Self-pay/uninsured musings

[Carrie12345]

Dd and I were both in the ER last month.  Same ER. Even same ER room and same doctor.  My bill went through insurance. Hers is workman’s comp, but they just sent me a bill run through without insurance.  I’ll straighten that out once I recover from the shock I’m experiencing over the differences.

I had many more tests than she did, but we both have the charge for, you know, just walking into the ER. Mine was $4,003 with my insurance discount taking it down to $1020.  I need to pay the $1020 toward my deductible. My total responsibility for all services with insurance is over $2.000.

DD was billed $1,604 for the ER. Not $4003. Another $580 charge for x-rays.  With the “self-pay/uninsured discount”, her total bill is $384 for the ER and x-rays combined.

😮

I’m losing my mind over here.

[SamanthaCarter]

Medical care math is the hardest math. 

 

 

 

😂

[RootAnn]

When my oldest was an infant, the clinic billed us for a well baby check & shots as if we didn't have insurance. The shots were like $6 each and the whole bill was less than $100. When they "fixed" it to go through insurance, the same shots were $40+-$100+ each plus a per shot admin fee plus a $150+ visit charge. The insurance company was charged $$$ (over $500 but less than $1000). 

I'm glad they made the visits affordable for those who didn't have insurance. I was amazed at the difference, too.

Edited November 11, 2019 by RootAnn
Added an each

[Frances]

18 minutes ago, RootAnn said:

When my oldest was an infant, the clinic billed us for a well baby check & shots as if we didn't have insurance. The shots were like $6 each and the whole bill was less than $100. When they "fixed" it to go through insurance, the same shots were $40+-$100+ each plus a per shot admin fee plus a $150+ visit charge. The insurance company was charged $$$ (over $500 but less than $1000). 

I'm glad they made the visits affordable for those who didn't have insurance. I was amazed at the difference, too.

Interesting. When our son was born, my husband was in grad school, so we only paid for insurance to cover me for the pregnancy and birth. Our pediatrician just advised us to go the county health department for shots at cost. They would also sometimes give us drug samples for free because they knew we didn’t have insurance. But the price charged for things was no different, as we found out later when my husband’s grad school started offering low cost family insurance. Perhaps they didn’t charge differently because they had lots of student patients like us who qualified for free government insurance but didn’t use it.

[Arcadia]

Similar charging happens for dental work too. I have asked out of network dentists how much it would cost without insurance and it can be cheaper than the out of pocket with insurance.

[Arcadia]

1 minute ago, Æthelthryth the Texan said:

 I'm haven't decided if it's inexperience and fear of overlooking something or straight up over charging. 

 

When our previous dentists start aggressively looking for cavities and keep harping on deep cleaning, we knew it was time to change. I did max out my out of pocket for dental this year by doing a RCT and a crown on my chipped molar, as well as filling a few small cavities.

[Katy]

It's ridiculous everywhere. I don't understand how it's legal.  

[Frances]

13 minutes ago, Æthelthryth the Texan said:

I feel like every year dental insurance becomes more of a sham. And supposedly we have good dental insurance!! But the math is making less and less sense. And don't even get me started on how I now feel like I'm being "upsold" by my dentist- the son has taken over for the father, who is my parents age and was not an over-treater by any stretch of the imagination, but his son seems to be the opposite and leans toward being overly aggressive instead of taking the whole "let's just keep an eye on that spot." I'm haven't decided if it's inexperience and fear of overlooking something or straight up over charging. 

Vision insurance is the one that seems like a real scam to me. I get it basically for free so we use it. But the pricing and discounts seem so convoluted. And you’re actually incentivized to get new glasses every single year. Plus, even though my husband and I have coverage with the same insurance company, many eyeglass places can’t seem to deal with double coverage. So the time I spend getting reimbursed for double coverage is often much greater than the financial benefit. But, I know I’m very fortunate to have almost free health, vision, and dental insurance with very low deductibles and copays, so I really shouldn’t complain.

