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| Raised Hands Surround Us Three Nails To Protect Us  |
I understand Doctors do wonderful things and deserve to be paid accordingly but man alive sometimes these numbers are astounding. Wife had a telehealth assessment visit for our son’s cognitive hearing test for an out of state hospital because no one here can make the official diagnosis needed for the folks here to treat the boy. Yes, I understand we’re talking about a specialty here. So we got sent about a 10 page questionnaire about medical history, past visits with other doctors that led us here blah, blah, blah. So my wife spends maybe 45 minutes on the phone with the doctor just reading the questionnaire answers in preparation for the upcoming in person testing. That’s it that is all. The actual cognitive hearing test was held a couple weeks later at the hospital. So we get the $175 bill for our portion of the the visit AFTER insurance has already paid out $1,404!!! Anyone want to start taking guesses what the actual day of testing is going to cost us???? I’ll update you when that bill arrives. ———————————————— The world's not perfect, but it's not that bad. If we got each other, and that's all we have. I will be your brother, and I'll hold your hand. You should know I'll be there for you! | ||
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| Little ray of sunshine  |
Doctors make my rates look cheap. I wonder how much you would have been billed had you not had an insurer that negotiated that $1600 rate - $3200 or even more wouldn't surprise me. And you couldn't have got them to tell you that number in advance. They won't give you the price up front. Now, you could have probably bargained that down a lot, but they would have started that high or higher. Another interesting question is what is the Medicare and Medicaid rate? This is one of the real problems with health care. There are many prices. And you can't find the price out in advance. How can the market work in those circumstances? It cannot. The fact that the end user does not pay the bills is the root of this. Insurers pay. The government pays. Only rarely does the actual consumer pay. How can supply and demand work when the payors are not the buyers? The market is totally out of whack. The fish is mute, expressionless. The fish doesn't think because the fish knows everything. | |||
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| Member |
^^^^^^^^^^^^^^ These rates are set by the Government, and are a fraction of what private insurance will pay. Collection involves a complex process with pitfalls. Most independent physicians do not deal with Medicaid and try not to deal with Medicare. It is a matter of economics. | |||
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| Member |
^^^^^^^^^^^^^^^ A doctor's office is not a used car lot. Most physicians would be showing you the door. IDK maybe Houston is different. | |||
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My dog crosses the line |
Not the same thing but I had spinal fusion a year ago. The insurance company pre approved the hospitals estimate of 987,000.00. 9 months later the final statement arrived. The insurance company paid 170,000, file closed. It’s all a game. | |||
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His Royal Hiney |
Take a look at your EOB again. The insurance company did not pay your doctor $1,404. There are four dollar amounts in the Explanation of Benefits. 1) The health provider's invoice amount. In your case, this is the "$1,404" + your coinsurance of $175 so the total amount is $1579. This amount is a work of fiction. No one in the industry is obligated to pay this. 2) Your coinsurance that you're responsible for which is the $175. 3) Inside $1,404 are two amounts. There's the "adjustment" amount and then there's the amount that the insurance plan actually paid. Before, the EOBs were transparent in showing the adjustment amount and the actual amount that the insurance company paid. Nowadays, they've moved to combining the two. They do this to hide the fact that the amount invoiced isn't actually real for those in the industry. The actual amount the insurance paid plus your coinsurance is the actual cost of the service. The adjustment amount isn't paid by anyone. The only ones who are obligated for the full amount are those outside of the industry as in those who don't have insurance. ETA: Jeff Yarchin's story above illustrates what I am explaining. "It did not really matter what we expected from life, but rather what life expected from us. We needed to stop asking about the meaning of life, and instead to think of ourselves as those who were being questioned by life – daily and hourly. Our answer must consist not in talk and meditation, but in right action and in right conduct. Life ultimately means taking the responsibility to find the right answer to its problems and to fulfill the tasks which it constantly sets for each individual." Viktor Frankl, Man's Search for Meaning, 1946. | |||
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| Raised Hands Surround Us Three Nails To Protect Us |
I am very clear on reading EOBs the $1,404 is the adjusted payment the insurance actually paid. The billed was something like 1,875. ———————————————— The world's not perfect, but it's not that bad. If we got each other, and that's all we have. I will be your brother, and I'll hold your hand. You should know I'll be there for you! | |||
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Prepared for the Worst, Providing the Best |
