Any doctors out there?
 

I am wondering about some bills that I received. I needed to have a cataract removed and replaced so I asked my eye doctor what the cost was going to be.Since I didn't have any health insurance when it was discovered, I was going to have to foot the bill. He said, "3 thousand to 35 hundred". I think, OK, fine, I can come up with that easy enough. Well, I get the bill from him and it's actually less, around 27 hundred and I'm smiling. Then yesterday I get a bill from the hospital, 11,000 dollars! Is this the normal practice, when I asked the doctor what the cost was going to be, I meant the whole thing. When you ask somebody what it's going to cost, would be safe to assume you mean the whole thing? When you ask the mechanic what it's going to cost to rebuild your engine, you don't expect him to say 500 dollars and then you go to pick up the car and there is a 6 thousand dollar garage use fee. Well I guess I know where any "extra" income is going to go for the next year or so. BTW, I was in the outpatient surgery center for about an hour and a half for the whole thing. :eek:

Tobra, Moses, and Livi I know. There are a few more here tho....

See my thread here.: http://forums.pelicanparts.com/off-topic-discussions/455112-wife-has-have-hernia-surgery-tale-healthcare-amerika.html?highlight=hernia+surgery

FWIW you may want to contact hospital business office and try to negotiate the price. Often they will reduce it by about half....maybe more if you can pay it within 30 days.

You get billed by the various parties involved in the procedure: surgeon, facility, and anethesiologist. Those are the big three charges you'll incur. If you had a pre-op clearance or labwork or chest x-ray, those might be billed by the various providers (internist, lab, radiology service, and radiologist) as well. As you can see, you might get 4 or 5 or 6 separate bills. And each provider honestly has no idea what the other providers charge. Maybe ballpark guestimates, but no solid idea. You'll have to deal/negotiate with each bill separately.

I understand your position as the consumer, asking the question of "what's the tab gonna be?" It's a bit ridiculous and disjointed that there aren't clearer ideas on costs PRIOR to the service being rendered. As a surgeon, I try to warn patients about these things beforehand, and let them do their due diligence.

Tell the hospital you will pay $1,000 and if they don't take it, have it go to collections. Insurance probably wouldn't pay more than that.

Are there any rev codes on your hospital bills? We sell medical billing software and I can see what insurance companies and medicare typically pay for that particular code.

WTF kind of advice is that? STIFF the hard working doctors and staff just becauses you think the bill is too high?

This is more of a problem than some people realize. If you ask for the cost of a medical procedure they don't want to come up with a figure. It just happened to me. If it is covered by insurance it seems the bill is astronomical and the facilities/doctors agree to accept 20%-50% of stated cost. How ridiculous is this? So it costs you $10,000 if you pay it or only $3500 if they get paid by insurance.
So there is overbilling of those able to pay to account for those who can't pay. I say pay the doctor and let the rest go into collections. If you have a good credit rating otherwise these bills will not affect it much anyway.
This advise is worth what it cost you.

No, I say pay the doctor what had been agreed upon and negotiate with the hospital for their portion of the bill. Chances are that the insurance would have only paid $1,000 on the $11,000 bill anyway.

I agree with this approach. I definitely will pay the doctor what ever he wants, but when you see what the hospitals get paid by the insurance companies, why should I have to pay them a greater amount just because I give them cash?:confused:

Your view is only one side of the equation.

You're right. Why should insurance companies get to pay far under market value/MSRP/regular pricing for medical services? That's not fair to the uninsured consumer. Why should little, single person you have to pay $11,000 for something if a big corporation like AIG (which has enough money to give out bonuses and such) can pay $1000, instead? That certainly doesn't sound fair or make sense.

On the other hand, why should health care providers have to discount services for everyone--insured or not--just because people don't want to pay full price? That's not fair to the provider, is it? Should health care providers (whether they are a hospital, physician, lab, etc) be able to pay their obligations (rent, electricity/water/utilities, office staff wages, office supplies, etc.) less than market value, in return?

