topic Re: Medical Charges in Wellness

Medical Charges

CelticCrafter — Fri, 25 Aug 2017 13:44:20 GMT

I'm going through all the EOB's from my husbands recent hospital stay and gallbladder surgery.

The charge for an abdominal CT scan was more than what the surgeon charged...

Re: Medical Charges

hoosieroriginal — Fri, 25 Aug 2017 14:44:26 GMT

Not sure if I had an MRI or a CT scan when I had my kidney stone, but I don't think it was that much. I know one is more expensive - I must have had an MRI. Heck, my ambulance was almost as much as my entire ER visit!

Re: Medical Charges

Gracies Mom — Fri, 25 Aug 2017 14:57:01 GMT

CelticCrafter....To be honest, if the hospital your friend's husband was in participates in their insurance plan, it doesn't matter what the hospital bill says-------their insurance has an agreement with the hospital to accept whatever they will pay aside from their deductible or any co-pays they might owe anyway. If he was an in-patient, the hospital gets paid by diagnosis and any complications he might have encountered--the charges themselves don't matter---this is called a "DRG"--diagnostic related group. For instance, the hospital bill itself could be, in total, for $50,000--but if the insurance company and hospital agree on the amount of $20,000 for an uncomplicated gallbladder surgery stay for let's say 3 days, then that's what the hospital has to accept. Feel free to call the hospital's billing department for further explanations. I know it can be confusing!!

Re: Medical Charges

Gram W — Fri, 25 Aug 2017 15:13:35 GMT

I would also check with the insurance company. Explain your situation and they can check the bill they received from your hospital. I had a case where the code on my bill do not relate to the procedure that was done. My hospital had to rebill with the correct code. With the correct code all was as it should be. I was very glad I had checked my bill and not automatically paid the original amount billed without question.

Re: Medical Charges

Katcat1 — Fri, 25 Aug 2017 16:03:00 GMT

The problem is hospitals and some doctors abusing the system and are medical coverage rates are sky high. There are companies that proofread hospital bills for double entries and mistakes. I truly wish this medical insurance system could be corrected.

Re: Medical Charges

CelticCrafter — Fri, 25 Aug 2017 21:10:47 GMT

@Gracies Mom wrote:
CelticCrafter....To be honest, if the hospital your friend's husband was in participates in their insurance plan, it doesn't matter what the hospital bill says-------their insurance has an agreement with the hospital to accept whatever they will pay aside from their deductible or any co-pays they might owe anyway. If he was an in-patient, the hospital gets paid by diagnosis and any complications he might have encountered--the charges themselves don't matter---this is called a "DRG"--diagnostic related group. For instance, the hospital bill itself could be, in total, for $50,000--but if the insurance company and hospital agree on the amount of $20,000 for an uncomplicated gallbladder surgery stay for let's say 3 days, then that's what the hospital has to accept. Feel free to call the hospital's billing department for further explanations. I know it can be confusing!!

Ah, I didn't know that. I knew if the hospital was a network provider they had an agreement as far as what would be paid to them.

I just found it strange that something done by a machine cost a lot more than something done by a human.

We are very fortunate, we have excellent pensioner benefits, no

co-insurance or deductibles and it's not an HMO plan.

Out of the entire bill, including the surgeon, we will be responsible for less than 3% of it and that's because the surgeon was out of network. The insurance company paid him what they would normally allow to an in network doctor.

Re: Medical Charges

Gracies Mom — Fri, 25 Aug 2017 21:52:39 GMT

CelticCrafter.....

Scans are VERY expensive---that goes for CAT scans, MRI's and PET scans---plus the radiologist who reads the scan (and compares the scan to an earlier one, if need be) has to be paid aside from paying for the scan itself. The scanning machines cost a fortune--to buy and maintain. Plus the technicians who run the machines have to be paid by whomever owns the machine. That is why most insurances insist on the doctor getting prior approval for certain scans--they want to make sure the scan is medically necessary.

For example, I have cancer--I go for a PET scan every three months at Sloan-Kettering (cancer hospital). The hospital has the responsibility of getting prior approval from my insurance company--which means they agree to pay for the scan and the reading of it. According to my explanation of benefits, a PET scan cost $6,000 and the radiologist's reading costs $500--my insurance tells me I am responsible for paying nothing--I don't know what they actually pay the hospital--but whatever amount it is, it is per their agreement. I have great insurance, thank goodness!!!!

I know that CAT scans and MRI's are cheaper than PET scans--I am allergic to CAT scan dye, so I can't have that type of x-ray--I have had MRI's recently, but that's when my oncologist was looking for another issue.

I hope I answered your question as to why scans are so pricey. There's more to it than pushing buttons to take a scan--it involves many experienced people to do it properly, aside from maintenance of the machine so it stays safe and works properly.

