Outpatient procedure, facility charges, how to lower the bill?

[LOL!]

I was in the ER the other day, but not so bad that I met my high deductible for 2018. But now my specialist has recommended that I have a medically necessary procedure or two done although there is no rush to get them done.

Has anybody been able to get a very good idea of what they would have to pay for an outpatient procedure and did it actually match after the procedure and/or what were the surprises and discrepancies?


I decided that I would delve into the mysteries of paying for them because my wife had different outpatient procedures and the bills are endless because there was no disclosure of all the charges and no choice of things like whether the anesthesiologist was in network and a whole bunch of stupid nickel and dime charges plus mistakes made about deposits and credits.

It seems that the physician's office has no idea what the recommended procedure costs the patient. They can estimate what I will have to pay the physician after insurance which they get by calling my insurance company and pre-certifying me, but they don't give a rat's ass about anything else.

So I call the insurance company and they are helpful, but they cannot tell me all the charges either. They have an estimate, but I know from my wife's situation that the estimate was about 50% of what she owed in the end.

Has anybody had better luck on getting a great estimate? How about reducing costs somehow or negotiating a lower payment? Any luck?

Or do you have any horror stories that you can tell us?

Thanks!

 

[COcheesehead]

We went down this road with my wife. Good luck getting any kind of accurate quote. Everyone says there are standard codes, but the exceptions to these will make your head spin. We went ahead and had the procedure done and in the end it didn't turn out too bad from a cost standpoint, but we never could get a number prior.

 

[MichaelB]

When I had cataract surgery the hospital sent me a cost letter, the total amount I would be charged, including all physician fees, with a disclaimer for emergencies and such. They billed the exact same amount.

 

[COcheesehead]

When I had cataract surgery the hospital send me a cost letter, the total amount I would be charged, including all physician fees, with a disclaimer for emergencies and such. They billed the exact same amount.

One of my employees had a baby and she got a cost letter like this, but we could not get a letter for my wife's procedure. Not sure why.

 

[MRG]

When I had cataract surgery the hospital send me a cost letter, the total amount I would be charged, including all physician fees, with a disclaimer for emergencies and such. They billed the exact same amount.

Similar experience with a balance therapist, his office gave my the codes they would bill and wanted verification from my insurance company.

I think his motivation was he really didn't need to work, but wanted to help people without losing money on billing BS.

Medical billing is an absolute nightmare. They expanded the number of codes back when I was still w*rking. I got called into constult with another part of Megacorp as the coding techniques they had used, were no longer viable. They had data in COBOL tables and the compiler couldn't deal with the new required sizes. [emoji23]

 

[Rianne]

One can only guesstimate based on the sources and information given. Digging in about the coding and what extra expenses could happen, you're never sure as something unexpected/hopefully not, can always happen.

Same with car repairs, home remodels, vacations and so on. As FIRE, I have the time to question over and over. I can't say how many phone calls I made to be sure I understood what the last person told me. Obviously, if one is working full time, there's no way you could dig as deep. I'm always super nice, and take notes. I remind them I spoke to Jane or whatever and she explained this to me. But I have another question, and go further.

You can get the codes for various procedures but depending on the smallest change, the code changes. And they code incorrectly, often I might say. That's why I depend on the EOB's and talk to CS with EOB in front of me.

Yearly physicals with blood tests are essential benefits, with some insurance companies and vary with plans within the IC. The devil is in the details and it is worth my time to make sure I understand them. We do have an insurance broker, paid by the IC who can answer a lot of the questions too.

 

[LOL!]

Just spoke with my insurance and I learned that if I am having an issue with a physician accepting only what they will pay to give the insurance company a call and they will go to bat for me. Example: Anesthesiologist keeps saying I underpaid, so send them $1,000. Instead of paying the $1,000, I should call the insurance company.

 

[aja8888]

What we have found over the years is the Anesthesiologist firms are usually out of network in some hospitals and you have to track them down ahead of time to see if they will accept your insurance. I have had to do this a few times in the last year or so for DW and it paid off. We got a bill from one for $10,000 after DW had an operation and reminded them that they agreed to take Medicare up front. They backed off on that invoice that was set directly to us.

