I HATE our stupid medical/insurance system in the USA! (update post 10)

[ktgrok]

I'm looking at having a surgery, and some tests. And trying to find out how much to budget. My word, I've spoken to at least half a dozen people, some twice, and still have only about half the answers. No one knows anything, no one will say anything, the one person at the insurance company told me there was no such test and I must mean another one (no, I don't, those are entirely different things that just happen to start with the same letter!) etc. And you can't just check a price list, even if my state mandated those (we don't, but I hear some states do), it wouldn't matter, because the price is different based on the insurance company you have! Then one office said I'd already met my dedcutible, so I would only have to pay the 20% coinsurance. No, I have NOT met my deductible. I know I haven't. She couldn't tell me what the full price was. Luckily, I know how to multiply by 5 and could figure it out myself, lol. 

 

Anyway, vent over. I don't see how they can expect you just to show up without knowing how much something is! And yet, when you call to find out, you get the runaround. 

 

Vent over. 

 

Now, I will say, I do know I'm VERY lucky to have healthcare, money, etc. I do know that. But for the $800 I pay every month for our families insurance (that doesn't even kick in until we spend 6K as a family) you'd think I could at least get someone on the phone that can give me some information. Or knows what an upper GI series is. (also told her Barium Swallow, but she still kept trying to tell me it was an endoscopy). 

[sunflowerlady]

I hate it too.

[JustEm]

Hugs! Its so frustrating, hope you figure it out soon . you reminded me that I have a medical bill I have to dispute since I shouldn't have had to pay anything.thanks

[creekland]

:grouphug:

 

My frustrations lie in having to get referrals to actually do anything or see a specialist.  It's been tempting to take medical needs/desires overseas.  VERY tempting.

 

And ironically, I detest medical stuff so theoretically should be happy about being told no.

 

I guess I hate having to follow stupid rules more.

[*Alyssa*]

I'm looking at having a surgery, and some tests. And trying to find out how much to budget. My word, I've spoken to at least half a dozen people, some twice, and still have only about half the answers. No one knows anything, no one will say anything, the one person at the insurance company told me there was no such test and I must mean another one (no, I don't, those are entirely different things that just happen to start with the same letter!) etc. And you can't just check a price list, even if my state mandated those (we don't, but I hear some states do), it wouldn't matter, because the price is different based on the insurance company you have! Then one office said I'd already met my dedcutible, so I would only have to pay the 20% coinsurance. No, I have NOT met my deductible. I know I haven't. She couldn't tell me what the full price was. Luckily, I know how to multiply by 5 and could figure it out myself, lol. 

 

Anyway, vent over. I don't see how they can expect you just to show up without knowing how much something is! And yet, when you call to find out, you get the runaround. 

 

Vent over. 

 

Now, I will say, I do know I'm VERY lucky to have healthcare, money, etc. I do know that. But for the $800 I pay every month for our families insurance (that doesn't even kick in until we spend 6K as a family) you'd think I could at least get someone on the phone that can give me some information. Or knows what an upper GI series is. (also told her Barium Swallow, but she still kept trying to tell me it was an endoscopy). 

 

There is nothing lucky about being scammed.   ALL health insurance is a scam and it hurts everyone.

 

:grouphug:   I avoid medical offices like the plague for reasons like what you just described.  I'm sorry. :(

 

 

[AimeeM]

:grouphug:

 

My frustrations lie in having to get referrals to actually do anything or see a specialist.  It's been tempting to take medical needs/desires overseas.  VERY tempting.

 

And ironically, I detest medical stuff so theoretically should be happy about being told no.

 

I guess I hate having to follow stupid rules more.

Wow. We haven't had to get referrals for a while now. The last few insurances we've had do not require them. Now, occasionally a high-in-demand specialist's office will require a referral, but that's rare.

[Luckymama]

We do not need referrals either.

[mamaraby]

Wow. We haven't had to get referrals for a while now. The last few insurances we've had do not require them. Now, occasionally a high-in-demand specialist's office will require a referral, but that's rare.

We have to get referrals in order to save out of pocket costs. They added it well in advance of the ACA as a cost saving mechanism. With referral, my visit requires a co-pay. Without referral, it's paid like an out of network visit. I don't mind it, quite frankly, because it encourages developing a relationship with a care provider that can work with you to coordinate care. Otherwise, some folks run out to see a specialist at the first twinge when a PCP could handle it just fine.