And yes....I've worked in hospitals for many years...I worked in a radiology department years ago for a few awhile, too. And I've been a patient since acquiring cancer six years ago--I am a survivor because of those scans!!!!!!

Re: Medical Charges

Moonchilde — Fri, 25 Aug 2017 23:59:28 GMT

Many people are unaware that for any diagnostic procedure involving Radiology, including biopsies or fine needle aspirations, there is a completely separate charge for the department (to include the personnel and all equipment and supplies) and a charge for the radiologist's expertise in looking at films, interpreting them, and comparing them to previous films.

This goes for the hospital Pathology Dept as well, for the same reasons, with additions - in a needle biopsy, the pathologist will often be the one doing the actual tissue/fluid withdrawal, and the same with a bone marrow, as two examples. And their professional interpretation charges are separate as well.

If anyone thinks this isn't needed - wait until you have a diagnosis where skill, accuracy and experience is crucial.

Re: Medical Charges

chrystaltree — Sun, 27 Aug 2017 04:22:08 GMT

@CelticCrafter wrote:
I'm going through all the EOB's from my husbands recent hospital stay and gallbladder surgery.

The charge for an abdominal CT scan was more than what the surgeon charged...

That wouldn't be unusual. Imaging is very expensive but the surgeon's charge would depend on the surgery. Some are high dollar, some aren't.

Re: Medical Charges

chrystaltree — Sun, 27 Aug 2017 04:27:59 GMT

@CelticCrafter wrote:
@Gracies Mom wrote:
CelticCrafter....To be honest, if the hospital your friend's husband was in participates in their insurance plan, it doesn't matter what the hospital bill says-------their insurance has an agreement with the hospital to accept whatever they will pay aside from their deductible or any co-pays they might owe anyway. If he was an in-patient, the hospital gets paid by diagnosis and any complications he might have encountered--the charges themselves don't matter---this is called a "DRG"--diagnostic related group. For instance, the hospital bill itself could be, in total, for $50,000--but if the insurance company and hospital agree on the amount of $20,000 for an uncomplicated gallbladder surgery stay for let's say 3 days, then that's what the hospital has to accept. Feel free to call the hospital's billing department for further explanations. I know it can be confusing!!
Ah, I didn't know that. I knew if the hospital was a network provider they had an agreement as far as what would be paid to them.
I just found it strange that something done by a machine cost a lot more than something done by a human.
We are very fortunate, we have excellent pensioner benefits, no
co-insurance or deductibles and it's not an HMO plan.
Out of the entire bill, including the surgeon, we will be responsible for less than 3% of it and that's because the surgeon was out of network. The insurance company paid him what they would normally allow to an in network doctor.

The charge for the CT is not just something a "machine" did assuming that your husband's CT was not done by a robot. The CT charge includes much more than just use of the equipment, it also includes reimbursement for radiology technician who is a person and who is the person who actually operates the equipment. There are other things that are factored into the CT and MRI charges, that's why they are so expensive.

Re: Medical Charges

Blingqueen023 — Sun, 27 Aug 2017 13:16:35 GMT

Don't come down with a Lymphoma. I had 6 treatments with chemo and it was 33,000 dollars a treatment. Thank goodness that the Lymphoma Society donated money to me to pay these bills and the American Cancer Society did the same thing. Plus, I received Medical Assistance even though I was working. I never even asked for medical assistance, the Oncologist office applied for it for me. If it wasn't for that, I'd probably be in jail today, lol

Re: Medical Charges

terrier3 — Sun, 27 Aug 2017 16:11:09 GMT

@CelticCrafter wrote:
Ah, I didn't know that. I knew if the hospital was a network provider they had an agreement as far as what would be paid to them.
I just found it strange that something done by a machine cost a lot more than something done by a human.
We are very fortunate, we have excellent pensioner benefits, no
co-insurance or deductibles and it's not an HMO plan.
Out of the entire bill, including the surgeon, we will be responsible for less than 3% of it and that's because the surgeon was out of network. The insurance company paid him what they would normally allow to an in network doctor.

The new machines can cost millions!

Re: Medical Charges

Snoopp — Wed, 30 Aug 2017 11:04:43 GMT

@Gram W wrote:
I would also check with the insurance company. Explain your situation and they can check the bill they received from your hospital. I had a case where the code on my bill do not relate to the procedure that was done. My hospital had to rebill with the correct code. With the correct code all was as it should be. I was very glad I had checked my bill and not automatically paid the original amount billed without question.

I know this happens but sometimes the insurer won't cover charges and the doctor/hospital insists the coding is correct. Don't know where you go from there.

