Mike95060
Work In Progress
Sometimes It's enough to make me want to armor a bulldozer.
Mitigating Medical Costs - Planning For Surgery
- Thread starter EjGlows
- Start date
Sometimes It's enough to make me want to armor a bulldozer.
My900ss
Puts the work in
What I suspect you are running into here is the difference between an individual who is on a heavily subsidized ACA plan vs. those who do not receive subsidies. Those who are spending other peoples money don't "pay" close attention to how its spent. When it is your money you do pay attention.
I do think this thread is interesting and while I have not spent many elective days in a hospital the approach you are offering is interesting. This qualifies as "I learned something new today".
Thanks,
T
rodr
Well-known member
Erin, perhaps it would help to ask the hospital for a written estimate of your charges in advance, including your portion of those.
The subsidies are just for the premiums - those are not the topic here. They do not cover the patient's share of doctor and hospital visits, and I'm pretty sure patients care plenty about that.
The subsidies are just for the premiums - those are not the topic here. They do not cover the patient's share of doctor and hospital visits, and I'm pretty sure patients care plenty about that.
greggargubby
Back For More
This is a very useful thread and I hope you can find the energy after your surgery to update it. I do have one worry, though: I'm concerned this could compromise the care you receive. Not so much regarding a particular device or surgery implement, more that a practitioner would spit in your soup (for lack of a more elegant phrase).
drewcandraw
Hired Grunt
Um from my experience, I declined whatever i was able to purchase outside of the surgery center i went to. I got my meniscus tear repaired and scar tissue removed.
The anesthesiologist called me to speak for less than 5 min about the procedure and just told me what to expect. That phone call was 15 bucks and I complained with the insurance so I had it removed.
I paid 40 bucks total for a knee brace and crutches. I could have asked ahead of time to borrow crutches but was lazy. I think this portion is where you will save
I called both my insurance provider and the surgery clinic and anyone involved in my surgery. My total out of pocket at the end was a 50 copay plus 40 for the equipment for a total of 90 bucks. Total surgery cost for an hour was 24k.
The anesthesiologist called me to speak for less than 5 min about the procedure and just told me what to expect. That phone call was 15 bucks and I complained with the insurance so I had it removed.
I paid 40 bucks total for a knee brace and crutches. I could have asked ahead of time to borrow crutches but was lazy. I think this portion is where you will save
I called both my insurance provider and the surgery clinic and anyone involved in my surgery. My total out of pocket at the end was a 50 copay plus 40 for the equipment for a total of 90 bucks. Total surgery cost for an hour was 24k.
This is the part that gets me. The insurance company, not you or your Dr. determines what is medically necessary. Case in point Colonoscopy, my Blue Cross covers as preventive. My friend has Kaiser and his does not cover (elective) until he got blood in his poop test. I had my Colonoscopy yesterday and friend has his tomorrow.
I was in good shape this time with only one small polyp. My first colonoscopy was 14 years ago, I was not a perfect asshole. Larger growth cut out and I was on a 3 year check for a while. Had an uncle who died from Colo cancer so family history.
Lorry
Well-known member
This happened during my wife's gall bladder surgery two years ago. In advance, we checked that the hospital was in network and I specifically asked if everything would be covered under my insurance. The answer was yes. A month after the surgery, it turned out that the anesthesiologist was not in network and we received a bill for $7500. We got in touch with the hospital and insurance company and they resolved it between them - luckily.
A second issue that came up was one provider decided afterwards that they wanted more $ than was agreed with the insurance company. The insurance company said that they had paid the agreed amount, and, furthermore, that we owed nothing. However, the dispute took about 18 months to resolve and did hit the credit report.
As far as I can see, you can check as many things in advance as possible, but you can still run foul of the billing/payments system.
gnahc79
Fear me!
I think you either left out or forgot the most important part...leave all of this to your wife the day of the surgery and afterwards. Just focus on healing up :thumbup.
we have Kaiser, but our son's open heart surgery was sent to UCSF. Kaiser covered everything after our co-pay, but we did see the bill. Over $200K. And no bogus charges on there either.
we have Kaiser, but our son's open heart surgery was sent to UCSF. Kaiser covered everything after our co-pay, but we did see the bill. Over $200K. And no bogus charges on there either.
Lunch Box
Useful idiot
There are some great responses in here. Keep them coming. Unfortunately for me, almost all of my major surgeries were unplanned. I've been luck enough to have decent coverage most of the time, though. Please keep us posted and, more importantly, let us know if there is anything at all that we can do to help out. BARF has a fair amount of power when properly motivated.
m_asim
Coitus Infinitum
How can you negotiate after the fact?
UDRider
FLCL?
Two separate things. Negotiating before, which was Erins original intent for this thread, and just commenting how hundred grand plus was justified.
JakesKTM
Well-known member
The biggest problem in California (and other states that have not outlawed it) is the practice of balance billing. This is the practice by doctors and medical groups who have standing contracts with your insurance provider for a certain billing rate. Your insurance uses that agreed on billing rate to factor your responsibility, i.e you pay $20 for a $100 agreed on office billing rate.
The problem arises when the doctors and medical groups apply their rate (not agreed upon by your insurance) to the procedure and send you a bill for the balance between the agreed upon rate and their medical group rate.
This happened to my son after a moto injury. Mother's insurance paid the agreed rate for the medical procedure, but then the medical group had their own rate and said the difference would be $12K.
