<p>I, too, have had issues getting a price- even when I knew the surgical procedure, neither the doctor nor hospital could tell me the price until the did it. They had to know how many hours they would spend in the OR etc in order to know the billing. But you would think they would know how much they bill for a simple colonoscopy.</p>
<p>When you have a high deductible, you still only pay the insurance company allowed amount, so you do get that discount, which can be substantial.</p>
<p>I don’t know about an employer sponsored HSA account, but I can reimburse myself for items paid by means other than the debit card, so I would think I could wait until the funds are there.</p>
<p>If it is an employer plan, be sure to find out if the money rolls over at the end of the year. I believe there are some employers who fund something like an FSA which does not rollover.</p>
<p>I’ve had a high-deductible, 20% co-pay plan for ten years now (and we’ve been glad to have it, what with both of having had cancer). Always ask for the cash discount! You’d be amazed to know how many billing offices are thrilled to give you the savings they get by NOT going to the insurance company. The orthodontist took $400 off my husband’s wisdom teeth (was $2000); the optometrist took 25% off the exam and the glasses; the colonoscopy was done in a different facility to save money (ended up at $1300 total).</p>
<p>We had a plan with a $15K per person deductible for about 10 years. No HSA: we were self-insured. It cost over $400 per month for two people. Not a bargain. We paid over $40K for it over the time we had it and never collected a dime.</p>
<p>Essentially, we were uninsured but paying for the privilege. I basically never went to a doctor unless the situation was truly dire. (Coughing up blood, for a real life example.)</p>
<p>Now that H has a regular job, we have insurance with a $3K deductible and an HSA that is funded from each paycheck. Unfortunately, even comparatively routine expenses such as having a dilated eye exam and getting new glasses was enough to drain it. (In prior years I simply didn’t have things like eye exams.) It would have to build up for a long time to cover any actual illness. And don’t you have to use it each year or lose it? Or am I behind the times?</p>
<p>We had Consolation’s plan. DH is now, believe it or not, on Medicare… who knew that would be an age to celebrate?</p>
<p>We paid about what Consolation paid with about the same results. Now I have a plan which is slightly better, allows a few MD visits per year “for cause”, vision benefit, but still huge deductible. New plan has lower premium and discount for paying full year premium in advance. Kind of a “no name” company, but so far claims paid smoothly for the couple times I used it.</p>
<p>dmd77, thank you for the tip re seeking “cash” discount. All those years, I never thought of that. The colonoscopy cost was outrageous, imo, between the physician, the facility, the anasthesia etc. So your $1300 looks good from here!</p>
<p>Consolation – no, HSAs are not use-it-or-lose-it – Once you’ve established an HSA and the associated High Deductible Health Plan you can even make claims against the money you put into the HSA in a future year. (If I was covered by my HDHP and had an HSA in 2010, but spent more than I had available in the account in 2010, the money I put in in 2011 can be taken out as reimbursement for those unreimbursed 2010 expenses.)</p>
<p>One of the problems is that we’re not used to comparison shopping on health care. I had elective surgery in December – the surgeon I chose operates at two different hospitals and a free-standing surgical center, all of which are in-network for my HDHP, and all of which had very different costs for the costs other than the surgeon’s fee. (Costs ranged from $3200 to >7K.)</p>
<p>There is some sort of employer plan (FSA?) which I have heard about which is a use it or lose it, it mimics an HSA in terms of high deductible and health cash account, but it is lost each year. I have never had one, so don’t know the name or details, but an employed person would need to be certain which type they have.</p>
<p>FSA is kinda like an HSA with slightly different rules.
There are IRS rules pertaining to all FSA accounts and then other rules that are specific to each employer FSA plan.
I’ve participated in my employer FSA for about 5 years. It is an optional plan to complement my employer provided health coverage for which I pay premiums each pay period.
