RC K9 Posted November 23, 2015 Report Share Posted November 23, 2015 These are legit questions coupled with some rants, so if it belongs in the kitchen, please move it there. So basically, I am a simple jack when it comes to understanding our healthcare system, (and probably other things as well). So I am hoping some people with extensive knowledge on the matter can explain it to me. Under my current PPO we have a $6000 individual out of pocket max and $12000 family max. When my wife had our daughter, I wound up paying like $10,700ish out of my pocket after insurance. $3171 of that apparently didn't count towards my deductible though, because apparently they don't cover private rooms, even though that's all the hospital had. How the fk that happens, I have no idea. So anyway, the breakdown of what applied to my deductible was something to the tune of $1500ish for my daughter and the rest was towards my wife. Fast forward to now. My daughter needs a sedated MRI. So her Dr sent the orders over to a hospital they work with. Well, i call the hospital to find out what my out of pocket cost is going to be. All they would tell me was after looking at the insurance, my out of pocket would be $4500ish, since I had only met $1500 of Elia's max out of pocket. Well holy crap. So after I threw up in my mouth, I called another hospital. They were about the same after insurance. I pay $4500 and Ins covers the rest. So then I ask the other Hospital, what if I pay out of pocket. Forget I have insurance. Well, that knocked it down to an est of $2300. So WTF do I have insurance for? So I call the original hospital to see what they will charge me out of pocket if I say forget insurance, and they said they can't do that since I do HAVE insurance with whom they are contracted. I asked how that mattered, what would they do if I just walked in off the street. They said they would just charge me directly. I asked why they couldn't do that then, and she wouldn't give me an answer. So I cancelled her appt. I'm not tossing $2k in the trash. So here are my questions: 1.) If a Hospital can offer a service to someone for $2300 why are they charging $6000 if insurance is involved? Wouldn't this greatly contribute to the reason my insurance costs continue to go up every year while my coverage gets worse? If a service can be charged for X amount, I would think it shouldn't matter who is being billed/paying it. 2.) Why in the world would a hospital not give me an out of pocket cost if I were to forego insurance? They can clearly invoice directly, but refuse to do so when they know I have insurance? I am hoping I am missing some key elements here that can be explained, and that this isn't how thing really work, which is essentially screwing every day citizens. $2000 difference...wow. Quote Link to comment Share on other sites More sharing options...
Mensan Posted November 23, 2015 Report Share Posted November 23, 2015 If you have them bill you, after your insurance pays they will most likely negotiate your bill down to something more reasonable. They DO charge insurance companies more. Quote Link to comment Share on other sites More sharing options...
El Karacho1647545492 Posted November 23, 2015 Report Share Posted November 23, 2015 Long story short is the healthcare industry is completely and utterly FUCKED due to many people simply not paying their bills, and the rest of us pay for it one way or another. Quote Link to comment Share on other sites More sharing options...
jeffro Posted November 23, 2015 Report Share Posted November 23, 2015 Insurance is a scam and the .gov is in on it. /thread. Quote Link to comment Share on other sites More sharing options...
SRTurbo04 Posted November 23, 2015 Report Share Posted November 23, 2015 It's way more expensive with out insurance normally Let's say it's 15k for the procedure. If you have insurance they are most likely contracted to accept say 8k If you don't have insurance they can and will charge you 15k. Now in your suitation they sound like they are willing to work with you which is not always common so I would run with it. Also the reason why they charge more to insurance(even know they will accept less) is they know they will get there larger sum of money some how. Sucks but thank you for keeping me in a job Quote Link to comment Share on other sites More sharing options...
Tractor Posted November 23, 2015 Report Share Posted November 23, 2015 Because you have insurance they are going to rape you and your insurance company because you can afford insurance so you can afford the rape. Makes perfect sense in DC. Quote Link to comment Share on other sites More sharing options...
SRTurbo04 Posted November 23, 2015 Report Share Posted November 23, 2015 Also ask for the tax I'd of the place your going to and the procedure code, and call your insurance company to see what there contracted rate is. The facility that gave you a quote might not know there contracted rate with your insurance and is just giving you a generic figure. Also your insurance company can find your other facilities and give you a price on those too. Quote Link to comment Share on other sites More sharing options...
