OK…here is mine. Medicare paid $400 or so out of the $2000 billed for my colonoscopy, but didn’t pay ONE PENNY of the anesthetic for the procedure. Really? They EOB says it wasn’t a pre approved item. Really?
The allowable charge for Medicare is only $68 but still…ridiculous that this was not covered, don’t you think?
No bill yet from the doc office…patiently waiting for that.
Our private insurer covers anesthesia, tho if you need and have a separate anesthesiologist, that’s an additional charge and you will pay more (yep, we have paid it each time).
I still am having a hard time with the $19K bill we got from Stanford for one MD visit, an echocardiogram, a chest CT and several blood tests. We paid our 10% of that bill but it sure seemed high. Our insurer was fine with it, so I guess it was all fine. Our D just saw one NP, one MD, and had a bunch of blood tests, all in a few hours there. Her bill was $6.6k! We have no idea yet what our share of that will be.
Medical expenses dwarf college costs, IMHO.
My insurance company was just billed $700 for 4 X-rays of my back. My share is nearly $100.
$1200 billed by laboratory for blood work. Contracted rate was cut down to $128, much of which I will cover under my deductible as it wsn’t part of an annual checkup, which I am fine with.
So if you don’t have the insurance, the lab basically bills a person 10x the going rate? I know it has been this way for awhile but what is wrong with hits picture? You don’t need insurance just to help pay the bills, you need insurance to avoid the crazy, inflated charges that come with not having insurance.
My insurer was billed $530 for an initial visit with a specialist. I paid $15–insurer paid about $250. We did talk for 2 hours.
Urgent care sent me home with a short boot for my broken fibula. They charged me my portion of about $60 for it. The next day, I went to an orthopedic specialty urgent care clinic. They told me I had too short a boot and gave me a taller one. They NEVER billed me for the taller one, I guess assuming insurer would balk at paying for 2 boots for same injury and foot. I thought that was very decent of them. I called insurer because I could find the short boot I was discharged with at a lower price for MY portion than the amount they charged me and MUCH LESS than they were charging insurer. Insurer said it was fine to pay what was charged. I was grateful to ortho clinic and highly recommend for future.
Well, this is a story looking at the issue from the other side.
Someone I’ve known for years – decades – is a renowned expert in the field of employee benefits. Nationally known, gives speeches all around the country. His brother had cancer and was dying. The hospital wanted to perform certain procedures that would extend his life modestly. Both the ill brother and the benefits expert wanted to know what the cost of the procedures would be before they agreed to them. The hospital couldn’t tell them, because it depended on what was billed. The doctors who would perform the procedures couldn’t tell in advance what procedures would be performed – it depended on what complications came up during the procedures. They went around and around for several hours and no one could say in advance what the cost would be.
And yet, we’re supposed to make decisions about what services to “buy,” with absolutely no knowledge of the cost.
Right, @VeryHappy. I can’t think of another service or product we buy that works like that. You would think they could at least provide a range - low end to high end. When someone is facing major health issues and feeling super crappy, having to deal with the situation you described sounds like unnecessary aggravation.
If they have N procedures, there is a finite number of ways these procedures could be administered! And in this day of computers, it should be easy to have all of those priced out as a range or two.
Retired physician here- never primary care practice. Regular (not Medicare) insurance. Last annual exam got two bills for the same uncomplicated visit- added a simple diagnosis (no teaching needed, btw). Found out that can be done- insurance companies will pay for it. Thought the purpose of the annual exam was to check on any new problems along with the old… Never saw this years ago. Do not expect your physician to understand the ways of acceptable billing/insurance, it would take even more years of schooling (and then they’ll change the rules).
@VeryHappy, my brother ran into the same issue when he needed surgery on a broken arm. My coworker also ran into it when her doctor recommended a particular test - no facility would quote a price. My insurance has what I thought was a great tool that allows you to pull up a facility & request a price. I found out it’s just an estimate … well, the office visit was about 80% more than the estimate. Just the office visit. I no longer bother to use the tool.
I went for a screening mammogram. They saw something that warranted a follow-up exam. My gynecologist and the radiologist agreed that an MRI was in order. I called the insurance company to make sure it would be covered and was assured that it would be, and that I did not need to get a preauthorization. All of the physicians and facilities were in network.
About a month later I got the bills. MRI was denied because the insurance company thinks I should have gotten an ultrasound before getting the MRI. After much arguing back and forth I ended up having to eat the cost of the MRI. At least the radiology clinic only charged me the insurance negotiated price.
It still bugs me that the insurance company thinks it should have more control over my healthcare than my own doctors.
Now I know to get everything in writing instead of relying on what the customer service person says on the phone.