[Wheres Toto]

2 hours ago, Æthelthryth the Texan said:

Yes!!! OMG, don't even get me started with co-insurance. My oldest is covered under her father's health insurance per our divorce decree, but since dh's insurance is self+family, we added her there too as secondary. They made that such a massive, miserable experience, wanting copies of divorce decree, custody agreements, and all of the every five minutes, and then the plans fighting over who covered what it totally wasn't worth it. It's all so scammy on their end, and they acted like we were the ones trying to scam them! 

If Medicare was only 1/10 as suspicious about claims as private pay insurers are, their fraud rate would drop by millions. 

We had to deal with this with my dd all the time.  Constantly asking us to confirm secondary insurance.   Part of the problem was that the insurance companies have their own rules about what's primary/secondary, usually having to do with when the birthdays fall during the year.   Both ex and his wife had birthdays earlier in the year than dh and I, so the insurance companies constantly wanted them primary.  I had to keep sending copies of the divorce decree.  I actually wished they would just drop her from their insurance.  I was the one who always took her to appointments and they had our information if it was ever needed.  

[Tap]

22 minutes ago, Where's Toto? said:

We had to deal with this with my dd all the time.  Constantly asking us to confirm secondary insurance.   Part of the problem was that the insurance companies have their own rules about what's primary/secondary, usually having to do with when the birthdays fall during the year.   Both ex and his wife had birthdays earlier in the year than dh and I, so the insurance companies constantly wanted them primary.  I had to keep sending copies of the divorce decree.  I actually wished they would just drop her from their insurance.  I was the one who always took her to appointments and they had our information if it was ever needed.  

(DD13 is biologically my niece and I am her guardian)

I deal with this as well. DD13's biodad is court ordered to provide private insurance for her (if his work offers it).  According to birth date rule, I am primary. It is so hard to convince doctor's offices and insurance providers that court orders trump birth date rules!!!! It isn't that complex people!!!  Every single year, I have to battle to get the insurances billed in the right order, because someone decides they were entered wrong and switches them.

The other screwy thing...he has to provide private insurance and the state takes part of his child support to pay for Medicaid (she is a ward of the state so she has medicaid whether I apply or not). So, he has to pay for both out of his meager pay. 😞   I like her to have my insurance because he changes jobs regularly and doesn't tell me so I  have no idea if his insurance stops working until the office tells me.  So....she usually has 3 (and for a while 4) insurances.  It is a NIGHTMARE!!! It would be so much easier, if they just made him pay for Medicaid and left it at that.  They are payer of last resort, so I wouldn't have the bday rule to deal with.

Edited November 11, 2019 by Tap

[Jentrovert]

44 minutes ago, Patty Joanna said:

I just had to have some PT for a crushed rotator cuff.  

They charge $150 self-pay, $225 with insurance...and my insurance co-pay was $175.  Duh. 

With insurance-pay, I would have gotten written medical records.  Well, I'm not going to sue anyone, and all I want is to get better, and I'm pretty sure that written records have nothing to do with healing.  In the time my therapist would have spent filling out paperwork, she can bring in "half a customer"--so all in all, it's a double benefit:  the PT can see more patients and hire fewer support staff. 

This has been my experience again and again.  Pay-on-the-spot gets the doctor out of the insurance run-around which means s/he has to hire fewer people which reduces over-all costs.  Some doctors pass that savings along to the patients who make them possible.  Some do, but not all.

Yes. We have a very high deductible, which I almost never meet (I've been covered by insurance for decades and only one year, when I had my gallbladder out, did I meet the deductible. Barely.) Many times I've been able to pay less doing private pay than with the insurance discount. And it usually doesn't matter, because I'm not going to meet the deductible anyway, so might as well not run through insurance and pay less.

[Carrie12345]

My main purpose in paying for insurance is the belief that I’m covering my rear for Big Things.
Google is depressing me.

 Quick Fact:

Total annual cost of copays, coinsurance, deductibles and insurance premiums for average lung cancer patient: $5,000 to $10,000

Source: American Cancer Society, 2016

I’m paying way more than that in premiums. Every year.

[easypeasy]

14 hours ago, Carrie12345 said:

With the “self-pay/uninsured discount”, her total bill is $384 for the ER and x-rays combined.

😮

 

Wow. When we were uninsured, we received a whopping $0 0% "self-pay/uninsured discount." Zero. Zip. Zilch. Nada. Every single doctor's visit, every single urgent care visit, and every single (thankfully nothing serious and not too many) ER visits caused severe anxiety with the stress of it all.

