Medical Costs

[Okie Boarder]

Having gone through the recent leg break and surgery, I've gotten a little more first-hand experience with medical costs. For those of you that have gone through medical issues I'm curious to see your experiences.

For example, on my Explanation of Benefits (EOB) from the hospital, it read something like this:

Amount billed: $30,000
Discount: $15,000
What your plan paid: $7,000
What you owe: $1,500

I've understood the amount billed is a bit of a "pie in the sky" amount and the discounted amount is more realistic. Also, I understand those that are footing the bill themselves usually pay somewhere around the discounted rate or less. Then the other items have a lot to do with you specific plan, deductibles and total out-of-pocket limits for the year.

Have your experiences been similar?

Anyone in the category of cash payers?

Any that would be willing to share, it would be good to hear about it.

[Neognosis]

yup. my experiences have been worse, even.

But I'm SURE not as bad as for some others.

I'm not a cash payer, I have "good" insurance, so I'm told.

My favorite is when I get the bill for a 15 minute visit to my primary. No tests, not a comprehensive examination, just 15 minutes during which he takes my blood pressure, I tell him I have had a sore throat for 2 weeks, he writes me a prescription, then he leaves the room. less than 15 minutes.



For this, it's nearly 100 dollars that gets billed to the insurance company, then I end up paying whatever.

But this guy makes or bills around 400 dollars an hour then?

Idk how much his overhead is, but that seems like a good living.

[jryoung]

On my most major medical services the coding and allocations were about as easy to understand as Farsi.

We paid an upfront down payment then they allocated that to three different agencies that provided services (surgery, imaging, labs/testing) and then our insurance covered the remainder and reimbursed us in many cases.

The surgery center was not "in-network" but the other two were (they are all in the same building, on the same floor and if you weren't paying attention you'd think you were in the same place the whole time). Because of that a greater portion of our down payment should have been allocated to the surgery and our insurance would cover imaging and labs since they were in-network. They allocated much of our payment to the imaging and labs leaving out surgery unpaid and having them (the surgery center) come looking for additional funds now a year later.

Fortunately, my wife understands all of this and has called them out. They should have never allocated our cash payment to the in-network providers, our cash payment should have been all we needed to pay and much of it should have come back to us.

Finally, for the real kicker (and working in our favor) since the nearest in-network surgery provider was more than 30 miles away she was able to get them to agree on an "in for out of network" service. That is, since there is no "local" provider of services our insurance would work with the surgery center to cover our treatment as an in-network location.

At the end of the day we had issues going against us and for us, but the insurance networks are so complex unless you understand how they work you can easily taken advantage of through errors or not fully understanding your rights.

.....and thus is why my wife does not take insurance in her practice.

[jryoung]

[Okie Boarder]

I've had some similar experiences with "in network" vs "out-of-network" with other bills. I've usually been able to work them out with a phone call and they re code it. With this whole thing I had a couple items coded wrong like that and the first urgent care visit was coded as a hospital visit rather than a doctor visit. It seems to me that this happens frequently and some people just don't pay attention and just pay the bill.

The most interesting thing to me is the difference between the "billed" and "discounted" rates. Why do they even show us that? I doubt anyone ever pays that much.

[Neognosis]

[ohsix]

I can not understand health insurance which is sad as I'm the group plan administrator at my company. We have what is basically catastrophic insurance through UnitedHealthcare. Our plan is $2500/$5000 deductible in network/out of network. Max out of pocket $5000 per individual. I have a family of 3, and my max out of pocket for all 3 of us is $10,000 per calendar year. My understanding is that I pay100% of UnitedHealthcare's pre-negotiated rates to care providers until I meet my deductible. However, I get bills that show what the insurance company paid even though I know I haven't met my deductible.

I look at max out of pocket costs. My family and I are pretty healthy for the most part. I can handle $10,000 out of pocket per year if I have to. I like health insurance for the big things like brain tumors and badly broken bones. If I didn't worry about those things, I wouldn't buy health insurance as I probably incur less than $1000/year in medical expenses and my wife is about the same.

[Neognosis]

You have to pay 10,000 dollars every year before insurance kick's in?

Man, that SUCKS.

I have something in the neighborhood of 1,000 a year, and I thought that was robbery...

[ohsix]

[jryoung]

They're typically rushing because they make $.35 on the dollar billed. Most doctors have to run on a Wal-Mart high volume low margin model.

I believe many doctors do have an out of pocket price I beleive...though some states may restrict it.

As soon as they take insurance their costs increase significantly...but, often if they don't they won't see many patients.

This is one of the core problems with heath care, it is simply not a priority for people and they feel that if they go to the doctor they should not have to pay because they have insurance.....and the doctor has no financial incentive to follow up and make sure a patient is adhearing to their health care plan.

When my wife tells patients what her fees are, many balk at paying that out of pocket. To which she puts it in context for most women (the bulk of her paitients).

"How much did you pay for your last haircut/color"

"Umm, about $150"

"How long did it take"

"Umm about an hour"

"Did your hairdresser go to school for eight years"

"what? no"

"I did, and your willing to pay someone $150/hr with a HS/beauty school educationso you can look good and are heasitant to pay rougly the same about for a doctor so you can feel and look good"

If we took greater responsibility in our health we would be much healtier and health care costs would be lower. But, as a socitety on the whole we choose not to. Everyone wants a $10 co/pay and cheap meds so they can continue to not take care of themselves.

[ohsix]

[eeven73]

Why worry, the Federal Gov't is taking this over in 2014 and will straighten it all out.

[Neognosis]

[jryoung]

and because of this they practice defensive medicine, run too many tests an further drive up costs.

