Community Chat

[Group 5 minus 1]

Never!!

[jackthebear]

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@wagirl wrote:

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.

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@wagirl   rapport  

in case you want to know

[3suwm5]

Healthcare - the inmates are running the asylum.  Understand, no matter the plan, you will be paying dearly.  It's not going to get any better.

[Deanie]

@pitdakota  Excellent response.  Some practices are going to what is called "boutique medicine"  or Point of Service.  You pay them and go back and submit to your insurance company.  As far as I am concerned, it is all a racket, because insurance companies are in the business of denying claims or paying as little as possible. 

[chrystaltree]

Good grief, what third world country do you people live in....lol   I've worked in healthcare for over 30 years and I never heard of such a thing....like never.  Every provider of every medical and dental service has a charge book or rate book and no one should be expected to book a serice without knowing what the cost will be.  Now, it's medicine and there are often multiple factors so sometimes they cannot give an exact charge.  They can always give a range.  Always.  That's the charge, insurers do not pay charges.  So the provider won't be able to tell you what your insurer will pay and what your copay will be but if you have the charge for the service, your insurer can give you that information.  I don't know if it applies to physician charges but my state has regulation that hospitals must provide charges within 72 hours whenever a patient asks and insurers must do the same regarding reimbursement.  Of course that would never apply for emergency care and the charges are approximate.  Now, the problem might be a matter of terminology.  "ultrasound of the heart" is pretty vague and nothing in medicine is as simple as some patients think it is.  Heart ultrasound might not be how the charge is listed in charge books.  This is my field and I'm not sure what what you mean by heart ultrasound.  

[Peaches McPhee]

What a coincidence.  There was a column in our local paper this week about just this same thing.  She called 2 of our major health systems (I can guess which ones she meant even though she did not use their names) and reported back on how easy/hard it is to get this information.  Mostly it was hard.  Apparently, some states (not mine) have laws to make getting this info easier.

[pitdakota]

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@Deanie wrote:

@pitdakota  Excellent response.  Some practices are going to what is called "boutique medicine"  or Point of Service.  You pay them and go back and submit to your insurance company.  As far as I am concerned, it is all a racket, because insurance companies are in the business of denying claims or paying as little as possible. 

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Yes, we have had doctors that switched to the concierge concept for quite some time.

We also have an assignment for our nursing students to find out how much a hospital charges for a particular IV fluid, medicine, etc.  Boy, do they ever learn how hard it is to find out what the patients in the hospital are charged!  

When doctors have joined part of a business group that manages their practice, it is not uncommon for people in that office to have no idea what the charge is for a lab,test, etc.  But at the very least, they should be able to give the name and number of the person in the managing business to contact for that information.  Maybe if more people ask it will help to at least reduce the run around one might get.  It may be better in some states, but it is certainly a problem here. 

[pitdakota]

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@chrystaltree wrote:

Good grief, what third world country do you people live in....lol   I've worked in healthcare for over 30 years and I never heard of such a thing....like never.  Every provider of every medical and dental service has a charge book or rate book and no one should be expected to book a serice without knowing what the cost will be.  Now, it's medicine and there are often multiple factors so sometimes they cannot give an exact charge.  They can always give a range.  Always.  That's the charge, insurers do not pay charges.  So the provider won't be able to tell you what your insurer will pay and what your copay will be but if you have the charge for the service, your insurer can give you that information.  I don't know if it applies to physician charges but my state has regulation that hospitals must provide charges within 72 hours whenever a patient asks and insurers must do the same regarding reimbursement.  Of course that would never apply for emergency care and the charges are approximate.  Now, the problem might be a matter of terminology.  "ultrasound of the heart" is pretty vague and nothing in medicine is as simple as some patients think it is.  Heart ultrasound might not be how the charge is listed in charge books.  This is my field and I'm not sure what what you mean by heart ultrasound.  

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It is quite common in this area to experience a great deal of frustration if you are trying to find out how much you will be charged.

I assume when the OP posted ultrasound of the heart that she is referring to a 2-D Echo.  And as we know....there are 2 separate charges for that.  One for the test and another for the cardiologist to read the 2-D Echo. 

[susan kay]

I had a similar situation last year, but with a different test.  My doctor wanted a baseline.As soon as my test was scheduled, I called my insurance company.  Wrote down the date, time and person that I spoke with.  Several days before the test, I again contacted the insurance company to verify that my cost was zero.  That wasn't a 100% guarantee that I wouldn't be charged, but it made me feel more comfortable.

[SahmIam]

I ALMOST did. My doc wanted to have to do a test at home (pick up on Friday, drop off on Monday) even though I believed it was unnecessary. We sorta had a stare down. I agreed simply because I wanted to be able to prove him wrong.

The more I spoke about it with family and friends, the more ticked off I became that he simply didn't listen to me. Understand that I see him twice a year so he doesn't make much money off of me; even his nurse commented (jokingly) that "we don't make ANY money off of you and other super healthy patients!" It was almost 2 weeks before I could pick up the testing kit so I, for WHATEVER reason, contacted my insurance to see what the cost would be: understand that HIS office told me it was covered, gave me the billing code when I asked for it and said 99.9% of the time, it's covered at 100%.

Called BCBS. This test costs $10,500!!  Yes, that's TEN THOUSAND FIVE HUNDRED DOLLARS.

*Stop by front desk to pick up kit.

*Go home, read instructions, wear kit at night.

*Drop off kit at front desk Monday morning.

*Will be mailed results.

FOR TEN THOUSAND FIVE HUNDRED DOLLARS.

BCBS pays EIGHT THOUSAND to the doctor (negotiated price). Oh, MY SHARE would be $1500.

P!issed off doesn't come CLOSE to what I felt after that! Called the office, cancelled the test and told them why. 

People, that is OUTRAGEOUS. You better believe I'm doing this for EVERY test ordered for me and my family going forward.