Health Insurance Warning

[buzz2400]

I just wanted people to be aware (at least in CT). Before you get any procedure done, call and find out how much it is going to cost you. I had a stress test done. Looked it up in my little booklet and it said it would only be a copay since it would be performed in the doctor's office. Well the doctor's office said that they bill everything through the hospital so it is an outpatient thing which kicks in my deductible. Called my insurance agent and she said that this is the norm now. So I am now stuck with a very very big bill.

 

[Sadie22]

I see some specialists whose offices are located next to the hospital. One bills through the hospital billing service and provides a warning on every piece of paper and every phone call that this may mean a higher billing amount because it is billed as an outpatient hospital service rather than a simple doctor visit. It does not for me, but apparently it does for some. It's really important to check everything by calling your insurance company and not relying on the summary literature. My insurance company has much more information available online now and we can price some procedures online as well, so we can see what they might cost at various facilities.

 

[Halle]

OP I understand your frustration. DH is a doctor and I work in his office. Always check with your insurance company regarding your benefits and what is or isn't covered, deductible info and be sure to find out if you need prior authorization to have testing done. Every insurance company requires different things and most insurance companies offer more than one insurance product which may have different requirements.

 

[NYCDiane]

Most doctor's offices are now going under a "healthcare system" (aka Hospital) so they can bill higher. If you have a procedure in the doc's office, they will bring in a doc who is from the hospital (even if he doesn't do anything but "advise") so they can bill hospital charges.

There are going to be so many changes coming in "Healthcare" in the coming months.... you're going to really start wondering if it isn't all just "big business" (it IS) rather than actual "health care" (it ISN"T)

 

[JanaDee]

Most doctor's offices are now going under a "healthcare system" (aka Hospital) so they can bill higher. If you have a procedure in the doc's office, they will bring in a doc who is from the hospital (even if he doesn't do anything but "advise") so they can bill hospital charges.

There are going to be so many changes coming in "Healthcare" in the coming months.... you're going to really start wondering if it isn't all just "big business" (it IS) rather than actual "health care" (it ISN"T)

Health care hasn't been true health care for a very long time. When insurance companies make decisions regarding your health instead of doctors, you know the system is royally screwed up.

 

[NYCDiane]

Another thing everyone should be aware of: Most insurance companies have a "0" co-pay for yearly physicals. HOWEVER, if you go in for your physical and there is any mention of anything else (even a prescription refill!), it is no longer a yearly physical and they will charge you a copay!

 

[NYCDiane]

Health care hasn't been true health care for a very long time. When insurance companies make decisions regarding your health instead of doctors, you know the system is royally screwed up.

True and I remember when this all started happening about 18 years ago or so. It's only going to get much, much worse in the next couple of years. All I can say is if you are healthy, STAY healthy. If you aren't healthy GET healthy!!! These doctors are only out for themselves and their pockets. And don't think that because you've been seeing your doctor for "x" amount of years that he really gives a crap about you ---- his bottom line is what he is worried about. Hey, someone's gotta pay for the BMW, the big house, the trophy wife and/or mistress, the golf outings, etc!!!

 

[JenKate]

True and I remember when this all started happening about 18 years ago or so. It's only going to get much, much worse in the next couple of years. All I can say is if you are healthy, STAY healthy. If you aren't healthy GET healthy!!! These doctors are only out for themselves and their pockets. And don't think that because you've been seeing your doctor for "x" amount of years that he really gives a crap about you ---- his bottom line is what he is worried about. Hey, someone's gotta pay for the BMW, the big house, the trophy wife and/or mistress, the golf outings, etc!!!

And the student loans and the malpractice insurance and the costs they have to write off from people not paying their bills.

 

[MRIMI]

I work in Radiology, I'm a MRI Tech. Always shop around for prices on non-emergency radiology tests. The prices can vary greatly. An MRI for a knee at a hospital can cost $1500, go to an outpatient clinic, same scan, same type of scanner could cost $600. I scanned an entire spine on a patient, we charged $1700, this is actually 3 total scans. The patient was quoted $7000 at a hospital based system here in Minnesota. The patient asked them why so much more for their scan, they said we used inferior equipment & the scans would be much worse. Also we had inferior Radiologists. We have the exact same equipment as the hospital & our Radiologist's trained at their facility. This is never advertised & pricing is never disclosed unless you ask. When MD's issue orders for radiology tests they are required my law to put in the order, other places you can have the test done. look at the bottom of your radiology order there should be 3 other places listed where you could have the test done. Most people just go with the place they are at & hospital based clinics always have the highest prices. Always show around for prices on optional, non emergency radiology tests.

