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

[Just_Steve]

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...

I just did a provider search for my plan for Anesthesiologist and come up with 129 in network within my zip code most attached to the two hospitals I would most likely use.

 

[LOL!]

Just a short update to this thread ....

I had a procedure yesterday and another will happen in a few weeks. I was able to stiff-arm the folks from the physician's office who wanted payment ahead of the procedure. And that's all because of this thread which made me actually understand how all my insurance really works. The physician's office will just have to get money from my insurance company and not from me. None of this "Oh, we'll refund your credit when it happens!" crap.

So thanks everybody!

 

[6miths]

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.

We are all hoping for you. Certainly an example where the 'Free Market' seems to have failed.

 

[NW-Bound]

I am due for a colonoscopy. The good doctor that took care of me in the past is not in the insurance plan that I have now. But I prefer to go to him, rather than finding a new gastroenterologist.

My deductible is $10K or something like that, and I have not spent but $160 this year, so I would have to pay out-of-pocket the charge anyway.

So, my wife called the office, and asked if they would quote the price that they normally bill their insured patients. They gladly told us the cost break down (a bit less than $1K total). And we scheduled it, and that's that.

 

[NW-Bound]

... The physician's office will just have to get money from my insurance company and not from me. None of this "Oh, we'll refund your credit when it happens!" crap...

My service providers always called the insurance to see if I had met the deductible, which has been usually $10K for me.

They then said "Uh, we want you to pay upfront", which of course I did.

I made sure that they sent the info to the insurance, so that it went on records in case I got sick enough to exceed that $10K later in the year. Plus, that made sure that I got the negotiated rate. I once paid $120 on the spot, then received a check for $40 later because it was above the negotiated fee.

 

[LOL!]

My service providers always called the insurance to see if I had met the deductible, which has been usually $10K for me.

Yes, service providers call, but I learned that the number the insurance company gives them is only up-to-date at that moment.

So when several providers are involved in a procedure (facility, physician, pathologist, anesthesiologist, radiologist, lab work), then bills are paid in the order they are sent to the insurance company. Normally, the order would not matter, but if one bill puts one past the deductible or the out-of-pocket max, then there will be a mismatch between what the service provider was told before the procedure and what actually happens when the bills hit the insurance company.

Does that make sense?

I'll give a fictitious example: One has $5,000 left on OOP max. Physician wants $5,000 upfront, but facility also wants $5,000 upfront. There is no reason to pay $10,000 combined upfront and work on the $5,000 refund later.

 

[braumeister]

They gladly told us the cost break down (a bit less than $1K total).

Interesting how different parts of the country can vary so much.

I had a colonoscopy last year and after all the bills were in they amounted to nearly $4K, of which insurance paid about $1,100. I didn't have to pay anything, thank goodness.

 

[aja8888]

Re: colonoscopy. If there are any polyps removed, there will probably be charges for lab work to determine if they are cancerous or benign. That's over and above the Doc, facility charge and anaesthesia.

 

[travelover]

Re: colonoscopy. If there are any polyps removed, there will probably be charges for lab work to determine if they are cancerous or benign. That's over and above the Doc, facility charge and anesthesia.

I know this is true, but it seems ridiculous.

 

[NW-Bound]

Re: colonoscopy. If there are any polyps removed, there will probably be charges for lab work to determine if they are cancerous or benign. That's over and above the Doc, facility charge and anaesthesia.

Yes.

Here's the update on the colonoscopy a couple of weeks ago. No polyp, so no extra charge. Total out-of-pocket cost for me: less than $900.

We have had 5 colonoscopies (4 for me, 1 for DW) going back 10 years, and this recent one is the cheapest one so far. How is that possible?

My wife dealt with the medical office staff, and they said that the cost could be higher, depending on the anesthesia drug that they used. For me, their record showed that they used the cheaper one the previous time, so they would do the same this time. The price difference would be a bit less than $400.

My wife did not ask how they chose the anesthesia drug.

 

[NW-Bound]

Yes, service providers call, but I learned that the number the insurance company gives them is only up-to-date at that moment.

So when several providers are involved in a procedure (facility, physician, pathologist, anesthesiologist, radiologist, lab work), then bills are paid in the order they are sent to the insurance company. Normally, the order would not matter, but if one bill puts one past the deductible or the out-of-pocket max, then there will be a mismatch between what the service provider was told before the procedure and what actually happens when the bills hit the insurance company.

Does that make sense?

I'll give a fictitious example: One has $5,000 left on OOP max. Physician wants $5,000 upfront, but facility also wants $5,000 upfront. There is no reason to pay $10,000 combined upfront and work on the $5,000 refund later.

I have had a couple of years when my healthcare cost way exceeded the deductible of $10K. The treatment was all coordinated by one clinic, hence they had all the billing info.

 

[Spock]

When I am made emperor, healthcare reform will consist of:
1. All medical providers must publish a list of their charges by code. They can charge whatever they want, but they have to publish that price "up front".
2. All insurance providers must publish what they pay for a given code. They can cover as much or as little as they want, but they have to publish that coverage amount "up front"
3. (there was a website with a healthcare manifesto that these and other points were posted on back when Obamacare was passed, but the words "healthcare manifesto" have been used so much in the last 3 years I'll never find the link back).

