Thoughts on this medical situation?

[Alan]

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.

 

[John Galt III]

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.

 

[MichaelB]

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.

 

[utrecht]

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.

 

[redduck]

.... 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?

 

[utrecht]

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.

 

[redduck]

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.

 

[utrecht]

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!

 

[EastWest Gal]

+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.


Sent from my iPhone using Early Retirement Forum

 

[Walt34]

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.

 

[Dancer373]

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.

 

[travelover]

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.

 

[utrecht]

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?

 

[Walt34]

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.

 

[Dreamer]

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.

 

[audreyh1]

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.

 

[travelover]

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.

 

[athena53]

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!

 

[sailor]

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

 

[sengsational]

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).

 

[Bamaman]

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.

 

[MBSC]

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

 

[utrecht]

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.

 

[MRG]

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.

 

[sengsational]

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.