There are so many problems in the system it's almost impossibe to pick where to start. To me though, the core of the problem is the way we take care of (or not) ourselves.

[Neognosis]

Man, my guy almost NEVER runs tests unless I ask for them.

And he doesn't seem to really ask any probing questions.

I was in a minor MC accident 2 years ago. I saw him a week later, and my shoulder was still full of some fluid.

Two years later, I still have pain in that shoulder and my neck. I want to see a PT, but I need a referral.

Last time when I was there for my throat, I mentioned that I was still feeling tightness and pain in that side of my shoulder and neck since the crash... He completely disregarded what I said and went back to talking about how he's going to give me a prescription for my throat, then in a flurry of white lab coat, he's gone....

[Faust]

[Okie Boarder]

cameraboy, I just wen through the scenario of out-of-pocket (OOP) costs with this surgery that you're asking ohsix about. The only difference in my case is that my deductible is $400 and my max out-of-pocket is $3,000. Since this was a pretty major event I was easily able to pass those two milestones. So, this was how it worked...

Urgent care and doctor visits: Co-pay and maybe a little OOP (went towards deductible and total OOP)

CT: C-pay and OOP (went towards deductible and total OOP)

There were several miscellaneous costs like that were the same. When it came to the surgery and everything associated with that is when I started hitting milestones.

I was paying co-pays and 100% costs until I hit the deductible. After that, the insurance picks up 80% of the tab until the OOP max is met. After that, the insurance picked up 100%. So about halfway through the detailed billing for the hospital I saw that switch and everything was covered. When all said and done I am ending up paying a total of $3,000 plus a few co-pays that don't apply towards OOP.

So in ohsix's case he would pay 100% of whatever the insurance company deems his part until he meets his $2500 deductible, then insurance pays 80% until he hits his OOP max.

[Nor*Cal]

I also have a catastrophic plan but my HSA has 2 years worth of deductibles in it now so I'm good to go...

[b_girl]

it's discussions like this that make me happy I'm living in Canada. The only bill I've ever recieved from a hospital was for a custom splint when I tore the RCL in my thumb... and I think it was for only $16 or so. Well, plus prescriptions, but my work benefits cover 100% of that.

[Neognosis]

But doesn't everything about Canada's medical system suck?

Didn't you have to wait 3 years to see someone for your tore RCL?

[microman]

[Neognosis]

Did you have to have an interview with a Death Panel before they fixed your torn RCL?

[b_girl]

HAHA

cameraboy, uuhh... no. my torn RCL was dealt with immediately, waited < 10 minutes in the waiting room and was out of there in less than an hour (including xrays, and a plaster cast)... and off to see a specialist a few days later who confirmed the tear and hooked me up with my splint.

Had surgery last week and was in within a few weeks of them telling me I needed it (it wasn't major surgery), and that didn't cost me a cent either.

[brew]

We have a $5,000/$10,000 deductible catastrophic plan that includes a prescription drug benefit. I pay BCBS's negotiated rates on all doctor visits up until I meet the deductible. Each family member also gets one free visit a year to their primary care provider. For this excellent version of insurance I pay $650 a month for family coverage. Tell me medical insurance doesn't suck balls.

[b_girl]

no interview with a death panel either! although I guess my type of injury wasn't very common (did it snowboarding) so the specialist called in some med students to help run the range of motion tests and such.

[Faust]

Holy smokes... well I think I have been sold on moving Canada

[Okie Boarder]

I'll take our tax rates and Canada's health care personal costs.

[Okie Boarder]

[Okie Boarder]

brew, that seems like an awfully expensive premium for what you are getting.

[brew]

No kidding. However, our policy is skewed heavily towards the older side as a lot of the younger employees have opted not to participate. That plus a few cancer issues, heart issues, etc. lead to $hitty insurance for the whole.

[Okie Boarder]

Seems like you could go away from the company offered plan and get individual insurance for a better price.

[chavez]

Okie Boarder, that would depend entirely on his family's medical history. If they are squeaky clean, sure. If not, they are probably better off where they are.

That, in a nutshell, is one of the biggest issues with health insurance from the patient's side. It is also the reason why mandatory participation is necessary for programs like "Obamacare" and "Romneycare" to work. Otherwise, people would only buy insurance when they got hurt/sick, and the insurance companies would not be able to operate for lack of premiums.

[Nor*Cal]

[Craig-R]

when i sliced my finger open and needed surgery the total bill was $30,000 also, and insurance covered something like 24,000 of it, i had a $700 bill for the ER doctor, a $1700 bill for the anesthesiologist, and a $3400 bill for the surgeon. i paid the first two then my surgeon said he'd be fine if i just paid him $1,000 which was incredible so all in all i only paid about 2500 out of pocket

[Dragonlady8]

I would never choose Catastrophic ins. Not that I don't have that 10k lump sum sitting around, but that's a huge chunk of change out of your life.
The nice thing about an HSA is that it's yours- belongs to you and goes with you if you were to change your job and it carries into your medicare years.
It's pretaxed and helps when april 15th comes around.
The problem with an HSA now, there's a cap - which is BS thanks to all who sit in that white house on the hill.

If you have children ( which we all know are little vectors for disease) it's usually smarter to go with an HSA or PPO. It won't take long for your kid to hit your deductible if your kid gets sick a lot. The nickel & dime game that goes with medication will get you to that limit in no time.
This info was passed along during an insurance meeting by an associate who use to have catastrophic coverage and now changed to an HSA because of the deductible.
BTW - what you see on an EOB for the MD isn't always what they get. Physicians have to negotiate a contract with insurance companies to get on their plans. It's the insurance company that holds all the cards in that deal.