 

Now, calling the insurance company amd trying to get them to explain why they won't cover an audiologist for my dd? That's beyond frustrating. And trying to find out how much it will cost to pay for it out of pocket since the insurance won't cover it? Forget about it. I'm sorry, OP. It's frustrating. If it makes you feel better, the inability of the insurance company to answer questions seems to be a universal thing regardless of price or deductible.

[Bluegoat]

I find the American system really strange - it is so complicated, the stress seems to affect people as much as their health problems do sometimes.

 

But I think the thing about specialists is in part a reaction to the problem - it's tempting to go right to a specialist rather than pay for and go through the administrative hassle of getting a referal.

 

Generally speaking though, there are good reasons for a system where you usually go to  your GP before going to a specialist.  It can prevent people going unnecessarily, which overloads the system and is more expernsive overall, it makes sure they actually go to the right kind of specialist, the GP can try and match you up with someone who would be a good fit, and it keeps your GP, who has the picture of your overall health and that of your family, in the picture. GPs too can often have more contact with trends in the local population, and so can see patterns of illness that a specialist might not.

[ktgrok]

OH MY GOODNESS! Just got the price for the surgery. They are saying that the insurance negotiated price is 30K, I would have to pay $8,517. What is INSANE is at the seminar they said the SELF PAY price for one procedure is $14,000. Not 30K. that's less than HALF! And yes, that 14K includes hospitilization, anesthesia, and the facility fee, etc. So, my insurance has "negotiated" a price that is TWICE the self pay price? What am I paying them $800 a month for?????? 

 

I want to throw up. I thought the price would be more aroudn 5K, not over 8K. That's a big difference. Now I see why so many people go to Mexico to have medical work done. Now, the guy at the hospital said that he didn't have an "exact code" so this was the general charge for inpatient surgery. Mind you, I asked about 2 different surgeries, one quoted as a self pay of 14K, the other a self pay of $20K and this guy at the hospital said it didn't matter, any surgery would be 30K, with my out of pocket at the 8.5K he told me. None of this makes sense. How does a longer, more involved procedure cost the same as the shorter procedure???

 

I am furious. 

[Momof3littles]

No referrals here on our current plan. DH works for a business with under 50 employees, and to add our family on to their plan is about 12K/yr.  We do better in the private market with a deductible.  Even in a worst case year scenario, we would be close to breaking even.  The work plan has always been a good one without referrals, but in the last year they switched to one that requires referrals in order to keep costs down.  They've asked us to participate, since they could use some younger and healthier employees in their insurance pool, but we have opted to stay with our private plan for the last 5 years.  No referrals.  I think we pay around 800 per month also; DH's employer does kick back to us what they would have paid for his healthcare benefits.

 

It is ridiculous that it is so difficult to get prices in advance.  I worked in healthcare and understand that you can't always anticipate how things will go in terms of procedures, etc. but there's no reason prices should be as difficult as they are to obtain.  I don't think we'll ever contain costs until we move away from our current model.  Right now we have a perfect storm of a mandate for insurance without adequate price controls. 

 

On the upside, my dad's healthcare funds in his retirement accounts have been through the roof.  Just trying to find a single upside to the profits being made ;)

[creekland]

Wow. We haven't had to get referrals for a while now. The last few insurances we've had do not require them. Now, occasionally a high-in-demand specialist's office will require a referral, but that's rare.

 

It isn't our health share that requires referrals at all.  It's the doctor's offices around here.

 

And the reason that it bugs me is due to having a difference of opinion about an issue, but tough luck on that.  I have no desire to hijack the thread with specifics, but I suspect the vast, vast majority of you would have agreed with me rather than the doctor involved.  (At least all of my friends IRL do anyway.  ;)  )

 

OH MY GOODNESS! Just got the price for the surgery. They are saying that the insurance negotiated price is 30K, I would have to pay $8,517. What is INSANE is at the seminar they said the SELF PAY price for one procedure is $14,000. Not 30K. that's less than HALF! And yes, that 14K includes hospitilization, anesthesia, and the facility fee, etc. So, my insurance has "negotiated" a price that is TWICE the self pay price? What am I paying them $800 a month for?????? 

 

I want to throw up. I thought the price would be more aroudn 5K, not over 8K. That's a big difference. Now I see why so many people go to Mexico to have medical work done. Now, the guy at the hospital said that he didn't have an "exact code" so this was the general charge for inpatient surgery. Mind you, I asked about 2 different surgeries, one quoted as a self pay of 14K, the other a self pay of $20K and this guy at the hospital said it didn't matter, any surgery would be 30K, with my out of pocket at the 8.5K he told me. None of this makes sense. How does a longer, more involved procedure cost the same as the shorter procedure???

