Pay in advance for surgery - Dr, facility charges

[Born2Fish]

I have been contacted by the surgeon and surgery facility asking for me to pay in advance for my portion of the cost based on BCBS approved estimate.

I have never experienced this before.

The procedure is a cystoscopy, local anesthesia, only takes a few minutes to complete.

Is this the new normal? Should I worry about it?

My total out of pocket cost is around $775.

 

[jollystomper]

How far in advance are they asking for payment? I think paying the day of the surgery is becoming common.

DW had hand surgery the end of September, with anesthesia, in a surgical facility. We had to pay the morning of the surgery, about $1,800 out of pocket, before it happened, based on their estimate of what we would owe from our insurance. When the actual claim was filed, they had overestimated by about 10%. We received a refund of the excess in early November.

 

[MRG]

Should have figured... I had a deviated septum repaired on Monday and the facility reached out for MY convenience to collect my Medicare B deductible weeks prior to the surgery.

I think what's happening is there was a law passed saying they had to give you a price upfront. Since they pulled it off they're going to get their investment back by decreased float. Days outstanding in healthcare is one of their key measures.

 

[Aerides]

I had to pay the day of, upon arrival, for the surgical facility portion, when I had outpatient knee surgery. They knew how much I'd owe based on my insurance.

One of my local MRI facilities also request a pre-payment.

 

[athena53]

I agree- I've handed over my credit card the day of the procedure. I can see them asking a few days early to make sure you'll be there and have a valid credit card. They lose money if you show up and your only credit card is maxed out.

I once did this for a colonoscopy that we had assumed would be considered diagnostic and thus not covered as preventative under ACA (previous one had polyps). For some reason it DID get covered and I got a refund from the facility a month or so later without having to do anything to chase it down.

 

[Born2Fish]

All of this so far is reassuring.

The person who called me requesting payment told me that this is just an estimate from BCBS and my actual amount could be substantially more depending on BCBS final EOB.

I hate insurance companies.

 

[MichaelB]

All of this so far is reassuring.

The person who called me requesting payment told me that this is just an estimate from BCBS and my actual amount could be substantially more depending on BCBS final EOB.

I hate insurance companies.

I suspect it’s not just the insurance company here, but your feeling is easy to understand. Paying ahead of time is unreasonable, more so if they can’t even give a firm price.

 

[travelover]

.......I hate insurance companies.

Why? The real crooks are the medical facilities with the opaque pricing and conflicts of interest with respect to owning the facilities they refer you to. If not for the insurance company negotiating rates, you'd be charged even more.

 

[ivinsfan]

Why? The real crooks are the medical facilities with the opaque pricing and conflicts of interest with respect to owning the facilities they refer you to. If not for the insurance company negotiating rates, you'd be charged even more.

Well the whole system is broken IMO and it doesn't do any good to point fingers at who get the most blame, there is more then enough blame to go around.



DH had a pacemaker replacement which included new state of the art pacer, and outpatient day in the cardiac unit anesthesia and several hours of an EP cardio docs time. Billed 82K Medicare approved and paid amount 24K.



AFA medical owned faculties how would having outside money build and maintain them be any cheaper?



We have Medicare supplement and were not asked to pay anything up front.


I wouldn't have had a problem paying something up front if asked. Also if you don't have the upfront money most places will set you up with a payment plan.

 

[Born2Fish]

Well the whole system is broken IMO and it doesn't do any good to point fingers at who get the most blame, there is more then enough blame to go around.



DH had a pacemaker replacement which included new state of the art pacer, and outpatient day in the cardiac unit anesthesia and several hours of an EP cardio docs time. Billed 82K Medicare approved and paid amount 24K.



AFA medical owned faculties how would having outside money build and maintain them be any cheaper?



We have Medicare supplement and were not asked to pay anything up front.


I wouldn't have had a problem paying something up front if asked. Also if you don't have the upfront money most places will set you up with a payment plan.

Yep, you said it better than I did.

I don't mind paying what is agreed to but I don't like the uncertainty of what the eventual "final" payment will be.

I stay in-network for my HDHP. Once I spend $7k it's all free.

I pay it off, keep good records, and we can take it out of the HSA some day if we want to.

Guess I just don't like spending the money.

 

[fh2000]

I had a surgery 3 years ago. Hospital called me few days ago to prepay my share for 10% discount, so I did.

 

[HawkOwl]

There is a reason Burger King takes your money at the drive through before handing over your burger.

 

[athena53]

Yep, you said it better than I did.

I don't mind paying what is agreed to but I don't like the uncertainty of what the eventual "final" payment will be.

In fairness, some procedures will have an "it depends" cost. I would expect a colonoscopy to cost more if they have to snip out a dozen polyps. If there are fees to use the facility that may also be a function of time. DDIL and I were trying to figure out her bill for the birth of the last baby (yes, it is pitiful that it took a retired actuary and an intelligent woman with an Associates degree in Business a fair amount of time to sort it out) and part of the charge was the hourly rate for the labor room. Those things can't be predicted ahead of time.

