@JustaMom5465 - I also decline my benefits. For years I was lucky enough to get compensated for doing so. However my company stopped that a few years ago.
To the original question. I don’t think I could tell you numbers. However, I know where to find all that information if I needed to. The only part I feel compelled to review is how much we are paying. However if what you are really asking is am I aware of all the parts that go into it? Yes.
Yes, and we will be making spreadsheets soon. I hate this! hate it! The worst part of retirement!!
Down to the penny. My insurance cost come up every quarter when the consistory reviews church financial reports. I ask ahead of procedures what they will cost so I can decide if I can afford the copay or put off treatment.
I think there’s a difference between knowing what medical care costs, and medical insurance premiums. Our health insurance is through H’s employer, so he is the one who gets the pay stubs, annual compensation reports, etc., that lists it (although I do look at a couple of times a year to see what we pay toward our premium). Health costs is an entirely different matter. I do believe the majority of Americans have no idea what medical care costs, unless either, they themselves have had to seek medical care (other than an annual exam/screening tests) or have had a loved one seek medical care. I am the ‘expensive’ one in our family since I have a number of chronic health conditions, seeing several specialists, although some of them are only once or twice a year. I also have a lot of dental issues that I have to stay on top off - H had to have his first root canal and crown a couple of months ago, and when he came home from the dentist after the appt. when they told him what he needed to have done, he reported it all to me, then, with lots of animation said, “You know how expensive dental work is?” I just laughed… he has no clue. (and our dental coverage is not too shabby - I’m not complaining)
We also looked at cobra for D2 last February, but then he saw how much it would cost and we let her go on MediCal. It’s really not a bad system at all - not what we expected after her having been on our fairly nice plan for all her life.
Oh, yeah, I know. $20,000/year in our copays, plus premiums for medical/dental/vision, plus what the insurance pays. It is why DH stays at his current job vs. getting another one where the medical care and cost would be more iffy. I cost our insurance co about $150k/year, and have been doing so for fourteen years now. I track and reconcile very stinkin’ EOB.
I’d been very good about doing that, then we hit one year in particular when I had a lot of health problems and just couldn’t face all the EOBS - they were just a constant reminder of what I was going through. So H took over for a couple of years; for a couple of years we were able to take a tax write-off for medical expenses. I’m embarrassed to say we have not followed up on any EOBs this year. They’re organized, just not cross-checked. Two weeks ago, I was going through them to at least have them all face up and in the same direction and found TWO uncashed checks (dated over 3+ months ago) - one for some copay reimbursement (I think the doctor’s office must have charged us a copay when one wasn’t needed) for $25, and another check for over $500. The $500 check was from early summer - about a week after finding it, we got a letter from UHC following up on why the check hadn’t been cashed. It’s just the kind of error we would have caught if we had been reconciling all those EOBs.
I just can’t fathom going through all of 2015 right now at this point, but in 2016, I might try a new system for keeping track. I keep thinking that each year, we’re finally not going to have so many… I can always hope.
Everyone should understand their EOBs and their benefits. I cannot tell you how often tests have been denied because of improper codes, or simply test A is covered but Test a1 is not. If I call the doctor, then the lab, then the PCP, then the insurance, I can usually get it ironed out. But you have to have a good base knowledge and the credibility to ask the right questions. I have spent many years teaching the medically fragile offspring how to do this – we just ironed out (don’t use the term corrected or argued!) a $1200 test because he knew to read his EOB.
Parenthetically — parents of unmarried 20-somethings should get a simple power of healthcare attorney in the event that your child becomes seriously ill or incapacitated. Otherwise, you will not have access to their doctors, tests, etc. as treatment decisions are made, nor will you have legal input. With no spouse, care decisions are up to the doctors and hospital. It only goes into effect if your child cannot decide for themselves, and does not need to cover every situation. You can find downloadables on the web.
When you say you reconcile each EOB, do you mean you match it up to the eventual bill you get from the provider?
I guess I don’t do it that thoroughly, but I recognize each EOB procedure or visit.
A side note, I CANNOT understand why so many conversations with doctors or other health providers begin with, “well, if your insurance covers xyz, then” I know they are frustrated too, but why does any care have to be contingent what my insurer will cover? Outside of cosmetic surgery or other types of issues?
Because the US system has made health care options something of a consumer sport to those who can afford it.
Painfully aware. Pay for it all.
Surf CIty, that’s exactly what I do. EOB compared to doctor’s invoice with procedures listed. My EOB from the insurer doesn’t even specify the procedures or codes. I match up charges to the doctor’s statement. Checks get sent to the provider for things I have already paid up front, they are processed incorrectly, and for years, I had a terrible time getting my leukemia testing covered. The hospital kept billing it as genetic testing, which my insurance would not pay for. I kept battling, they kept reporting to the credit bureaus. Finally the hospital refused to accept my insurance and I went elsewhere for the testing. Hasn’t been wrong since.
Yes, I know what all parties disclosing information have submitted to me. (And it gets exhausting.)
I reconcile every EOB as well, and have had success at pointing out, where there are capitated costs, when the doctor’s billing service has then tried to pass the difference on to me. The insurance companies do not want to hear that medical offices they have contracted with are trying to meet their full stated cost of service where there is a negotiated volume insurance break.
I also question the billing codes as applied to treatment rendered, and have twice caught errors that were corrected in my family’s favor.
Before this year’s opt-ins regarding insurance, I sent my husband in with a small flowchart. The highlighted If/Then scenarios, depending on how HR answered the questions, let him know which plan and level of service to choose.
