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re: How Do We Fix American Healthcare?
Posted on 8/18/19 at 2:04 pm to Diamondawg
Posted on 8/18/19 at 2:04 pm to Diamondawg
quote:
Your OOP is based on your policy, where you are with your deductible and maximum OOP. Easy enough to determine. Your OOP would have been the same whether your surgery cost $30K or $40k. Ask your insurance company if they knew to the penny what their hit was going to be.
That’s not exactly the case. You should know better. If the surgery is $30k billed charges and the insurance pays at 80% for the case rate (which wouldn’t be uncommon) and I’m responsible for a percentage of the remaining after my deductible is met, it’s a pretty significant difference.
It goes back the same point which you are studiously avoiding - hospitals don’t want us to know and to be able to shop by price.
Posted on 8/18/19 at 2:24 pm to the808bass
quote:If you have an insurance that pays 80% after your deductible and you have not reached your max OOP for the year, I call bullshite on the business office giving you an amount "to the penny" of what your OOP would be.
That’s not exactly the case. You should know better. If the surgery is $30k billed charges and the insurance pays at 80% for the case rate (which wouldn’t be uncommon) and I’m responsible for a percentage of the remaining after my deductible is met, it’s a pretty significant difference.
quote:Didn't avoid. Addressed it in my very first post in this thread. It's impossible to do and have it make any sense.
It goes back the same point which you are studiously avoiding - hospitals don’t want us to know and to be able to shop by price.
ETA - out of curiosity, I just pulled up the procedural pricing for the hospital that I had a procedure done. There were over 65,000 items listed in the chargemaster. Of course it was list pricing which is pretty useless unless you are self pay. I challenge anyone to go to any hospital's chargemaster and estimate the cost of your gall bladder removal. I'll wait.
This post was edited on 8/18/19 at 2:59 pm
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