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Old 04-08-2015, 03:50 PM   #61
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I doubt the schedulers know, most people even in the industry are clueless. Sometimes the price is different based on age of machinery, specialty, etc..so sometimes it legit, but yes never go to the hospital for an MRI unless it is something that cant be avoided.


United Health has more of this online and helps with pricing..and its the same everywhere, usually looking around you can find a range of 2-3K difference. unfortunately its the only good thing about the high deductibles, people are finally asking.. ie before the deductible I'm sure you wouldn't have thought twice and would have immediately gone to the hospital leaving the insurance with the outrageous tab.


As for your back, really sorry to hear... please take care, I have 2 herniated disks, got 2 shots, ignored it for 5 years, and then it blew out and I lost permanent feeling in 2 toes forcing me to do the surgery (btw, cost shown $26K, 'after adjusted price' $2500). So while you may feel better now, it is something to be mindful of as even though they said it should go away..it doesn't always. supposedly I'm part of the 10%.
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Old 04-09-2015, 10:55 PM   #62
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Quote:
Originally Posted by MRG View Post


Edit to add:
HOLY HOSPITAL STICKER SHOCK

I just checked my insurance company's website there are 2 charges, pending status. These are the non negotiated rates:

Dr. performed epidural - $1,045
Hospital facility - $5,427

Sure hope that gets negotiated down. I know it will but that's a silly price. Procedure took ten minutes.
Think this gives a good view of the importance of being able to shop. Also some of the missing information.

The rest of the charges:

The cervical mri done at a stand alone facility: Billed $1256
Write off $838
My copay $100

Hospital would have been @ $2500

Cervical Epidural #1 DR $1045
Write off $767
Appiled to deductible $277

Hospital charge CE#1$5,427
Write off $4,196
Applied to deductible $722 -maxed
Co insurance @10% $50

I'm pretty sure the Drs. fee would have been the same at his pratice. My PCP recommended I go to his facility, his schedule and my pain dictated the first available time at the hospital outpatient clinic. I'd love to know the difference between what the hospital accepted vs. his practice.

I had a second epidural today so another 10% of $1000 goes to max OOP. Should be hitting that soon as I may need a third epidural and PT. I guessed correct by having a low deductible low OOP plan, feel bad for folks with higher maxes, but I guess we all gamble.

Utrecht wanted to give one comparison. FYI on the sedation, pass, if you've ever had a filling or crown with lidocaine, the epidurals easier. Best wishes.
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Old 04-11-2015, 09:42 AM   #63
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So this situation gets even worse. You may remember that I had the doctor's scheduler shop around for a reasonable MRI facility. She called a stand alone MRI facility close to my house. At first the MRI person didnt want to give out a price but then the scheduler told them that I was not sure whether or not I wanted the MRI and wanted to know how much it would cost at their facility before deciding. The person then quoted a price of $230-$360. Not sure why the range but that's what they said.

I left the doctor's office and went directly there and got the MRI. When I left they said "that will be $231", which I paid. Now a couple weeks later I found out that they billed $4740 to the insurance company??

After plan discounts and partial payment by the insurance company, they say I owe about another $2500. At no time did they tell me I was making a partial payment at the office. I didn't sign anything agreeing to pay anything other than my debit card transaction. How can a medical provider tall you something costs $231 and then bill you for some random amount later that you know nothing about? How would you feel if you took your car to a mechanic and the bill was $400 and he later sent you a bill for $3500 that he had never mentioned? I seriously doubt you would pay it. I'm not paying this bill either. I would've never even had the MRI if I was told it wold cost almost $3000. My credit score is 821. If they want to send the bill to collections, so be it but Im not paying the bill.

This brings me to the steroid injection. I was told the doctors fee is $200 and the hospital fee is $1150 for a total of $1350. Is that the real amount? Or will I get a bill 6 weeks from now for another $3500 that I was never told about. How can this be legal in the USA? Imagine getting your taxes done and paying $250 and then getting another bill for $1800 that you had no idea about?
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Old 04-11-2015, 09:51 AM   #64
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That sounds like an absolute nightmare Utrecht, how incredibly stressful.
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Old 04-11-2015, 10:24 AM   #65
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utrecht,

Sorry you're having billing issues along with back issues they each are a pain by themselves let alone at the same time.

