Medical Bills and Being an informed consumer - vent

[barbarabini]

So, everything I read about controlling my medical costs comes down to being and informed consumer. Shop around, find out how much the procedure is ect. ect. so you are not caught unaware by the bill.. ect.. Seems easier said than done.

Preface: I have insurance - HBCBS - deductible 3000 with 20% coins. on some services and - 50%-50% on scrips. So, I know, no matter what I am in it for at least 3000 plus the premiums. Ok. Its the coinsurance part that is causing all the trouble.

So far, I have had the same two lab services, one was coded as routine - so no payment, one -the same service - coded as maternity - so I got a bill for coinsurance. Lab said talk to doctors office. Doctors office sent the same slip for each. Talk to the lab. ugh. Insurance says 100% of routine covered. But neither provider will recode the second lab.

I have called on four ocassions to the hospital for an estimate of my out of pocket exp. for an upcoming c-section. Nobody knows. Can't tell me until at least the day of the c-section. That really doesnt help budget wise. I was told - "Do you have insurance? well yes. Then don't worry about it" But my insurance has a coinsurance component. 20% of 5000 is only $1000. But is its going to be out of $50,000 it is going to be $10,000. By the way, my first child's delivery the hosp. billed insurance $50,000 but it the ins. contracted it to 7500. The last one, the contracted rate was 20,000 and I paid $4000 of it.
There doesnt seem to be a rhyme or reason to it. The doctor can't help, because he says he doesn't know the hospital charge.

I decided to save another 3000 to have 6000 for medical costs but have no idea if that bears any relation to the reality of it. IT would be nice to at least have an estimate if its going to be another 2000 out of pocket or 10,000 out of pocket.

Last, went to CVS with a kids scrip (decongestant), asked for the price was told oh - we cant give you the price until we run the scrip. Leave it with us and come back in an hour. Of course, the decongestant turned out to be 138.00 but rather than just running the scrip, they filled it. So, I bought it. How do you get prices from them?

I am trying to control the med. costs for the family but there is no transparency to any of it. As for the insurance plan, it is the only one the company offers all of its employees. There is no choice to pay more or less and I don't think we would do better individually.

Anyone with any experience on this?

 

[mistysue]

Do you have an out of pocket max? I only ask because if you do it will help you to know what the limit is. Unfortunately, there are a lot of variables with the c/s because you don't know what will happen if you go into labor. It might be a different doctor, different anesthesiologist, you might need some sort of emergency medication. They don't want to tell you a cost because they don't want to see you again in a few months screaming at them for giving you the wrong number.

I have also gotten the same answer about running a prescription, I actually walked away and came back 20 minutes later to ask a different person who told me an amount.

Unfortunately the rules about running labs while you are pregnant can get confusing and strange... you may want to talk to your doctor about what they would charge you for a routine pregnancy with a planned c/s if you didn't have insurance. Numbers vary wildly by region, but there are people without insurance who I know paid much less than some women pay just in co-pays just by negotiating this way.

 

[mrsklamc]

You don't have to buy the script just because they filled it.

 

[kydisneyfans]

First thing to remember is that 80/20 for insurance doesn't necessarily mean you are paying 20% of the full cost-you pay 20% of the contracted rate between your insurance company and the hospital.

For example, if the csection is $10,000 but the insurance company states it should be $6,000, you will owe $1200, not $2000.

-CVS should have been able to tell you the cost of the prescription as soon as they ran your insurance card. You did not have to buy it since it was filled, you could have transferred it to Kroger/Walmart/ etc.

-Also make sure your hospital is a primary hospital on the plan. If I get xrays done at our local hospital, which is covered at 80%, I still pay deductible or about $60 once the deductible is paid. If I go to a different hospital in lexington (20 miles away), I pay $7 and no deductible since it is a "preferred parter"

 

[angierae]

What someone else said - when you're looking at a procedure that expensive, what you need to do is call your insurance company and find out what your max out of pocket is. That's the absolute most you'll end up paying.

For me, it's $2k per person per year. When I had reconstructive surgery, I knew that was the most I would end up paying. (It ended up only being about $1200, though.)