They are slimy turds and one must be diligent with them.

 

[Texas Proud]

Just spoke with my insurance and I learned that if I am having an issue with a physician accepting only what they will pay to give the insurance company a call and they will go to bat for me. Example: Anesthesiologist keeps saying I underpaid, so send them $1,000. Instead of paying the $1,000, I should call the insurance company.

That is only good if they are in network... and I was going to point out that most are not in any network....



They have a monopoly and know it... you cannot have a surgery without them...


Good luck, but I would call and see if you can get it down from them... I did... but then again they charged 2 people 2 hours each for my DWs surgery that took a whole 10 to 15 minutes...

 

[Rustward]

I got an anesthesia bill reduced from $5250+ to $580 just by calling the insurance company and asking them to reprocess the claim as in network because the facility was in network even though the anesthesiologist was out of network.

Also did this a different time with different numbers but similar results.

Saved thousands.

 

[Jerry1]

One of the best ways to save money is to stay out of the hospital. This is not as simple as it sounds, because some outpatient locations can seem to be independent of a hospital but the billing will still process as a hospital based facility. Of course not all services can be performed outside of a hospital, but that’s the first thing I check.

 

[Hyper]

NEVER, but have tried in vain to be responsible and get prices before the procedure and compare. Anesthesiologist have been the worst. Anesthesiologist are separate from the actual hospitals in our area. Not once have I ever had a bill that didn't say cost too high for the area and had to pay more.

 

[LOL!]

Thanks to the responses in this thread, I have now called up 4 of the places that will affect my bills for the outpatient procedure.

I think I have a pretty good idea of what's going on and everybody is going to be "in network", AND I will meet my maximum annual out-of-pocket amount, so charges look like they will have a limit.

Now to schedule some other "work" to be done since I should have a $0 deductible, co-pay, etc for everything going forward in 2018.

 

[swakyaby]

They are slimy turds and one must be diligent with them.

They have a monopoly and know it... you cannot have a surgery without them...

Anesthesiologist have been the worst.

Hmmm, I think I'll stay out of this.

 

[HI Bill]

Good luck on getting any type of accurate estimate. You're going to need it. My friend had a hip replacement, and all sorts of third-party doctors and specialists would stop by, each adding to the bill. Medicare billing is astoundingly permissive. What Medicare paid for my mom's outpatient physical therapy is astounding, not to mention what they paid for her hospital stays and resident physical therapy. The system is so far off base, I can't even believe it! Let's say a physical therapist comes to a nursing home for 2 hours...they charge $1500! Complete rip-off and farce. The employee probably made $200 for her two hours, if she's lucky!

 

[cbo111]

I just had hernia surgery done as an outpatient in a clinic attached to a hospital. The itemized bill from the hospital included $30,000 for use of operating room for the first 30 minutes, then $1,000 a minute after that. I was in the room for just over 2 hours, about two times what the surgeon estimated. So the charge was $61K just to use the room!
Not sure how your insurer or doctor could predict with any accuracy how long you will be in the operating room. They know about how much it will cost under standard conditions with no complications. But many procedures come with a few surprises.

 

[Texas Proud]

Hmmm, I think I'll stay out of this.

Why? Because you were one?


I did not say they were slimy.... but I have not met one yet that is in network.. I have a sister who knows one and she was not in any network... another sister that was a nurse and worked at a major hospital in surgery and none were in networks... so, I stand by my stmt...

 

[Silver]

Having worked in the health care industry for over 35 years and as a VP of a large, non-profit hospital I was involved in internal billing at times. My observation was is that the industry wants and takes advantage of pricing confusion. Why should they be clear about prices? There are no incentives to 'set prices", no consequences when they don't, and huge disadvantages to their margin if they do. Health care is all about profit.

It will take a HUGE overhall of the industry to do anything differently. I know some providers are attempting to do some up front price setting. This is most certainly discouraged within the industry, and they are frequently excluded from referral patterns that keep a practice alive.

 

[JoeWras]

In my area, the anesthesiologists have been in my network and were no problem.

