Mitigating Medical Costs - Planning For Surgery

[EjGlows]

After reading yet another article on the unexpected expenses of medical procedures, I've decided to see if I could mitigate any additional costs for my upcoming surgery in December by being as proactive as possible since I have a few months to do a little legwork.

After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn't Know

I have decent insurance (PPO group plan through work) and have even worked a stint in the insurance industry reading through coverage, liaising with providers and clients, so I've got a bit of a bone up on the average Joe. My goal is to pare down the costs so that my out of pocket expenses cover only my co-pays and market-rate for any durable medical equipment that I may go home with (of which I know exactly what to order online). So, here's the plan:

1. Request that any provider (surgical assistant, nurse anesthetist, etc.) be pre-approved by myself and my insurance.

2. Request billing codes ahead of time and ask that a pre-surgery plan be made. You know, like a car estimate? :laughing

3. Get quotes from insurance regarding DME and order before surgery so that the negotiated costs are not passed onto me as the patient. (I've paid $500 for a sling before!)

4. Require that any additional medically necessary procedures are approved by my wife (documented Advanced Health Directive)

In the past, I've had some unexpected bills show up months later and would really like to zero out any additional expenses, not because I'm cheap, but rather I'd like to know if it can be done.

Thoughts? Suggestions? I feel a little crazy shopping around like this, but if I have to pay for a pregnancy test I'm going to lose my mind! :mad :laughing

 

[augustiron]

Great subject. I'd love to hear advice on this from folks in the know like yourself. Best of luck.
Also there are always home surgery kits and YouTube videos if you really want to keep the costs down. Haha

 

[EjGlows]

Great subject. I'd love to hear advice on this from folks in the know like yourself. Best of luck.
Also there are always home surgery kits and YouTube videos if you really want to keep the costs down. Haha

I hear it's possible to get a r̶a̶c̶e̶ ̶ medical license and show up the day of the surgery to perform it myself with local anesthetic, perhaps a ball gag, and a bottle of Jameson. arty

 

[Nemo Brinker]

Terma Gant and I would be happy to help if that's the route you choose. :devil Also down to bring you ice cream and watch movies afterwards.

Seriously, this is awesome information for the rest of us facing planned surgeries. Keep us updated with how that goes--that NY Times article on industry abuses was scary as hell.

 

[rodr]

Why is this your problem and not the insurance company's? Don't you have a max on out of pocket expenses?

 

[EjGlows]

Terma Gant and I would be happy to help if that's the route you choose. :devil Also down to bring you ice cream and watch movies afterwards.

Seriously, this is awesome information for the rest of us facing planned surgeries. Keep us updated with how that goes--that NY Times article on industry abuses was scary as hell.

Always so helpful. :love

I think that most people aren't inherently savvy consumers when it comes to healthcare, but even more so they can't be. The system is intentionally obfuscated and designed to pull every last pound of flesh from all of us that are walking around emaciated.

Why is this your problem and not the insurance company's? Don't you have a max on out of pocket expenses?

I do, but that doesn't mean I should pay up to that point for services rendered, non-negotiated, or medical equipment I can buy without a 2000% markup.

I paid almost $200 for two strips of that orthopedic tape (didn't help) that would have cost me $24/roll to purchase on my own and bring with me to PT. Should I not be penny-wise? :dunno

 

[Nitewaif]

Let me know how this works out for you, Erin. Having paid an absurd amount for a 5-day hospitalization for food poisoning, I get where you're coming from.

Nemo, do y'all do tubal ligations?

 

[UDRider]

Hmm, I wonder if in cases like this model like what Kaiser has is better. Since they pay their doctors.

 

[Ducky_Fresh]

After reading yet another article on the unexpected expenses of medical procedures, I've decided to see if I could mitigate any additional costs for my upcoming surgery in December by being as proactive as possible since I have a few months to do a little legwork.

After Surgery, Surprise $117,000 Medical Bill From Doctor He Didn't Know

I have decent insurance (PPO group plan through work) and have even worked a stint in the insurance industry reading through coverage, liaising with providers and clients, so I've got a bit of a bone up on the average Joe. My goal is to pare down the costs so that my out of pocket expenses cover only my co-pays and market-rate for any durable medical equipment that I may go home with (of which I know exactly what to order online).

Doesn't your PPO have a max out of pocket? Mine is $3000. Who cares what they do after that..

 

[bikeama]

All good arguments for single payer, medicare for all.

I had my colonoscopy this morning. There is a new prep out that not all insurances pay for. The nurse told me if my insurance did not pay it would be worth spending the $80 plus so I did not have to take the old one gallon gag you shit.:welcome

 

[mlm]

Push the surgery to January and max out your medical FSA. Start of year is also when your deductibles reset, so take into consideration

 

[rodr]

I do, but that doesn't mean I should pay up to that point for services rendered, non-negotiated, or medical equipment I can buy without a 2000% markup.