 

I am furious. 

 

Wow.  Yes, it would be tempting to see what the cost would be elsewhere...   :grouphug:

[umsami]

I went to Mexico for my first surgery.  Great experience, wonderful care.

 

My second surgery I had insurance....and I ended up paying so much OOP....I think $6k?  And this was before the days of the giant deductible.  My first surgery was 10k, and honestly, because of the lack of hassles and knowing exactly what I owed, it was far easier.  The 10k covered all my pre-op tests, the surgery, the hospital, fabulous nursing care, pain meds post-op, and two "house calls" by my surgeon when I was in my hotel.  

[*Alyssa*]

OH MY GOODNESS! Just got the price for the surgery. They are saying that the insurance negotiated price is 30K, I would have to pay $8,517. What is INSANE is at the seminar they said the SELF PAY price for one procedure is $14,000. Not 30K. that's less than HALF! And yes, that 14K includes hospitilization, anesthesia, and the facility fee, etc. So, my insurance has "negotiated" a price that is TWICE the self pay price? What am I paying them $800 a month for?????? 

 

I want to throw up. I thought the price would be more aroudn 5K, not over 8K. That's a big difference. Now I see why so many people go to Mexico to have medical work done. Now, the guy at the hospital said that he didn't have an "exact code" so this was the general charge for inpatient surgery. Mind you, I asked about 2 different surgeries, one quoted as a self pay of 14K, the other a self pay of $20K and this guy at the hospital said it didn't matter, any surgery would be 30K, with my out of pocket at the 8.5K he told me. None of this makes sense. How does a longer, more involved procedure cost the same as the shorter procedure???

 

I am furious. 

 

Wow, I'm really sorry!  :(

[itsheresomewhere]

I ask for the cash rate. About half the time it is cheaper than using the insurance. The audiogist visit was 200 cash verses about 450 insurance.

 

My insurance company has a treatment cost estimator online. A quote for one test was between 35-5500. Wasn't that helpful.

[melmichigan]

OH MY GOODNESS! Just got the price for the surgery. They are saying that the insurance negotiated price is 30K, I would have to pay $8,517. What is INSANE is at the seminar they said the SELF PAY price for one procedure is $14,000. Not 30K. that's less than HALF! And yes, that 14K includes hospitilization, anesthesia, and the facility fee, etc. So, my insurance has "negotiated" a price that is TWICE the self pay price? What am I paying them $800 a month for?????? 

 

I want to throw up. I thought the price would be more aroudn 5K, not over 8K. That's a big difference. Now I see why so many people go to Mexico to have medical work done. Now, the guy at the hospital said that he didn't have an "exact code" so this was the general charge for inpatient surgery. Mind you, I asked about 2 different surgeries, one quoted as a self pay of 14K, the other a self pay of $20K and this guy at the hospital said it didn't matter, any surgery would be 30K, with my out of pocket at the 8.5K he told me. None of this makes sense. How does a longer, more involved procedure cost the same as the shorter procedure???

 

I am furious. 

I'm sorry, but yes, codes matter.  I would call the surgeon's office and get the codes, and then contact all hospitals that the surgeon has privileges that you would consider.

[kewb]

I hate dealing with the insurance company. A minimum half hour on hold just to ask the question.

This drug is covered but this one is not.

Our new plan requires referrals. Which requires at least one week notice to get. In general I don't object to getting a referral. Too many people skip the gp. However, I have had docs in the past who try very hard not to give you a referral. Yes, anyone can order the blood test but not everyone can read the numbers correctly.

[Guest]

We self pay and honestly won't do business with places who don't offer substantial discounts. I've spent most of my adult life paying out the nose for basic things because an insurance group bargained treatment down to almost nothing, Medicaid eats a chunk of the hospital's budget too, and the handful of us who write checks are the only ones left by which the bottom line can be met.

 

With our HSA we still often just self paid because so little was covered.

 

However with I surance premiums that kept increasing and a high deductible plan, the straw broke this camel's back. Screw that - we were paying $1700 per month for a healthy, low risk family, and our deductible was $10,000 with a yearly out of pocket max of $15,000. So things like being responsible and going with inexpensive midwives? Just lead to a birth that wasn't covered at ALL. Any outpatient surgery or labs? We just eat the cost. Cash paying it now has allowed us to save the immense money we paid out every week (seriously, $425 per week just in case of an emergency? No dice.) and put it in an account to save for our normal medical costs. We bargain as many discounts for service as we can and joined a cost sharing ministry with catastrophic allowances so that if we actually get in a bind we won't be medically bankrupt. But the ACA jacked our rates from $450 per MONTH for those same deductibles to nearly that much each WEEK.

