats being an invalid--in bed all day, every day.

Good luck to you.
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Old 04-04-2015, 08:02 AM   #47
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Exactly. If your insurance company doesn't offer an estimator application, select a location that is not required by law to treat anyone that shows up, irrespective of having insurance or ability to pay (ie a hospital).
Here is a cost estimator that can be used if the insurer does not offer one. It's not as precise but will generally let you know which providers are lower cost.

Procedure Cost Estimator: Medical Procedure Cost & Healthcare Cost | NewChoiceHealth.com
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Old 04-04-2015, 08:40 AM   #48
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My wife has spinal stenosis, and went on disability at age 50. The following is our experience in dealing with her bad back:

1. Since your back problems are chronic, you should choose health insurance plans with lower deductibles. Your condition will be very expensive to manage in the future.
2. Doctors will always prescribe physical therapy--time and time again. Expect it.
3. Look for a physician in a Pain Clinic that's an anesthesiologist with a fellowship in Pain Management. We also prefer to deal with neurosurgeons rather than orthopedic surgeons.
4. And ask if the doctor is willing to manage your condition medicinally--rather than just shooting you up with steroids. Just shots don't work--meds are required.
5. Steroid injections must be done by flouroscope. Never let a doctor inject steroids by "feel" as it's a waste of time.
6. Injections are best when done in series of three--a month apart. Often, it's the third shot that puts you over the top.
7. Don't be ashamed to be managed medicinally. With proper medicines, chances are that you'll be capable of living a decent life. It beats being an invalid--in bed all day, every day.

Good luck to you.
Maybe it will get worse as I get older but other than mildly annoying stiffness that Im used to, my back really doesnt cause me problems. I walk a mile or two everyday and do a lot of stretching and exercises to keep my core strong like planks. That seem to keep it under control. Other than this recent episode I haven't been to a doctor for my back in 20 years.

Actually I havent spent more than $100 on any doctor in 20 years. I'll keep all of this advice in mind if it gets worse though. Thx.
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Old 04-04-2015, 09:04 AM   #49
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Stenosis is a different issue as I understand, IIRC does take long term care. Utrecht sounds like you pulled something and it's flaring up(bulging disk), still can be extremely painful. The MRI should have revealed stenosis if that's the issue.

I've done 3 cervical epidurals, only one with a floroscope, they all worked, I do prefer the floroscope as I feel more secure. Laying face down opposed to sitting upright. I think most centers use floroscopes today for insurance reasons. They may help the docs get a better placement as well. My first epidural this time around may do more good than the 2 I had in 2000, but that's very subjective.

The only reason I did epidurals, was I was in way too much pain. The pain pills did did nothing(80 mg of hydrocodone daily or 60 mg of percocet), except make me stupid. So the epidural was needed to reduce pain for PT to be performed. As much as I don't enjoy PT it's what makes me get well, epidurals and pain meds reduce inflammation and pain until I can do PT. I can understand why PT may not be as successful in a case of stenosis.

For me PT has worked for years at a time, trama to the spine is what gets my discs inflamed causing nerves to pass signals, that the brain registers as pain.
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Old 04-04-2015, 09:14 AM   #50
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Here is a cost estimator that can be used if the insurer does not offer one. It's not as precise but will generally let you know which providers are lower cost.

Procedure Cost Estimator: Medical Procedure Cost & Healthcare Cost | NewChoiceHealth.com
That's fantastic! The first sign of competition I've ever seen in US healthcare...you can submit an RFQ for the procedure you want.
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Old 04-04-2015, 09:17 AM   #51
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I have stories of my own dealing with the medical establishment I could offer .... but don't we all, so I won't bother you all with them.

Thought just came to me though reading this thread: Is it any wonder "medical" cannabis has become so popular? Especially for chronic pain management.

(And yes, I do tell the doctors the pharmaceutical industry can keep their statins)
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Old 04-04-2015, 09:23 AM   #52
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I have stories of my own dealing with the medical establishment I could offer .... but don't we all, so I won't bother you all with them.

Thought just came to me though reading this thread: Is it any wonder "medical" cannabis has become so popular? Especially for chronic pain management.