Re: Medical Charges

panda1234 — Wed, 30 Aug 2017 12:05:07 GMT

@Blingqueen023 wrote:
Don't come down with a Lymphoma. I had 6 treatments with chemo and it was 33,000 dollars a treatment. Thank goodness that the Lymphoma Society donated money to me to pay these bills and the American Cancer Society did the same thing. Plus, I received Medical Assistance even though I was working. I never even asked for medical assistance, the Oncologist office applied for it for me. If it wasn't for that, I'd probably be in jail today, lol

Just wondering, did you not have insurance?

@Blingqueen023

Re: Medical Charges

Blingqueen023 — Thu, 31 Aug 2017 00:34:42 GMT

@panda1234 wrote:
@Blingqueen023 wrote:
Don't come down with a Lymphoma. I had 6 treatments with chemo and it was 33,000 dollars a treatment. Thank goodness that the Lymphoma Society donated money to me to pay these bills and the American Cancer Society did the same thing. Plus, I received Medical Assistance even though I was working. I never even asked for medical assistance, the Oncologist office applied for it for me. If it wasn't for that, I'd probably be in jail today, lol
Just wondering, did you not have insurance?
@Blingqueen023

@panda1234I've had FEderal Blue Cross since I was 17 and I'm now 64 and still carry Federal Blue Cross. I don't have Medicare yet so my patient responsibility would have been in the thousand of dollars. Without the medical assistance that the office applied for me and the donations from the Lymphoma Society I would have made payments for the rest of my born days. I'm forever grateful that this Oncology Office thought of applying for medical assistance for me. After what Federal Blue Cross paid, the medical assistance and the donations paid the balance. The chemo cost me nothing.

By the way if you're wondering how I'm doing The chemo took away the Lymphoma I'm very grateful and happy about that I'm doing very well. Thanks for asking.

Re: Medical Charges

panda1234 — Thu, 31 Aug 2017 09:31:49 GMT

@Blingqueen023

So very glad you are doing well. Both of my parents had this and like all cancers, it was difficult.

I was just curious about your insurance not paying for all or most of your treatment. I am not familiar with Federal Blue Cross.

It is terrible that you have the stress of your illness and on top of that financial worries. Getting sick should not cost so much.

Re: Medical Charges

Blingqueen023 — Fri, 01 Sep 2017 01:06:17 GMT

@panda1234 wrote:
@Blingqueen023
So very glad you are doing well. Both of my parents had this and like all cancers, it was difficult.
I was just curious about your insurance not paying for all or most of your treatment. I am not familiar with Federal Blue Cross.
It is terrible that you have the stress of your illness and on top of that financial worries. Getting sick should not cost so much.

@panda1234 I sure hope both your parents are well and they beat it. Cancer really changes your whole life. I wish everybody in your family much good health and happiness!!!!

Re: Medical Charges

panda1234 — Fri, 01 Sep 2017 01:29:38 GMT

@Blingqueen023 wrote:
@panda1234 wrote:
@Blingqueen023
So very glad you are doing well. Both of my parents had this and like all cancers, it was difficult.
I was just curious about your insurance not paying for all or most of your treatment. I am not familiar with Federal Blue Cross.
It is terrible that you have the stress of your illness and on top of that financial worries. Getting sick should not cost so much.
@panda1234 I sure hope both your parents are well and they beat it. Cancer really changes your whole life. I wish everybody in your family much good health and happiness!!!!

@Blingqueen023 Thank you for your kind wishes. They have both passed away. Their doctor said it was very unusual for two people to come down with this at the same time. They lived in a house that was almost 100 years old and we wondered if it was something in the house.

Re: Medical Charges

Blingqueen023 — Fri, 01 Sep 2017 02:59:07 GMT

@panda1234 wrote:

@Blingqueen023 wrote:
@panda1234 wrote:
@Blingqueen023
So very glad you are doing well. Both of my parents had this and like all cancers, it was difficult.
I was just curious about your insurance not paying for all or most of your treatment. I am not familiar with Federal Blue Cross.
It is terrible that you have the stress of your illness and on top of that financial worries. Getting sick should not cost so much.
@panda1234 I sure hope both your parents are well and they beat it. Cancer really changes your whole life. I wish everybody in your family much good health and happiness!!!!
@Blingqueen023 Thank you for your kind wishes. They have both passed away. Their doctor said it was very unusual for two people to come down with this at the same time. They lived in a house that was almost 100 years old and we wondered if it was something in the house.

@panda1234 I'm so sorry to hear that. I'm always wondering how I got mine because I was on a blood thinner that was new on the market for a year and one of the side effects was that is may cause certain cancers. I guess we'll never really know the answer to this one. Again, I'm so sorry for your loss. I lost my dad this past April. You just never get over it. Please have a wonderful holiday weekend coming up

Re: Medical Charges

Pooky1 — Fri, 01 Sep 2017 11:24:38 GMT

you probably had a ct scan. mris are really expensive.