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No wonder medical cost or so high...
Posted on 11/20/14 at 7:44 am
Posted on 11/20/14 at 7:44 am
My employer provided medical insurance requires no premium payment on my part for years. Beginning last year, in order to continue to be premium free, I and wife have to do a yearly preventative care visit. Here is the twist. These preventative care visits, including the required blood test are free. This year my doctor, at the world renowned Cleveland Clinic system, wants to do a follow up blood test. I ask if this follow up test would be coded as preventative care, so I wouldn't be charged. The answer was "no, you will be billed, this is a follow up diagnostic test". Fair enough. I ask " what are you going to charge me for this visit, lab work and consultation?" I need this info so I can reach out to my insurance company to determine how much they are going to cover so I know what my out of pocket cost will be. Their reply " you will have to contact insurance company to find out how much we will charge you." Genius. How much money does it cost for all the administrative "you bill me this, I'll discount that, we'll send multiple eob's and this is not a bill invoice from doctor and on and on.
On a related note, I try to keep up with the eob's and all the crap listed above and keep the doctors paid timely, but one bill from an allergy test for my son slipped thru my fingers. Lawyers office/collection firm, contracted by doctor, calls and informs me of this past due bill and ask if I can pay now. I ask if this has been reported to credit agency and rep says no and will not be unless it is unpaid in another 60 days. And then the reps says, "pay it now and I can take 20% off." Gladly. What a great business model.
I guess all I have do now is not pay the bill, what for collection to call, take the 20% discount and be on my way.
On a related note, I try to keep up with the eob's and all the crap listed above and keep the doctors paid timely, but one bill from an allergy test for my son slipped thru my fingers. Lawyers office/collection firm, contracted by doctor, calls and informs me of this past due bill and ask if I can pay now. I ask if this has been reported to credit agency and rep says no and will not be unless it is unpaid in another 60 days. And then the reps says, "pay it now and I can take 20% off." Gladly. What a great business model.
I guess all I have do now is not pay the bill, what for collection to call, take the 20% discount and be on my way.
7
Posted on 11/20/14 at 8:26 am to cuyahoga tiger
It is the only service or product I know of where you do not know the actual cost until after the service is performed. It is a total cluster.
With that said, because of that model, payment appears as optional/negotiable to some people. You can literally haggle on medical bills because payment rates are low.
Prime example of where centralization would create a huge benefit to the system, albeit at some security concern of wherever the information is being centrally located.
With that said, because of that model, payment appears as optional/negotiable to some people. You can literally haggle on medical bills because payment rates are low.
Prime example of where centralization would create a huge benefit to the system, albeit at some security concern of wherever the information is being centrally located.
Posted on 11/20/14 at 8:36 am to lynxcat
quote:
It is the only service or product I know of where you do not know the actual cost until after the service is performed. It is a total cluster.
It's also the only model I can think of that their prices are fully set by the government.
Posted on 11/20/14 at 8:36 am to lynxcat
The gig is this...
Doctors bill way too high. Insurance pay a lesser negotiated amount. The docotra then claim the extra unpaid amount as losses which are tax benefits.
Doctors bill way too high. Insurance pay a lesser negotiated amount. The docotra then claim the extra unpaid amount as losses which are tax benefits.
Posted on 11/20/14 at 8:43 am to GeeOH
quote:Only if he first declares the gross amount of his billing as sales revenue.
The docotra then claim the extra unpaid amount as losses
It's a zero net sum tax effect.
Posted on 11/20/14 at 8:43 am to cuyahoga tiger
You are in the minority for even looking at your EOB statements. Most people don't even care what they are charged because "someone else" takes care of it.
Lack of a direct transaction between provider and consumer and lack of transparency on quality of care and pricing got us into this mess.
Lack of a direct transaction between provider and consumer and lack of transparency on quality of care and pricing got us into this mess.
Posted on 11/20/14 at 9:02 am to LSURussian
quote:
Only if he first declares the gross amount of his billing as sales revenue.
It's a zero net sum tax effect.
Bot really, because many timea thwy get paid the higher amount. Which they wouldn't have got if not for overbilling
Posted on 11/20/14 at 9:08 am to cuyahoga tiger
I remember a few years back when my wife's employer switched everyone to an HDHP. The talking point they said over and over was a variation of "When all you pay is a small co-pay, you don't know what the actual cost is, so you have no incentive to control costs. When you know what the actual cost is, and are responsible for it or a portion of it, you are more likely to take actions to control costs".
