Half Price Medical Bills?

[Hermit]

I got a bill for a minor surgical procedure I had done at an urgent care facility last April. My insurance had made a mistake in billing and had not paid the bill. The bill I received listed a payment adjustment for "Uninsured Discount - Self Pay" for half price.

When DW died many years ago the Flight for Life people billed me and said if I paid within 30 days, the cost was $15,000. If not the full price was $30,000.

Both of these bills were to be paid by my medical insurance and the insurance companies in both cases paid the full price.

It seems like medical providers are pretty eager to get half their standard rates.
I wonder how the US Medical costs would stack up against the rest of the developed countries medical costs if the costs were half what is normally billed?

 

[SumDay]

Interesting thought. I had a lot of lab work done last fall, and was amazed at some of the write-offs the lab took just to be a UHC preferred provider. Like a $375 test was settled by a payment of $18.50 by UHC. DH had an ER visit billed at $20,000 and was paid in full by $4,000 from UHC. I've always wondered if there really is anyone who actually pays full price.

 

[FIREmenow]

Interesting thought. I had a lot of lab work done last fall, and was amazed at some of the write-offs the lab took just to be a UHC preferred provider. Like a $375 test was settled by a payment of $18.50 by UHC. DH had an ER visit billed at $20,000 and was paid in full by $4,000 from UHC. I've always wondered if there really is anyone who actually pays full price.

I would bet that what is "reported" to be paid "in full" by UHC is also done with a lot of fancy hand-waving, side payments, write-offs, fake discounts, etc.

Nothing is transparent.

 

[ChiliPepr]

I've always wondered if there really is anyone who actually pays full price.

Anyone who has money and does not have insurance would be my guess.

I have always thought that it would be a great idea to require all medical services to be be the exact same cost, no discounts. If you charge BCBS a certain price for a procedure, then you have to charge a person walking in off the street the same price.

I have a friend that has a high deducible and always wants to know the price of a procedure/test before he has it done. Most doctor's offices have no idea, and the same procedure can cost different amounts depending on how it is coded.

 

[MRG]

Anyone who has money and does not have insurance would be my guess.

I have always thought that it would be a great idea to require all medical services to be be the exact same cost, no discounts. If you charge BCBS a certain price for a procedure, then you have to charge a person walking in off the street the same price.

I have a friend that has a high deducible and always wants to know the price of a procedure/test before he has it done. Most doctor's offices have no idea, and the same procedure can cost different amounts depending on how it is coded.

That would never work. The entire industry is built on the fact the price is unavailable. There's major companies who's only business is to collect the money owed to the providers. Do you think they want to give up billions in revenue every year? What about their profits? I mean all in the name of being better for the public?

I did have an evaluation with a balance therapist and audiologist. They gave me the codes and insisted I contact my insurance before my appointment. It was a 4-5 hour appointment and I guess he didn't want to go through the process of collecting when many insurance companies didn't cover this testing.

 

[Geld ist Freiheit]

Everything is negotiable.

I worked with a contractor who did not have any insurance. When he or the family would need something done, he let the doctor know the situation. Most of them accepted 25 cents on the dollar.

I asked my physical therapist about continuing treatments for an old injury if the insurance wouldn’t cover it. He said he had 12 people on staff that did nothing but process insurance claims. He indicated that if I paid as I went, he could charge a lot less since there was much less overhead involved. He was getting the money immediately instead of months later through Insurance.

 

[Texas Proud]

Just some info.... for awhile I was trustee on an asset backed security that was funding for a firm that paid medical bills early...


The company would pay a Dr or facility about 70% to 75% of the insurance amount right away and then wait to get fully reimbursed by insurance... there was a payback clause if for some reason the insurance company failed to pay eventually.... I was surprised how many Drs took this offer... I think part of it was the company would track down the payments from insurance which took that off the Dr office....

 

[LARS]

I would bet that what is "reported" to be paid "in full" by UHC is also done with a lot of fancy hand-waving, side payments, write-offs, fake discounts, etc.

Nothing is transparent.

Which begs the question, much like in retail where everything is on sale all the time, what are the real prices?

Much like retail, I assume the negotiated rates with Insurance providers reflect true prices... not pre-discount numbers.

 

[sengsational]

The "chargemaster" aka "rack rates" are pure fiction. It's going to be what they bill a non covered person, but they'd be an idiot if they simply paid it in full.

Will something like this break the log jam?

http://www.king5.com/mobile/article...reating-new-health-care-company/281-512774364

SEATTLE - Amazon, Warren Buffett's Berkshire Hathaway and the New York bank JPMorgan Chase are teaming up to create health care company "free from profit-making incentives and constraints."

