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Some questions about our healthcare system


RC K9

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The other thing with this whole situation too is I am VERY limited in where I can take her since she is 10mo old. There are two hospitals in the area that will do sedated pediatric mri's. Most of the other places I have called do not offer the service. :(
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The best thing we have going for us (users of the healthcare system) right now is technology. I have an app on my phone that I can plug in what I need done and it returns pricing options. So if I go to the hospital and they tell me to go down a floor to get an MRI I can price it out almost live. I have an 'advocate' that I can call at any time and they walk me through anything I need from personal medical help to a family member that is having trouble getting a bill paid. I have a Dr. I can facetime/skype with for free (to me) that can prescribe basic medications that will be ready at Walgreens in 30 minutes. I work for a healthcare broker so we need to walk to talk, but these services are VERY cheap for the value they return.

 

It is no secret that technology is always getting cheaper and everyone feels the burn of healtcare rising. The free market is doing its best to fix this problem. The government is doing its best to get in the way.

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  • 3 weeks later...

Update: MRI was Monday. I called today to get an itemization. Grand Total was like $7k and some change. They knocked it down to like $3200 due to it being self pay and not going through Ins. Then if I paid it all at once, (which I did today), they took it down to $1643.

 

Now, this doesn't include the Physician invoice which will be separate; but on the Hospital/MRI side, we went from $7k down to $1643.

 

Can someone explain to me what I am paying $12k/yr in insurance for?

 

This is just bonkers. If I didn't have kids, I would almost tell the government to fly a kite. Not buy insurance at all. Take those premium savings and max out an HSA, and just do self pays on everything.

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many are just paying the fine to the IRS and saying "screw it."

 

I'd have to say, for a lot of people, I don't think that's a bad way to go. Outside of childbirth, we have never come anywhere near hitting our annual individual or family out of pocket max. Not by a long shot.

 

Kids are the make or break factor in my decision to keep insurance due to the fact that kids are always getting into shenanigans. Broken bones, split chins, etc.

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What do these HSA folks do if they happen to get really sick and rack-up a $1M medical bill?

 

HSA accounts are paired with a high deductible health plan. Annual out-of-pocket expenses (deductibles, copayments, and other amounts, but not premiums) cannot exceed $6,450 for self-only coverage and $12,900 for family coverage.

 

check out: http://obamacarefacts.com/health-insurance/health-savings-account-hsa/

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What do these HSA folks do if they happen to get really sick and rack-up a $1M medical bill?

My HSA is paired with an extremely good health insurance but almost all of it is company paid. I pay $30/month for my insurance which gives me full medical with a $1500 deductible but the company provides me with an HSA and deposits $1K in it every Jan 1. which in turn makes the deductible only $500. Not sure how other companies do it just an example of mine but Worthington Industries does provide some of the best benefits around.

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My HSA is paired with an extremely good health insurance but almost all of it is company paid. I pay $30/month for my insurance which gives me full medical with a $1500 deductible but the company provides me with an HSA and deposits $1K in it every Jan 1. which in turn makes the deductible only $500. Not sure how other companies do it just an example of mine but Worthington Industries does provide some of the best benefits around.

 

You work for worthington? Which division? I Worked at Cylinders off Maxtown and then Steel, before I got a fancy dancy white collar job. Have a buddy that started at the same time as me that works there still. It's a good company to work for.

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Worthington is a great company with great benefits. They built an on-site care facility in the 70s with full Rx, which is a trend we are seeing in the market now to combat costs.

 

Yeah, I think that is where I had to take my pee test way back in the day.

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Check this shiz out: Elia (my daughter) had a post-mri follow up eye exam today. After the exam, and after the insurance, it was going to cost us $112 out of pocket. So I had my wife ask, "how much if we keep insurance out of it and just pay it out of pocket right now?" $80. So we paid the $80 and save $32. With 2wks left in the year, its not like we were going to hit our deductible anyway, so why not save the $30?

 

I really feel my insurance company should be cutting me checks for saving THEM money by shopping around and negotiating rate. Whats that? The MRI was going to cost the insurance company a few grand? But I just paid for it myself out of pocket for $1643? BCBS needs to be cutting me a check and sending me a thank you card and some cheryl's cookies.

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It's all funny money. I work in a pharmacy function of sorts and the typical inpatient markup on drugs or outpatient infusions is 450%. The negotiated rate with Medicare, Medicaid, or your insurance might be 150% of the cost or less, which pays for the medication and administration fees. A large portion of the self-pay patients I deal with don't pay anything because they qualify for charity care / discount and never pay their bills anyways.

 

tl;dr - what things are listed as, the negotiated rate, and what it actually costs are all really different.

 

Oh, and that Times article someone posted earlier... if he had come to the James he could have gotten treated for practically free

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It's all funny money. I work in a pharmacy function of sorts and the typical inpatient markup on drugs or outpatient infusions is 450%. The negotiated rate with Medicare, Medicaid, or your insurance might be 150% of the cost or less, which pays for the medication and administration fees. A large portion of the self-pay patients I deal with don't pay anything because they qualify for charity care / discount and never pay their bills anyways.

 

tl;dr - what things are listed as, the negotiated rate, and what it actually costs are all really different.

 

Oh, and that Times article someone posted earlier... if he had come to the James he could have gotten treated for practically free

 

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.

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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.

 

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.

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In the end it doesn't matter what the insurance company would have paid. The bottom line is that if you had used your insurance you were going to have to pay $4500 deductible. Insurance probably was going to be billed zero and the hospital was going to laugh all the way to the bank with about $3k more of your money than you ended up paying by paying cash up front.

 

That right there is the problem and should piss us all off.

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Insurance probably was going to be billed zero and the hospital was going to laugh all the way to the bank with about $3k more of your money in order to cover the cost of the 30 people before you that never paid them.

 

That right there is the problem and should piss us all off.

 

Fixed.

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