Wow–that’s bad that they TOLD you no pre-auth needed and then refused to pay! My docs always get pre-auths for MRIs since our insurance started requiring it. It’s very contentious and I believe there was a bill in the leg this year about it, since the insurers used to routinely waive pre-auths for most of the local docs to do diagnostic screenings, including MRIs.
I had a pre-authorized CT in Feb. It showed opacities. I had pneumonia that showed up in chest xray. My doc wanted to get new CT pre-authorized but his request was rejected. My pulmo sent in a pre-auth request for a CT that was granted, so I did get the CT and it showed that the opacities had cleared and pneumonia was gone. Phew, what a mess and waste of doc’s time!
Thumper, unfortunately some insurers consider anesthesia to be medically unnecessary for colonoscopy.
It is unreasonable to expect patients to be informed consumers when we can’t even get reasonable estimates or ranges for services and procedures from providers. What other field can get away with not providing accurate written estimates?
Mechanics are supposed to call you if things arise in addition to what they wrote in their quote. My mechanics are very accurate on their quotes.
Yes, a car is not a body, but at least an estimate would be good. Other countries can come up with them. It’s crazy!
Pharmacies also have trouble quoting a price–depends on your policy, the formulation, how many days supply, etc. Several of my drugs are FREE under my Rx plan if I get a 90 day supply but various prices if I get fewer days supply.
Coupons from drug manufacturers often can only be used by full pay patients of folks with private insurance and NO govt coverage. The coupons can make the Rx free or at least much cheaper than it would otherwise be. It makes me crazy. I get free or low cost drugs when I can afford to pay for them while patients who are on govt programs with limited funds have to pay much more.
The other things that slay me:
The cost on a hospital bill for something as simple as ibuprofen. You could by a 10 year supply for what they charge for a tablet or two.
Check your hospital bills carefully. It’s amazing what charges they try to slip through and if you point out errors or items you never should have been charged, they act like it was just a little mistake. I’m sure they get away with it tons with those to inform or old to notice or those not looking line by line. One I remember from giving birth several decades ago was several hundred dollars for drugs that are prescribed to dry up the milk production of new mothers choosing not to breastfeed. Since I was breastfeeding, I was surprised it showed up on the 10 page itemized bill, along with every pair of disposable gloves, water jug, and other tiny item. It pays to check those bills carefully!
Yes, it is very informative to check the bill. They are surprised when you bring up mistakes on the bill, but will make corrections if you insist. Sometimes I feel they are trying to tell us indirectly not to make waves and not complain if insurer isn’t complaining, but that doesn’t seem right but reimbursements are too low, they should try to get that addressed directly instead of by “creative billing.”
If I like the provider, I may not say anything, but I do notice how some MD offices bill allergy shots as an allergy shot and others as an office visit.
I remember having to fight for 7 months to be allowed to buy rather than rent a $200 nebulizer machine that took 7 days to get. If I had been allowed to by it from a competing pharmacy, I could have paid only $100 but only would have been reimbursed $50. I bought it from the preferred supplier and was reimbursed $160, so out $40. They wanted me to rent it for $17/month out of pocket instead. I said, there are 4 asthmatics in our home–if it saves one MD visit or urgent care visit or ER visit, we will all save $$ and heartache. Have now had the machine 16 years and still use it as needed!
Recently, got insurer to allow me to buy a travel nebulizer machine. I pay all and am reimbursed 70%. It works for me. We didn’t even have to fight this time about my buying and NOT renting.
Colonosvopy is completely covered, unless they take out polyps. They took out 3 for me and I was charged $1,200.
One think I’ve learned is yo now check around for different echocardiogram pricing, as it can swing wildly at hospitals and facilities. I had one at a large hospital and it was $400 out of pocket. The very same thing was $$1,600 at another. Who would have thought?
Worst. Healthcare. System. In the world.
My GYN wanted me to have a colonoscopy for years. I called several offices, and my bill, 12 years or so ago, would have been $4-5,000 for,procedure, let alone the other charges. I had college tuition and other expenses, so I delayed.
As the great age of 65 approached, I had it set up. I was charged for office visit, but polyps and everything else covered. If I had been quoted the Medicare price for procedure, I would gladly have paid.
My nsurance use to cost $1200 a month, just for me. A mammogram cost $950 or so. I could go on. thank goodness I’m now happily on Medicare.
Our insurance changed over a year ago. I went to the dentist and was told that they take our new insurance. Did a check up and then brought the kiddos in a few weeks later for theirs. 6 months pass and the three of us go back using the same insurance card. About a month later I get a bill for full-pay for all 6 visits. Accountant at the dentist said they don’t take our insurance. So they treated me, realized that they didn’t take our insurance, and then allowed me to believe that they did through 5 more visits, thereby racking up hundreds of dollars in charges. Meanwhile I’m still paying the dental insurance premiums.