 

We refuse to play that game. Full stop.

 

I'm sorry your surgery is pricy - that's another reason I haven't gone that route, truth be told. Hopefully you can find a better solution!

[cjzimmer1]

Oh I know this stuff is ridiculuous.  I needed some expensive labs done last year and was trying to use up my flex spending money but didn't have the budget for all the tests. My doctor was out of network but the clinic she works at is in network.  All I wanted to know is if the insurance company would process the labs as in network but the lab was in network or if they would process them out of network since the ordering doctor was out of network (I hadn't even got to the actual cost of the labs just wanted to know how the claim was processed).  I didn't think it was that hard of a question.  3-4 hours of phone calls with easily 10 different people yielded the answer,  we don't know, submit your claim and then we will let you know.  So yeah, I could have been on the hook for thousands of dollars of labs or not but we won't tell you until it's too late so you have to gamble on forking over lots of money you don't have.

 

Sorry this is so rough on you.  Do you have the codes for the procedure?  Could you ask your surgeon for them?  I've found when asking for cost numbers everything is dependent on those stupid medical codes.  When I pried those out of the doctors office, then I have always been able to get actual numbers from the insurance company.  Also what is your deductible for the year?  If it's more than 8,000 then yes you could get left with that amount.  If it's less than even though they say that's your portion, you know you won't have to pay that amount.  Finally what does the doctor's office billing department say about it? Usually they have some sense of what an insurance company will pay and how much will be discounted especially if it's an office that does lots of these surgeries. 

[ktgrok]

I just left a message for the insurance person a the surgeon's office, explaining that I need some kind of idea on price of the actual surgery. I am not going to go through with all the tests I have set up (that costs hundreds of dollars themselves) if I can't afford the actual surgery. So to please call me back, leave a message if I don't answer (nap time is coming) and let me know. 

[VaKim]

OH MY GOODNESS! Just got the price for the surgery. They are saying that the insurance negotiated price is 30K, I would have to pay $8,517. What is INSANE is at the seminar they said the SELF PAY price for one procedure is $14,000. Not 30K. that's less than HALF! And yes, that 14K includes hospitilization, anesthesia, and the facility fee, etc. So, my insurance has "negotiated" a price that is TWICE the self pay price? What am I paying them $800 a month for?????? 

 

I want to throw up. I thought the price would be more aroudn 5K, not over 8K. That's a big difference. Now I see why so many people go to Mexico to have medical work done. Now, the guy at the hospital said that he didn't have an "exact code" so this was the general charge for inpatient surgery. Mind you, I asked about 2 different surgeries, one quoted as a self pay of 14K, the other a self pay of $20K and this guy at the hospital said it didn't matter, any surgery would be 30K, with my out of pocket at the 8.5K he told me. None of this makes sense. How does a longer, more involved procedure cost the same as the shorter procedure???

 

I am furious. 

Yep. That's the way it works. We do not have insurance, and when I had to have my hysterectomy 3 years ago, we got a 60% "discount" on everything for it being uninsured. Discount. Yeah, right! It is indeed all a big legalized scam!!

[PinkyandtheBrains.]

If Insurance companies didn't pay the rates they do, the self pay cost would go up as well.

 

 

 

 

I hate our system too, I am a fan of universal coverage for all.

[Guest]

If Insurance companies didn't pay the rates they do, the self pay cost would go up as well.

 

 

 

 

I hate our system too, I am a fan of universal coverage for all.

From my experience that's backwards. If consumers were not insulated from the cost of their procedures by and large, and the bureaucratic bloat in both medical administration and insurance was decreased, the consumer demand for more reasonable procedure prices and published lists of covers for service would drive prices down. There is a direct correlation over the last seven decades between increased and more expansive insurance coverage and the skyrocketing cost of those services.

 

And as an anecdote, one of my doctors simply refuses all insurance and is cash pay only, for every service and lab, with a list of prices is right on her wall. She is bumper busy and offers some of the least expensive services in town. She doesn't have to hire a billing service, waste man hours arguing on the phone with insurance companies, and refuses Medicaid and Medicare, both, in order to offer low base prices for consumers. She's just opted out of the system entirely, like we have.

[heartosunshine]

I have struggled with this same thing. Good luck.