Be happy you aren't on a high-deductible plan. I used to have a good PPO plan where we had nice things like $20 family doc/$40 specialist co-pays. Then the un-affordable care act came along and screwed that all up. I now have a $3000 deductible/$6000 max out of pocket plan, $12000 family. Last year I went to urgent care with some chest pain, and they sent me to the ER (thankfully I didn't comply with their demand that I take an ambulance, because that would have cost even more). I was there for four hours, they did some tests, and then ended up telling me it was either a pulled muscle or pinched nerve and sent me home with a scrip for muscle relaxers and ibuprofen. Then I got the bill. $12,000 after the adjustment. Of which I was out of pocket for $5600 and change. No games...I had to pay them $5600. For a couple of hours in a bed, two blood draws, a CT scan, and a few pills. Next time I'm gonna just risk death...it'll be cheaper. | |||
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| Member |
^^^^^^^^^^^^^ You just subsized the care of patients without insurance. Biden wants more of this. BTW the cath lab is more expensive. | |||
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Invest Early, Invest Often |
But I thought everyone HAD to have medical insurance now ??  | |||
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| Dances With Tornados |
No, the requirement that people had to have health insurance or pay a financial penalty has been done away with. . | |||
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Member |
I was admitted to the ER 2 years ago with intense chest pain and pressure like an elephant was standing on my chest. Immediately I was admitted into the cath lab and had a stent put in and cleaned a valve that was blocked. I stayed a few days at Jackson and I was thinking that the bill was going to be quite a bit. I have a Medicare Advantage Plan and the only charge's I've paid to date was $145 for the trip to Jackson South from Miami-Dade Paramedics. I was always waiting for the proverbial foot to drop with more bills but that was it. It's been 2 yrs now. Since this COVID started last year I've had a couple of telehealth calls with my PCP. My co-pay was $45. Regards, Will G. | |||
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I Deal In Lead |
I won't go into the details, but the Reader's Digest version is that I offered a code fix to Homeland Security for free. But no, they had to have a meeting each month for a year, two of which I had to teleconference in for...for free. So when they asked me to spend 30 minutes in a video conference with one of their guys on the East Coast just to hold his hand and make him feel secure I charged them $2,000.00 So I guess I was worth more than the Doctor for that one. | |||
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| Member |
Blame the insurance company. In order to be paid $170,000, your hospital had to bill them $987,000. | |||
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Striker in waiting |
That's not the insurance company's fault. This all started (quite intentionally) with LBJ and his damned great society. CMS is almost solely responsible for regulating medical billing to the point where we are now. A hospital chargemaster is kind of like the sheet on the hotel room door that shows the rack rates. Nobody actually pays them, but what you did pay is somehow based on them. -Rob I predict that there will be many suggestions and statements about the law made here, and some of them will be spectacularly wrong. - jhe888 A=A | |||
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אַרְיֵה |
 הרחפת שלי מלאה בצלופחים | |||
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| SIGforum Official Eye Doc  |
Centers for Medicaid & Medicare Services An excellent illustration of government bloat and bureaucracy. | |||
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| Little ray of sunshine |
It also goes back to some WWII wage controls. There were some government mandates prohibiting pay raises. So big business decided to give pay raises by buying health insurance for some employees to avoid the wage controls. After that, employer-provided health insurance became more common, until we are where we are. Why does that matter? Because the consumer of health care is no longer paying the bill. So consumers consume more health care since they don't bear the cost of the additional health care that they buy. The demand-side pressure on price diminishes. Health care prices increase, and consumers of health care don't care so much since they are insured and premiums don't directly reflect the price of the health care they consume. So now the free market is broken, and . . . Then the government starts buying more and more health care which has the same problem plus inefficiencies. I've told this story before, but my dad found the bills from the doctor and the hospital and the doctor from when he was born in 1935. The doc billed $35 and the hospital billed $50. Whatever the cost of an uncomplicated birth now is FAR higher than that, adjusted for inflation. But my grandfather had to write those checks, not just submit a claim to Blue Cross. The fish is mute, expressionless. The fish doesn't think because the fish knows everything. | |||
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| Peace through superior firepower  |
What's "telehealing"? Do people just not see how ridiculous the world has become? Or, do they see it and just don't care to speak up? ALL doctor's visits should be IN PERSON AND IN PERSON ONLY. FFS! | |||
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| Striker in waiting |
I agree 95%. The one exception in my experience over the past year is psychological exams. I had a long conversation with my favorite defense psychiatrist who told me he didn't feel at all inhibited by videoconferencing. As he explained it, he could tell all sorts of crazy just by getting to observe people sitting in a more comfortable home environment vs. his office, not to mention the clues and such he could pick up on by getting to see what was in their background. With that explanation, I authorized those exams to be done by video. So there's that... -Rob I predict that there will be many suggestions and statements about the law made here, and some of them will be spectacularly wrong. - jhe888 A=A | |||
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