At the time I was suing Wells Fargo in federal court in pro se, and had enough boilerplate debt letters lying around to stave off the attempt, but they reported it on my credit anyway, just never sued me. it is now past statute of limitations.
The problem is not the insurance. It is the doctors and medical groups who try to threaten collections and lawsuits when balance billing! Most consumers don't know any better and think it is an insurance issue. When you call your insurance company you find out they aren't the one's billing you. So you pay it to stay out of collections. It's a very common but filthy practice that is pervasive in California.
Good luck with getting any solid estimate from your medical group. They really don't want you to know. I suspect they will refer you back to your insurance company rather than give up the golden goose.
One letter to your medical group sent certified should suffice: I would say "please provide your medical group rate for this procedure on or before (date) and, if not received by said date, you forfiet your right to bill me beyond the insurance rate under XXXX policy."
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EjGlows
Well-known member
The ChargeMaster is rarely disclosed (how much stuff is billed for) and estimates between the insurance company and the practitioner is what I'll likely get in writing. The delta between the two is generally the liability of the patient, even if they weren't given an opportunity to compare costs, fees, equipment, and given a choice to "shop around". Oftentimes, the urgency of the situation doesn't allow you to do that.
An OON provider can charge whatever they want for their services without prior authorization from the patient and this is where it gets tricky. Insurance can negotiate a claim rate, say $4k on a $20k procedure, but the provider will bill YOU for the difference. At this point, you can negotiate with the provider for a more reasonable cost but you can be sent to collections concurrently.
It's an impressively wasteful and corrupt system.
I'm already making arrangements to have a few BARFers babysit me so that wifey doesn't go crazy with all my whining. :laughing
No sponge baths needed, thank you. :x
afm199
Well-known member
Easy. I got mauled by a dog and med evaced via ambulance. I had a five hour wait in the eroom while they found their neurologist and got him to the eroom, where he wiggled my thumb and said:" It's fine." I had $2k deductible blue cross and the charges were $2.3k. ( quite a while back, obviously. The ambulance alone would have been more today.)
I took the bill and argued with billing. Basically said; "Hey, I'm the guy who is going to pay you full boat for the expenses in cash. If you think I am paying for three hours of eroom waiting because your neurologist is golfing, you're crazy." Eventually got the bill knocked down several hundred.
I've seen the "worst case" scenario that Erin noted.
Checked the manic-depressive (now ex) wife into UCLA medical center for mental health issues. Check-in included us signing a document agreeing how much we'd pay, and showing receipt of that payment.
The stay in their mental health unit turned out really bad, but then...THEN.. we started getting the bills. You'd think that UCLA Hospital would be one organization, but no.. it's more like a hotel where a bunch of people rent space and "work" together on projects. From the bills we got, it looked like they rolled the wife down the hall on a gurney and people would reach out their office door, touch her, then turn around and write up a bill.
We got a stack of bills about 6 inches high for shit that made NO sense, so I started sending back a form letter that explained that I'd be glad to pay that bill, as soon as they provide me with documentation showing that this procedure was pre-approved by the insurance company. Lots of noise ensued, but I never paid a single one of those goddam bastards.
Checked the manic-depressive (now ex) wife into UCLA medical center for mental health issues. Check-in included us signing a document agreeing how much we'd pay, and showing receipt of that payment.
The stay in their mental health unit turned out really bad, but then...THEN.. we started getting the bills. You'd think that UCLA Hospital would be one organization, but no.. it's more like a hotel where a bunch of people rent space and "work" together on projects. From the bills we got, it looked like they rolled the wife down the hall on a gurney and people would reach out their office door, touch her, then turn around and write up a bill.
We got a stack of bills about 6 inches high for shit that made NO sense, so I started sending back a form letter that explained that I'd be glad to pay that bill, as soon as they provide me with documentation showing that this procedure was pre-approved by the insurance company. Lots of noise ensued, but I never paid a single one of those goddam bastards.
JakesKTM
Well-known member
Erin - there is no delta. There is the insurance rate and the balance between the doctor and or medical group rate. It is perfectly legal for you to be billed both by your insurance out of pocket (according to your insurance policy agreement) and the medical group (regardless of in network or out of network) the balance between the insurance rate and the medical group rate. You dont need codes or the charge master unless you are deciphering a bill and yes you do have the right to see it. What is illegal (in california) is balance billing for ER services. That is the only time a medical group cannot balance bill. Everything else is fair game. So if your procedure is say 100k total and your copay is 80/20 and the insurance rate is $60k then insurance pays 48k you pay insurance 12k or your max deductible and the medical group bills you 40k. THAT is how people get stuck with big med bills even with insurance. Send your medical group a legal disclaimer that unless they provide an up front cost for this procedure by such and such date then they waive their right to balance bill.
Update on my post. I was wrong my friend had his colonoscopy today.
Just got a call, he has Cancer, fuck Kaiser.
IF YOU ARE OVER 50 GET YOUR ASS CHECKED RIGHT.
gnahc79
Fear me!
:wtf
did not know that. PPO you can proper care but risk getting clobbered with a big bill. HMO you don't get a big bill but have to really push your way to get proper care. How incredibly awesome!
rodr
Well-known member
Here's another article describing the problem. Very educational.
http://www.latimes.com/opinion/opin...s-surprise-new-york-times-20140922-story.html
http://www.latimes.com/opinion/opin...s-surprise-new-york-times-20140922-story.html