 

The other problem is that a doctor, specialist, technician, etc, may perform a function during surgery but they aren't contracted under your health plan. It ends up as a surprise bill later. I've asked how to avoid this in the future & got shoulder shrugs from everyone. Next time I have surgery, I'm going to use a Sharpie marker on my skin saying, "DO NOT touch me unless you take XYZ Insurance!"

[Bluegoat]

From my experience that's backwards. If consumers were not insulated from the cost of their procedures by and large, and the bureaucratic bloat in both medical administration and insurance was decreased, the consumer demand for more reasonable procedure prices and published lists of covers for service would drive prices down. There is a direct correlation over the last seven decades between increased and more expansive insurance coverage and the skyrocketing cost of those services.

 

And as an anecdote, one of my doctors simply refuses all insurance and is cash pay only, for every service and lab, with a list of prices is right on her wall. She is bumper busy and offers some of the least expensive services in town. She doesn't have to hire a billing service, waste man hours arguing on the phone with insurance companies, and refuses Medicaid and Medicare, both, in order to offer low base prices for consumers. She's just opted out of the system entirely, like we have.

 

Universal insurance is generally much cheaper than the American system, and one of the reasons is those admin costs.  When there is a set price for everything, and only one billing system for everyone, it simplifies things a lot. 

[Alessandra]

I'm looking at having a surgery, and some tests. And trying to find out how much to budget. My word, I've spoken to at least half a dozen people, some twice, and still have only about half the answers. No one knows anything, no one will say anything, the one person at the insurance company told me there was no such test and I must mean another one (no, I don't, those are entirely different things that just happen to start with the same letter!) etc. And you can't just check a price list, even if my state mandated those (we don't, but I hear some states do), it wouldn't matter, because the price is different based on the insurance company you have! Then one office said I'd already met my dedcutible, so I would only have to pay the 20% coinsurance. No, I have NOT met my deductible. I know I haven't. She couldn't tell me what the full price was. Luckily, I know how to multiply by 5 and could figure it out myself, lol.

 

Anyway, vent over. I don't see how they can expect you just to show up without knowing how much something is! And yet, when you call to find out, you get the runaround.

 

Vent over.

 

Now, I will say, I do know I'm VERY lucky to have healthcare, money, etc. I do know that. But for the $800 I pay every month for our families insurance (that doesn't even kick in until we spend 6K as a family) you'd think I could at least get someone on the phone that can give me some information. Or knows what an upper GI series is. (also told her Barium Swallow, but she still kept trying to tell me it was an endoscopy).

That is awful. I wouldn't use obscenities here, but I sure am thinking them.

 

It makes me mad on your behalf, but I also wonder about the larger picture. How much GNP is used to buy, sell, negotiate, appeal, or just plain find out about insurance and medical costs? Probably enough to provide a lot of medical care for people who need it.

 

And policy makers complain that people don't get needed care.... Imo, senators, congressmen, and bureaucrats should have to buy their own insurance, individually.

[ktgrok]

No call back yet. Oh, and I'm scheduled to have a test that costs $300 tomorrow, that honestly, if I'm not doing surgery, I'm not going to do. Except, it is now too late to cancel without paying a penalty fee. I just never thought that the price would be DOUBLE what was quoted to me before. I didn't realize the self pay price was SO different. Ithought I'd be paying 20% of that price. My only thought is, they offered me a payment plan for the testing, so maybe they have one for the surgery??

[Guest]

Katie, in my experience if you talk with them beforehand almost every provider will work with you for a payment the plan. Call ahead, explain how much you can out down, and what you can offer for monthly payments. Go from there, usually they will play ball.

[G5052]

Katie, in my experience if you talk with them beforehand almost every provider will work with you for a payment the plan. Call ahead, explain how much you can out down, and what you can offer for monthly payments. Go from there, usually they will play ball.

 

Absolutely.  A family member has had multiple, complex medical issues for over a decade and regularly sees a variety of specialists, some out-of-state.  

 

I've never had much luck getting estimates on the costs.  One time the estimate was $50,000-70,000 total for a surgery and it ended up $40,000 with us owing around $5000 total after insurance.

 

And I ALWAYS negotiate and ask about payment plans as soon as the bill comes.  Last week we got a bill not covered by insurance down 50% with ten months to pay.

 

And I ALWAYS challenge anything they turn down.  We got a big anesthesia bill recently because insurance claimed the doctor was out-of-network.  I showed the insurance company how the doctor's office billed it wrong so that it looked like out-of-network when it really wasn't.  The revised insurance statement said we owed 1/8 of what the first one said. 

