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Some questions about our healthcare system


RC K9

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Yes you can, get the tax id # from the provider your going to(they will give this out. Also your insurance company im sure can find this info as well) and the procedure code of the procedure. and then call your insurance company. They can look up the contract they have with that facility and can give you what the actually contracted rate for that service is.

 

Sometimes the contract will state a set fixed price, some contracts are set to pay a % of what the initial bill is. example bill is 100$ contracted is to pay 75% of submitted charges, the contracted rate would be $75.

 

I had actually tried to ask BCBS what their contracted rate was on the cpt code I gave them and the rep said she did not have access to that info.

 

The reason I want to know is because if the Ins Company was going to pay $2000 to the hospital for an MRI that I paid $1643 for, I would the the Ins company should reimburse me at least a percentage of the difference since I actually saved them money. Now, if the Ins company would have only paid $1500, then I didn't "save" them money, but that leads to a whole other issue. If your "cost" was only $1500, then why am I being told it's going to cost $6000. I pay you $12k/yr to negotiate for me...

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I had actually tried to ask BCBS what their contracted rate was on the cpt code I gave them and the rep said she did not have access to that info.

 

The reason I want to know is because if the Ins Company was going to pay $2000 to the hospital for an MRI that I paid $1643 for, I would the the Ins company should reimburse me at least a percentage of the difference since I actually saved them money. Now, if the Ins company would have only paid $1500, then I didn't "save" them money, but that leads to a whole other issue. If your "cost" was only $1500, then why am I being told it's going to cost $6000. I pay you $12k/yr to negotiate for me...

 

:lol: they will tell you to go pound sand. Also since you havnet met the deductible they wouldn't of payed anything anyways.

 

If the rep didn't know how to look up the contract, speak to a manger, every insurance company has this info and is accessible.

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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.

 

THIS. I feel like the market isn't coming around to satisfy the needs of the consumer enough. Maybe it's because everything is so regulated because its healthcare afterall? I don't know. Any other market this happens and the consumer wins in the end but not healthcare.

 

Perfect example, I've started going to the OSU walk-in clinic in Giant Eagle. I had a stigma about going to see a nurse practitioner in a grocery store but when the bill is a FRACTION of what it would be if I went to my real doctor (who coincidentally NEVER has any convenient openings anyway) I got over that shit real quick. I will say I have gotten great care, the nurse even walked out to the pharmacy with me to pick out an OTC medicine that would help the best. That's customer service.

 

I've never had to deal with high priced MRI's or any serious medical cases thankfully and I can only imagine what the OP is going through not only worrying about his baby's condition and getting the best care possible but with the burden of the financial aspect of it as well.

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Converse to that post, I have a loser brother who's on medicare/cade along with his live-in girlfriend her three kids and one of his own litter. Every minuscule healthcare problem they have they go to the ER. THE FUCKING ER! kid has an earache? ER. Tummy upset? ER. Kid having a temper-tantrum and can't control her? ER.

 

Its fucking unbelievable the waste that goes on in that family. While normal people are cognizant of what costs are and trying to conserve he doesn't give a shit b/c after all its not his money anyway so what does he care?

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THIS. I feel like the market isn't coming around to satisfy the needs of the consumer enough. Maybe it's because everything is so regulated because its healthcare afterall? I don't know. Any other market this happens and the consumer wins in the end but not healthcare.

 

Perfect example, I've started going to the OSU walk-in clinic in Giant Eagle. I had a stigma about going to see a nurse practitioner in a grocery store but when the bill is a FRACTION of what it would be if I went to my real doctor (who coincidentally NEVER has any convenient openings anyway) I got over that shit real quick. I will say I have gotten great care, the nurse even walked out to the pharmacy with me to pick out an OTC medicine that would help the best. That's customer service.

 

I've never had to deal with high priced MRI's or any serious medical cases thankfully and I can only imagine what the OP is going through not only worrying about his baby's condition and getting the best care possible but with the burden of the financial aspect of it as well.

Half the time your going to your doctors your talking with the nurses anyways, doctor comes in for split second. I use these as often as I can for the little stupid stuff as its way cheaper.

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Converse to that post, I have a loser brother who's on medicare/cade along with his live-in girlfriend her three kids and one of his own litter. Every minuscule healthcare problem they have they go to the ER. THE FUCKING ER! kid has an earache? ER. Tummy upset? ER. Kid having a temper-tantrum and can't control her? ER.

 

Its fucking unbelievable the waste that goes on in that family. While normal people are cognizant of what costs are and trying to conserve he doesn't give a shit b/c after all its not his money anyway so what does he care?

 

you should punch him in his face for this. :lolguy:

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Is there a way for me to find out exactly what the negotiated rates between the Ins Co and the provider are? Like, originally, the MRI was $6000, $4500 would have been out of my pocket, then Insurance would have covered the rest as I would have met my deductible. Now, I know that there is no way BCBS was going to pay $6k, but were they going to pay less than $1643?

 

Story on NPR the other day was about how some big Incs companies allowed researchers to go through their negotiated rates and apparently some of this info was released, but I need to find it.

 

If the BCBS Rate was anything below $6000, then why the heck are they trying to screw the consumer by charging them as such? So frustrating.

 

Like paul said, with the procedure code and provider information (tax ID, NPI of facility, etc) you might be able to get that. I don't think insurance likes people asking the question you are, so they likely make the information difficult to obtain. You may ask HR at your work for a specific representative at your insurance, as the member services representatives will probably not know how to get your prices.

 

Unfortunately the ethical component of healthcare prevents it from being an efficient business model. At least state institutions can't turn patients away based on them clogging up the ED, not paying their bills, not doing what they are supposed to post-hospitalization, etc. All their bills get defaulted as a tax write-off and then all the insured people end up paying the difference so that the hospital can stay afloat.