 

[grasshopper]

On a January 2 opthamologist appointment I was asked to pay my Medicare deductible. I suspect they knew they were first in line for my $233.

 

[MRG]

There is a reason Burger King takes your money at the drive through before handing over your burger.

Burger King seldom kills their customers. ETA: That day.

 

[latexman]

The surgery center for DW’s two cataract surgeries overcharged us and had to send us a check for $538! Not happy about their poor estimating!

 

[Car-Guy]

All of this so far is reassuring.

The person who called me requesting payment told me that this is just an estimate from BCBS and my actual amount could be substantially more depending on BCBS final EOB.

It's normal but usually the estimate is spot on in my experaince.

I hate insurance companies.

+1

Evolution of organized crime. Totally legitimatized by law.

 

[pb4uski]

.... +1

Evolution of organized crime. Totally legitimatized by law.

You can always go without insurance... pick your poison.

 

[Car-Guy]

You can always go without insurance... pick your poison.

Unless you are young and/or very healthy, that's not much of a choice in the US. Unless you are someone like Bill Gates or Warren Buffet. (Rhetorical)

I've said for years, the true value in medical insurance is in being able to take advantage of the insurance companies "negotiated" rates.

As a gross example, if Joe Blow goes into the hospital for "whatever" he may easily run up 50k in charges for a short stay. If he has insurance, the hospital still charges the insurance company the 50K. But the insurance company has an established or negotiated rate for "whatever" for only 5k (not the 50k charged). Then they typically pay the hospital 4k (80% of the negotiated rate) and you pay 1k (20% of the negotiated rate). Without insurance, you'd be on the hook for the full 50k. Of course there are endless exceptions, in and out of networks, etc, etc. But to me that's the real value of having (needing) medical insurance for most folks in the US today.

 

[jollystomper]

Burger King seldom kills their customers. ETA: That day.

<ThreadTangent>

Interesting, that almost happened yesterday: https://www.wesh.com/article/florida-burger-king-shooting-mayonnaise/39477155 (Burger King employee shoots at customer)

</ThreadTangent>

Now back to the regularly scheduled thread...

 

[CRLLS]

Unless you are young and/or very healthy, that's not much of a choice in the US. Unless you are someone like Bill Gates or Warren Buffet. (Rhetorical)

I've said for years, the true value in medical insurance is in being able to take advantage of the insurance companies "negotiated" rates.

As a gross example, if Joe Blow goes into the hospital for "whatever" he may easily run up 50k in charges for a short stay. If he has insurance, the hospital still charges the insurance company the 50K. But the insurance company has an established or negotiated rate for "whatever" for only 5k (not the 50k charged). Then they typically pay the hospital 4k (80% of the negotiated rate) and you pay 1k (20% of the negotiated rate). Without insurance, you'd be on the hook for the full 50k. Of course there are endless exceptions, in and out of networks, etc, etc. But to me that's the real value of having (needing) medical insurance for most folks in the US today.

I agree with your true value part. Whether one is in the deductible stage or past that, there is a huge savings anytime you see a Dr. with insurance. However you leave out the months and years of premiums you (and your employer) may have paid before you get any "appreciable" benefit on the order of your example. It is hard to put a price on that to find the real "true value".

 

[Car-Guy]

^^^^^
An immediate family member ran up a hospital bill of "almost" 200k a few years ago... (Not a typo) That was for about 10 days in the hospital for a single event. That one event covered a lot (if not all) of my premiums over the years.

 

[jollystomper]

^^^^^
An immediate family member ran up a hospital bill of "almost" 200k a few years ago... (Not a typo) That was for about 10 days in the hospital for a single event. That one event covered a lot (if not all) of my premiums over the years.

True. For us that is well beyond the premiums we paid. From My Quicken Data, since 2002 we have paid about $108K in premiums, including for our children. Megacorp started making employees pay insurance premiums about 10 years before that. I do not have the records, but even if I used what we paid in 2002 for those previous 10 years ($106/month), our total premiums have been about $120K for our lifetime.

 

[Buckeye]

I had to pay the day of, upon arrival, for the surgical facility portion, when I had outpatient knee surgery. They knew how much I'd owe based on my insurance.

One of my local MRI facilities also request a pre-payment.

A friend said she had been asked to pay about $80 at the imaging facility where she had a couple of x-rays taken. I told her that didn't sound right (she has a Medicare Advantage Plan) so we looked up her plan benefits. It wasn't right. Her co-pay was $15! I called the imaging facility billing folks right then and they agreed they had overcharged my friend and would process a refund that she should have within 30 days. I asked when she would have received her refund if we hadn't called and the billing rep said that an audit would have caught the overpayment "at some point in the future."

 

[Skoach]

I had one experience 25 years ago having to chase down a refund after a poor estimate by a facility and have never prepaid again. I simply tell them I want it to run through insurance first to make sure it’s right. If they challenge that, I explain that I am up against my OOP max and the number depend on the order the bills from all previous providers are settled. Has never failed.