I paid almost $200 for two strips of that orthopedic tape (didn't help) that would have cost me $24/roll to purchase on my own and bring with me to PT. Should I not be penny-wise? :dunno

OK. I figured pretty much any surgery would hit the max, but maybe not.

 

[Bronto]

Heard that taking your own hygienic stuff for stays in the hospital. Apparently there is a charge for Hospital provided tooth brush and paste.

 

[afm199]

This is why I like and recommend Kaiser. You pay a small fee for tests, medicines, office visits, a couple hundred for surgeries and MRI's and zero hidden costs. That's what I hate about insurance. You get the care and three months later you get a bill telling you that $3400 of it was not covered and is due immediately. Fucking thieves.

 

[EjGlows]

Just to be clear, I'm not asking which healthcare to purchase. I've had Kaiser in the past and I would choose it again if it were an option at my current company.

Secondly, I've put off this surgery for 8 months (yes, I'm looking to reach my OOP) but I'm a bit in shock at how many of you would rather max out your costs and just say "screw it". Insurance covers what they contract to cover, otherwise it is on the consumer to pay the differential. Even if the insurance is justified in paying or not, the consumer is on the hook and credit can forever be impacted. Again, this is part of why it is important to keep all of these bills/costs at the forefront and not just expect the system to work.

For the record, I've pushed this surgery out as long as I can both financially and physically.

I sincerely hope all of you scrutinize the cost of your healthcare because it does have an effect on premiums, deductibles, co-pays, etc.

 

[UDRider]

Thanks for starting this thread. Yeah most people don't even think about negotiating or seeing what all the costs are. They kind of assume insurance will handle it.
Also $117 thousand dollars for assisting? Freaking highway robbery.

 

[rodr]

Insurance covers what they contract to cover, otherwise it is on the consumer to pay the differential.

I would expect the insurance to cover anything that is medically necessary, subject to your share which should never exceed OOP maximum per year. If your surgery is elective (cosmetic for example) then it's a different story.

Read your policy carefully and also have your insurance rep explain it in detail.

If you somehow got stuck with a policy that escaped ACA compliance then you should look into your options with the new enrollment period coming up.

 

[MrIncredible]

I have decent insurance (PPO group plan through work) and have even worked a stint in the insurance industry reading through coverage, liaising with providers and clients, so I've got a bit of a bone up on the average Joe. My goal is to pare down the costs so that my out of pocket expenses cover only my co-pays and market-rate for any durable medical equipment that I may go home with (of which I know exactly what to order online).

I would expect the insurance to cover anything that is medically necessary, subject to your share which should never exceed OOP maximum per year. If your surgery is elective (cosmetic for example) then it's a different story.

Read your policy carefully and also have your insurance rep explain it in detail.

If you somehow got stuck with a policy that escaped ACA compliance then you should look into your options with the new enrollment period coming up.

I'm thinking you're not quite following the young lady.

 

[rodr]

I'm thinking you're not quite following the young lady.

I quoted what I was responding to. That much I followed just fine.

There is SO much misinformation floating around about this. Even many doctors don't get it.

 

[EjGlows]

I quoted what I was responding to. That much I followed just fine.

There is SO much misinformation floating around about this. Even many doctors don't get it.

Here's a sample:

My PPO covers 80% of whatever "x" costs for in-network but only 60% for out-of-network.

Let's say I'm sedated and although I'm at an in network provider hospital with an in-network surgeon, the anesthesiologist is an OON provider contracted without my knowledge by the hospital. I'm on the hook for the difference even though I chose to go "in network". I can fight this charge, but will eventually have to settle with the provider and possibly a collections agency.

The article gives an example of the fly-by-night MD's who hop in, bill, and leave without providing care. I haven't had that happen (yet) but am in a position for that to occur. However, I have had the medical biller wrongly code my procedures and have had to go through very time-consuming reviews and recalculations. For someone who can't read a bill, this is NEARLY impossible. My insurance says that I've saved 80% on my bill but still owe a couple hundred bucks - that's where it gets confusing:

Insurance negotiated a rate of $500 for durable medical equipment (e.g. a sling) and say I saved 60% and have to pay the other 40%. However, I know that piece of equipment costs less than their negotiated rate and LESS than what I have to pay out.

Sling Insurance-negotiated cost = $500
my co-insurance (@40%) = $200
Actual Sling Cost (on amazon) = $100
I pay $100 more for something I could provide and that's just ONE item on my bill.

Really, it's not as simple as it sounds to just let insurance "pay for it". I guarantee that I'm charged for a pregnancy test when it's 100% impossible and not even requested by my MD. I'll be updating this post to help others inform themselves.

This surgery is not something I'm doing for fun.