The system is such a cluster-f*$# it's just... *sigh*

It's impossible to fix because it's impossible to DISCUSS with other people! We could all go to the same hospital with the same complaints and receive the same treatments... and all of us would have a different bill at the end of the day. It's Tower-of-Babel level disparity.

Edited November 12, 2019 by easypeasy

[easypeasy]

5 hours ago, Patty Joanna said:

I just had to have some PT for a crushed rotator cuff.  

They charge $150 self-pay, $225 with insurance...and my insurance co-pay was $175.  Duh.

 

Annnnnd then you have the dilema of: Saving the $$ by doing the self-pay option but none of it going toward your deductible!!

When DD had months and months of PT, the PT who specialized in her treatment (a very specific sports-related injury) did not accept ANY insurance. It was all self-pay only because they were busy enough without having to deal with the insurance companies. So, we self paid. Thousands of dollars by the end. And STILL had to keep paying out-of-pocket for other issues because our deductible just sat stagnant.

 

Edited November 12, 2019 by easypeasy

[Arcadia]

3 hours ago, Carrie12345 said:

Google is depressing me.

 Quick Fact:

Total annual cost of copays, coinsurance, deductibles and insurance premiums for average lung cancer patient: $5,000 to $10,000

Source: American Cancer Society, 2016

I’m paying way more than that in premiums. Every year.

We pay $180 per biweekly pay check for family premiums ($4,860 annual) and I maxed out at $6k out of pocket for my breast cancer treatment. Each 15mins oncologist visit was listed as $999 in my bills though patient responsibility is zero now.

[Frances]

2 minutes ago, Æthelthryth the Texan said:

I love the Tower of Babel comparison. That is so apt. 

I finally managed to get through to my Mother that the people demanding change and being outraged about healthcare weren't all hippie socialist freeloaders, some of are quite the opposite, but that the system is crazy broken in the decade since she left the workforce and something has to give. You can't have health insurance companies making record quarterly profits and taking a bigger percentage of peoples' checks going to health insurance than is going to income/state/etc tax and not think something is wrong. I'm not saying socialism is the answer, and I don't want to get political, but I do think some of the discussion problem is people my Mother's age, or people who say are on Government or State health plans which tend to be much better due to enrollment numbers, and who weren't at particularly elite levels in the career level in their positions, yet still had/have what now would be considered Golden Goose Egg benefits and they simply haven't seen what the options are now- they don't have an idea of what it's like- even at even the highest end of positions/firms. They never had to deal with High Deductibles. Or Magic 8 Ball- pick a plan type of set ups where you are gambling if you will outspend your premium and deductible. I think a lot of people just don't know. There is a percentage of the population that is still shielded from what smaller companies/self employed/etc. see as far as premiums. I think that part needs to get more publicity. Of course if you are paying $400 a month for a family PPO plan with a $750 deductible and $1500 max out of pocket you're going to think that other people are just being whiney when they are freaking out about paying $2500 a month for a $10k deductible before copays even kick in. It's so crazy it begs belief. I think it needs more coverage. 

For instance, when my parents worked you could be an executive assistant aka secretary/lower on the org chart and have kick ass benefits and a full pension. Now, you can be a CEO and still have crap health insurance. Granted, at that level your salary might help compensate for some of it, but it doesn't change the fact that health insurance as a whole has become completely nuts. My dh just switched jobs and we went on COBRA for two months and it took me talking about/her seeing the worksheets for her to understand what exactly a lot of us are complaining about. $350 yearly deductibles, and $300 a month premiums have gone the way of the dinosaur. At least for me and most of my friends- it doesn't' matter what level you are on the org chart. Unless you are working for the federal government or some extremely large corporation, I think all of us have the Medical Care Math headache Samantha so aptly named. 

While I completely agree with most of what you are saying. I also think there are plenty of people like me who are fortunate to have amazing insurance for which we pay very little (less than $50 per month for family health, dental, and vision coverage with a family deductible of $750 per yr), but would be more than happy to pay more in taxes for some sort of universal healthcare so that everyone could have the healthcare security we have, even if it means I get less while paying more. Not everyone has to personally experience the problem themselves in order to want something better for others.

