<p>I’m guessing that United Healthcare didn’t pay the $145, rather that was the amount by which your bill was reduced under their negotiated discounted rate for that service. One of the advantages of having insurance, even with a super high deductible, is that you usually pay a discounted rate for services, at least when you are using a doctor or hospital that is in the insurance company’s network.</p>
<p>Ugh so confusing. I’m glad we have Kaiser just $20 a visit. No charge for labs or xrays.</p>
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<p>Given that as the alternative I’m sure the OP would prefer to pay the bill! I know I would!!!</p>
<p>In the future you might want to try some of the over the counter ear wax removers. They run less than $5. It just takes several days.</p>
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<p>Actually, they did. OP says the $145 was “United Healthcare Payment.” The “Adjustment” was the piece UHC didn’t pay due to their negotiations.</p>
<p>For wax removal, you can also go to one of the retail clinics like Take Care or Minute Clinic. I did that once and it cost ~$80.</p>
<p>A few of you mentioned “walk-in clinics.” As far as I know, this is not a common thing in the U.S. In my major urban area, we have clinics funded by the government for low-income people, but even those cannot just be walked into without an appointment. </p>
<p>I remember trying to get some simple friggin advice from the pharmacist at Walgreens about which product to use - he refused to do so, and said I needed to see a doctor. This was for a common skin condition. </p>
<p>A doc visit would have cost me at least $100, followed by some overpriced tube of ointment, that could just as easily been dealt with by a $10 tube at Walgreens. (I have spent $135 for a tube of non-generic antibiotic cream that was proprietarily combined with some other cream.) </p>
<p>So no, I was not going to pay $200 for this particular thing, and instead was on my own. We managed to take care of the thing by talking to friends, choosing something at Walgreens, and it worked out. But a walk-in clinic - yeah, that would be good. Where are they?</p>
<p>I have seen such private clinics in malls all over the US. Very common is suburbs. And not public funded.</p>
<p>I can think of 4 walk-in clinics within a 6-mile radius of my home. They are not cheap, probably in the $100 range for something minor, but they are cheaper than my doctor’s office and they do bill insurance.</p>
<p>Based on comments 28 & 29, then, I would guess that the structure of our medical care differs greatly among regions. I am in CA. </p>
<p>$100 though, this still doesn’t address the needs of the middle & working classes. We need walk-in clinics that may cost $20 or $30, that deal with minor medical issues.</p>
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<p>Solve that and then you can move on to finding affordable education too. Without significant subsidies, that just isn’t possible.</p>
<p>Here’s another question, wise parents: is it common practice for insurance companies to refuse to tell you for sure whether they’ll pay for a procedure/visit/service, until you’ve had the procedure and submitted the claim already?</p>
<p>I’m going through this right now–got a doctor’s referral for an x-ray, but I call the company and they say they need to have the claim in front of them before they’ll tell me if it’s covered or not (they can tell me general things like “we usually cover x-rays” but, importantly, won’t tell me what they consider a pre-existing condition). This is key because if I will have to pay myself, I’d rather not go to the only in-network radiologist (who is over an hour away from me). </p>
<p>Yeah, Canada isn’t looking so bad right about now…</p>
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<p>Generally if you know what the procedure and reason for visit are, they can say if it’s covered or not, but may ask you for the CPT/ICD9 codes. You do have to make sure that the procedure code and dx code the physician uses matches.</p>
<p>One point about urgi care centers, ERs, and such. Sometimes you will get a facility charge and a professional charge for a treatment. Sometimes your tests may incur a copay in addition to the office visit copay. </p>
<p>Your new patient visit is not just one flat charge. There are different levels of new patient visits (like level 2, level 5 etc) each requiring specific things to be documented. If your ear problem visit triggered a level 5 code, you may want to check why. For some insurances, there’s even a difference between a new patient visit and a new patient consult, where the latter requires a report to be sent to the consulting physician. </p>
<p>What can I say, lots of variations…</p>
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Actually there is a quirky feature that applies to many (most) inpatient bills - what the hospital gets paid is not directly tied to what they bill but is a fixed rate based on what was treated. So if there are two patients with the same ailment, and one is kept for a day and the other for three, with CTs and MRIs, etc. the hospital could indeed get the same payment from the insurance company and lose big on the tests and length of stay.</p>
<p>What gets me is the new requirement by the local hospital that we have to pay for many things in advance. I got a call on my cell phone last summer while I was in vacation, saying that I needed a diagnostic mammogram and ultrasound because of a suspicious spot on my routine mammo. While I was coming back from out of state at the end of the vacation, the hospital called to tell me that I had to fork over $200 and change before they’d do the exam - bad enough that I was worried about cancer, but then I had to come up with the money immediately… wouldn’t have gone to visit my folks if I’d known that! And then, it turns out I didn’t owe even half that amount and had to fight like crazy to get it refunded.</p>
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<p>Unfortunately it is common practice. While a particular procedure (even one specifically identified by CPT code) may be covered under the policy, it won’t be covered unless there is an indication that it’s medically necessary. For example, someone with the diagnosis of some sort of foot pain would not have their chest x-ray covered – even though a chest x-ray is a covered expense if you’ve got respiratory symptoms. </p>
<p>What the insurance covers has to make sense in terms of what your diagnosis or symptoms are.</p>
<p>KKmama, I encountered that too this year. I was scheduled for surgery that required an overnight stay, for which I have a $250 copay. The hospital wanted that upfront. (I must add that I like my HMO, that $250 was all I paid for a tricky neurosurgery.)</p>
<p>I have seen stories on the news here that some patients are getting double charged by hospitals that own the physician practice - so not only is someone charged for an office visit, but an extra charge for hospital facilities, even though the physician office is not even at a hospital.</p>
<p>At some medical facilities (including teaching hospitals), it is not uncommon to be charged a portion of the “overhead” of the facility. I was surprised by the charge but insurer didn’t complain & seemed quite fine with it, paying it without complaint.</p>
<p>I have a friend who took her son in for a strep test to their local doctor and got a bill from the hospital. Apparently the hospital now owns the practice. She is changing doctors after being charged more than $250 for a strep test.</p>
<p>That’s pretty outrageous! Sounds like it would have been much cheaper to go to a “doc-in-a-box” somewhere. Someone’s getting a pretty high profit margin!</p>