Forrest Gump 9 Posted November 23, 2015 Report Share Posted November 23, 2015 Because you have insurance they are going to rape you and your insurance company because you can afford insurance so you can afford the rape. Makes perfect sense in DC. Ain't that the fucking truth. Quote Link to comment Share on other sites More sharing options...
Not Brian Posted November 23, 2015 Report Share Posted November 23, 2015 When my wife had our daughter, I wound up paying like $10,700ish out of my pocket after insurance. What the literal fuck How do all these poor people keep having babies Quote Link to comment Share on other sites More sharing options...
Mr. Jones Posted November 24, 2015 Report Share Posted November 24, 2015 What the literal fuck How do all these poor people keep having babies The collective "we" pay the bill. Quote Link to comment Share on other sites More sharing options...
spectragod Posted November 24, 2015 Report Share Posted November 24, 2015 What the literal fuck How do all these poor people keep having babies They get a "raise" when they have more kids, they get more welfare. Lets talk about the $86,000.00 hip my wife just got.......... Generally they will bill the insurance company for all they can, they insurance company will only pay their "negotiated" price, period. If they are offering you a deal, I would take it, although by doing so, it won't apply to your copay, not that it matters, as it appears you are doing a good job of getting a better deal for yourself without your insurance company....:fuckyeah: Quote Link to comment Share on other sites More sharing options...
RC K9 Posted November 24, 2015 Author Report Share Posted November 24, 2015 (edited) It's way more expensive with out insurance normally Let's say it's 15k for the procedure. If you have insurance they are most likely contracted to accept say 8k If you don't have insurance they can and will charge you 15k. Now in your situation they sound like they are willing to work with you which is not always common so I would run with it. Also the reason why they charge more to insurance(even know they will accept less) is they know they will get there larger sum of money some how. Sucks but thank you for keeping me in a job My story isn't the only one like this. Girl I work with had to go to the emergency room. They asked her if she was paying pocket or it it was going though insurance. They priced her both ways. Was going to cost her a few grand if she went through insurance because she hadn't yet met her deductible. $400 if she just paid out of pocket. She paid out of pocket. In what reality does that crap make sense? Also ask for the tax I'd of the place your going to and the procedure code, and call your insurance company to see what there contracted rate is. The facility that gave you a quote might not know there contracted rate with your insurance and is just giving you a generic figure. Also your insurance company can find your other facilities and give you a price on those too. Thanks. What the literal fuck How do all these poor people keep having babies Because they don't have debtor's jail anymore and those kinds of people don't care about credit scores or anything else the rest of us care about. Edited November 24, 2015 by RC K9 Quote Link to comment Share on other sites More sharing options...
Smokey Posted November 24, 2015 Report Share Posted November 24, 2015 Ask them if you can get a further discount by paying prior to the procedure. I've heard that's the cheapest way to do it out of pocket but never actually tried myself. Quote Link to comment Share on other sites More sharing options...
SRTurbo04 Posted November 24, 2015 Report Share Posted November 24, 2015 Ask them if you can get a further discount by paying prior to the procedure. I've heard that's the cheapest way to do it out of pocket but never actually tried myself. Bingo! After all, it is a business. Office managers want income right away vs waiting months after the procedure to get it in payments made on them (most common for common people) Quote Link to comment Share on other sites More sharing options...