[easypeasy]

19 minutes ago, Æthelthryth the Texan said:

I love the Tower of Babel comparison. That is so apt. 

I finally managed to get through to my Mother that the people demanding change and being outraged about healthcare weren't all hippie socialist freeloaders, some of are quite the opposite, but that the system is crazy broken in the decade since she left the workforce and something has to give. You can't have health insurance companies making record quarterly profits and taking a bigger percentage of peoples' checks going to health insurance than is going to income/state/etc tax and not think something is wrong. I'm not saying socialism is the answer, and I don't want to get political, but I do think some of the discussion problem is people my Mother's age, or people who say are on Government or State health plans which tend to be much better due to enrollment numbers, and who weren't at particularly elite levels in the career level in their positions, yet still had/have what now would be considered Golden Goose Egg benefits and they simply haven't seen what the options are now- they don't have an idea of what it's like- even at even the highest end of positions/firms. They never had to deal with High Deductibles. Or Magic 8 Ball- pick a plan type of set ups where you are gambling if you will outspend your premium and deductible. I think a lot of people just don't know. There is a percentage of the population that is still shielded from what smaller companies/self employed/etc. see as far as premiums. I think that part needs to get more publicity. Of course if you are paying $400 a month for a family PPO plan with a $750 deductible and $1500 max out of pocket you're going to think that other people are just being whiney when they are freaking out about paying $2500 a month for a $10k deductible before copays even kick in. It's so crazy it begs belief. I think it needs more coverage. 

For instance, when my parents worked you could be an executive assistant aka secretary/lower on the org chart and have kick ass benefits and a full pension. Now, you can be a CEO and still have crap health insurance. Granted, at that level your salary might help compensate for some of it, but it doesn't change the fact that health insurance as a whole has become completely nuts. My dh just switched jobs and we went on COBRA for two months and it took me talking about/her seeing the worksheets for her to understand what exactly a lot of us are complaining about. $350 yearly deductibles, and $300 a month premiums have gone the way of the dinosaur. At least for me and most of my friends- it doesn't' matter what level you are on the org chart. Unless you are working for the federal government or some extremely large corporation, I think all of us have the Medical Care Math headache Samantha so aptly named. 

 

YEP. To all of it. It's all so convoluted, *I* can barely understand (actually... I DO NOT understand) what my co-pays/deductibles/etc are, what goes toward our deductible and what doesn't, which hospitals are IN our network AND employee DOCTORS who are ALSO on our network!

When DS last had to go to the ER, DHs insurance had just changed. We sat for a few precious minutes just staring at each other because we realized that we had no clue where to take him. There we were, DS bleeding all over the place, surrounded by hospitals in our area.... and we had NO idea where to go. In the end, we took a leaping guess and went to a new ER they'd just built because I *thought* I had remembered seeing it on the website when I was browsing through the hospitals weeks and weeks before. We lucked out, but... that expensive bill could have easily tripled if we'd have landed at the other nearby hospital.

(edited to add: I did know our "home" ER hospital to visit. But we weren't at home when ds was injured. We were too far from home to drive him all the way back to the "home base," but close enough to be generally familiar with the area itself)

My parents don't get it either. Dad worked for a company his entire career. Doctor's visits were FREE when I was a kid (and man did my parents freak OUT when it raised to $10/visit!). It's just not that way now. At least, not for anyone *I* know.

Edited November 12, 2019 by easypeasy

[easypeasy]

2 minutes ago, Frances said:

While I completely agree with most of what you are saying. I also think there are plenty of people like me who are fortunate to have amazing insurance for which we pay very little (less than $50 per month for family health, dental, and vision coverage with a family deductible of $750 per yr), but would be more than happy to pay more in taxes for some sort of universal healthcare so that everyone could have the healthcare security we have, even if it means I get less while paying more. Not everyone has to personally experience the problem themselves in order to want something better for others.

 

I honestly didn't think plans like this existed for anyone anymore! I'm seriously impressed! DH changed jobs a while ago and for the first time we have solidly good insurance. I no longer break out into a cold sweat if someone gets sick, lol!