Probably because they know that most people cannot afford to pay for medical care that their insurance does not cover. If uncovered treatment is given, the likelihood is that the provider will never be paid while the patient goes bankrupt. That may not apply to some (wealthier) people, but such people are probably only a small percentage of patients.
In this context, it is odd that hospitals and anesthesiologists are so cavalier about that when scheduling anesthesiologists for surgeries without checking the patient’s insurance network, which leads to nasty surprises when the patient thought that the surgery was being done by an in-network surgeon at an in-network hospital but gets an out-of-network anesthesia bill.
I had the same thing happen just this last month. Thankfully I had an alert provider’s office who told me right away because they were used to getting paid from me, and then I’d submit to insurance. I actually have several out-of-network providers that don’t take insurance, so I have to pay, then submit to be reimbursed.
And yes, we used to be as diligent as @CountingDown is, but got lazy this year. For the most part, everything is on the up and up, but when I found that $500 check, it was a reminder that I should be following this stuff religiously. @CountingDown, I would love to know what kind of spread sheet you use to follow this stuff. Did you create something yourself? Or find one already available?
Yep…I reconcile every single EOB with every single bill. My DD had a major claim in th Spring that resulted in surgery and multiple bills, and therapies. She sat with me and eco wicked every single EOB with the bills, and understood where she needed to pay, and how much of her deductible and max out of pocket costs had been met…and what would no longer b covered (e.g. Limited number of PT sessions).
Yep…I take the EOB, and keep it until the bill comes. Then I compare the two. If I have an pit of pocket cost, I also make a copy of check I use to pay it…and they all get put together.
Unfortunately I have had too many errors by insurance companies and billing offices over the years. One resulted in a $20,000 OVER payment to us…and that was a doozie to deal with.
So yes…my kids and we oarents fully understand an EOB, and reconcile each one with each bill.
I will say,.,it gets confusing now that you don’t get EOBs once the insurance is paying the total cost. At least we don’t here. But you can always view your entire account online. Everything!
Teriwtt, I don’t use a spreadsheet unless I get multiple bills with different service dates for the same procedure/test and find problems (which can happen because I get the same blood tests drawn every three months and it often takes a while to get bills). I take the dr bill and the EOB, match up the items, pay the out-of-pocket, and I mark the credit card/check and date on the invoice. Staple it all together and it goes into a LARGE three ring binder. I also record all payments on Quicken, where I reconcile the checking account and credit card statements monthly, more or less.
It helps that I have worked in benefits and have some clue as to what should happen. As it is, I spend a couple of days a month going through all the paperwork and paying stuff. Noone else in my house will touch the stuff.
My brother has stage four cancer, has no insurance, no job, has been turned down for Medicaid and lives in a non-Medicaid expansion state (and is still smoking and drinking – the very things that led to his inoperable cancer…). He is relying on docs and hospitals to declare him indigent and is not going to worry about them coming after him for the bills. He says he has $60k in doctor bills sitting on his desk already, not counting chemo and hospital charges. I fear that his soon-to-be-spouse will get to deal with all of this, which is why I was just down there to discuss whether it was better to have a commitment ceremony vs. a wedding. Oh well. They are getting married anyway. He has a lifetime of bad choices to justify his decisions here. Fiancee doesn’t have insurance, either, and says my brother’s way is fine, because she doesn’t have insurance either and she asks the docs to declare her indigent so she can get care.
A tale of two siblings.
Yes. Do not always check the nitty gritty details. Physician who has declined some tests when I won’t follow through on any treatment. ie osteoporosis scan- won’t take the fancy drugs, not at high risk and it costs money to society even if I/my ins don’t pay. Anyone realize how expensive vit D blood tests are? People without health insurance can take pills without spending around $250 out of pocket. Unfortunately I have to jump through hoops for some unneeded lab work my physician here wants despite national subspecialty recs for frequency, sigh. Actually was kicked out of one physician’s practice- and the clinic offices she is affiliated with because I disagreed with her on this (new to town needed doctor). Found new doctor via a new MD friend who later joined that clinic, so now I’m back in it. Choose nonclinic specialists when I can, however.
Today’s medical care is an improvement over my childhood’s era but there will always be problems. My pet peeves include overtesting- thank lawyers and making money from them. Second is pharmaceutical companies. Outrageous drug price increases because a new company owner wants to make money. Etc. It was upsetting back in the Clinton era when doctors were not allowed to help with a plan for universal health care but industries out to make a profit went untouched. Too much business model instead of healthcare model in the US.
btw- how about same middle aged men- one the lousy health decisions (smoker, obesity, alcohol hx) and the other healthy lifestyle (diet, runs, nondrinker)- guess who got the stage 4 lung cancer? Life isn’t fair.
Several years ago, when my family either didn’t have health insurance or had a very high deductible (sorry, it’s hard to remember because my husband’s long-term unemployment resulted in many changes in our insurance status), my primary care doctor recommended a particular blood test, to help eliminate some potential causes of a health problem. I asked how much the test cost. He said, “a few hundred dollars.” I got the test, then I got the bill; the cost was approximately $800. I was distressed. I really like this doctor, but I was upset, and so I wrote him a letter, diplomatically worded, in which I expressed my distress about the cost of the test. The next time I saw him, he apologized; he is a physician who understands that cost is an issue for many patients and he just was misinformed in this case.
There is a problem when you ask a dr about the cost of a third party process though, this is unfair to the dr, but you should easily be able to access the cost before going ahead. The problem is that it is made inaccessible by the third party system, because otherwise there would be way more savvy consumers shopping around. DH had a heart CT scan for $69 because it is just a pay for access service. No RX, just OTC service. Imagine if your blood tests were like that?
Yes. My employer has been including their portion of the cast as part of the Health Care Enrollment package for many years.