ktgrok Posted March 25, 2015 Author Share Posted March 25, 2015 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. some states have passed such a law. While googling I found that Ohio has. You can actually go on hospital websites and find a price list. Imagine that! 1 Quote Link to comment Share on other sites More sharing options...
ktgrok Posted March 25, 2015 Author Share Posted March 25, 2015 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. Good point. I did read recently that Canada has the longest waits out of any country for medical procedures. Of course, that means that I might be better off in most other countries...but either way, I'm here. heck, the PRIVATE, self pay price in the UK is only 2K more than I'm going to end up paying, and I wouldn't be paying 800 bucks a month in insurance premiums. Yes, I'd pay more taxes, but not as much as I pay in insurance premiums. Quote Link to comment Share on other sites More sharing options...
ktgrok Posted March 25, 2015 Author Share Posted March 25, 2015 Ok, update: Got a call by from "john the insurance guy" at the surgeon's office. yes, the price is the same no matter what surgery. (how on earth does that make sense???) Yes, it is the 30K. yes, my out of pocket will be $8,542. However.....I can pay half up front, and make payments on the other half. I had previously understood that ALL of it had to be paid up front. So, that's sort of a relief. My husband is still in shock a bit, I think. I messaged him, we will talk later about it. In good news, he is getting a big bonus at work, that will go right in savings, making it easier to justify using my book advance money on the surgery. 7 Quote Link to comment Share on other sites More sharing options...
3 ladybugs Posted March 25, 2015 Share Posted March 25, 2015 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. We have this now it is called Medicare and Medicaid. All states have it and it is the basis of ALL negotiated priced by insurers. The problem is we don't have access to these lists because they are very complicated and sometimes depend on your diagnosis. Many doctor are finding out that it is better for them to just drop taking insurance and see patients that way. When I see my oncologist in June, after she tells me I hit my 5 year remission status (ðŸ˜) I will tell her that I would follow her if she moved. For how often I see her I would gladly pay the price for the "insurance" she gives me. 1 Quote Link to comment Share on other sites More sharing options...
SparklyUnicorn Posted March 25, 2015 Share Posted March 25, 2015 To me insurance should ONLY be for the unthinkable. The cancer treatment, severe injury, or other issue like that. Not for the routine. Well, after seeing the charge for the routine visit I just brought DS 13 to, I'm not so sure. It would basically mean I would not have brought him if that is what it would have cost me. $750. This was for three vaccines, a look in his ears, a tap on his knee, standing on the scale, and some sort of mental health check off sheet that they glanced at for 2 seconds. There was no lab stuff..no nothing. The entire visit took about 10 minutes. Where do they get off charging that for that?! The contract paid $650. I paid $20. I'd die to have to pay $650 for that! Quote Link to comment Share on other sites More sharing options...
Guest Posted March 25, 2015 Share Posted March 25, 2015 Welcome to our world, Sparkly :( Quote Link to comment Share on other sites More sharing options...
SparklyUnicorn Posted March 25, 2015 Share Posted March 25, 2015 Welcome to our world, Sparkly :( I just don't know where they get off charging that kind of money for essentially nothing other than the vaccines. And they weren't the biggest ticket items according to the EOB. Oh and he even did both of my children's exams in the same room at the same time. So less bang for my buck. AND my younger kid was sick for two days after probably from some crap he picked up there. Quote Link to comment Share on other sites More sharing options...
ktgrok Posted March 25, 2015 Author Share Posted March 25, 2015 I just don't know where they get off charging that kind of money for essentially nothing other than the vaccines. And they weren't the biggest ticket items according to the EOB. Oh and he even did both of my children's exams in the same room at the same time. So less bang for my buck. AND my younger kid was sick for two days after probably from some crap he picked up there. to be fair, they are charging for their time and expertise, continuing ed, medical school payments, etc. But yes, I agree, way overpriced. 1 Quote Link to comment Share on other sites More sharing options...