Draco-REX Posted November 24, 2015 Report Share Posted November 24, 2015 Long story short is the healthcare industry is completely and utterly FUCKED due to many people simply not paying their bills, and the rest of us pay for it one way or another. It isn't just non-payments. It's how the insurance companies handle claims that has contributed to the shithole our system currently is. So, you go in to have X done. What does X cost? You can add up the labor, overhead, supplies, etc. and come up with a number. I'm sure hospitals do this. And I'm also sure it's actually a sane number. The problem is that someone, at some point, realized that the cost of X DOESN'T MATTER. They realized that what does matter is what the insurance company will PAY for X. This person figured out that if the insurance company will pay $1000 for X but the hospital only asks for $100, the hospital loses out on $900. Since the insurance company isn't going to hand out a menu of their pay outs, this guy figured out that he could charge teh insurance company $10,000 for X and let the insurance company negotiate it down to the maximum they are going to pay. That way the hospital gets every penny they can from the insurance company. So your $100 visit is now a $10,000 visit. What I don't understand is why the insurance companies decided to squeeze their customers rather than cracking down on the hospitals. There must be some financial sleight-of-hand that makes paying these inflated bills more profitable than controlling the costs. Quote Link to comment Share on other sites More sharing options...
Tractor Posted November 24, 2015 Report Share Posted November 24, 2015 What I don't understand is why the insurance companies decided to squeeze their customers rather than cracking down on the hospitals. There must be some financial sleight-of-hand that makes paying these inflated bills more profitable than controlling the costs. Thats very interesting. Quote Link to comment Share on other sites More sharing options...
everlight44 Posted November 24, 2015 Report Share Posted November 24, 2015 Try here for the procedure code: http://www.icd10data.com/Search.aspx?search=Magnetic+Resonance+Imaging+ The code for an adolescent and adult may be different. Other thing is to look into financial assistance. It varies by hospital and your household income, but at OSU any patient can apply for HCAP/Charity care of their portion of the hospital bill. You might call and ask a financial counselor at OSU at 614-293-0860 or 293-2100 for specifics, as it is not my primary area. Quote Link to comment Share on other sites More sharing options...
10phone2 Posted November 24, 2015 Report Share Posted November 24, 2015 What I don't understand is why the insurance companies decided to squeeze their customers rather than cracking down on the hospitals. There must be some financial sleight-of-hand that makes paying these inflated bills more profitable than controlling the costs. It's a win win for the hospitals. They get to say that they help the needy for feel good stories and the rest cover the bill. My sister in law was a nurse at a hospital in Phoenix that never turned a patient away due to cost. They were bought out and they are now cutting everything possible to stay afloat. I knew it wasn't going to go well with health care cost when I tested a perfect score (20/20) for my health exam 2nd year in a row and my cost still went up $60-70 a month. At the end of the day, I can't blame the poor people completely since life happens good and bad. Our society is based on immediate satisfaction, fast food, and sitting around watching tv/video games and the nation's poor health is the result of it. Quote Link to comment Share on other sites More sharing options...
Alex1647545498 Posted November 24, 2015 Report Share Posted November 24, 2015 Long read but this explains a lot on how things are charged and how fucked up it is. http://time.com/198/bitter-pill-why-medical-bills-are-killing-us/ Quote Link to comment Share on other sites More sharing options...
Sledhead36 Posted November 24, 2015 Report Share Posted November 24, 2015 Without getting into how screwed up everything in the healthcare industry is since Obamacare took over…… Try a private MRI company. When I had my medical distribution company we needed to do an MRI for a particular procedure. The hospitals would bill the patient $3000-$3500. We went to a private MRI company that was not associated with the hospital and got it done for $650. It might've changed names now, but it was called open MRI on Bethel Road. Quote Link to comment Share on other sites More sharing options...
Trouble Maker Posted November 24, 2015 Report Share Posted November 24, 2015 Without getting into how screwed up everything in the healthcare industry is since Obamacare took over…… Because it was all roses, rainbows and unicorn fart perfume before? To the OP, you could try something like this to have someone shop around for you and maybe get something back to cover some of that deductible. http://www.npr.org/2015/10/09/447098694/why-most-people-don-t-shop-around-for-medical-procedures http://www.vitals.com/ Quote Link to comment Share on other sites More sharing options...
wagner Posted November 24, 2015 Report Share Posted November 24, 2015 Without getting into how screwed up everything in the healthcare industry is since Obamacare took over…… Try a private MRI company. When I had my medical distribution company we needed to do an MRI for a particular procedure. The hospitals would bill the patient $3000-$3500. We went to a private MRI company that was not associated with the hospital and got it done for $650. It might've changed names now, but it was called open MRI on Bethel Road. Listen to this guy here, he has something most don't on CR, REAL WORLD EXPERIENCE... What I don't understand is why the insurance companies decided to squeeze their customers rather than cracking down on the hospitals. There must be some financial sleight-of-hand that makes paying these inflated bills more profitable than controlling the costs. This is what the .gov should have done instead of the fucking Obamacare mess. Tweaks to the old system, plus not allowing people who had a condition be denined coverage would have fixed a lot of problems. Instead we now have a system that is going to fail under it's own weight due to one man's stupidity and ego. Quote Link to comment Share on other sites More sharing options...