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you should punch him in his face for this. :lolguy:

 

HA if he wasn't 3 times my size maybe. We have gotten into it a few times and I just love pushing his buttons about being a responsible adult. fucking loser.

 

Like paul said, with the procedure code and provider information (tax ID, NPI of facility, etc) you might be able to get that. I don't think insurance likes people asking the question you are, so they likely make the information difficult to obtain. You may ask HR at your work for a specific representative at your insurance, as the member services representatives will probably not know how to get your prices.

 

If your insurance carrier is hesistant to give up that kind of information then why not ask the hospital? i guess they might not be as cooperative if they know they wont be getting paid as much.

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HA if he wasn't 3 times my size maybe. We have gotten into it a few times and I just love pushing his buttons about being a responsible adult. fucking loser.

 

 

 

If your insurance carrier is hesistant to give up that kind of information then why not ask the hospital? i guess they might not be as cooperative if they know they wont be getting paid as much.

 

Typically the staff at a hosp wouldnt have access to this info. You would have to try to get it out of the billing office, good luck with those un happy un helpful tool bags.

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THIS. I feel like the market isn't coming around to satisfy the needs of the consumer enough. Maybe it's because everything is so regulated because its healthcare afterall? I don't know. Any other market this happens and the consumer wins in the end but not healthcare.

 

Perfect example, I've started going to the OSU walk-in clinic in Giant Eagle. I had a stigma about going to see a nurse practitioner in a grocery store but when the bill is a FRACTION of what it would be if I went to my real doctor (who coincidentally NEVER has any convenient openings anyway) I got over that shit real quick. I will say I have gotten great care, the nurse even walked out to the pharmacy with me to pick out an OTC medicine that would help the best. That's customer service.

 

I've never had to deal with high priced MRI's or any serious medical cases thankfully and I can only imagine what the OP is going through not only worrying about his baby's condition and getting the best care possible but with the burden of the financial aspect of it as well.

 

The good part is, there were 3 things possibly going on with her, 2 being serious, and one not being serious. We were blessed enough to find out it was the non-serious possibility. It sucks that it took a few grand to find that out, but that's the price you pay to have kids, right? Ha ha.

 

you should punch him in his face for this. :lolguy:

 

I 2nd this motion. It's one thing if you do what you can in your power to be responsible, and you still need help. I am all for that. Everyone needs some kind of help at one point or another. But there is a difference between doing your due diligence to be a responsible member of society, and being a someone that just takes advantage of society. Need to take it 3rd world and have him and his GF flogged in the town square.

 

Like paul said, with the procedure code and provider information (tax ID, NPI of facility, etc) you might be able to get that. I don't think insurance likes people asking the question you are, so they likely make the information difficult to obtain. You may ask HR at your work for a specific representative at your insurance, as the member services representatives will probably not know how to get your prices.

 

Unfortunately the ethical component of healthcare prevents it from being an efficient business model. At least state institutions can't turn patients away based on them clogging up the ED, not paying their bills, not doing what they are supposed to post-hospitalization, etc. All their bills get defaulted as a tax write-off and then all the insured people end up paying the difference so that the hospital can stay afloat.

 

I had the CPT code and they knew the hospital where I was originally going to have the procedure done. At least now I know to just keep bumping it up the ladder until I receive the information I am requesting. I am chocking all this up to an educational experience. Also, I don't have an HR department, and I buy my own healthcare, so this is kind of something I have to learn and fight for on my own.

 

HA if he wasn't 3 times my size maybe. We have gotten into it a few times and I just love pushing his buttons about being a responsible adult. fucking loser.

 

 

 

If your insurance carrier is hesitant to give up that kind of information then why not ask the hospital? i guess they might not be as cooperative if they know they wont be getting paid as much.

 

The Hospital had told me they didn't have that info available to them. I don't doubt this is true for the girl I was speaking to, but I know someone there has that info.

 

Typically the staff at a hosp wouldnt have access to this info. You would have to try to get it out of the billing office, good luck with those un happy un helpful tool bags.

 

Yeah, I think both parties, Hos and Ins would not want this kind of information made public.

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  • 3 months later...

Summation of all this crap:

 

I got the MRI knocked down to $1643 if I paid it all at once instead of making payments.

 

The Anesthesiologist invoice was $855

 

Total cost was $2498.

 

So, what I did was, got a chase freedom CC that has 0% interest on purchases for 15mo. They also give you 1% back, and $125 for opening the card.

 

I paid the invoice(s) all at once so I got that phat discount from the hospital. I make monthly payments on the CC so I don't have that much cash tied up at once. It will be paid off in less than 12mo instead of doing the whole 15mo so I definitely am not paying any interest.

 

With the $125 bonus and the points earned from the transaction, Chase essentially gave me $150 which I credited towards my bill.

 

In case you can't tell, I try to make the "system" "work" for me as best I can.

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Summation of all this crap:

 

I got the MRI knocked down to $1643 if I paid it all at once instead of making payments.

 

The Anesthesiologist invoice was $855

 

Total cost was $2498.

 

So, what I did was, got a chase freedom CC that has 0% interest on purchases for 15mo. They also give you 1% back, and $125 for opening the card.

 

I paid the invoice(s) all at once so I got that phat discount from the hospital. I make monthly payments on the CC so I don't have that much cash tied up at once. It will be paid off in less than 12mo instead of doing the whole 15mo so I definitely am not paying any interest.

 

With the $125 bonus and the points earned from the transaction, Chase essentially gave me $150 which I credited towards my bill.

 

In case you can't tell, I try to make the "system" "work" for me as best I can.

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