Guest Posted March 25, 2015 Share Posted March 25, 2015 I just don't know where they get off charging that kind of money for essentially nothing other than the vaccines. And they weren't the biggest ticket items according to the EOB. Oh and he even did both of my children's exams in the same room at the same time. So less bang for my buck. AND my younger kid was sick for two days after probably from some crap he picked up there. They basically told me, flat out, that the prices were inflated because of the way insurance negotiates deals. They could only get paid a certain percentage of their full fee amount, so they jacked their fee amounts up to get recommendation up to the level of solvency with a bit of profit. That's why they offer cash pay discounts - because the billable rate for their services doesn't reflect the fair market value of the service but what they must charge to get reasonable reimbursement from insurance companies. That's why we are leaving our pediatrician. Now that we have dropped our insane insurance we cash pay, and they are the most expensive and specialized pediatrics practice in town, and offer no cash pay discount (because they don't have to - they're not hurting for business). The GP/midwives I see are half the cost and offer a twenty percent discount on top of that. It's a no brainer, despite me being loyal to this pediatrics office for eight years I can no longer justify their costs when I'm the one footing it, with no hope of a deductible kicking in or insurance coverage. Fortunately, what we are saving each month on the premium we used to pay could cover monthly visits for ALL FIVE CHILDREN and we'd still have money in the bank. It was insane. So we hopped over to a cost sharing ministry that has no ceiling for catastrophic reimbursement at the rate of plan we use. We pay all preventative care costs and negotiate discounts, but any event over $500 is reimbursable, thankfully. We haven't used it yet but it's nice to have the option since the ACA left us no choice. Quote Link to comment Share on other sites More sharing options...
Bluegoat Posted March 26, 2015 Share Posted March 26, 2015 to be fair, they are charging for their time and expertise, continuing ed, medical school payments, etc. But yes, I agree, way overpriced. There is no way it should cost that much though. Here in NS, a doctor gets a fee of about $31 for a regular office visit of a patient under 65. He has to pay all his staff and business expenses from that. I can't imagine three vaccines making up the difference. And it isn't like they don't make any money - most would fall into the upper-middle class income bracket. Quote Link to comment Share on other sites More sharing options...
SparklyUnicorn Posted March 26, 2015 Share Posted March 26, 2015 to be fair, they are charging for their time and expertise, continuing ed, medical school payments, etc. But yes, I agree, way overpriced. I do get that, but a tap on the knee, look in the ear, listen with the stethoscope, and glancing at a mental health multiple choice quiz just doesn't seem like $650 worth of treatment. 1 Quote Link to comment Share on other sites More sharing options...
ktgrok Posted March 26, 2015 Author Share Posted March 26, 2015 I do get that, but a tap on the knee, look in the ear, listen with the stethoscope, and glancing at a mental health multiple choice quiz just doesn't seem like $650 worth of treatment. No, I'm not justifying $650. Heck, the specialists I've been to don't charge that much. But as much as I hate admitting it, you aren't paying for a listen with the stethoscope, you're paying for the years of knowledge and training and continuing ed that will allow your doctor to hear if there is something wrong when they listen. Just because there wasn't anything wrong, doesn't make it less expensive than if there was. I know in veterinary medicine we got frustrated because people are like "I paid all that money and all the tests were negative!". Well, they cost the same if they are negative or positive. If that listen had turned up a rare heart defect, that your doctor was able to catch, suddenly the act seems more valuable, even though it's the same act. That said, 650 is insane. Quote Link to comment Share on other sites More sharing options...
shawthorne44 Posted March 26, 2015 Share Posted March 26, 2015 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 find the price difference between self-pay and charged to insurance not shocking (anymore). After I delivered DD, DH asked out of curiosity how much the entire hospital bill would have cost if we'd paid cash. $1600. That was for three inducing treatments, an epidural and vaginal delivery. The insurance charge was 30K. Quote Link to comment Share on other sites More sharing options...
creekland Posted March 26, 2015 Share Posted March 26, 2015 I do get that, but a tap on the knee, look in the ear, listen with the stethoscope, and glancing at a mental health multiple choice quiz just doesn't seem like $650 worth of treatment. Our self pay for a visit like this here is $85. Vaccines are extra, but they tell us what they cost and we can either opt to do them in the office or head to the local clinic where they cost less. It depends upon our mood at the time as to which we choose. I haven't yet had any specialist visit cost $650... everything we do is billed to us - though things associated with health issues (or tests to see if there are issues) are covered by our health share at 100%, so we don't really pay it unless it's routine. The last routine specialist visit cost me $161, but that included a test with it, so not just the visit. I really don't get why, as a country, we put up with our health insurance system. I've never once regretted opting out and wish there were more options for others to do the same (rather than specific groups). If I ever found a concierge doctor who didn't deal with insurance at all... I'm pretty sure I'd switch. As it is, my doctor's office staff appreciates not having to deal with insurance - as have most other places I go to (all but one place and they've since come around too). ;) Quote Link to comment Share on other sites More sharing options...