Have you contacted your insurance company? This doesn't sound right they may be able to help. Last year I appealed a decision and won. It was a smaller amount and completely different but it didn't take much time. Best wishes.
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Old 04-11-2015, 10:26 AM   #66
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That sounds like an absolute nightmare Utrecht, how incredibly stressful.
+1

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This brings me to the steroid injection. I was told the doctors fee is $200 and the hospital fee is $1150 for a total of $1350. Is that the real amount? Or will I get a bill 6 weeks from now for another $3500 that I was never told about. How can this be legal in the USA? Imagine getting your taxes done and paying $250 and then getting another bill for $1800 that you had no idea about?
This is why you absolutely must have health insurance in the US, make sure all of your medical care is within the insurer's network.
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Old 04-11-2015, 10:48 AM   #67
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So this situation gets even worse....

I left the doctor's office and went directly there and got the MRI. When I left they said "that will be $231", which I paid. Now a couple weeks later I found out that they billed $4740 to the insurance company??

After plan discounts and partial payment by the insurance company, they say I owe about another $2500...
Are the MRI people in your insurance's network?
Did they actually bill you for the difference?
If the answers to the two above questions are "Yes," I would call the MRI billing office and tell them your insurance is supposed to cover the cost of the MRI, less the deductible and/or co-pay. Sometimes the billing office makes these sorts of "mistakes". The deductible and co-pay (let's say it's 20%) is based on the negotiated fee, not on the amount billed to the insurance company.

As I understand it (and experienced it), if you stay in network, your fees have been negotiated for you (and for everyone else) regarding office visits, procedures, supplies used, etc. So, whatever the medical people bill the insurance company for should not affect you.
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Old 04-11-2015, 12:15 PM   #68
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I haven't contacted the insurance company yet but I will on Monday. Everything is within the network. I haven't received a bill from the MRI facility yet. I'm looking at my United Healthcare account online. It shows the total bill for the MRI was $4740 with plan discounts of $1422 for a actual bill of $3318. This would put me over my deductible so the insurance then covers $495 meaning I owe a little over $2800 of which Ive already paid $231. I have 2 other doctor visits billed since then that show I owe 30% of the bill since the website thinks Ive met my deductible now (including this big MRI bill).

So it looks as if everything would be correct if they had told me up front that the MRI costs $3000-$4750ish. But they told me it cost $231 and said nothing about further billings or that I was only paying part of the bill. They didn't ask me if I had met my deductible or anything like that. All they said was the MRI would cost me $231. If they had said it was over $3000, I wouldve either not gotten the MRI or kept looking for a cheaper place. For that price I could've just gotten the MRI in the hospital where the doctors office is. The doctor told me NOT to do it there because of the cost.

So now I'm sitting here with an appt. to get the injection on April 28th. I haven't decided whether or not I will get the injection. It seems to be healing every so slowly. On the other hand, my physical therapist is of the opinion that I need surgery. If so, none of this will matter because I will hit my max OOP for the year of $6350.
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Old 04-13-2015, 11:12 PM   #69
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I haven't contacted the insurance company yet but I will on Monday. Everything is within the network. I haven't received a bill from the MRI facility yet. I'm looking at my United Healthcare account online. It shows the total bill for the MRI was $4740 with plan discounts of $1422 for a actual bill of $3318.
So, where are we with this?
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Old 04-14-2015, 09:13 PM   #70
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What horror stories ! I do hope it works out for you, both physically and financially.

4 months ago I needed a CT Scan. The rep from Humana called me to help me find a lower cost alternative than the one I had scheduled at the hospital. I was happily stunned !
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Old 05-21-2015, 03:50 PM   #71
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These whole medical and insurance industries confuse the hell out of me. You may remember I got a lumbar MRI at a stand alone facility back on April 1st. I was told the cost to me would be $230ish. I got the MRI , paid $230 and left. Later they billed the insurance company $4740. After discounts my UNH account showed I owed about $2822. They dont know how much I paid at the time of service. Here it is May 21st and I still have never received a bill.