(And yes, I do tell the doctors the pharmaceutical industry can keep their statins)
I just learned that if you have the COMT V158M on both genes, MJ is not recommended. But don't let that stop you, hehe!
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Old 04-04-2015, 09:32 AM   #53
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Maybe it will get worse as I get older but other than mildly annoying stiffness that Im used to, my back really doesnt cause me problems. I walk a mile or two everyday and do a lot of stretching and exercises to keep my core strong like planks. That seem to keep it under control. Other than this recent episode I haven't been to a doctor for my back in 20 years.

Actually I havent spent more than $100 on any doctor in 20 years. I'll keep all of this advice in mind if it gets worse though. Thx.

Utrecht, I thought you were basically writing about me. My back went out on me so bad I was bedridden for almost 3 weeks (who would ever think an oncoming urge to sneeze or use the bathroom could install so much fear in a person). GF madder than hell at me that I wouldn't go to doctor. I told her the first thing would happen is I would get screwed on an MRI bill. I told her Im retired and I got time to wait this out and they wouldn't provide me any help anyways. Ignore the problem and it will go away strategy has always worked for me.
Though I hope if some knot ever starts to grow on my head I will have the intelligence to go get it looked at.


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Old 04-04-2015, 09:46 AM   #54
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Good point Mulligan. The first time I met with a Nuersurgon he minimized the herniated/bulging discs. My PCP acted quite concerned like I needed surgery asap. The Nuersurgon asked how many millions of people did I think were walking around leading normal lives not even knowing they had herniated disks. He used me as an example according to him these disks had been herniated/bulging for many years, from my childhood in his opinion. So the only thing that changed was my awareness. Now he didn't say to play football or wrestling or cage fighting, but golf, walking, running, fishing, hunting, gardening were all good.

Time can heal many painful back issues. A fast growing brain tumor not so much.
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Old 04-04-2015, 10:01 AM   #55
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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.
I've been reading this forum for many years (but only joined a few years ago) and I have never read a post that I agree with more than what MichaelB wrote above.

Unfortunately, last year a close family member had a serious medical problem. Without going into the details, the bills totaled up to about 200K (not a typo). That is what the insurance company was billed by all the doctors, hospitals, etc, but after the insurance paid the "negotiated rates", the total that was actually paid was about ~75k. (Including the 3k deductible that the patient had to pay)

What happened to the other ~125k? Surely the doctors and hospitals are still making money even after the discounts for the insurance companies negotiated rates.

What would have happened if this person didn't have good insurance?

And forget about trying to understand the endless stream of EOB's or talking to the insurance companies for anything more than the simplest of issues.
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Old 04-04-2015, 10:40 AM   #56
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I think that hospital bill is like a car's sticker price. Almost nobody pays it, but every once in a while some fool who doesn't know better walks in and does pay the full price
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Old 04-04-2015, 12:34 PM   #57
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I think that hospital bill is like a car's sticker price. Almost nobody pays it, but every once in a while some fool who doesn't know better walks in and does pay the full price
The problem with this is that negotiating skills are key to avoiding getting fleeced.
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Old 04-04-2015, 12:43 PM   #58
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I know now that if I go to a hospital for some kind of scan, etc., I will talk to my insurance company first and let them tell me the negotiated rate, because otherwise they will pressure me to pay too much up front since I "haven't met my deductible".
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Old 04-04-2015, 07:58 PM   #59
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I just learned that if you have the COMT V158M on both genes, MJ is not recommended. But don't let that stop you, hehe!
Well, I haven't been genetically tested or anything ... but I'm quite certain from personal experience I don't have that COMT V158M thing.
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Old 04-05-2015, 05:02 AM   #60
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I know this was alluded to earlier, but I want to emphasize the value of healthcarebluebook.com.

I use this site to research ballpark figures before having anything done medical related. I may then check with my insurance company on what their negotiated rate would be for the procedure to verify my cost. It is usually not an issue in that my insurer is the large colorful health insurance company that nearly all providers around here are signed up with (ie monopoly power on the provider side).

Consulting a site like I mentioned above is even more important if your procedure is not covered by insurance due to the retail prices in health care being all over the map.


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