RC K9 Posted November 24, 2015 Author Report Share Posted November 24, 2015 Try here for the procedure code: http://www.icd10data.com/Search.aspx?search=Magnetic+Resonance+Imaging+ The code for an adolescent and adult may be different. Other thing is to look into financial assistance. It varies by hospital and your household income, but at OSU any patient can apply for HCAP/Charity care of their portion of the hospital bill. You might call and ask a financial counselor at OSU at 614-293-0860 or 293-2100 for specifics, as it is not my primary area. I was able to get the CPT code or whatever it is, but it was like pulling teeth. As for the OSU counselor, not sure how much that would help me since I live in TX now. Thanks for the info/advice though. Long read but this explains a lot on how things are charged and how fucked up it is. http://time.com/198/bitter-pill-why-medical-bills-are-killing-us/ Will Read. Without getting into how screwed up everything in the healthcare industry is since Obamacare took over…… Try a private MRI company. When I had my medical distribution company we needed to do an MRI for a particular procedure. The hospitals would bill the patient $3000-$3500. We went to a private MRI company that was not associated with the hospital and got it done for $650. It might've changed names now, but it was called open MRI on Bethel Road. Thanks for the info. What makes this situation a little more complicated is that it's a sedated MRI since my daughter is only 10mo old. Because of that, the cost essentially doubles because a pediatric anesthesiologist has to be involved, and those people are hard to come by, (assuming it's because no one wants the liability of pumping babies up with drugs and knocking them out). To the OP, you could try something like this to have someone shop around for you and maybe get something back to cover some of that deductible. http://www.npr.org/2015/10/09/447098694/why-most-people-don-t-shop-around-for-medical-procedures http://www.vitals.com/ Thanks. Will check out. Listen to this guy here, he has something most don't on CR, REAL WORLD EXPERIENCE... This is what the .gov should have done instead of the fucking Obamacare mess. Tweaks to the old system, plus not allowing people who had a condition be denined coverage would have fixed a lot of problems. Instead we now have a system that is going to fail under it's own weight due to one man's stupidity and ego. Don't get me wrong, I didn't vote for him either time, and I become more distasteful of him every day that goes by; however, I think it took more than one man to get this system to where it is right now. Pretty sure a few other people had to vote to make it come to fruition as well. Quote Link to comment Share on other sites More sharing options...
Trouble Maker Posted November 24, 2015 Report Share Posted November 24, 2015 Thanks. Will check out. Yeah, just a suggestion and example of one company. I'm sure there are other similar companies, programs out there. I also hope someone with some insight can chime in on how good or bad these things are. Quote Link to comment Share on other sites More sharing options...
Sledhead36 Posted November 24, 2015 Report Share Posted November 24, 2015 Because it was all roses, rainbows and unicorn fart perfume before? To the OP, you could try something like this to have someone shop around for you and maybe get something back to cover some of that deductible. http://www.npr.org/2015/10/09/447098694/why-most-people-don-t-shop-around-for-medical-procedures http://www.vitals.com/ Actually not bad,never really had a complaint. I paid $700/moth for a family in 2013....now pay $2000/mo and deductibles doubled. I feel sorry for those less fortunate who have been screwed by this debacle. A friend who paid less when the plan came out was thrilled by paying less. Until he got a $5000 promotion at his job and he no longer qualifies for the reduced rate he once had, has to pay back $3900 to the Feds on his healthcare....He should have turned the raise down. Quote Link to comment Share on other sites More sharing options...
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