, Seems like there are some inequities in the US medical system.:rolleyes:Let's see, I have to keep AIG afloat with my tax money, they get a huge discount from the providers, and I have to pay full price to the same provider for the same services that AIG or (fill in name) gets a huge discount on. Then I'm sure factored into my price somewhere is me paying for those who don't pay at all.Why not charge everybody the same?No discounts for anybody, just the fair market value.

You don't need to convince me that insurance companies act like Satan. Medical insurance companies are about making money, not taking care of people.

You're absolutely correct in that we need more realistic medical billing practices in this country, so uninsured people who pay their bills aren't unfairly charged ridiculous prices. We also need people who are willing to pay their medical bills (after all, the service is already rendered by the time the bill comes--why should the patient worry about paying it at that point?). And we need some tort reform to avoid the ridiculous lawsuits and settlements which are fairly commonplace, today. Don't think those costly lawsuits and malpractice/consumer liability premiums don't trickle down to the end users (like you).

So I suppose that we are in complete agreement. I intend to pay all the bills, whatever they may be and take my lumps. Unfortunately, this approach seems to be not in vogue anymore.I value my reputation more than my money. Somewhat along these lines, someone suggested letting bills draw out as long as possible due to the upcoming huge rise in the rate of inflation, it will be easier to come up with the same number of dollars when they are worth less!

Why does an unisured party get billed for more than an ins co? And, what's more, the ins co pays even less than the listed charges. It's time for the same bill for like services to be sent out no matter where it goes and who pays it.

Frankly, if I was a state attorney general, I'd start an investigation of what has been going on for way too many years. I'm serious, people are getting boned every day. In fact, if I have cash to pay today with no paperwork, I should get a lower figure on the bill. But, I'd settle for equality.

To billyboy, at least attempt to negotiate. And include a payment plan in your negotiations. Don't bring that aspect up until near the end and don't agree to any interest charges. Your money serves you best in your account as long as you can keep it there.

This is truly BShttp://query.nytimes.com/gst/fullpage.html?sec=health&res=9504E0DC143BF930A3575 1C0A9629C8B63

$2700 for a cataract? Maybe I should have been an ophthalmologist.

Seriously, it's unfortunate that you did not get the estimate from the hospital prior to having the procedure and that you had to have it done at the hospital instead of an outpatient surgery center (generally cheaper) or even while it was not covered. Maybe, you can find out the going rate for the insurance companies, and offer to pay only the equivalent amount.:(

OK...

I chose an HSA or Health Saving Account as my health care insurance.. My company offer us three types of care.. a high plan , a low plan, and HSA..

I am on my third year of HSA.. which is a high deductible plan ( $1500 for single)

I recently went for a check up...

The Dr. charged over $400 for the visit, and $200 for the EKG....

My my responsibility for the services was $8.33...

Needless to say I am bewildered, but wont complain about a $8 visit to a Doctor..


BTW I always mention to the Dr/Dentist/Specialist who I am seeing...

That the time I wait to see them should be deducted from the bill...

Insurance companies negotiate lower rates for their members. Let's say they take an equal premium from 10 - 40 year old guys. then they negotiate rates based on that pool of guys. They know that not all of them are going to get sick, some percentage will and some won't. The risk is how many of them will get sick. That's how the majority of the health care in America works - employers buy into these pools and it costs everyone the same amount. The companies negotiate a contract rate with the providers of 'reasonable and customary' charges.

If you take the insurance companies ability to negotiate what the providers charge and equalize everyone you basically do away with the benefit of group insurance carriers. You drastically change the basis of medical care in the US.

I'm not saying it shouldn't be done, I do believe that would go against our 'market' system but our market system today with this process in place is more like 'capitalist socialism'. The insurance companies act like capitalists to get members to their groups with their premium costs but then the groups themselves are more like socialist environments.

I don't know what the solution is, I'm quite frustrated with medical bills myself. I absolutely hate the way billing is done. I do not think I could be more frustrated with it. I do not think I could hate it any more than I do. I don't hate much...

