Your misfortune blows. For your sake, I hope you are a bad saver and 9 yrs of savings is only like 2,200 bucks or something. Sorry you have to deal with this..
So I just got a bill...
- Thread starter patrick593
- Start date
Your misfortune blows. For your sake, I hope you are a bad saver and 9 yrs of savings is only like 2,200 bucks or something. Sorry you have to deal with this..
That's not true.
Ive seen what goes through our billing offices. There is nothing shady.
As a Dr I put the ICD9 codes with my diagnosis and what extra testing I feel needs done. The billing department then has to run the codes through to bill the pts insurance. It is a lot of numbers.
Most offices are not doing anything shady. The penalties that come with that type of fraud are more than enough to prevent medical practices from intentionally trying to overcharge.
there are some insurance and medical folks on here. This, in my opinion is why our healthcare costs are out of hand. To me a basic policy should cover or help with preventative stuff like Dr's visits, weight loss, smoking cessation,etc...; emergency coverage for things like a broken bone or accident; and catastrophic coverage above deductible for things like heart attack and cancer. But all this, what I would call "quality of life stuff" like sleep studies, CPAPs, sinus/allergy, stomach issues, ED, etc.. for the basic policy, if covered should have a decent amount covered by the patient so they have skin in the game. Patrick didn't give a flip because he thought it was covered, but if he'd had to cover a third of it, he'd have to think twice if it was really necessary, and been more involved in selection and price. If you still want a more rich coverage policy, then you're premiums would jump accordingly.
Curious as to what industry pro's think, but I think that would make meaningful cuts in insurance costs. I actually think the ACA was the right idea, but it was implemented so poorly we lost the opportunity to actually achieve "affordable care" for the masses.
Curious as to what industry pro's think, but I think that would make meaningful cuts in insurance costs. I actually think the ACA was the right idea, but it was implemented so poorly we lost the opportunity to actually achieve "affordable care" for the masses.
I am guessing they can re-code it to have it as a covered claim.. if they can get the facility in network. He will need to just see what in network facilities were available to use for the sleep study in his area. If there were not any then he has a case to say hey there are no in network places and this was the closest to where I live. They can then change the claim to in network and then if it is a coding "error" (guessing it is not just an out of network issue) they can re-code the claim to get it covered.
Our daughter has a sleep study next week. Not looking forward to that.
Significantly more than that... I never claimed to be a great saver. Owning a home on a single paycheck isn't easy. A 5 digit bill is something I wouldn't wish on anyone, even CF
Good chance it may be able to be worked out. The Drs office should check to see what they can do to help. Run through billing or have the Dr's office send a letter to the insurance stating why they needed to use an out of network facility.
You are on the right track and that is exactly what an HSA does. We have the weapons we are just not consumers. The #1 thing we work for when we implement a new plan is consumerism. Everyone is still stuck in their old ways. Low Co pay plans.. I want to pay my $20 and be done with it. Well that is great but you are not teaching them how to be a consumer. You get a cold oh I will just go to the doctor it is $20... you fart wrong oh I will go to the doctor $20 co pay. We are not shoppers we are just buyers when it comes to heathcare. I think driving a higher deductible and teaching employees and companies on how to be better consumers is the key to success. Actually we know it is. We have 2 accounts that we have had on the books for 5 years+. They are self insured which means the company pays the claims up to a certain point before reinsurance kicks in. The one company when we picked up the account had an annual premium of $1.2 million for 85 employees (talk about expensive). This year we took them a renewal for $650,000 (max out of pocket). We did that be bring in nurses and teaching consumers how to be consumers in the healthcare world. We do network checks and we check facilities.The other account hasn't renewed but right now they have a surplus of $400,000 in the bank (knocking on wood). We have some larger ideas for the future but with ACA it is to much of a what if game. We have some ideas to change the health insurance/ health care world but with the ACA it makes it very hard to do that or take a risk and lose our ass because of government interference.
That has nothing to do with his situation.
The adjustments are the negotiated amounts between the in network provider and the insurance company, and are commonly half or more of an original bill. Also you had an emergency situation, so most insurance will pay any provider as in network, even if it wasn't.
Patrick went to an out of network provider. All this talk about billing codes, etc, is irrelevant if the provider wasn't in his network. He'll generally have no recourse with the insurance company. It was his responsibility to check that providers were in network, he failed to do so.
His only chance will be pleading with the sleep study place for some kind of discount.
His situation is the poster child for what is wrong in our health care system from the consumer side. A sleep study is an elective procedure that you schedule well in advance.
Would someone take a car to a body shop, and not even get a cost estimate before scheduling? Only in HC does the consumer just assume it will be paid by someone else, then bitch about the bill after the fact.