[BlsdMama]

I am beyond sorry. You're right it absolutely is ridiculous. (((Hugs))

 

We have had our 2015 family out of pocket raised to $11k this year. Blessedly our premiums are cheap but that's crazy.

 

It's a very broken system IMO.

[3 ladybugs]

Self pay/insurance rates can be like that. I had a PET/CT scan that cost $5000+ and that was a 1 hour, non invasive test! I called the insurance fraud line thinking there was a mistake but there wasn't. 😥 I will say that for doctors visits, sometimes it is better to not admit insurance. When I see my oncologist it is $238 self pay, last time I went this was also the negotiated rate, however I wouldn't be surprised if the negotiated rate changed.

 

I just wish that going to the doctor was more like going to McDonald's. There should be a big sign that says "doctor visit -15 minutes ...... $200, 30 minutes ......$300, Pap smear ..... $100, routine OB ultrasound.....$250" you get my point.

[ktgrok]

Thanks all, for the comisseration. Our family out of pocket is a whopping 12K, so even if those prices are right we won't meet it yet. That's a scary thought. 

[JeanM]

I'm so sorry that you're going through this. I have a friend who is in a similar situation. She needs surgery on both knees, and both she and her doctor would like to spread the surgeries out, do one this summer and one next summer. She is a teacher so it is easiest for her to do it in the summer so she can recover without missing work. However, due to deductible issues, etc., she is going to have both knees done this summer since it will cost much less to have them both done in the same calendar year.

[umsami]

Just putting this out there, Dr. Aceves has a really good reputation and has for at least seven years regarding Gastric Sleeves.   My Lap-Band was done by Dr. Rumbaut in Monterrey.  He was wonderful too.  

 

If you wanted to go to Canada, Dr. Michel Gagner does everything...and was the guy who did the first lap DS.  His surgical reputation can't be beat.  He was at Weill-Cornell for years and is extremely well regarded.  A few years ago, he was charging 18k all inclusive for a DS.  I want to say he's in Montreal these days.   http://www.cliniquemichelgagner.com/en/home.php

 

OMG...was just looking up Dr. Aceves website for you and he has died.   He was killed tragically last summer. :( :( :(

[Guest]

Thanks all, for the comisseration. Our family out of pocket is a whopping 12K, so even if those prices are right we won't meet it yet. That's a scary thought.

That's what happened with this last baby. It sucked. There was no way around it and it was the least expensive care option, but no wonder we can't replace broken appliances or get a working, new car. Every year or two I'm shelling out the equivalent of a small vehicle in medical expenses, and if you add in the monthly premium it's the equivalent of a *large* vehicle.

 

I'm so sorry you're hitting these roadblocks. It's immensely frustrating that medical care is as expensive as it is.

[QueenCat]

Wow. We haven't had to get referrals for a while now. The last few insurances we've had do not require them. Now, occasionally a high-in-demand specialist's office will require a referral, but that's rare.

 

We haven't had to get referrals for about ten years now...... makes life so much easier.

[QueenCat]

I have struggled with this same thing. Good luck.

 

The other problem is that a doctor, specialist, technician, etc, may perform a function during surgery but they aren't contracted under your health plan. It ends up as a surprise bill later. I've asked how to avoid this in the future & got shoulder shrugs from everyone. Next time I have surgery, I'm going to use a Sharpie marker on my skin saying, "DO NOT touch me unless you take XYZ Insurance!"

 

Oye, that stinks. Our insurance covers all providers at the in-network rate as long as the hospital and main doctor are in-network.

[mamajag]

If Insurance companies didn't pay the rates they do, the self pay cost would go up as well.

 

 

 

 

I hate our system too, I am a fan of universal coverage for all.

 

But the insurance never pays that rate. They pay a lower, negotiated, allowable charge and leave you paying 20% of the full price. It's a scam.

 

We have a high deductible plan for catastrophic things but otherwise we pay cash. It's amazing how little our "good" insurance was saving us. We were paying $1400 a month in premiums and it saved us $60 a doctor visit and $40 on my daughter's ADD medication and treatment. The only thing they lost money on was one of my mood stabilizers.

 

Oh, and we've found the doctors around here are quite happy to be able to treat us as they see fit without insurance hassles.

[goldberry]

So sorry...it really is frustrating and a mess.

 

I was on another forum in a discussion about how a good starting point for healthcare reform would just being able to know what the price of something is.  If a place just had to tell you, we charge X for Y procedure. Places would still be charging all different crazy rates like they are now, but at least you would KNOW.