The issue is, as you saw, that's not how healthcare works. With the exception of some basic tests and shots, it's very hard to get an actual cost of something ahead of time. Because the "rack rate" listed by the doctor is so much bullshite. In reality, medicare decides what they will pay, the insurance companies use the medicare amounts to negotiate with the doctors as to what they will pay, and that's what they pay.
I mean, imagine if when you got in an accident, you went to get your car fixed, and you asked them for an estimate, and they told you, well, the price you are charged depends on what auto insurance company you have, or, if you are a cash payer. It's insane.
The issue is, as you saw, that's not how healthcare works. With the exception of some basic tests and shots, it's very hard to get an actual cost of something ahead of time. Because the "rack rate" listed by the doctor is so much bullshite. In reality, medicare decides what they will pay, the insurance companies use the medicare amounts to negotiate with the doctors as to what they will pay, and that's what they pay.
I mean, imagine if when you got in an accident, you went to get your car fixed, and you asked them for an estimate, and they told you, well, the price you are charged depends on what auto insurance company you have, or, if you are a cash payer. It's insane.
Posted on 11/20/14 at 12:40 pm to cuyahoga tiger
quote:
This year my doctor, at the world renowned Cleveland Clinic system, wants to do a follow up blood test.
Problem is you shouldn't be asking questions about the cost, but questions as to why a follow up is needed. People don't ask enough questions around this kind of thing and unnecessary costs to your insurance company are what drives up the cost.
This post was edited on 11/20/14 at 12:42 pm
Posted on 11/20/14 at 12:50 pm to GeeOH
quote:
The docotra then claim the extra unpaid amount as losses which are tax benefits.
no... just no
Posted on 11/20/14 at 1:12 pm to cuyahoga tiger
When my wife had her gallbladder out a year ago, the "cost" was over $45,000. Insurance "discounted" $24K, paid $17K and left us with the other $4k. Then I'm sure I could have saved 20% by writing a check for it, but we just rolled it in with other medical bills and keep paying $100/month, interest free for forever.
It's absolutely ridiculous to be able to charge a price, then have someone else say- "That's too much, you can only charge half that- or we can just send our customer base somewhere else"
It's absolutely ridiculous to be able to charge a price, then have someone else say- "That's too much, you can only charge half that- or we can just send our customer base somewhere else"
Posted on 11/20/14 at 3:17 pm to swanny297
quote:
Problem is you shouldn't be asking questions about the cost, but questions as to why a follow up is needed. People don't ask enough questions around this kind of thing and unnecessary costs to your insurance company are what drives up the cost.
Funny you mentioned that. The past two years this preventative visit was performed by Internal Medicine MD...this year by a certified nurse practitioner CNP. I am sure this is the providers way of lessening their cost for this ACA mandated free preventative care visit. Anyway, I ask the CNP why the follow up and she says an enzyme level was high. Should have been less than 50 and it was 61. I go home and do some research and discover that the statin drug I am on to keep cholesterol in good shape side effects are may cause increased levels of this particular enzyme. I again, follow up, and ask about the statins effect and to inquire what the enzyme level was in the past as a baseline reference.
She admitted the enzyme was at the same level for the past two years "but she wanted to err on the side of caution" and that the statins could be the cause. I should have declined the test, but did it to keep the wifey from worrying.Discussed with the head MD my concerns with the CPN's decisions and while he would not say so his demeanor was "wait till I get a hold of that dumb bitch."
Posted on 11/20/14 at 3:33 pm to LSUFanHouston
Yup, I had a HDHP which my employer has now gotten rid of.
Broke my finger playing flag football reliving the glory days.
No you cannot find out the price in advance, I tried
Not like it "matters," the bill was going to be over the $3,000 deductible any ways after surgery, so I was going to be out the same amount regardless at that point.
Who really probably got screwed was the insurance company (and its customers). Over $20,000 for 1 hour surgery and to go under. I mentioned that once on this site and some guy supposedly familiar with the industry mentioned it was definitely high, but what is anybody going to do about it?
Broke my finger playing flag football reliving the glory days.
No you cannot find out the price in advance, I tried
Not like it "matters," the bill was going to be over the $3,000 deductible any ways after surgery, so I was going to be out the same amount regardless at that point.