My FSA plan allows contributions up to $3000 per year which are deducted from my pay PRETAX. I can use the mastercard connected to it to pay copays, deductibles, etc for entire year, up till March of following year. UNUSED $$$ is forfeited. So some planning is necessary. With DH and I aging, we have not had difficulty finding need for the $2000 I contribute. I can actually ‘spend’ the entire $2000 in January if I want for qualified expenses…in essence getting an interest free advance.<br>
Works great for our family. Easier than finding the chunks of money for unexpected procedures, or even planned colonoscopies, etc.</p>
<p>I sympathize with all of you who have these worries. It makes me scratch my head in wonder, though, that some choose to scare people with the possibility of a Canadian style system, when so many Americans have concerns similar to those being posted in this thread.</p>
<p>Every time I have asked a dr. or hospital what a procedure or test would cost, they would not/could not tell me. That makes decision making difficult. I think most doctors, maybe out of necessity, practice CYA medicine. They order a ton of tests without regard to cost. Most of them don’t even appear to consider cost to the patient. As mentioned above, if my cholesterol has been fine for 15 years, does it need repeated testing? If I have never had a bad Pap smear in 30 years, do I need the test every year?</p>
<p>My D has a genetic chromosome condition, with heart issues. They are stable and tested yearly by echocardiogram. Her new, young, really test happy MD decides she “needs” a MRI. $8,000 and the results were “clinically not as accurate as desired because the images were fuzzy”. #&* Yearly bloodwork, nothing wrong…just checking…$2,000.</p>
<p>I am hopeful that consumers will demand more and become most cost cognizant as so many are forced into HSA, high deductible plans and that this will help make changes. Not holding my breath though.</p>
<p>Yea, my internist ALWAYS orders blood work for our annual physical, even tho it’s nearly always been normal. He also does an EKG very year for the physical & orders a chest xray. I have refused the chest xray now for many years as neither he nor any of his staff can say waht they’re looking for or WHY I should have it.</p>
<p>It is amazing the different prices you can get for the same thing with the same doc & staff and how tough it is to get a straight answer about how much it will cost.</p>
<p>I’m not an advocate of a lot of unnecessary tests, however, what your physician is doing is screening you to make sure they are still normal. Just like they do with a colonoscopy. The fact that those tests have always been normal is meaningless.</p>
<p>For example, my best friend’s husband as well as my FIL both found out they have a form of Leukemia based upon their white blood count done at their annual physicals. Both of them had always had normal blood tests until that point. Many diseases, particularly cancer (such as lung cancer, which the chest x-ray might pick up) don’t show symptoms until they are very far advanced. I had a friend (who was 43 and never smoked a day in his life) die of lung cancer a few years ago. By the time he exhibited symptoms it was at Stage 4 and he died within a year. My grandmother also died within 6 months after her first symptom of lung cancer. Had the doctor done a routine chest x-ray, they would have probably caught it at an earlier stage.</p>
<p>Other things they are looking for are a decrease in kidney function, abnormalities on an EKG that might indicate a heart problem, glucose levels that might indicate diabetes, etc. Pap smears can pick up cervical cancer (also one that doesn’t exhibit symptoms). Mammograms - breast cancer. As we age, the risk of all these diseases goes up. A 20 year old probably only needs a physical every 3-5 years but at 50, you really should be getting one every year. Though I agree you might not need every test every year. My doctor only does a pap smear on me every 2 years now.</p>
<p>There’s a lot of value in many routine screenings. In fact, if we could get more people in for routine screenings, we could cut some of the our health care costs as a country. Much cheaper to get a $50 lab test and treat diabetes at the onset than to try an control it in someone who has had it undiagnosed for years. This is the reason many health care plans will pay 100% for annual exams and other screening tests.</p>
<p>OTOH, there’s not much value in going to the doctor if you have a cold or a stomach virus (unless you are dangerously dehydrated). The most common diagnosis in our emergency room is a cold.</p>
<p>I do feel like it’s really important that people educate themselves as much as possible about their own health. There’s a TON of conflicting data out there and idly sitting back and letting your doctor make all the decisions for you might not be in your best interest.</p>
<p>From all that I’ve read, xrays are NOT sufficient to detect lung cancer at early stages. There was a clinical trial (HI for a change participated) to see if CTs were sensitive enough to detect early stages of lung cancer where treatment had greater chances of success. I haven’t heard of any positive results but will try to find out when I attend a conference in May. From al I’ve read & heard, the risks of repeated chest xrays outweigh the benefits for most people unless the doc is looking for something in particular.</p>
<p>Wouldn’t surprise me at all. Honestly, I look at studies and medical data all day long and I’m beginning to suspect that it’s all a guessing game. Study after study contradicts each other. Medications, procedures and tests aren’t studied for very long before they are put into use. No one understand the long-term effects of anything until it’s been in existence for a decade or longer. I’ve begun to rely on my instincts more and more. If something doesn’t seems right, go with your gut.</p>
This is not, in general, true. It seems counterintuitive, but while the health care cost for the afflicted person are less, the costs of testing everyone and his brother to find the small percentage of afflicted persons is much greater than the cost would be to treat them for advanced cases and have no testing. </p>
<p>Of course, for the individual it is better to catch things early. For the system, that’s another matter.</p>
<p>This is one of the reasons it makes sense to test those who are most AT RISK for the condition rather than screening the entire population, most of whom are NOT at risk and will not benefit from the expense and hassle of the test. This is what we try to do with the non-profit in the clinics we do. We go to the communities most at risk and particularly try to work with those who have risk factors to test them and counsel them. (Of course, if we have the resources available, we work with anyone interested as well.)</p>
<p>I think that’s the whole point…in our system right now, most times we don’t know, or even CARE how much a procedure costs. If it doesn’t come out of our pocket, we consider it “free”. But we all know SOMEONE is paying for it, and of course those costs are passed to everyone as premium increases. Consumer-driven healthplans really make the consumer consider the need and costs of procedures. The company I work for has made available online resources to compare prices/satisfaction ratings of many providers in order to make it easier for the customer to “shop around” for value in healthcare.</p>
<p>Yes, alwaysamom. We are a headscratch-inducing people down here south of the border, are we not? We could be the character in some absurdist tragicomedy, I think sometimes.</p>
<p>Generally speaking if you ask the provider for the CPT code your insurance might be able to look up an estimate of their in network negotiated price for you… but without that code you are kind of stuck in limbo</p>
<p>I’m curious about the original premise of this thread. “Just because insurance doesn’t pay for it, I’m not getting needed health care.” seems to be the idea. Huh? I pay for a lot of things I want and don’t need (like a pretty new sweater), but only after I pay for things I do need (like food and the repeat chest xray after my pneumonia). The fact that I hadn’t met the deductible for my insurance was meaningless. Yes, it’s annoying when they’re not sure how much it will cost, but how much shopping around are you planning to do?</p>