 

[barkley]

we have a ppo so I've got some choice in providers but depending on if I choose a preferred or non preferred provider I can end up w/a larger share of cost. what I've found though is by shopping providers I often SAVE money by choosing one of the non preferred providers despite having a higher share of cost. with high cost items like when dh needed a neck mri the cost difference between local providers ranged up to as much as a several thousands of dollars in difference, w/ the providers my insurance has as preferred being at the most expensive end. worked out to be a much lower cost for us to go elsewhere despite having a higher percentage for my share of cost.

 

[phred52]

Even when you call ahead, sometimes there are surprises. My dd had her tonsils out last July. I called our insurance and was told since we already met our (high) deductible everything would be covered 100%. Fast forward to end of August when we received a $1400 bill for anesthesia. Now, everything else WAS covered 100%. Just not the anesthesia. We fought and fought and fought with the insurance company over that. In February, SEVEN MONTHS later, insurance decided they would, after all, pay for the general anesthesia. I was ready to give up and pay but my DH was MAD!

 

[kathy884]

You have me scared now. I just had a stress test done last Tuesday -- doctor wanted to rule out any issue with an abnormal EKG just done to have a base line. I guess the good news is that everything came out fine on the stress test. I guess the bad new is that I may be stressed when I see the bill. I'm usually inclined if something isn't invasive to do what my doctor recommends. I guess I need to be prepared that I may need to go into medical emergency reserves to pay the bill and then have a savings goal of building those back up.

I keep a fund of our max out of pocket for each member of our family as a medical emergency fund. One year my son had to have two surgeries (knee issue) and husband had surgery, and it wasn't even just our max out of pockets we paid for both of them, but my son also ran out of physical therapy visits for the year, so I paid for eight of those out of pocket, too. You don't stop physical therapy for a month in the middle of treatment just to wait for the next calendar year when visits are covered again. They did, though, give me a lower rate till insurance kicked in again in January. And again, why with insurance do they bill so much higher. Something sounds wrong with that picture too. Our total out of pocket that year for medical ran about $8,500 so I was really glad I had those reserves. One hospital visit and you're up there in costs, that's for sure. And without insurance you could be wiped out financially pretty fast. Just you're coinsurance (a small portion of everything) is huge.

There seems, though, to be something wrong with our medical system in that when you come in with no problems or issues, the doctor finds something that doesn't look totally normal that they think is just fine, but they just want to cover their butt/make sure all is fine, just in the off chance. So the doctor sends you to a specialist or two, the specialist runs you though lots of tests just to rule anything out, and in the end everyone says everything is fine. What a great way to spend PTO and money -- not. // I don't know what the answers are, but I think we are a bit test happy.

 

[lauradis]

True and I remember when this all started happening about 18 years ago or so. It's only going to get much, much worse in the next couple of years. All I can say is if you are healthy, STAY healthy. If you aren't healthy GET healthy!!! These doctors are only out for themselves and their pockets. And don't think that because you've been seeing your doctor for "x" amount of years that he really gives a crap about you ---- his bottom line is what he is worried about. Hey, someone's gotta pay for the BMW, the big house, the trophy wife and/or mistress, the golf outings, etc!!!

Ouchee I happen to know my primary doctor and I can assure you even thou he can be a but. He cares deeply for all his Patience. He loves his original wife of over 25 years, does have a sports car and hates golf, doesn't live on top of a hill looking down on people.

 

[Judique]

I like my doctor also, but I have no idea what car he drives or where he lives. I just know he's been there for me for 22 years.

I'm one of the lucky ones with what I believe is fabulous insurance. $10 copays, $25 emergency room, $20 specialist copay and $0 for the hospital.

But this week I was rear ended and had to visit doctor and get xrays and everything associated.