shinyhappypeople Posted March 26, 2015 Share Posted March 26, 2015 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. Oh my gosh, I was just dealing with that stupidity yesterday! 11 yo DD has hypothyroidism that is managed with medication. Insurance (crappy Medi-Cal offshoot called Alliance ) will cover the prescription for adults but not for children because hypothyroidism is, according to them, so very, very rare in children. (SO? It still needs to be treated. No one prescribes levothyroxine for kicks.) After 6 mos. of me telling the doctor's office "this prescription isn't covered by insurance, please try to get it pre-authorized" (rinse and repeat) and them telling me I'm wrong (Um, if I'm wrong, then why am I paying out of pocket?) they FINALLY figured out the adult/child discrepancy and are working with the pharmacy to get it pre-authorized. All that to say... OP, I'm with you. Insurance is stupid. I cannot fathom how ticked off I would be if I had the privelige of paying $16,000/yr (premiums & deductible) and STILL having to deal with their stupidity. You have my sympathy :grouphug: For myself, I finally set aside my reservations and just joined a health care sharing ministry. Simple and works. Quote Link to comment Share on other sites More sharing options...
ktgrok Posted March 26, 2015 Author Share Posted March 26, 2015 I really want to do a health share ministry, but the fear of something catasrophic stops me. My ex husband had cardiomyopathy from a simple virus, and then later a kidney trasnplant. Those bills are and were outrageous. I worry that because health shares are not licensed in the same way, that a bill of that proportion would not be covered/paid for and I'd end up bankrupt. But, the alternative isn't great either. Quote Link to comment Share on other sites More sharing options...
SparklyUnicorn Posted March 26, 2015 Share Posted March 26, 2015 I really want to do a health share ministry, but the fear of something catasrophic stops me. My ex husband had cardiomyopathy from a simple virus, and then later a kidney trasnplant. Those bills are and were outrageous. I worry that because health shares are not licensed in the same way, that a bill of that proportion would not be covered/paid for and I'd end up bankrupt. But, the alternative isn't great either. To be fair, WITH regular insurance you could end up bankrupt. We are always told what our out of pocket max is, but it's so misleading because so many things don't count towards the out of pocket max. Copays don't count. Deductibles don't count. Anything paid for drugs does not count. Many rehab services have a maximum benefit of 10K (which would be ridiculously low if you got into a serious accident and needed a lot of rehab). 1 Quote Link to comment Share on other sites More sharing options...
creekland Posted March 26, 2015 Share Posted March 26, 2015 I really want to do a health share ministry, but the fear of something catasrophic stops me. My ex husband had cardiomyopathy from a simple virus, and then later a kidney trasnplant. Those bills are and were outrageous. I worry that because health shares are not licensed in the same way, that a bill of that proportion would not be covered/paid for and I'd end up bankrupt. But, the alternative isn't great either. I used to wonder about it, but after seeing how they handled (and are handling as it's ongoing) my brain tumor thing, then my carpal tunnel thing, then unexplained X at the moment, and youngest's epilepsy diagnosis from a few years back, and hubby blacking out in the horse pasture also from a few years back... I no longer worry at all. If we'd stuck with the insurance we had, we'd be out thousands - in the mid 5 digits just from the OOP deals, not to mention it cost far more than the $405/month I pay for our family now. I'm thankful we didn't choose that route! Super, super thankful. But, they don't cover elective deals, so that wouldn't help you in this situation. (At least I don't think it'd be covered. I guess to know for sure I'd need to check the guidelines.) Quote Link to comment Share on other sites More sharing options...
Guest Posted March 26, 2015 Share Posted March 26, 2015 I really want to do a health share ministry, but the fear of something catasrophic stops me. My ex husband had cardiomyopathy from a simple virus, and then later a kidney trasnplant. Those bills are and were outrageous. I worry that because health shares are not licensed in the same way, that a bill of that proportion would not be covered/paid for and I'd end up bankrupt. But, the alternative isn't great either. Katie, we do Christian Healthcare Ministries and have the Gold Plan and Brother's Keeper for me - it covers maternity and has no upper limit on reimbursement for an event, so the cost is more per month than the silver and bronze plans. However it is less than a quarter of what we were paying to Premera. Check it out! We felt the same way, and this was the only one, out of the cost sharing ministries, that fit our needs with potential catastrophe. Quote Link to comment Share on other sites More sharing options...
