Community Chat

[Abrowneyegirl]

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@millieshops wrote:

They should be able to tell you what they will bill you, but I haven't had experience with any offices that will tell you the cost after that bill is submitted to your insurance. 

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I do not expect them to know how it is going to cost me out of pocket they have no way of knowing that.  

I am ONLY asking what they are going to bill me/my insurance company.

Once I know how much they are going to bill.  I can do the math.

The fact they do not know how much anything cost is alarming to me!

[Mrsq2022]

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@jackthebear wrote:

agree and it is annoying.

but every insurance company has a different deal

did you call  your insurance company for the cost to you?

but NOONE wants to go with a single payer.   (don't answer it will be political)

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Actually, this frustrating procedure pricing has been the same for years.  Nothing new here.  And I wholeheartedly agree with OP that is is ridiculous how much the price varies depending on whether or not you have a PPO, an HMO, an HSA, in-network versus out of network, etc....ridiculous!  

[jackthebear]

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@Abrowneyegirl wrote:

@jackthebear  Yes I did call the insurance company.  I thought that would help, they most they could tell me was the 'customary charge' 

I would have to contact the practice to find out what they were going to charge, because anything beyond the customary charge was paid 100% by me, in addition to deductible and co-insurance........

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ugh

so annoying

hope you can work it out

[qualitygal]

@Abrowneyegirl,

Here, here!! I agree, more questions before we say, yes, without checking the $$$costs. I had one doctor suggest something at the dentist's office, and I thought I'd think about it, since it was just a suggestion. Well, I came home and looked it up, and got my answer. I'm not doing this...but, I could have just said sure, and they'd have run with it. Think of a cliff and decide if you just want to walk off it blindfolded. About the same thing. Honestly, we must ask first!

[Abrowneyegirl]

@Mustang Shar  It was the billing office that I called when I spoke to 7 different people. When I told the manager that the $2500 variance was unacceptable she finally agreed and has offered to research it and get back to me.  That was 8 days ago......

[wagirl]

mememe---I have to commend you on your intestinal fortidude about all this. I, too, have done the same thing--just said yes without first finding out what the bottom line will be. And I think that calling your insurance company should be the first plan of attack. I have a great insurance plan---yes, I know, am I nuts ?---but I do and after going thru breast cancer 4 years ago and all the horrendous scans and tests and procedures, surgery and then the chemo and radiation; most of which I just let happen without thought of cost., I prob only had to pay $5000 total and my ins covered the rest of the $100,000 + bill. But my point is, now I call my insurance first and I have a great woman there, that I bounce all sorts of questions off of. She has saved me thousands of dollars I'm sure. So build a  repore (sp?) with someone if you can and go to him/her first and let them do the work. The people who are the worker bees don't really have a clue about insurance. and they shouldn't; they need to do their jobs. You still need to be vigilant and always be on top of things. Bravo to you for that.

[Abrowneyegirl]

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@Snowpuppy wrote:

The "price" for a procedure is usually what an insurer will pay.

You'll find many doctors fees are far less when you tell them it's not covered or you have to use an HSA.

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Oh, yes to this.

I thought I would make it easy (ha hah ha) at the imaging center- I said "just tell me the price this scan would cost if I had NO insurance, I will pay that right now, so I can have the scan done now and leave."  

No one knew the price......... grrrrrr!

[CelticCrafter]

If they can't tell you what they bill for the procedure and it's not an emergency for a life threatening issue then I wouldn't have it done.

[Adamlambert]

I think they are trying to determine what your out of pocket cost would be w your ins. I processed claims for years.  Go by the usual & customary

Personally, when a Dr tells me I need a test I ask why, get their reasoning. Then I google, research it all and then I determine if I want it. Not the Dr. If I'm paying, I want to eliminate all duplicate procedures and only have things done I feel are necessary. I was told I needed a body part removed years ago, went to get other options and waited ......issue resolved itself.  

I've been to practices where they do additional tests just to get money. Saw it all the time when working for the insurance company.  

[pitdakota]

It is frustrating isn't it, @Abrowneyegirl!

Since the 1990s many physician groups turned over their practices to physician practice management groups.  That business determined scheduling, charges, etc.  Those groups ran into some fairly significant money problems and declared bankruptcy around 13-15 years ago.  They are now making a come back to some degree though.

So hospitals started doing the same type of businesses to manage physician practices.  The net result is that today a significant number of physician groups are either employees of a hospital, a hospital organization, or a physician practice management group. 

Meaning people in the doctor's office itself have no idea what the charges might be in that situation.  It is not the doctor's office that determines the charge, it is the group that manages the practice.  So it sounds like that is what you encountered in your situation.

And unfortunately, charges for any type of procedure, tests, etc. is closely guarded.   This practice is the same in the hospital.  Many staff nurses have no idea what the charge for various equipment or supplies are in their hospital.  And it can be quite difficult for them to get an answer when they inquire.  Funny thing, hospitals want nurses to deliver more cost effective care....but then the nurses have no idea what the charge for commonly used items used in that area might be!

Good for you in asking though.  Public pressure might make a difference in holding health care personnel accountable for knowing what their patients are being charged and being able to relay that information when asked.