2 examples:

My wife and son were in a minor car accident back in June of 08. They ended up in the emergency room since my wife was 6 months pregnant at the time. Everyone was fine but I had my then 3 year old checked out by the ER doc. We didn't receive the bill for that part of the ordeal until February of this year. I'm amazed that it took them this long to bill me and I honestly have no idea how to ensure that the bill I am getting is legit. It isn't a significant amount and the car insurance will cover it 100% but still - how do I ensure we aren't getting taken?

Next: My son gives birth to our second son in September. We pay our part in full as soon as we receive the bill. Then This month we get another statement of my wife's account that says she is past due with an additional $100. WTF, we paid in full. So I call them up and they say it is from my son's account. I ask for them to send me a detailed bill.

If legislation is to be done - I think the first thing they should do is consolidate billing through a single provider. If a Dr. needs the services of multiple Drs to complete a procedure, they should consolidate that billing into one bill. You have a team of Drs working on you and they all have bills to be paid - send a single itemized bill to the patient outlining their entire cost for the procedure. It is insane to expect that the patient will be able to keep up with this and I believe that this type of system would be very easy to game. I did a bit of research and all of this is based on 'contract law'. I'm no lawyer so I could be 100% wrong and I don't recall any of the details but it is my understanding that it would be okay for a hospital to continue sending you bills for whatever they think they can bill you for a particular procedure for something like 3 years from the date of service.

I'm sure one of the board attorneys can clarify this but that's just what I recall - mainly that it is stupid.

I'm also no insurance or medical expert - just a frustrated consumer.

Insurance is a game of risk and I believe it is a game we can ill afford to continue to play as a society. There has to be a better way.

Because insurance companies "buy in bulk." It's a similar concept to why a stick of gum costs more (per stick) when you buy a pack from 7-11 compared to the price per stick if you were to buy an entire tractor trailor load from Wrigley's. The insurance company "brings" tens of thousands of potential patients to a provider. An individual household might consist of 4 or 5 consumers, in comparison.

At the same time, it's also unfair how insurance companies "negotiate" their reimbursement rates with providers. Insurance companies definitely hold the cards, in this regard. It's not an equitable, two-way negotiation. Rather, it's a take-it-or-leave-it proposition. The insurance company will tell the provider what it's willing to pay. Often that's based on some sort of percentage of going Medicare rates (i.e. 85%, 100%, 150% of what Medicare will pay for that service). Health care providers are single entities or small groups, but certainly nothing on the scale of an insurance company representing tens of thousands of consumers and cornering 10-30% of the market. It's illegal for providers to get together to negotiate with insurance companies. That would be anti-trust. But there's nothing to stop insurance companies from talking amongst themselves about the rates they offer for reimbursement.

So the option, for a provider, is to "leave it" and simply not sign on as part of the provider network. The problem is that there are few people like billyboy who do not have insurance, but have the means and integrity to pay their medical bills. I'd have to say that roughly 90% of the "self-pay" patients (what you're listed as when you don't have insurance) that I get called to see in the ER weasel out of paying their bill. At least my bill. I'd bet they skip out on paying the hospital/lab/ER doc/x-ray bills, too. But that's just a WAG. Those tend to be the same people who, while I'm sewing them up, promise that they'll pay whatever it costs to get the job done right. Never hear the insured promising that.

So a provider can bill an insurance company whatever that provider wishes (can't do that with Medicare--that's a federal offense), and the insurance company will pay whatever the contract (that they essentially wrote) stipulates. Some states allow balance billing, where the provider can then bill the balance (whatever the insurance company didn't pay of that bill) to the patient directly. California used to allow that. However, last month the state supreme court had a decision that struck that down. So it's not written in the lawbooks, but it's in legal precedence. It'll protect consumers from getting gouged by health care providers. But, in light of how these insurance contracts realistically are written and negotiated, it's also terribly unfair to providers. Given the recent track record of outfits like AIG and the rest of the insurance industry, what's the likelihood they'll pay fair reimbursement vs. lining their own pocketbooks?

there is a Hospital here that takes the bill and reduces it by 85-90% so your only stuck with around a grand bill. The poeple who run it aren't for the money, sorta pay only what it cost them... pretty nice as i had 4 grand bill reduce to around 700, then settled for 500... -.-