 

[NW-Bound]

+1000

I will add the following.

Penalty for violation: death by public execution. With a guillotine.

 

[Fedup]

+1000

I will add the following.

Penalty for violation: death by public execution. With a guillotine.

Haha, I hope you are not serious. There you go, blow away your nice guy image.

 

[NW-Bound]

Me nice? Thanks, but I never thought I was nice. Or rather, I can be really mean, when meanness is needed.

By the way, do people here know the last time the guillotine was used? By a legitimate government I mean, and not by terrorists or criminals?

Look it up. You would be shocked.

 

[JoeWras]

1. All medical providers must publish a list of their charges by code. They can charge whatever they want, but they have to publish that price "up front".

DW found herself in the infirmary of a cruise ship in the Mediterranean. That's another story. Anyway, I was waiting while she was being treated, and on the wall was exactly such a sign. It looked official, like it was some EU requirement. I found all the listed charges very reasonable. DW was treated for something like 30 euros. I don't know any procedure costing $40 in the USA, except for maybe a shot by a nurse.

Odd part of the story... Most of the procedures listed were what you'd expect for light emergencies. E.g. finger splint, sore throat, abrasions, sutures. But the one that really got me: "Testicular Torsion Reversal (manual)". Oh man, that made me hurt.

 

[NW-Bound]

Does it hurt even more if they asked the patient how he got himself in such a knot?

 

[Rianne]

DW found herself in the infirmary of a cruise ship in the Mediterranean. That's another story. Anyway, I was waiting while she was being treated, and on the wall was exactly such a sign. It looked official, like it was some EU requirement. I found all the listed charges very reasonable. DW was treated for something like 30 euros. I don't know any procedure costing $40 in the USA, except for maybe a shot by a nurse.

Odd part of the story... Most of the procedures listed were what you'd expect for light emergencies. E.g. finger splint, sore throat, abrasions, sutures. But the one that really got me: "Testicular Torsion Reversal (manual)". Oh man, that made me hurt.

Not sure if it is still the same in Europe, not on a cruise. I had an emergency in Italy@ 2005. Had an ambulance bring me to University of Bologna medical center. Saw 3 specialists. Extreme abdominal pain, they thought appendix, heart attack and something else. Turned out I had fibroid tumors but they were able to relieve the pain. Doctors said I would eventually need surgery. I decided to go back to states to get surgery. I was under their care for approx. 4-5 hours. It cost me $50. I did not have travel insurance. I came back to U.S. and had the surgery.

 

[audreyh1]

Me nice? Thanks, but I never thought I was nice. Or rather, I can be really mean, when meanness is needed.

By the way, do people here know the last time the guillotine was used? By a legitimate government I mean, and not by terrorists or criminals?

Look it up. You would be shocked.

OK - I looked it up in Wikipedia, and I was shocked.

The guillotine remained France's standard method of judicial execution until the abolition of capital punishment in 1981. The last person to be executed in France was Hamida Djandoubi, who was guillotined on 10 September 1977.

Another site lists the last public execution by a guillotine as 1939 in France.

 

[travelover]

OK - I looked it up in Wikipedia, and I was shocked.

I guess that's one way to get ahead.

 

[aja8888]

The guillotine is quick, painless (I think) and no chemicals are needed.

 

[NW-Bound]

OK - I looked it up in Wikipedia, and I was shocked.

Another site lists the last public execution by a guillotine as 1939 in France.

The last public execution was indeed in 1939. The executed was Eugene Weidman, who was a serial murderer.

Instead of solemnly observing, the crowd went wild after the head fell. The crowd behavior was so bad that later executions were no longer allowed to be in public.

Back to this thread about medical costs, if those convicted of medical gouging were executed publicly, do you think the observing crowd would went wild the same way?

See: https://rarehistoricalphotos.com/last-public-execution-guillotine-1939/, which even includes a short film of the final moment.

 

[audreyh1]

Instead of solemnly observing, the crowd went wild after the head fell. The crowd behavior was so bad that later executions were no longer allowed to be in public.

Hmmmm - I suspect the same thing happened in the late 1700s when the guillotine was at Place de Révolution (now Place de Concorde) and many aristo heads were chopped off.

 

[Bamaman]

Newspaper articles are being written about healthcare in the region to the north of us. There is one large hospital chain trying to takeover healthcare management for a whole state. They refuse to accept Medicare Advantage plans of any kind, but they accept traditional Medicare. Their 1,700 physicians (and CNPs) in practices they own refuse to take Advantage. That means untold thousands of patients are going to have to find new physicians and go to different hospitals for procedures--many hospitals of which are in different cities even.

And the anesthesiologists being used in these new hospitals are 100% independent contractors of which none have contracts with insurance companies or Medicare. Only the MegaHospital that chased off all the Advantage patients employs their own anesthesiologists and is within network. It's all a Catch 22, but many, many patients are being hit big in the pocketbooks and complaining about out of network physicians.

Best to ask on the front end who is and who is not accepting what kinds of insurance.

 

[14thMed]

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

Me too!