 

[barbarabini]

Yes, the max oop is 10000 on the plan. I didn't realize that you can decline the scrip once it is filled.
Yes, last time the contracted rate came to 20,000 and of that, I paid 20% - $4000. Trying to get the contracted hosp rate this time prior to the c-section but it has been impossible. My guess is that it probably has gone up.

I have been using the in-network providers and hospital, so, i don't incur the 40% coinsurance.

 

[Karenj2]

What irked me when I had DD was that there were some state mandated tests we had to have before the hospital would release our daughter. There was only one doctor/company that does the test (the hearing test) in the hospital. Apparently, even though the hospital was in-network, the doctor that works in that hospital wasn't, and we had to pay for the stupid test. (After paying $25k for the fertility treatments, the cost for that test was minor, but it was the principle of the matter...)

I hate health care plans! (Although so far I'm not totally loathing the plan we're on now - they actually covered our fertility treatments for #2 so far!!)

 

[laurafergie]

Yes, the max oop is 10000 on the plan. I didn't realize that you can decline the scrip once it is filled.
Yes, last time the contracted rate came to 20,000 and of that, I paid 20% - $4000. Trying to get the contracted hosp rate this time prior to the c-section but it has been impossible. My guess is that it probably has gone up.

I have been using the in-network providers and hospital, so, i don't incur the 40% coinsurance.

I had two kids with no insurance. Call the billing department of the hospital directly and ask how much is a routine c-section for a self pay. Then do the same thing for the anthesiologist sp? and you'll get a ball park. Don't forget about the pediatrician and your ob. Also a little known fact (doesn't help you, but may someone else) is if you pay the hospital ahead of time, the procedure is heavily discounted.

 

[wdwnomad]

Since your out of pocket your deductible is $3000 and your opp max is $10,000 then you'd need to incur $38,000 in medical expenses to max out. $3000 + (35000 x 20%) = $10,000.

Does your insurance plan have a cost estimator calculator on their website? My company does. You select the procedure and the provider and you get an estimate.

Hope that helps with your planing.

 

[Tink-aholic]

I don't know whether you even WANT to know this or not...but most insurance companies provide the most reimbursement for VBACs. Have you even considered this, if you are even a candidate? I'm talking significant dollars here. I have seen patients in your exact situation save $5000 or more. It makes sense, too; much less time in the hospital, less invasive, and the doctor (and, ultimately, the patient) has to take on all of the risk.

I only mention it because you ask about saving money and a lot of women don't know the incentive behind VBAC.

Good luck.

 

[dhardawa]

Since your out of pocket your deductible is $3000 and your opp max is $10,000 then you'd need to incur $38,000 in medical expenses to max out. $3000 + (35000 x 20%) = $10,000.

Does your insurance plan have a cost estimator calculator on their website? My company does. You select the procedure and the provider and you get an estimate.

Hope that helps with your planing.

While this may give you ballpark, don't count on it to be exact. A doctor may practice with more than one group and work through the hospital at other times. This means s/he will be associated with many different contracts with the insurance company. The insurance company has no way of knowing which taxid the provider will bill under and the reimbursement may be vastly different between contracts. So, the cost estimator is often very inaccurate.

 

[cdrn1]

I only mention it because you ask about saving money and a lot of women don't know the incentive behind VBAC.

Curious about this statement...what incentive? DD tried for VBAC twice (unsuccessfully) but $$ had nothing to do with it. Incentive on whose part? She just wanted to have a baby the good old-fashioned way. One of her doctors (and hospital) wouldn't allow it (small rural hospital) and so she chose to deliver at a larger hospital an hour away. C-sec anyway both times, unfortunately.

 

[Disneylush]

I also highly suggest you get an itemized bill after your hospital stay and go over it with a fine tooth comb! I had a charge of $50.00 for washcloth use.... that I didn't pay.

 

[Tink-aholic]

Curious about this statement...what incentive? DD tried for VBAC twice (unsuccessfully) but $$ had nothing to do with it. Incentive on whose part? She just wanted to have a baby the good old-fashioned way. One of her doctors (and hospital) wouldn't allow it (small rural hospital) and so she chose to deliver at a larger hospital an hour away. C-sec anyway both times, unfortunately.

I was referring to the financial incentive that the insurance offers for a successful one. Most pay far more for VBAC than a traditional CSection, and my previous post outlined why.