The surprise for me was the "admitting doctor." Some guy who could have been a PA or nurse for all I know that just asked me a few questions before admitting. You know, stuff like: "Do you feel well? Can you tell me what surgery you expect to have? Did you have an aspirin today?"

5 months after surgery I get this out of network bill of $250 out of the blue for this "service."

 

[trumpeting_angel]

My son-in-law has surgery upcoming. The hospital is in-network, the ortho surgeon is in-network, but the only neurosurgeon who the ortho guy will do this operation with is out-of-network. He has been calling that doc’s office for 3 weeks to get an estimate, being told that they will get him and estimate and, “Don’t worry; it’s not that bad. It won’t be that much.”

Last time he had back surgery an out-of-network assisting surgeon, who he never knew would be part of the team, sent a bill for $10,000.

He is wary. What a racket.

 

[John Galt III]

For my last outpatient procedure which was an untrasound, I was on the phone for hours trying to make sure it would be in network, facility charges would be covered, etc. Got bounced around a lot, and finally they *said* it would all be covered except for a $10 copay. I hoped they were right (you never know until afterwards) and went ahead with the procedure. I ended up only owing the $10 copay. And I even signed the waiver on the electronic form that says you will owe them whatever they want to charge you, no matter what. But next to my sig I squeezed in 'copay and coinsurance only'. (Not that it would have any effect, lol.) So yes, I had the procedure and did not get ripped off.

 

[Rianne]

My son-in-law has surgery upcoming. The hospital is in-network, the ortho surgeon is in-network, but the only neurosurgeon who the ortho guy will do this operation with is out-of-network. He has been calling that doc’s office for 3 weeks to get an estimate, being told that they will get him and estimate and, “Don’t worry; it’s not that bad. It won’t be that much.”

Last time he had back surgery an out-of-network assisting surgeon, who he never knew would be part of the team, sent a bill for $10,000.

He is wary. What a racket.

This happened to DH with knee surgery. The surgeon added an extra out of network surgeon to assist. In setting surgery date and in the admitting office, we went over all the billing details making sure everything w/in network.

This was a few years back, but we received the extra bill for the assisting dr. We fought it, complained to hospital (there is a competing hospital in the area), complained to insurance, complained to surgeon office. The complaint to surgeon's office did the trick. He brought in an extra surgeon without our knowledge and he paid for it. The hospital refused to pay, the insurance refused to pay. Bottom line, the surgeon made that decision.

 

[mitjaypat]

Slimy turds? Have you ever asked yourself WHY they are out of network?? Before you go trashing an entire group of professionals, you should probably stop and wonder why. Maybe its because the insurance companies do not want them in network. Do this exercise: go to your insurers website and search for anesthesiologists. See if the option even exists.

 

[Texas Proud]

Slimy turds? Have you ever asked yourself WHY they are out of network?? Before you go trashing an entire group of professionals, you should probably stop and wonder why. Maybe its because the insurance companies do not want them in network. Do this exercise: go to your insurers website and search for anesthesiologists. See if the option even exists.

Sounds like you are one...


Did what you asked and surprisingly there were a number listed...


Now, that might not mean anything as I was trying to get a new PCP last week and even though a lot were listed most of them were no longer in network or accepting new patients.... seems a number of groups have been changing hands and Drs moving around...



The website is WAY behind... that is one of my peeves... my old PCP has not been in her location since hurricane Harvey but they still list her... others are listed but their phone goes to some other group and they do not accept the insurance...

 

[Bamaman]

On Medicare, all hospitals and doctors office shoot for the sky on prices and accept what the insurance company pays. Then they send me a bill for the deductible ($250 for any hospital or ER stay) and write off a huge portion.

There should be a law where any hospital accepting Medicare has ER physicians, anesthesiologists and pathologists that accept Medicare. Those specialists are often slave labor accepting whatever they can squeeze out of patients and insurance companies. And often, they don't work for the hospital--outside contractors allowed to practice there.

We just got a notice from my wife's knee replacement hospital stay. Our Medicare supplement paid $90k of a ridiculous $100k hospital bill. That includes $559 for physical therapy twice a day in a class of 6 people. The therapist was grossing $6300 per hour--ridiculous.

Yep, industry changes are warranted.