It certainly highlights why many people really LOVE their current insurance plans and don't want anything to change. If that's "your" (not you, specifically... but "you") reality and the reality of most of your peers/coworkers, it would be difficult to understand why others are so desperately affected by insurance rates and clamoring for change!

(And 100% agreeing that not everyone has to personally experience the problem to want something better for others! But, for many people it really seems to be the case!)

[Frances]

Just now, easypeasy said:

 

I honestly didn't think plans like this existed for anyone anymore! I'm seriously impressed! DH changed jobs a while ago and for the first time we have solidly good insurance. I no longer break out into a cold sweat if someone gets sick, lol!

It certainly highlights why many people really LOVE their current insurance plans and don't want anything to change. If that's "your" (not you, specifically... but "you") reality and the reality of most of your peers/coworkers, it would be difficult to understand why others are so desperately affected by insurance rates and clamoring for change!

(And 100% agreeing that not everyone has to personally experience the problem to want something better for others! But, for many people it really seems to be the case!)

And my husband has double coverage on everything for about $35 more per month. A family plan would cost significantly more at his place of employment, but the benefits and other out of pocket costs would be very similar.

[easypeasy]

Just now, Frances said:

And my husband has double coverage on everything for about $35 more per month. A family plan would cost significantly more at his place of employment, but the benefits and other out of pocket costs would be very similar.

 

When I go back to work after we are finished with the homeschooling years, this will be my first question in the interview:

"My main priority is to find out what the company insurance plan looks like. I want The Frances Plan!!!"  😃

[BakersDozen]

This happened to us just last year. Our oldest got her wisdom teeth out. Cash pay was around $1500. Our son went in a month later to the same location...$3500 with insurance. I can order a blood pregnancy test myself and pay $22 at the lab, but the same test is over $100 if insurance is billed. It is nuts.

[Carrie12345]

4 hours ago, Arcadia said:

We pay $180 per biweekly pay check for family premiums ($4,860 annual) and I maxed out at $6k out of pocket for my breast cancer treatment. Each 15mins oncologist visit was listed as $999 in my bills though patient responsibility is zero now.

I’m sorry it was needed, but I’m glad you had that coverage!

My least expensive plan option is about $1,000/mo next year for me and 4 kids. Ds and dh are on work policies (so additional premiums and deductibles.) I don’t remember the actual deductible on that option (I think $7,900), but there’s 40% coinsurance after that.

The plans I have access to with 20% coinsurance or less after deductible are in the $1400-1500/mo range.  It’s definitely high enough to make me wonder what those doctors would charge an uninsured patient.

[Carrie12345]

5 hours ago, Æthelthryth the Texan said:

For instance, when my parents worked you could be an executive assistant aka secretary/lower on the org chart and have kick ass benefits and a full pension. Now, you can be a CEO and still have crap health insurance. Granted, at that level your salary might help compensate for some of it, but it doesn't change the fact that health insurance as a whole has become completely nuts. My dh just switched jobs and we went on COBRA for two months and it took me talking about/her seeing the worksheets for her to understand what exactly a lot of us are complaining about. $350 yearly deductibles, and $300 a month premiums have gone the way of the dinosaur. At least for me and most of my friends- it doesn't' matter what level you are on the org chart. Unless you are working for the federal government or some extremely large corporation, I think all of us have the Medical Care Math headache Samantha so aptly named. 

When I was 21 and a single mom, I worked retail for a small regional company. $75 biweekly, no copays, no coinsurance for the 2 of us.

Dh runs a national company. They don’t subsidies family plans. They pay 50% of his premiums. And the plan is based in his office’s home location, so there can be network issues. (They do use a national insurance company, thank goodness!)

I often wonder if people just don’t think about how much their employer is paying toward their plan. A friend of mine has 100% paid family coverage, but she’s their benefit negotiator. She knows how much it elevates her “pay”. But she’ll readily tell you that people think they want higher pay vs. great insurance.

[Pawz4me]

9 hours ago, Carrie12345 said:

My main purpose in paying for insurance is the belief that I’m covering my rear for Big Things.
Google is depressing me.

 Quick Fact:

Total annual cost of copays, coinsurance, deductibles and insurance premiums for average lung cancer patient: $5,000 to $10,000

Source: American Cancer Society, 2016

I’m paying way more than that in premiums. Every year.