I'm sorry that your daughter was not able to have a VBAC -- not everyone is eligible. It all depends on previous scarring, healing, and how thorough the records were from the previous surgery. I hope that the children and mom are all happy and healthy!

 

[ajh88]

Sorry to hear about these issues - I understand it can definitely be frustrating!

Others have given a lot of good advice about your hospital costs. Just wanted to throw out a couple of things about Rx's:

1. Just because it's filled, doesn't mean you have to buy it. Tell them to keep it or that you want your script back. Yikes - $138 for a decongestant - have no idea what that could be but it seems way overpriced (I can't think of one that is that expensive).

2. They do have to run the script on your insurance to give you a price (for the person who walked away then came back a few minutes later - that was probably enough time for them to get it billed to your insurance) - but you can call your insurance company to inquire about the price.

3. Finally, if you know your co-pay for Rx is 50%, you can always call around or just ask the pharmacy their cash price and take half of it - that would be your worst case scenario on cost.

Good luck to you as you try to get this worked out and for a healthy baby too!

 

[NYEmomma]

I don't have any good advice to give you, but just wanted to say that I feel your pain! We have different insurance for this pregnancy than we did for my last pregnancy and I'm having such a hard time getting my head wrapped around what I need to pay, what I'm going to be billed in the future & why.

Thankfully or unfortunately (lol) DH had an emergency appendectomy a few weeks ago which took a major chunk out of our max OOP for the year so I'm not worried so much about possible hospital bills for my delivery (I'm looking at somewhat high odds of a c-section and NICU time for the babies).

But seriously, when EVERY bill you get from the hospital just says, "forwarded amount" with some random dollar amount that they expect you to pay, it's REALLY difficult to make heads or tails of what you're being charged & why. I shouldn't have to call every time I get a bill to ask what it's for. At least give me SOME idea.

 

[auralia]

I can tell you 5 years ago in ga my insurance paid 33000 for my csection and another 7000 for the 7 days dd was in the hospital. And I have tricare and their pay outs I am told are lowball for the industry. It was an emergency csection because she was breech and 4 weeks early.

 

[cvjw]

I can't help you with the C Section question, but I can tell you what works for us with prescription costs - Call your insurance company and tell them the name of the drug prescribed, and they can tell you the cost you will pay. I had to do this with my son's acne meds - the doctor kept prescribing meds that cost over $100 each, which insurance didn't cover. I kept at it until I found meds that were covered under our plan, and had the DR prescribe him those. The insurance company can be a great help to you, so that you don't have surprises when you pick up meds from the pharmacy. And yes, you can leave a filled prescription with the pharmacy - I had to leave a few acne meds when I discovered the price of them - I started calling the insurance company after that.

 

[barbarabini]

1. The scrip was for ZDEX. I have no idea why it is so expensive and it is in such a tiny little bottle.
2. I don't think I could find a doctor in northern NJ willing to do a VBAC on a female attorney ...with an attorney husband. ....no, all kidding aside, I would have love to try it, but none of the OB's i knew around here would attempt it - and now having my 4th c-section, there isnt a doctor around who would even broach the subject.
3. I found the estimator and I am looking into it. I also scheduled a meeting with the cashier/ins office at the hosp after my preadmission testing, so maybe they can give me a clue at least a day before.
4. I will get an itemized bill from the hospital and I think that was a good suggestion.
5. I contacted the hosp and found there is a discount 5% is I pay the bill in its entirety in 30 days...soo, maybe that will at least save a little.

I am really hoping to get out of there for $6000 rather than 10,000. The extra 4000 will mean an Oct trip Its all about the disney...

 

[MomiTo2SwtGuys]

I know where you are coming from with insurance issues. We are 4000. out of pocket and then 20% up to 6000. 6000. is our max out of pocket and I am almost there now for 2012. We are expecting #3 and between sick kids, husband with cervical spine issues and my pregnancy ( also seeing a perinatologist) it has racked up very fast.

It is so frustrating to not have a good policy. We have a good insurance company (Cigna). Dh's employer doesn't want to shell out for a decent policy though. We have the best one that they offer through where he is working. I guess I should be thankful that we have insurance at all though, right? :

Good luck. I don't like to be out of the loop with charges either.