 

[pb4uski]

.... I have always thought that it would be a great idea to require all medical services to be be the exact same cost, no discounts. If you charge BCBS a certain price for a procedure, then you have to charge a person walking in off the street the same price....

I can see some differences in pricing but not near as much as there is... I have often thought that there ought to be a law that the highest price can't be any more than 200% of the lowest price for a specific coded service (excluding Medicare rates which are often ridiculously low).... that would be a good start.

 

[audreyh1]

Well it’s obvious to me that the providers jack the price way way up, and then the insurance companies knock it way way down. It’s ridiculous! It’s a game!

I routinely see factor of 10:1. Series of blood tests like a thyroid panel. Lab bills insurance $1,500 to $1,700. Insurance disallows all but $150–$155 which I pay.

It’s insane!

 

[Alan]

During the last 2 years living in the USA I finally started receiving EOBs that made sense. It was at the North Houston heart center to which I had several visits and lots of tests. The first couple of weeks was the usual crap where they supposedly checked with my insurance provider and my portion of the charges was thousands of dollars. When the EOBs actually arrived for those tests I was owed over $6k, but after that the EOBs for future visits showed the exact contract price and I would see that a doctor visit billed at $120, insurance paid $90 and my copay was $30. Of course I was never offered a refund for the overpayments and had to ask for a check to be cut, so that was the same as all other facilities I’d dealt with. It drives me nuts when I turn up to see the doctor and am told “that will be $30 for today’s visit” when in fact they owe me thousands.

 

[DEC-1982]

Most of them accepted 25 cents on the dollar.

This sounds about right.

We had a negotiated price for hospital services for about $3800, half of which we didn't pay on time. The hospital promptly sent us a bill for about $17,000. So I guess the medical industry tries to charge 4-5 times the actual cost.

 

[FIREmenow]

I would bet that what is "reported" to be paid "in full" by UHC is also done with a lot of fancy hand-waving, side payments, write-offs, fake discounts, etc.

Nothing is transparent.

Which begs the question, much like in retail where everything is on sale all the time, what are the real prices?

Much like retail, I assume the negotiated rates with Insurance providers reflect true prices... not pre-discount numbers.

At least with retail, YOU are in charge of what you pay. The "real" price is always what the market will bear.

Unfortunately, this is not the case with health "insurance" companies with so many hands between your money and the service being provided.

 

[Cobra9777]

Medical billing, procedure codes, network discounts, insurance, EOBs, hidden facility fees... it's a bureaucratic train wreck. It's extremely rare that we have a medical claim that doesn't require multiple phone calls or emails spread over several weeks or months to finally get it all straightened out.

Case in point: Every year I have a simple wellness exam with my PCP including a battery of lab tests, all of which are 100% covered as preventative under my insurance. Inevitably, the lab files one or more of the tests under a non-preventative code and sends me a bill. Insurance tells me to call the lab. Lab tells me to call the doctor. Doctor says they already sent the correct codes to lab and I should ask them to re-file. My last exam was in August and just last week, I finally got the correct EOB for the lab work.

The one that really pisses me off is when we go to a network hospital and then get huge bills from a bunch of non-network doctors that we don't even remember seeing... like someone who supposedly looked at an x-ray. About 10 years ago, I refused to pay one of these for several months and they threatened to send it to collection. I then offered to pay my network-negotiated amount and they accepted it. It was a bit less than 50%. For them, I guess it was about the same as selling the debt to a collection agency.

I'm a bit of a control freak especially on money stuff. I won't pay anything until I fully understand exactly what it is and why I'm paying. I'm one of those who actually enjoy the process of negotiating with a car dealership, including all the little fees they try to add at closing, as if it was a "tax" of some sort. I just wonder how many people actually pay these medical bills without questioning anything.

 

[LastOfTheBoomers]

Last summer I went for a test at a practice that was In Network - the doctor I saw was a Temp - when I got the bill - 3 months later - he was noted as an Out of Network doctor - but the negotiated price was the same as an in network doc - but it didn’t count towards my In Net deductible.

So I called and asked the business manager if they could resubmit under another doc name at the practice - a week later they called and said my balance was zero - have a nice day!
So absolutely question how things are charged especially with Temp docs!

 

[Scuba]

Everything is negotiable.

I worked with a contractor who did not have any insurance. When he or the family would need something done, he let the doctor know the situation. Most of them accepted 25 cents on the dollar.

I asked my physical therapist about continuing treatments for an old injury if the insurance wouldn’t cover it. He said he had 12 people on staff that did nothing but process insurance claims. He indicated that if I paid as I went, he could charge a lot less since there was much less overhead involved. He was getting the money immediately instead of months later through Insurance.