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I'm sure that's all true, but I wish they wouldn't have sent me a bill before running it through insurance. That about caused another emergency situation, if being supremely pissed off constitutes an emergency. vbg
And I'm sure it's probably an automated system and it just spits out bills and doesn't know if an account has been adjusted yet and blah, blah, blah.
I've been very lucky and that was the first time in my life (I'm 50) that I've been admitted to a hospital or had any kind of issue. No surgeries, serious illnesses or any of that, knock on wood. For that reason, I haven't had a lot of experience with "the system". That doesn't mean I don't have a healthy dose of mistrust or skepticism, though.
You would if it's your only mode of transportation.
I had a situation where I wasn't sleeping, as I drive for work I was dozing off behind the wheel. This was an emergency for me, I trusted my doctor to not sign me up for anything I wasn't covered for. I'm not an expert on insurance. I rarely go to the dr.
Just like people expect me to provide them the correct products when I'm selling them things, I expect Heath care professionals to do the same. that sure was a mistake...
I specifically voiced my concern when he was scheduling the gambit of tests and was reassured by said doctor that they don't send people out of network or plan.
Didn't you know? Parkview is not-for-profit. They CARE about our community.
Or something like that.
Man, I hate this new format. Not that I don't love re-reading quoted lines to see a point-counterpoint every other line. I'll just blame my disdain for the board on capitalism and obama to cover both sides. Well, maybe some white guilt too. Patrick, how much is a freaking sleep study without insurance? It can't be that crazy, it's such a common thing now.
I know my office mate was going to get one a couple of months ago, but didn't due to the cost and insurance not covering it. He did go to pick up the material for the at-home sleep study but was still pondering the price tag which I think he said was still a few hundred dollars. I will note that he is Jewish. A medical over-night and equipment costs can't be cheap these days.
But I await pNum's response ...
Sure. But if you want to distort any market, have a government pump in 10's or 100's of billions of dollars along with changing the rules of play. Medical industry and college education are two good current examples. Neither private enterprise or socialism, but some odd mix in-between with a perverse set of incentives create poor outcomes. .
When I had sinus surgery several years ago I asked a nurse what this would cost and she couldn't/wouldn't guess and said don't worry about it, it's covered. I said I just wanted to know... she had no clue. I would guess that was ultimately a $20K bill for something that was not medically necessary, but covered. If I'd have had to pay a third, no way would I have had it done if that was the true price, or I'd have been a choosey shopper!
BTW, I've never farted wrong in my life.
We are old and boring. The most popular thread is the cost of a sleep study and the insurances non pay ment of the procedure
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The doc has no clue when it comes to the insurance game. He/she is a health professional. Your beef should be with the front desk - they are the "insurance and billing experts"
It is an emergency. When you have apnea, you are depriving your heart and brain of oxygen. There's no telling how many heart attacks, strokes and other maladies occur because of apnea. If anything, it should be considered preventative care.
luckily, I learned my lesson with insurance coverage with a relatively small $250 charge (but it still pissed me off). Mrs. booyah had to have a procedure done, so we call our insurance to make sure it's covered, and they tell us it is. The doctor performs the procedure and schedules a follow up to ensure it was done properly. The procedure was covered, but the follow up wasn't. As far as we were concerned, the follow up was part of the procedure since its sole purpose was to verify the success of the actual procedure, but the insurance company treated it as a separate, unnecessary, and entirely unrelated event and charged us for it. The doctor didn't tell us the follow up wasn't a requirement of the procedure - what does he care if we have to pay out of pocket?
I consider myself lucky that it didn't end up being a lot more, and I now know that I need to get every doctor, line item, procedure, visit, whatever pre-verified for coverage by my insurance. It's all very silly and makes it difficult for 'regular' people to navigate the system unless they themselves are a HC professional or a health insurance employee. I learned not to expect any consideration from HC providers of the financial strain their work can unexpectedly place on their patients (even after doing some due diligence) and when going to the doctor I just have to hope that my insurance covers it once the dust settles.
I suppose it's too much to ask for the Dr. to at least be minimally aware of these (very real and expensive) issues his/her patients face. There should be some coordination between the Doctor and the other employees in his/her practice. I'd like to think that the entire practice is working together and looking out for the best interest of the patient both in terms of health and finances.
I am sure the doc is aware that some procedures are covered and some are not, but the doc cannot be expected to have any idea about any individual's personal plan. Our front desk spends half their day on the phone calling insurance companies about what will and will not be covered. Every plan is different. Thinking the doctor would be able to give much information on the insurance ramifications is just silly.
And most doctor's are aware that the cost for procedures has gotten out of control but the doctors are not the ones setting the prices (unless a small private practice). The hospitals/clinics are setting those prices after negotiating with insurance companies. The doctor is usually an employee just stating what he did and has nothing to do with the billing portion.
