Mitigating Medical Costs - Planning For Surgery

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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.

That's exactly how I described my experience at a Berkeley hospital. I crashed on Claremont Ave and was lying in the road with broken ribs and the wind knocked out of me.
I wanted to catch my breath and get a ride home but someone called the cops and an ambulance. Within 10 min I was on my way to emergency.
There were a few x-rays taken and a couple of hrs waiting on a stretcher to be released with them saying there not much they can do for broken ribs.
I thought I got bills from everyone that walked passed me. Most of them were small, less than $20 and a few in the hundreds. I was just surprised by the number of bills, there was a stack.

Another surprise was the cops reporting my crash and learning that it resulted in a point on my driving record, I never made a claim or reported it on my bike insurance.

 

[wannabe]

Very nice. Although $1,200 is still a good chunk of change, I guess things could have been a lot worse. So, you reached your out if picked maximum in December 2014 when the surgery happened. Now that we are into a new year, does this mean that any bills for services incurred after January 1st count towards a new out of pocket max for 2015? (Follow up visits, etc...) Or, since this is all part of something that started in 2014, does your 2014 out of pocket maximum still come into play?

 

[Nemo Brinker]

Well, the deed's been done and I'm on the road to recovery. The bills are starting to come in and I thought it might be helpful to post one or two up and explain how to read the bill, explain my financial responsibilities, show how the insurance company tries to convey their plan details so that it reads as pro patient advocate, and as a cathartic exercise to get through the pain and suffering of having to shell out cash. :laughing

First off, I purchased an ice machine that counts as DME (durable medical equipment) that was prescribed by my surgeon. My provider required this to be purchased out of pocket (upfront) and I've submitted for reimbursement which will be paid out via check and will cover 90% the cost per my insurance coverage. I had to call the insurance company 3 times to get the correct form and for an explanation how to fill it out so that the payment would not go directly to the provider (as is the typical mode). I can see how frustrating this would be for someone that isn't organized or doesn't have the patience. I'll get a few hundred dollars back and it's worth the wait.

Secondly, I've reached my out-of-pocket for the year (yay!) and the additional bills for the anesthesia/post-op visits have been covered at full cost (no co-payments, etc). I'll show this in another bill so you can (again) see the language that Cigna chooses to use when explaining benefits.

Without further adieu...

I hope your healing is going really well. More beignets sometime? :teeth The chart with your explanation of each billed item is REALLY helpful.

 

[EjGlows]

Very nice. Although $1,200 is still a good chunk of change, I guess things could have been a lot worse. So, you reached your out if picked maximum in December 2014 when the surgery happened. Now that we are into a new year, does this mean that any bills for services incurred after January 1st count towards a new out of pocket max for 2015? (Follow up visits, etc...) Or, since this is all part of something that started in 2014, does your 2014 out of pocket maximum still come into play?

That's only one of the bills, I wish it was only $1200 OOP! :cry

In total, it will be a few thousand when all is said and done - I'm not complaining. It's just a big hunk at the end of the year and through the first few months until I hit my 2015 OOP. My aftercare will re-start the bean counter back to $0 and I'll have many more bills until I again reach the same OOP max. That's what will really make this an expensive endeavor (medication, PT, follow up appts, radiology, etc).

I hope your healing is going really well. More beignets sometime? :teeth The chart with your explanation of each billed item is REALLY helpful.

It's a long recovery and I'm on the right trajectory. More beignets will most definitely help the healing process. I hope the translation helps and I'd be happy to post up more examples if requested. :thumbup

 

[planegray]

............I can see how frustrating this would be for someone that isn't organized or doesn't have the patience. ................

I think I see my problem here ! :cry


Erin, Thank You for this thread... You ROCK 1 ! ! :hail

 

[EjGlows]

I think I see my problem here ! :cry


Erin, Thank You for this thread... You ROCK 1 ! ! :hail

I also believe they make the paperwork impossibly difficult to complete so as to reduce the likelihood that people can complete the process in its entirety and have to pay out. Too many hoops to jump through...

I hope this has been helpful and I welcome any questions. :thumbup

 

[Killroy1999]

I think everyone should put at least $500 in there Flexible Spending Account because thanks to the Affordable Healthcare Act, $500 can carryover to next year.

I have never used FSA, so tell me if I am wrong, but you can spend it on sun screen and I solution at places like FSA Store.

 

[EjGlows]

I think everyone should put at least $500 in there Flexible Spending Account because thanks to the Affordable Healthcare Act, $500 can carryover to next year.


I have never used FSA, so tell me if I am wrong, but you can spend it on sun screen and I solution at places like FSA Store.

*quoted from Wannabe below*


FSA only up to $500 of the total carries over now. But, it used to be 'use it or lose it.' The entire balance of an HSA carries over. That's why they max out your contribution to $3,300 (I think) every year. The difference is that you must have a high deductible health insurance plan in order to qualify for an HSA. The other difference is that your company owns the FSA while you own the HSA. So, if you leave the company, you lose all the money in your FSA while you can roll the balance of your HSA into another account.

Tax deferred would have saved me a few pennies (and the possibly lowered my tax bracket) but do keep in mind the maximums and how it impacts your situation. I didn't have this option last year and now that I do(just married, legally), we've put a good chunk into my wife's FSA to help with all the payments.

 

[wannabe]

^^^ Actually, slightly incorrect. FSA only up to $500 of the total carries over now. But, it used to be 'use it or lose it.' The entire balance of an HSA carries over. That's why they max out your contribution to $3,300 (I think) every year. The difference is that you must have a high deductible health insurance plan in order to qualify for an HSA. The other difference is that your company owns the FSA while you own the HSA. So, if you leave the company, you lose all the money in your FSA while you can roll the balance of your HSA into another account.

I'm very familiar with this because my company was forced to get creative because Blue Cross raised our rates 40% in one year. Our accounting manager did some digging and found that it was much cheaper for the company to switch everyone to a high deductible plan and deposit an amount equivalent to the annual deductible into everyone's HSA than it would have been to just stick to the existing plan. So, as long as I'm careful and stay in network, my entire out of pocket this year is zero. Plus, I now have a pre-tax savings account that I can deposit up to $3,300 this year. And, since the balance carries over, I look at it as smart to just max it out every year.

 

[wannabe]

I just looked it up. The HSA max deposit for 2105 is $3,350. (Roughly $140 per paycheck - pre tax)

Edit: and the FSA max is $5,000 per couple. (As long as you guys are filing your taxes jointly.) but, as I mentioned, you can only carry over $500 to the next year. And, I just read that the carry over is only good until the end of March the following year. After that, the balance just disappears. So, from where I sit, it's better to guess low than high on the FSA.

 

[EjGlows]

Thanks for the correction (watching the Americans and hastily posted). I wasn't married last year and my company didn't offer any health savings/flex savings plan - so it's all a. It new to me.

Whatever it you choose, tax deferred is a pretty good option.

 

[stan23]

I remember when I was single and choose the easy route (kaiser) went there a few times for broken bones and never paid a dime. Now that i'm married with child, my health insurance premiums are $600/month, and that's with a heavy subsidy from my company I hear it goes down hill from here...