I asked all of my regular docs if they offered a cash price for people without insurance. They all said no.

 

[brett]

A former colleague had a heart attack While in Florida. He is a Canadian and had out of country medical insurance.

He was in the hospital for several days until he could be stabilized and flown home.

At home, he rec'd an itemized bill from the hospital. The amount shocked him. He called his insurance agent to make certain that the bill was settled.

It was, however the agent told him that the total on the bill was meaningless.

The agent told him that the insurer gets the billing amount amount and then the negotiations begin. He said they usually settle at an effective discount of 45 to 55 percent. The proviso is that the insurance company remit the adjusted amount within 24 or 48 hours. We met a Director of three clinics in the LA area. He said that they have multiple fee levels depending on coverage, the person's ability to pay, and their negotiation prowess, etc. Seems odd to me.

 

[ivinsfan]

Well it’s obvious to me that the providers jack the price way way up, and then the insurance companies knock it way way down. It’s ridiculous! It’s a game!

I routinely see factor of 10:1. Series of blood tests like a thyroid panel. Lab bills insurance $1,500 to $1,700. Insurance disallows all but $150–$155 which I pay.

It’s insane!

Crazy like a fox, IMO it's blackmail to make sure you are afraid to go without health insurance. Collusion between the health providers, insurance companies and a third party I won't mention since that will lead to thread closure.

I can think of no other industry that would get away with this kind of predatory type pricing model.

 

[ceciledian]

With the insurance I have now I always self pay and file myself. The plan has no negotiated rates with oroviders so if I let them file with Aetna I pay full price until $6k deductible. Not all doctors give 50% off, but at least 20%i n my experience.

 

[pb4uski]

Medical billing, procedure codes, network discounts, insurance, EOBs, hidden facility fees... it's a bureaucratic train wreck. It's extremely rare that we have a medical claim that doesn't require multiple phone calls or emails spread over several weeks or months to finally get it all straightened out.

Case in point: Every year I have a simple wellness exam with my PCP including a battery of lab tests, all of which are 100% covered as preventative under my insurance. Inevitably, the lab files one or more of the tests under a non-preventative code and sends me a bill. Insurance tells me to call the lab. Lab tells me to call the doctor. Doctor says they already sent the correct codes to lab and I should ask them to re-file. My last exam was in August and just last week, I finally got the correct EOB for the lab work. ...like this with .

We have a persistent problem like this with blood work associated with annual preventative exams... we are very clear with all parties in the process that the blood work should only be what is covered by the annual exam unless they talk with us first but inevitably we get a bill from the hospital for the blood work and have to have the doctor's office recode it and reprocess it. Just yesterday, DH finally got sorted out this issue with the physical that she had in 2016! We had received a bill way back then, talked to the doctors office and thought it was taken care of since we never received a followup bill from the hospital... then in January 2018 we get a bill!

In our case the doctor's office and hospital are under the same network umbrella. Here's what I think... I think that they miscode this work intentionally since many people who don't care or monitor such things will "assume" that the bill is right and just pay it and that gooses the group's revenues and a unsuspecting public pays more than they should.

 

[MRG]

Before EMR was generally available we were selling multi-million dollar systems into large hospital's. The goal was to provide the coders with more information so they would have a better chance of getting the codes correct to reduce turn around time on collection of insurance companies reimbursement.

The turn around time on billing was one of their key performance indicators that were used as internal measures.

Must of meant something as they paid us millions of dollars to make the system do as they wanted. They claimed to have saved millions by the implementation even though it's useful life was only a couple years.

You know who didn't save millions of dollars? Anyone who uses that hospital chain.

 

[MBSC]

Here is an article published today regarding a $17,850 urine test.

Moreno's insurer, Blue Cross and Blue Shield of Texas, refused to pay any of the bill, arguing that the lab was out of network and thus not covered. Had it chipped in, it would have covered the service at $100.92.

Sunset Labs says its list prices were "in line" with its competitors in the area.

Resolution: Fearing damage to his daughter's credit rating, Moreno's father, Dr. Paul Davis, paid the lab $5,000 to settle the bill in April 2017. A retired doctor, he also has filed a formal complaint about the bill with the Texas attorney general's office, accusing the lab of "price gouging of staggering proportions."

The takeaway: When a physician asks for a urine or blood sample, always ask what it's for. Insist that it be sent to a lab in your insurance network.

Full Article: https://www.npr.org/sections/health...st-after-back-surgery-triggered-a-17-800-bill