Did the doctor examine, and say holy shit, get Patrick to the sleep study this instant?
If not, then no, not an emergency. I'm sure he scheduled the thing days or even weeks in advance.
Cancer treatments are pretty important too, but the guy above knew to check his coverage.
There was once a time that HR would have reviewed all the paper work and informed you which was covered and which was not but now they're too busy planning cake and ice cream for some twit's birthday. No way in hell should any procedure = a life savings, but the Hyenas got to eat, and eat well, apparently. There was also once a time the medical industry waited until you were dying to pick your bones clean. I guess they're getting more proactive.
Gotta pay for all those buildings they are putting up. To build on FL33's thought, medicine and education seem to be the ones putting up the most buildings. How soon before they are the vacant factories built in the early 20th century?
I once had a job for a few months as a closing agent. You know doing all the paper work to close on a house and get title insurance. Well there was this old couple in their 80's who refinanced their house to pay off medical bills, only their lender was ripping them off and hard. It made me sick, I asked them if they had any children that could help advise them, which pissed their lender off. Nope, No immediate family in the area. So I asked the owner of the title company what I should do, because it was obviously a money grab by their lender and a very bad deal and it made me sick that I was helping rip this couple off. He screamed at me for asking if they had family, and then informed me it wasn't my job to police lenders. I called him that night and quit.
edit: fwiw - low pay was the main reason I quit, just to put that out there. I'm not a saint but the dishonesty was just the straw that broke this camel's back. Hey at least I kept my soul.
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That whole story is ridiculous and unneeded. My wife had to have surgery that wasn't life threatening, but would stop occasional pain. Her GP referred to the a specialist. The specialist agreed the surgery would fix the problem and asked her when would be convenient to have the surgery. She had it 10 days later and it never occurred to her that she needed to ask the insurance company of that 1 cent would be paid.
The US system is f'n awful. Why should one have to spend a lot of time trying to figure out the cost? Only because the hospitals and insurance companies don't want people to see how much they are ripping people off.
And anybody that thinks they trade off is better doctors is kidding themselves. US doctors are excellent, but so are doctors in other western countries. They don't have some secret medical information not available to others nor do they have equipment not readily available to others.
I left a job after three weeks once for some of the same reasons. Having to lie to people on the phone and screw vendors over was starting to keep me up at night. Not worth it at all.
We have Truth in Lending with the forms they make you fill out. Similarly, there should be Truth in Medicine.
Here's the sheet: This is the total cost, including clinic and anesthiologist. This is how much your insurance pays for each. This is your responsibility.
Everybody signs.
But Medical lobbyists would never allow it.
Americans have a habit of demanding the very 'best' (meaning newest and most expensive) in their health care, even when there is no proof that there is any benefit.
It's a complicated issue, but the biggest outlier I've seen anywhere is the vast difference in doctor pay in the US vs other developed countries. It's not uncommon to see doctors salaries at 2x to 3x the amount of their counterparts in Europe.
Somewhere along the line becoming a doctor, particularly a specialist, became a ticket to a very wealthy life. Part of that may be justified by the rigorous demands and exorbitant cost of the schooling. Who knows
LoL, thanks for clearing that up. Before the edit I left thinking, 'Was this back when you were practicing the faith?' OR 'And yet you are not a Christian, so ... [what does it matter]/[it is for naught]/[...]'
And this solidifies the change of tone since 15 minutes ago.
You are correct. I think bigger changes are needed, but there is no reason the cost for a procedure or anything should be hidden. Why do people accept this?
Insurance companies have some of the nicest buildings of all.
Dude, I don't consider you one of those slack jawed American Jesus followers. Just sayin' And, yes, this was when I was still very religious.
Absolutely, doctors here make good money, but they aren't rich by any means. The other big difference is the hospitals. They have every piece of modern equipment, but they keep everything else quit simple.
I much prefer the system here in every way. I get immediate, professional care and a very affordable cost. For those that want care above and beyond, they are easily able to purchase it. For the population as a whole, they get great care, with no hidden costs.
Have you seen the hospitals in this country? Pretty sure one of the top 10 most expensive construction projects east of the Mississippi just took place a few years ago in Ft. Wayne and it was a hospital not an insurance office. With ACA the regulations are extremely stringent on what they have to pay our vs what they can put away as profit. The companies know this and that is part of the reason we are seeing a lot of acquisitions in the last year. We will basically be a 2 company health insurance industry for anyone who wants to go fully funded (Anthem or UHC). That is why we are so focused on self insuring actually takes the companies out of the mix and allows them to help drive the cost down.