 

One bozo got on there and actually tried to make the argument that would only make things worse, because people would start making important medical choices based on price, and it was more important to start with tort reform.  Everyone was like, do you work for an insurance company?  a hospital?  what's the deal?  It was absurd.  We need a free market medical system supposedly, but then we are too stupid to exercise free market choice?  Whaaa?

[3 ladybugs]

So sorry...it really is frustrating and a mess.

 

I was on another forum in a discussion about how a good starting point for healthcare reform would just being able to know what the price of something is. If a place just had to tell you, we charge X for Y procedure. Places would still be charging all different crazy rates like they are now, but at least you would KNOW.

 

One bozo got on there and actually tried to make the argument that would only make things worse, because people would start making important medical choices based on price, and it was more important to start with tort reform. Everyone was like, do you work for an insurance company? a hospital? what's the deal? It was absurd. We need a free market medical system supposedly, but then we are too stupid to exercise free market choice? Whaaa?

I agree with both of you. Tort reform is needed. I am an infertile, mother to 3 (now not living) micro preemies who also had cancer and had a baby with failure to thrive, who was born after I was told by 2 doctors that I was crazy for wanting to get pregnant again. Trust me if I had a dime for every time a doctor talked to the imaginary lawyer behind me, I would be able to pay for OP surgery. So much is done in the medical world not because it is what is best for the patient, or because years of expirence tells the doctor to do this, but because of fear of litigation. 😥

 

We also need to have a clear idea of costs. Sometimes there are cheaper options available to get the same result and we should be able to see that and discuss those options with our doctor.

 

While we are at it we also need drug patent reform. The way the patent laws are set up drug companies have no choice but charge a lot for drugs. A simple change in timelines of patents would lower drug prices and spur innovation that is honestly disappearing due to price controls.

 

To me insurance should ONLY be for the unthinkable. The cancer treatment, severe injury, or other issue like that. Not for the routine.

[QueenCat]

But the insurance never pays that rate. They pay a lower, negotiated, allowable charge and leave you paying 20% of the full price. It's a scam.

 

We have a high deductible plan for catastrophic things but otherwise we pay cash. It's amazing how little our "good" insurance was saving us. We were paying $1400 a month in premiums and it saved us $60 a doctor visit and $40 on my daughter's ADD medication and treatment. The only thing they lost money on was one of my mood stabilizers.

 

Oh, and we've found the doctors around here are quite happy to be able to treat us as they see fit without insurance hassles.

 

Every plan I've ever had has one pay 20% of the lower negotiated charge, not the full price from before the negotiated price. And the lower negotiated price also applies to when towards one deductible.

[Guest]

I agree with both of you. Tort reform is needed. I am an infertile, mother to 3 (now not living) micro preemies who also had cancer and had a baby with failure to thrive, who was born after I was told by 2 doctors that I was crazy for wanting to get pregnant again. Trust me if I had a dime for every time a doctor talked to the imaginary doctor behind me, I would be able to pay for OP surgery. So much is done in the medical world not because it is what is best for the patient, or because years of expirence tells the doctor to do this, but because of fear of litigation. 😥

 

We also need to have a clear idea of costs. Sometimes there are cheaper options available to get the same result and we should be able to see that and discuss those options with our doctor.

 

While we are at it we also need drug patent reform. The way the patent laws are set up drug companies have no choice but charge a lot for drugs. A simple change in timelines of patents would lower drug prices and spur innovation that is honestly disappearing due to price controls.

 

To me insurance should ONLY be for the unthinkable. The cancer treatment, severe injury, or other issue like that. Not for the routine.

I fully agree. That is why we had an HSA and catastrophic. It was a financial management tool first and foremost. Great post.

 

Katie, I'm thinking about you tonight and hoping you got some good answers. Big hugs!

 

:grouphug:

[mamajag]

Every plan I've ever had has one pay 20% of the lower negotiated charge, not the full price from before the negotiated price. And the lower negotiated price also applies to when towards one deductible.

The one I just dumped claimed to do that but you have to file to get the difference back...and in 1 year they actually cut a check on 3 occasions. The rest are in paperwork purgatory and I don't expect to ever see that money. Before that my policies worked as you describe.

[SparklyUnicorn]

Yes, this is why I hated the HSAs we've had.  They were talked up as a way to be in charge of our health care spending including being able to shop around for the best prices.  Except nobody will give you their prices even if they know them.  That turned out to be absolute bull crap.  Makes me angry just thinking about it really.