Who really probably got screwed was the insurance company (and its customers). Over $20,000 for 1 hour surgery and to go under. I mentioned that once on this site and some guy supposedly familiar with the industry mentioned it was definitely high, but what is anybody going to do about it?
This post was edited on 11/20/14 at 3:34 pm
Posted on 11/21/14 at 8:31 am to cuyahoga tiger
I had a situation similar to that one as well. At my last physical, my blood sugar level was 101 (1 point above normal). I understand that I have Diabetes in my family history, but I looked at my blood sugar levels from my previous visit, and they were in the normal range (93). They asked for a followup, but I just never made the appointment. I'm due for another checkup soon, so I'll definitely pay attention to it, but I'm not making a followup for 1 point above normal.
Posted on 11/21/14 at 9:47 am to LSUFanHouston
quote:
Because the "rack rate" listed by the doctor is so much bullshite.
I think people view doctors fees as bullshite because normally they only see them in their office during business hours.
I can't tell you how many doctors have treated my son at 3am, at 7am after pulling 48 hours shifts, on holidays, including Thanksgiving and Christmas.
I understand their fee structure and appreciate the hell out of it.
Posted on 11/21/14 at 10:49 am to lynxcat
quote:
It is the only service or product I know of where you do not know the actual cost until after the service is performed. It is a total cluster.
With that said, because of that model, payment appears as optional/negotiable to some people. You can literally haggle on medical bills because payment rates are low.
Prime example of where centralization would create a huge benefit to the system, albeit at some security concern of wherever the information is being centrally located.
I live outside the US currently and here in the caribbean it is a cash up front policy. The doctor's office has sheet with the cost of the treatment or will tell you up front so you can pay. Then I have to file with the insurance company to get reimbursed which can take up tp 30 days but I have an "emergency" credit card for major medical expenses.
Posted on 11/21/14 at 11:52 am to LSUGUMBO
quote:
It's absolutely ridiculous to be able to charge a price, then have someone else say- "That's too much, you can only charge half that- or we can just send our customer base somewhere else"
This isn't really how it works. When physicians sign on with an insurance company, that company provides them with their reimbursement rates for office visits, procedures, tests, etc. Physicians are not allowed to charge people different amounts because of insurance differences, so they have to set one fee schedule. In order to not leave any money on the table, physicians set their fees at a much higher rate than insurance companies will reimburse, sometimes up to 75%-100% more, so that their fee will be higher than any insurance company's reimbursement. For instance, if I charge $50 for an office visit, one insurance company might allow $40 while another allows $60 for the same visit. If I submit $50 to company B, then I'm leaving $10 on the table. So, in order to avoid leaving money on the table with any insurance company, my fee schedule will probably list that office visit at $100 knowing that I won't collect 50% of that.
For cash paying patients, significant discounts are factored in to offset these "inflated" fee schedules.
Posted on 11/21/14 at 1:11 pm to cuyahoga tiger
quote:
No wonder medical cost or so high..
and the world thinks us Car Dealers are bad...
Posted on 11/21/14 at 1:15 pm to Meauxjeaux
quote:
I think people view doctors fees as bullshite because normally they only see them in their office during business hours. I can't tell you how many doctors have treated my son at 3am, at 7am after pulling 48 hours shifts, on holidays, including Thanksgiving and Christmas. I understand their fee structure and appreciate the hell out of it.
Understand I'm not questioning the amounts they charge, I am saying their pricing model is bullshite.
If they feel $100 per office visit is an acceptable amount to charge. Then charge it. Charge it to me, charge it to you, and charge it to the guy down the street.
What I don't get is they have a "charge" of $100, but because of my insurance, they only get $60, and because of your insurance, they only get $64, and because of the guy down the street's insurance, they only get $46, and the guy a block over doesn't have insurnace, so they send him a bill for $100 and leave it to him to call and negotiate it down (which if you ask, they always will).
Just charge us all $75 instead and let us decide how we want to pay it.
Posted on 11/21/14 at 1:30 pm to LSUFanHouston
It's not really the doctors decision. All the insurance companies decide what they are going to pay. They decide the different amounts for the same charge. If one insurance pays $100 and the rest pay $70, he would be stupid to only bill $70 and leave the rest on the table for the one that pays $100.
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