My medical situation has gotten worse. Ive switched to a Neurosurgeon who is going to perform a micro surgery on my back next Friday. In the meantime, my neck has started hurting and Ive started having burning in my arm. So the neurosurgeon sent me for a cervical MRI which revealed a herniated disc in my neck to go along with the herniated disc in my lower back. I got the cervical MRI at Baylor Hospital in Dallas which is probably the best hospital in the city and they only billed $1450. This included an IV because the doctor wanted a dye injected during the MRI.

Baylor MRI with IV...$1450
Stand alone MRI in a strip center...$4740.
Something is not right here. Like Ive said, Ive never received a bill from the stand alone MRI center. Its starting to look like they got their $230 from me and then bilked the insurance company by over billing them.

My max out of pocket is $6350 which I will hit easily. Ive had 2 MRIs, 3 steroid injections including 1 a few hours ago, a few Xrays, 10 or so doctor office visits and now the impending lumbar surgery. The neurosurgeon says I will most likely need neck surgery as soon as my back heals from the surgery.

The funny thing is that if I never receive a bill from the MRI facility, my $6350 max OOP will actually only be about $3750.
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Old 05-21-2015, 04:18 PM   #72
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Good luck with fixing the health issues, Utrecht. Due to the volume of bills you will get you may never understand them. But the positive side is your max ceiling will protect you. If I was you, I would get every conceivable health concern looked at or check up done by Dec. 31st and get the max benefit from your deductible.


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Old 05-21-2015, 07:36 PM   #73
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We bunched together his and hers colonoscopies, since we are on private insurance we pay about $400 each.
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Old 05-21-2015, 09:16 PM   #74
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But the positive side is your max ceiling will protect you.
Not always. While many policies have both an in- and out-of-network ceiling, the out-of-network ceiling may only apply to the insurance companies' allowed amounts; balance billing for which the patient is usually responsible may be unlimited.
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Old 05-21-2015, 09:20 PM   #75
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Not always. While many policies have both an in- and out-of-network ceiling, the out-of-network ceiling may only apply to the insurance companies' allowed amounts; balance billing for which the patient is usually responsible may be unlimited.

I assumed he had those ducks in a row, but you are definitely correct. Thanks to Obamacare ending my nice policy, I took a very narrow network to keep my increase under $300 a month. I will have to make sure the custodian dumping my trash in my room is in network to avoid an attempted fleecing!


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Old 05-21-2015, 10:02 PM   #76
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I'd love to hear peoples thoughts on this ... She recommended a steroid injection which requires an MRI....
I get the MRI immediatley (Mon) and have an appt to have it read by the doc 2 days later (today). I wake up on Tue feeling better for the first time in a while. Still have numbness but alot of pain is gone. I go back today and the doc tells me I have 4 herniated discs. Some worse than others and she recommends two steroid injections. Now, Ive had a few of these 20 years ago and they were done in the docs office for about $100.

I agree to the injections even though I'm thinking now I might not need them.
Questions:
1) Does this sound like a scam where the schedulers are getting some kind of kickback to use this expensive hospital?
2) Does anyone know if some doctors still give lumbar steroid injections in their office?
First of all let's clear up some terminology. I believe you are talking about epidural steroids. Their long-term efficacy is minimal ("yeah but I once knew a guy/gal..." IOKAG. You definitely want to be sedated if you have them (otherwise very painful for a few minutes and you might jump around) which means an outpatient surgery center or a hospital outpat department. As to this possibly being a "scam" I find that to be unimaginable except to the extent that our whole health care system is so chaotic and irrational.

Sounds like they are not doing a good job of educating you. If my degenerative disc disease symptoms improved prior to the epidural steroids I would cancel the procedure and reconsider if the symptoms recurred. But there might be individual factors that come into play. Consider asking your doctors what your options are now that the symptoms have resolved. Anyway, glad you are better and hope it sticks.

And see my signature line disclaimer.
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Old 05-21-2015, 10:28 PM   #77
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Somewhere there was a miscommunication. Im not better. Im having back surgery next Friday and need neck surgery as soon as my lower back heals from surgery. I had a neck ESI today to help with the pain until Im ready for the second surgery.
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Old 05-21-2015, 11:12 PM   #78
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Somewhere there was a miscommunication. Im not better. Im having back surgery next Friday and need neck surgery as soon as my lower back heals from surgery. I had a neck ESI today to help with the pain until Im ready for the second surgery.
I must have misread your situation. In any event, best wishes for speedy recovery from both procedures.
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