 

 

[TranquilMind]

OH MY GOODNESS! Just got the price for the surgery. They are saying that the insurance negotiated price is 30K, I would have to pay $8,517. What is INSANE is at the seminar they said the SELF PAY price for one procedure is $14,000. Not 30K. that's less than HALF! And yes, that 14K includes hospitilization, anesthesia, and the facility fee, etc. So, my insurance has "negotiated" a price that is TWICE the self pay price? What am I paying them $800 a month for?????? 

 

I want to throw up. I thought the price would be more aroudn 5K, not over 8K. That's a big difference. Now I see why so many people go to Mexico to have medical work done. Now, the guy at the hospital said that he didn't have an "exact code" so this was the general charge for inpatient surgery. Mind you, I asked about 2 different surgeries, one quoted as a self pay of 14K, the other a self pay of $20K and this guy at the hospital said it didn't matter, any surgery would be 30K, with my out of pocket at the 8.5K he told me. None of this makes sense. How does a longer, more involved procedure cost the same as the shorter procedure???

 

I am furious. 

Yep.  Welcome to "health" care in America now.  And I'm really sorry. 

 

I paid out of pocket for a surgery that would have cost 5 times as much through insurance. 

 

Insurance is basically for catastrophic use only now. 

 

Thailand is a new medical tourism mecca, I hear.  Not very convenient though. 

[TranquilMind]

I agree with both of you. Tort reform is needed. I am an infertile, mother to 3 (now not living) micro preemies who also had cancer and had a baby with failure to thrive, who was born after I was told by 2 doctors that I was crazy for wanting to get pregnant again. Trust me if I had a dime for every time a doctor talked to the imaginary lawyer behind me, I would be able to pay for OP surgery. So much is done in the medical world not because it is what is best for the patient, or because years of expirence tells the doctor to do this, but because of fear of litigation. 😥

 

We also need to have a clear idea of costs. Sometimes there are cheaper options available to get the same result and we should be able to see that and discuss those options with our doctor.

 

While we are at it we also need drug patent reform. The way the patent laws are set up drug companies have no choice but charge a lot for drugs. A simple change in timelines of patents would lower drug prices and spur innovation that is honestly disappearing due to price controls.

 

To me insurance should ONLY be for the unthinkable. The cancer treatment, severe injury, or other issue like that. Not for the routine.

THIS.  Totally.

Of course, then you get complaints that you don't care about poor people. Not to mention that they are still  poor whether they pay out of pocket for things or are required by law under penalty to pay whopping insurance costs for nothing in return. 

[Valley Girl]

We got a big anesthesia bill recently because insurance claimed the doctor was out-of-network.  I showed the insurance company how the doctor's office billed it wrong so that it looked like out-of-network when it really wasn't.  The revised insurance statement said we owed 1/8 of what the first one said. 

 

I recently contacted my insurance company about exactly this issue prior to having some testing done. The rep told me that because people don't generally have a choice of anesthesiologist and because most aren't in-network, the insurance company should process their bill as in-network provided the doctor and facility are in-network. She said to call and have the insurance company resubmit the bill as in-network if it comes through wrong. Of course, this may not be the case everywhere or with every company, but I thought I'd pass it along for what it's worth.

[plansrme]

If it is any comfort, you wouldn't necessarily be any better if you were in the Canadian system.  Five to ten-year waits, and only one or two procedures are covered.  

[Serenade]

I think failure to mandate a price list for medical procedures was the biggest fail of the new health care program.  Not being able to figure out how much something is going to cost in advance (barring the sometimes inevitable emergency procedures) is a crime, IMO. 

[goldberry]

I agree with both of you. Tort reform is needed. 

 

I don't disagree with that either.  The conversation was about what is one of the simplest things we could start with that might actually begin to fix our broken system.  I was surprised that anyone could actually be against transparent pricing.

 

The truth is, there are so many factors at play in the US healthcare system. Ridiculous and hidden pricing systems, tort reform, drug patents and pharmaceutical policies, absorbing costs for the uninsured and indigent... and more.  Which is why I think the ACA was such a mess, it tried to address only one part of the problem and left all the other parts untouched.  

 

The reality is that in our political system of lobbying and paid off politicians, some of those are far less likely to ever get addressed.  

 

I am a person in favor of universal healthcare...but after much researching agree with those that say under our current parameters universal healthcare would never work in the US and would drain all the money.  There is no real way to fix the healthcare problems without addressing the combined issues which are causing the problems.  And some of those issues are "off limits" because of the money involved in those industries.  Very discouraging.