creekland Posted March 26, 2015 Share Posted March 26, 2015 If you want to check them out, the one we go with is Samaritan Ministries. We've been with them for over 10 years now and absolutely no complaints. FWIW, we have sent our share for a liver transplant before, so I know those would be covered if major things are your concern. Paying the extra for Save to Share gives no maximum amount covered. Sticking with the basic plan has a max of 250K if I recall correctly. That could easily be a problem with something major going on. Quote Link to comment Share on other sites More sharing options...
shinyhappypeople Posted March 26, 2015 Share Posted March 26, 2015 Katie, we do Christian Healthcare Ministries and have the Gold Plan and Brother's Keeper for me - it covers maternity and has no upper limit on reimbursement for an event, so the cost is more per month than the silver and bronze plans. However it is less than a quarter of what we were paying to Premera. Check it out! We felt the same way, and this was the only one, out of the cost sharing ministries, that fit our needs with potential catastrophe. I'm with CHM, also, and want to add Brother's Keeper because of my concerns about something truly catastrophic happening. I was originally looking for something super-cheap and basic just to avoid paying the ACA fine, so I started with the Bronze plan ($45/mo), but I quickly upgraded. CHM is a *really* good deal. Samaritan also has a good reputation. There's also Medi-Share which uses a model that's more similar to traditional health insurance. I had my reservations about signing up with CHM (I don't like some of the things they exclude, like teen pregnancy) but overall it has been a VERY positive thing. 1 Quote Link to comment Share on other sites More sharing options...
Guest Posted March 26, 2015 Share Posted March 26, 2015 We chucked medishare off our list pretty quickly, but the choice between CHM and Samaritan Ministries took quite awhile. Overall CHM was a better fit but I know plenty of people with Samaritan who have been on it for years and love it, just like Creekland. We were a bit nervous as well, but not having to shell out for premiums has been such a relief. Quote Link to comment Share on other sites More sharing options...
QueenCat Posted March 26, 2015 Share Posted March 26, 2015 To be fair, WITH regular insurance you could end up bankrupt. We are always told what our out of pocket max is, but it's so misleading because so many things don't count towards the out of pocket max. Copays don't count. Deductibles don't count. Anything paid for drugs does not count. Many rehab services have a maximum benefit of 10K (which would be ridiculously low if you got into a serious accident and needed a lot of rehab). That varies by insurer. Our out of pocket max does include our deductible and copays, as well as prescriptions. Actually, prescriptions are part of our deductible. Quote Link to comment Share on other sites More sharing options...
VaKim Posted March 27, 2015 Share Posted March 27, 2015 To be fair, WITH regular insurance you could end up bankrupt. This actually did happen to my in-laws. Quote Link to comment Share on other sites More sharing options...
SparklyUnicorn Posted March 27, 2015 Share Posted March 27, 2015 That varies by insurer. Our out of pocket max does include our deductible and copays, as well as prescriptions. Actually, prescriptions are part of our deductible. I know it varies, but a lot of people assume out of pocket max means the most you will pay out of your pocket. No.. They should call it something else because that is not what it means! Quote Link to comment Share on other sites More sharing options...
3 ladybugs Posted March 27, 2015 Share Posted March 27, 2015 Katie, we do Christian Healthcare Ministries and have the Gold Plan and Brother's Keeper for me - it covers maternity and has no upper limit on reimbursement for an event, so the cost is more per month than the silver and bronze plans. However it is less than a quarter of what we were paying to Premera. Check it out! We felt the same way, and this was the only one, out of the cost sharing ministries, that fit our needs with potential catastrophe. Wow! I have never heard of this! Dh's company is threatening not covering spouses or dependents. DH has told his boss that if that happens he will have to leave. I am the highest risk out of all of us. Something like this could help us a lot. Quote Link to comment Share on other sites More sharing options...
kitten18 Posted March 27, 2015 Share Posted March 27, 2015 There is no way it should cost that much though. Here in NS, a doctor gets a fee of about $31 for a regular office visit of a patient under 65. He has to pay all his staff and business expenses from that. I can't imagine three vaccines making up the difference. And it isn't like they don't make any money - most would fall into the upper-middle class income bracket. Then how much are they getting from the government for that visit? There is no way you could run a profitable business on a $31 visit. How many patients can a dr. see per hour? I don't think it's usually more than 4. Quote Link to comment Share on other sites More sharing options...
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