My PCP charges for a physical and an office visit when I have my physical because she’s also following up on my hypertension and high cholsterol. Insurance allows it, and, to her credit, she informed patients of this before her office started doing that and she spends as much time as you need for your appointment. Of course, this complicates things with the insurance company. They pay for the physical without deductible, and apply the office visit to my deductible, but any tests (e.g./, urinalysis) she performs that should be covered as part of the physical doesn’t end up getting paid by my insurance because they assume any test is related to the office visit part of the appointment. I go through these hassles every year, regardless of who my insurance carrier is.
I had my 3rd ever colonoscopy back in July. I am on a 5 yr schedule because previously polyps were found. I think the doc removed 2 polyps this time. I opted for the upgraded anesthesia - I forget what it’s called, but I remembered nothing and woke up refreshed, not groggy and hung over. I did pay for the prep, but the procedure itself I paid zero, no copay, nothing for the anesthesia, nothing for the lab work (polyps were noncancerous) under my BCBSNC ACA policy. Colonoscopy coverage seems to be all over the map, especially how it is treated when polyps are found. I didn’t think Medicare coverage was that skimpy!
Well…I’m sure every Medicare patient would be willing to do a colonoscopy without anesthesia! NOT!
I’m waiting for the bill from the doctors office…lots of EOBs from Medicare and my supplement (which also didn’t pay any of this).
Gee…maybe next time, I should,offer to do the procedure without anesthetic. I don’t think the docs would allow that!!
These problems are exactly why I’m delaying a colonoscopy. It seems like I spend way too much time fighting insurance anyway. I thought there was supposed to have been a law passed where if they found polyps on a screening, they had to be removed without additional billing. Doesn’t sound like it’s worked out too well.
I guess I’m very happy with my medical coverage, I didn’t realize coverage for colonoscopies could be so skimpy.
I get to go every 3 years lucky me due to diagnosis of ulcerative colitis almost 30 years ago.
Seems like I could have gone broke many times over reading some stories here.
My employer, healthcare system, even began waiving the in network deductible about 5 years ago to encourage employees to get screened for colon cancer. It becomes clearer every day how much fatter my paycheck is when I factor in employer paid benefits. I don’t think it SHOULD necessarily be so, and it wasn’t so obvious when health costs weren’t so out of control. We do feel very fortunate.
DH is just finishing radiation and chemo after a second cancer related surgery. The numbers on the EOB s are scary.
Yes, I am very grateful that we have excellent medical coverage. I just spoke with my mechanic yesterday. He hasn’t seen any docs in decades and regularly gets letters from his insurer urging him to see a healthcare provider. He just laughs and throws them away. I can’t identify!
The amounts charged in the Explanation of Benefits ARE pretty high. I am especially glad that there is NO copay for blood tests ordered by my providers. It’s crazy high how much the bills can get!
I just feel awful,when I see an EOB from Medicare that has a billed cost of $2500 and an amount paid by Medicare of $400. It makes me understand why some doctors will not take new Medicare patients.
I went back and checked my previous test…and the same test 3 years ago…same cost…but my private insurance paid $1500 of the $2500 AND paid for the anesthetic!
It is crazy, the reimbursements. Our private insurance is pretty close to Medicare reimbursement, I believe. H doesn’t have any copays most of the time, now that he has Medicare A & B, plus private insurance. Our insurance is excellent and allows us to go to most providers in the state, plus many, many out of state.
I have been working with the federal government since SEPTEMBER trying to get clarification on whether D is allowed to continue as a disabled dependent or not. Today, I was finally notified that the person who was working on her file DIED! The supervisor is now working to re-assign the case and HOPEFULLY it will be resolved. I have sent them many emails and made many phone calls that went unanswered. I now have the supervisor’s phone number AND email and have sent him an email and spoken with him. I emphasized that our D continues to need and obtain medical care and the providers need clarification on how billing proceeds. He PROMISED to assign it to someone who doesn’t have too many cases so the case can be resolved SOON (whatever that means). He says if I call on Tuesday, we can get the name and contact info of whomever gets assigned the case.
6 years ago I broke my leg. I had 2 surgeries, 17 days in the hospital, other complications that arose during the hospital stay the following 6 months mostly related to the break or the hospital stay. The providers billed almost $250,000. BCBSIL paid about $45,000 of that. I think my deductible was $5,000 that year so I got off cheap. IIRC, the itemized copy of the hospital bill was about 50 pages long. Had to specifically ask for a copy.
At the time I kept thinking that I went in for them to change a flat tire and I end up needing a whole new power train and transmission.
Glad you “only” had to pay $5000 instead of the $45,000 your insurer paid or even more that the hospital charged. Hospital charges are really high! I think they really don’t expect anyone to pay the full amount, but sure wish they were able to give accurate quotes if they expect folks to be intelligent consumers.
But the real question is, What is the true cost of a procedure?
It depends what’s included in that cost. Hospital overhead? Unreimbursed care? The doctor’s time? The wholesale cost of the medication? We don’t have any standards. So the billed cost can basically be any old thing the hospital (or physician) wants it to be.
Don’t feel too awful.
I seem to remember some of the Today show hosts being awake and watching their colonoscopy on a video monitor.
And insurance coverage varies greatly. My colonoscopy, with anesthesia and a polyp removed was covered at 100%. I think I paid for the prep, though.
Oh I don’t have to pay anything…the docs are Medicare participants. But they definitely did not get paid what they billed…or what a private plan would allow.
DH just got the statement from the surgeon that stitched up his hand in the emergency room - $12,000 just for the doctor. That isn’t the hospital yet. And the doc is non-participating even though he went bleeding into the emergency room of a participating hospital. Not like he could shop around for one that participates. That’s a racket. The hospital makes you sign that you agree to pay if a non-participating doc provides service since the doc is on contract not an employee. I think the hospital should be on the hook for the difference.
We disputed an ER doc who,wasn’t in network. I called anthem and politely said…“it’s not like you have a choice in the little rooms. You don’t ask…gee are you a participating doc with Anthem?”
They waived the charge.
I called the hospital billing office today about the $1258 laboratory bill I reference in post #3. Even though I am only responsible for 10% of that figure, I requested more information just to hold them accountable.
All the bill had was:
Laboratory work $1,232
Laboratory work, other $26
Amount due $158
This was for a range of different tests. I don’t find the limited amount of info they provided helpful to me as an informed consumer. This is how they get away with stuff. My mechanic gives me an itemized bill. Don’t see why the hospital can’t either. I’m sure they broke it down for the insurance company so why not for me?
We had a procedure on S at a participating hospital. The MD was participating but the pediatric anesthesiologist wasn’t. We fought (we had no idea he wasn’t participating and we weren’t given any choices) and ultimately, insurer agreed to raise the amount it reimbursed and provider agreed Friday accept whatever insurer paid.
Okay, get ready to stone me here…I’m in the medical billing business. And of course humans are fallible and make mistakes, especially during the coding changes implemented last year.
However, no I can’t tell you what your price will be because there are tons of plans within the same insurance company. Rule of thumb is I 125% of Medicare allowable, but I accept as in network provider whatever the insurance allows.
So patient a could have one blue cross plan that pays x and patient b could have a different blue Cross plan that pays y. It would have to be verified at the time to tell you. Doctors don’t get involved in the prices because it’s impossible to know what your individual plan pays.
It is the responsibility of the patient to know their benefits.
Oh and Medicare sets the pricing, not the medical professionals. It doesn’t matter if a doctor bills 10,000, if they are in network with the insurance company they only get that rate, even if it’s 10 dollars.