Note those figures are three--almost four--years old. Which makes them completely meaningless given how quickly health insurance/health care costs have been rising.

[BlsdMama]

22 hours ago, Eliana said:

I have experienced it to be the other way around, but equally shocking in the disparity.   (Ie insurance negotiated rates that are far lower than those paid by individuals, even after the uninsured discount some providers offer)

This has been my experience as well. DH and I have always said people without insurance (discounts) face horrendous inequalities. But I didn’t realize there is a self pay discount. I find that actually encouraging. 

[BlsdMama]

11 hours ago, Frances said:

While I completely agree with most of what you are saying. I also think there are plenty of people like me who are fortunate to have amazing insurance for which we pay very little (less than $50 per month for family health, dental, and vision coverage with a family deductible of $750 per yr), but would be more than happy to pay more in taxes for some sort of universal healthcare so that everyone could have the healthcare security we have, even if it means I get less while paying more. Not everyone has to personally experience the problem themselves in order to want something better for others.

 

I think your sentiments are empathetic and caring. - thank you. I have to disagree slightly though. I suspect there are not many people in similar scenario as you. My DH worked for a moderate sized local company. Our out of pocket 3-4 years ago was approximately $9800, not counting premiums. The “voice of the employee” was that they wanted improved healthcare insurance over raises. 

This year, after having been acquired by a very large aerospace company, our insurance will change again. Premiums at approximately $350/month and a preliminary $6k out of pocket. Now, I’m not as horrified as three years ago, but a lot of that is perspective. I get Botox injected into my legs every 3-4 months. It makes my quality of life so much better. It’s $17k per time, covered by insurance. They do not cover B12 (methylcobalamin not cyanocobalamin - megadoses) injections ($360/month) and they won’t cover cannabinol (significantly less expensive than Botox for spasticity.)

I’m not complaining because I feel we have improved our insurance situation comparatively. The instance company  just covered a $50k+ power chair that allows me to stand - Medicare would never have covered that. But neither do I believe that many people have a scenario of $50-$150/month premiums with very little out of pocket. We need to come up with about $1200-$1500/month for medical expenses  to cover our associated costs including premiums. But I believe universal healthcare leaves much to be desired because I suspect patients like me with terminal diseases would experience medical neglect at best. 

[kristen18]

22 hours ago, Katy said:

It's ridiculous everywhere. I don't understand how it's legal.  

It's not, but good luck trying to get anyone to prosecute. No other industry can get away with the same BS.

[hjffkj]

13 hours ago, easypeasy said:

 

I honestly didn't think plans like this existed for anyone anymore! I'm seriously impressed! DH changed jobs a while ago and for the first time we have solidly good insurance. I no longer break out into a cold sweat if someone gets sick, lol!

It certainly highlights why many people really LOVE their current insurance plans and don't want anything to change. If that's "your" (not you, specifically... but "you") reality and the reality of most of your peers/coworkers, it would be difficult to understand why others are so desperately affected by insurance rates and clamoring for change!

(And 100% agreeing that not everyone has to personally experience the problem to want something better for others! But, for many people it really seems to be the case!)

 

If dh gets the job he is waiting to hear about our insurance will be very similar. It is for a university and they pay at least 95% of the premium on the plans they offer. Salaries are generally lower than private sector equivalent jobs but the health benefits, free tuition for spouses and dependants, 11% retirement contribution or state pension (depending on position,) vacation, and sick days makes up for the lower salary big time.

 

[hjffkj]

Insurance is quite ridiculous. We're currently on Medicaid so don't pay anything out of pocket except for prescriptions but even that is only a few bucks. But I got a bill for a 30 minute appointment with a midwife at a new practice because of an insurance miscommunication. This appointment was merely going over my medical history, measuring my stomach, listening to the heartbeat, and then sending me to the hospital. That 30 minute appointment with a midwife was just under $600. That is what they sent to insurance before it was rejected. I imagine if it was billed as self pay it would have been under $200.

The ultrasound bill I got was only $410. Still a lot but it makes no sense when an ultrasound is cheaper than a short appointment with a midwife who barely examines you.

Edited November 12, 2019 by hjffkj