Yikes! Plenty of insurance, but now I'm keeping track to see what may exceed my PIP, and what all the associated costs are. This is like a full time job! The other driver has insurance also and dealing with the REP was pleasant, but I still have to get all the treatments for my (relatively minor) injuries, but of course they want to pay me of now.

And what's with this repair shop stuff? Here is an estimate for what we can 'see'. So, what can't you see? Well, we will have to take the bumper of to see if something is bent. So, I said is that all, just take the bumper off? Apparently fixing the possibly 'bent' metal is costly.
So, how much to take the bumper off to get a reliable estimate? $100.

It may be worth it to pay for the bumper pull, as I may choose not to repair the car and use the money towards the new one I'm buying later this year. Decisions to be made.

So, my side hurts, I have a headache and I've got to get up and attend to car business today, after spending yesterday doing xrays and dr visit.

 

[Eastern]

These doctors are only out for themselves and their pockets. And don't think that because you've been seeing your doctor for "x" amount of years that he really gives a crap about you ---- his bottom line is what he is worried about. Hey, someone's gotta pay for the BMW, the big house, the trophy wife and/or mistress, the golf outings, etc!!!

I find your statement extremely offensive. And idiotic.

 

[Eastern]

A lot of hospitals are now buying out doctors' practices. They pay them an amount, usually with an agreement to continue working (for the hospital) for a set salary for X number of years. This allows the hospitals to get more money billing, and it allows the doctors to have less stress because now they are employees: they don't have the responsibility of running a business as well as practicing medicine. As hospitals merge this will become more common.

So don't place the blame on greedy doctors, it's more like greedy administrators.

 

[Eastern]

Even when you call ahead, sometimes there are surprises. My dd had her tonsils out last July. I called our insurance and was told since we already met our (high) deductible everything would be covered 100%. Fast forward to end of August when we received a $1400 bill for anesthesia. Now, everything else WAS covered 100%. Just not the anesthesia. We fought and fought and fought with the insurance company over that. In February, SEVEN MONTHS later, insurance decided they would, after all, pay for the general anesthesia. I was ready to give up and pay but my DH was MAD!

I'm not sure why this was so if you had met your deductible. Sounds like the insurance company was wrong to begin with because if they were right, there is no way they would have paid.

 

[ariel71]

True and I remember when this all started happening about 18 years ago or so. It's only going to get much, much worse in the next couple of years. All I can say is if you are healthy, STAY healthy. If you aren't healthy GET healthy!!! These doctors are only out for themselves and their pockets. And don't think that because you've been seeing your doctor for "x" amount of years that he really gives a crap about you ---- his bottom line is what he is worried about. Hey, someone's gotta pay for the BMW, the big house, the trophy wife and/or mistress, the golf outings, etc!!!

I guess someone should have told my father that he was only "out for himself" before he spent two years in Nigeria with the Peace Corps. Or told the patient who hand-made him a clock as a gift (that still hangs on their wall 30 years later) that my father didn't give a crap about him. Or that he should have spent hours on golf outings instead of reading medical journals in the evenings. My mother will find it amusing to know she's been nothing but a trophy wife for 46 years.

I lived in a small town where the hospital was the main employer, so I knew a lot doctors and their families. I also worked at a hospital for several years. One of my current doctors just got back from a humanitarian trip to Cuba. So I can keep going if you'd like...

 

[Lewisc]

I'm not sure why this was so if you had met your deductible. Sounds like the insurance company was wrong to begin with because if they were right, there is no way they would have paid.

I'm some areas few, if any, anesthesiologists, participate with insurance. The anesthesiologists won't accept an amount equivalent to what an in network provider charges. Patients can pay, fight with the insurance company or fight with the doctor.

 

[fac]

I just wanted people to be aware (at least in CT). Before you get any procedure done, call and find out how much it is going to cost you. I had a stress test done. Looked it up in my little booklet and it said it would only be a copay since it would be performed in the doctor's office. Well the doctor's office said that they bill everything through the hospital so it is an outpatient thing which kicks in my deductible. Called my insurance agent and she said that this is the norm now. So I am now stuck with a very very big bill.

I had a stress test a few months ago and I was stressed out on whether it was a copay as well. it turned out it was for me.