Africaster

Can’t be, surely ... can it?

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Wife needed an unscheduled procedure a few weeks ago. In and out in 3 hours, full anesthetic, procedure itself took about 25 minutes. Procedure was performed in a hospital by her doctor.

 

Our portion was $106 ..... medical insurance portion was ....... $35k!

 

Apart from the usual monitors and things, there wasn’t any NASA designed equipment required. My dad had a triple bypass a year ago back at home, and we shat ourselves over his $50k bill.

 

By all things holy, how the hell is this justified? ... and accepted by all?

 

 

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wait til he makes a mistake and you can sue him for forty bucks.  Wonder how much of that bill is risk coverage.  The whole system is out of control and not going to be reined in anytime soon.  You can't have a fixed pay system and a system that says I want what I want when I want it.  

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If you paid out of pocket with no insurance that bill would most likely be about 3,500 bucks. But an average Joe doesn't have 3,500 bucks so you need insurance and insurance can afford 35,000 bucks so why not charge that?

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59 mins ago, Cfinnely68 said:

If you paid out of pocket with no insurance that bill would most likely be about 3,500 bucks. But an average Joe doesn't have 3,500 bucks so you need insurance and insurance can afford 35,000 bucks so why not charge that?

 

Insurance companies are basically admin clearing houses, much like a casino, they will always make their profit margin over time ... and that margin is (simplistically) premiums collected less costs paid out to providers. Their margin remains unaffected by what the medical industry charges, because they will recoup by means of premiums... until of course, premium payers say enough is enough.

 

Based on absolutely no evidence whatsoever... I’d hazard a guess that the insurance company pays a percentage of the bill (in full and final settlement), but that amount is never disclosed to the premium payer, who is in absolute awe of the size of the bill that his insurance company has just paid for him. He’ll never question his premiums again. The insurance companies probably encourage the medical profession to continue with this farcical invoicing routine by not questioning it (on behalf of their premium paying clients).

 

I wonder which amount the medical profession pays tax on ... the amount they invoice, or the amount they actually receive?

 

The statement we received, shows the fully itemized charges as well as the entry attributed to our insurance provider, to end with the balance of $106 which is due by ourselves... what’s interesting to me, is the wording for that particular entry:

Words to the effect of - Payments and adjustments attributable to XXXX (insurer)

 

Why the secrecy?

 

 

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1 hour ago, Africaster said:

Wife needed an unscheduled procedure a few weeks ago. In and out in 3 hours, full anesthetic, procedure itself took about 25 minutes. Procedure was performed in a hospital by her doctor.

 

Our portion was $106 ..... medical insurance portion was ....... $35k!

 

Apart from the usual monitors and things, there wasn’t any NASA designed equipment required. My dad had a triple bypass a year ago back at home, and we shat ourselves over his $50k bill.

 

By all things holy, how the hell is this justified? ... and accepted by all?

 

 

It’s the ins companies dictating to the Drs what portion of the fee they will pay. You get your electric bill. It’s for $120. If you choose to only pay $75, the electric co shuts you off. The Dr submits his bill. Ins says no, I’ll pay you half. Drs raise their rates. Ins fights back. The patient loses. 

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11 mins ago, Jdeadman66 said:

It’s the ins companies dictating to the Drs what portion of the fee they will pay. You get your electric bill. It’s for $120. If you choose to only pay $75, the electric co shuts you off. The Dr submits his bill. Ins says no, I’ll pay you half. Drs raise their rates. Ins fights back. The patient loses. 

 

Sure ... but even if the Dr quadrupled his bill, the insurance is still only going to pay that original amount, so why quadruple the bill?

 

 

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1 hour ago, Cfinnely68 said:

If you paid out of pocket with no insurance that bill would most likely be about 3,500 bucks. But an average Joe doesn't have 3,500 bucks so you need insurance and insurance can afford 35,000 bucks so why not charge that?

Sounds like you've been there and done that.

Few weeks ago the wife's sposed to get a scan done, she's had the appointment for six months. She gets a call the morning of the appointment telling her that the insurance has refused coverage, they ask if she wants to cancel. She asks, "How much is it if I don't have insurance and pay out of pocket?"

The quote was about half of what her copay would have been.

We're trying to figure out why we still elect to buy insurance. :freak:

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15 mins ago, Africaster said:

 

Sure ... but even if the Dr quadrupled his bill, the insurance is still only going to pay that original amount, so why quadruple the bill?

 

 

Because ins stopped paying the rates. So to cover ins, salary, and costs the Dr increases rates to try and get what he was originally getting. The ins companies are the issue

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Yes I went without insurance for over a year, definitely not fun but it's amazing what the price difference is between insurance companies and out of pocket. You can almost always get rx's at discount prices, regular visits to my pcp were only 40 bucks, had x rays and minor stuff done that I was able to pay cash for fairly cheap. Same stuff on an insurance bill would be thousands upon thousands. My cost with insurance is definitely cheaper now but still makes no sense. If the Dr's charged insurance companies the same rate they charged me my premiums would be about 30 cents a month. 

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48 mins ago, Cfinnely68 said:

You can almost always get rx's at discount prices,

 

Another :worms:

 

We saved close to 10k last year buying rx's from the country with the second highest drug prices in the world. Averaged close to 1/5th US costs.  :freak:  :freak:

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bump

 

PSA

I just got back from CVS with an Rx for Zantac.

Ranitidine 300 mg, 180 tablets:

My out-of-pocket copay with Cigna Rx coverage- $106. So I ask how much it would be if I didn't have my Rx coverage. 

 

Answer: The guy types something, looks at a computer screen, then says, "That's weird" and he goes in back and talks with the pharmacist. 

When he comes back the bill is for $33. :freak:

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