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Started By
Message
re: Even with good health insurance, a CT scan is costing me $2,000 out of pocket
Posted on 1/23/24 at 6:17 am to VolunGator
Posted on 1/23/24 at 6:17 am to VolunGator
quote:
You shouldn't be paying more than about $600 max regardless of with or w/o contrast.
You should if that's your benefit and you want to use your coverage because you expect to hit your OOP max for the year
0
Posted on 1/23/24 at 6:28 am to Finch
quote:
That’s actually more of an insurance problem than a problem with the medical industry.
I promise doctors would rather be able to treat patients how they feel is best to get the best outcomes. It’s the insurance companies who try to dictate care and only allow reimbursement for certain services not the outcomes.
This is categorically incorrect.
Shared risk contracts are growing year after year and every payor out there wants more systems and groups to accept more risk an they'll pay when they find someone willing to do so.
Lose money, pay some of it.
Make money and you get some of it.
The larger systems are starting to come around more to the idea (definitely not rural systems) but you aren't going to find many Ortho groups with their own imaging and PT segments who want one bulk payments for certain procedures. It's the way out and we'll get there one day but the system is too easy to milk right now.
quote:
How would you handle reimbursement for noncompliant patients?
Regional per member / per month agreements have been a thing for decades so the idea isn't new. You just won't find many groups interested.
But non-compliance is an issue that's carried by the payor and the Primary Care Physician, why shouldn't the specialists, systems, facilities and diagnostic centers carry some of the health burden as well? I'll tell you why....because sick and unhealthy people is how they make their money.
There's really only three people who benefit when a patient is healthy.
1- the primary care physician
2- the insurance company
3- the patients
Everyone else in the game profits when you're sick.
Imagine how much better the healthcare system would work if they just treated their body and healthcare like their car and auto repairs.
People would be willing to pay if things got better, as they should. Maybe they take care of the vehicle, maybe they don't BUT paying for service after service with no improved outcome is insanity.
This post was edited on 1/23/24 at 6:31 am
Posted on 1/23/24 at 6:35 am to glorymanutdtiger
quote:
I’m all up for centralized health care
No you aren’t.
Posted on 1/23/24 at 6:37 am to mmmmmbeeer
quote:
We're the only industrialized nation on Earth without government ran healthcare.
This is false and you even stated so
The government is the single largest healthcare provider.
Also need to remember how our government acted during covid. They aren’t doctors, just tell doctors what they can and can’t use to treat covid. And instead of not treating unhealthy obese people. They would deny you care over an mRNA experiment.
Please give us more if this.
This post was edited on 1/23/24 at 6:42 am
Posted on 1/23/24 at 6:59 am to Finch
quote:
That’s actually more of an insurance problem than a problem with the medical industry. I promise doctors would rather be able to treat patients how they feel is best to get the best outcomes. It’s the insurance companies who try to dictate care and only allow reimbursement for certain services not the outcomes. How would you handle reimbursement for noncompliant patients?
I think it is a combination of factors.
Hospitals have come to realize that in order for your insurance or government programs like Medicaid and Medicare to pay a certain amount they have to markup the procedure costs so much that when the contract rate for that carrier or program kicks in they reach the break even point. The hospitals then also collect a copay based on the markup amount which is their profit.
Then the insurance company shows you they paid a lower amount and their contract rate shows a big discount making you think you saved money by not having to pay full price.
The other wild card is that every hospital has different contracts and contract rates for each carrier and program to favor the hospital. The sad part is that most of these rates are confidential until you get billed or ask ahead of a procedure. Some will provide that data publicly, but that data is usually based on the most expensive price.
Then you have your annual donut hole where it resets Jan. 1, so your deductible resets which means you are stuck paying full costs until the deductible is met. Hospitals should be required if they don’t do this, but you should get the benefit of the contracted rate and discounts the insurance company gets to pay when they pay for your care.
So if a procedure billed at 5k, your insurance has a contract rate for that procedure for 900, you pay only the 900 since you have not met your deductible.
I guess 6 or 7-figure administrators will not pay themselves they need you to pay 5k.
Posted on 1/23/24 at 7:23 am to Tarps99
quote:
they reach the break even point.
Hospitals are doing much more than breaking even on Medicare and Medicaid patients. Even with the reduction in payment allowables those patients make up the bulk of hospital and system profits.
quote:
The hospitals then also collect a copay based on the markup amount which is their profit.
Copays are deducted from payments by a health carrier.
If the payable amount of something is $100 and carries a copay of $25, they get $25 from the patient and $75 from the health plan...not both.
quote:
Then you have your annual donut hole where it resets Jan. 1, so your deductible resets which means you are stuck paying full costs until the deductible is met. Hospitals should be required if they don’t do this, but you should get the benefit of the contracted rate and discounts the insurance company gets to pay when they pay for your care.
Every plan is different but you should still be getting your plans discount if you stay in network (on most plans) until your deductible is met. Here's an example of an EOB I had from an MRI a couple of weeks ago.
This post was edited on 1/23/24 at 7:28 am
Posted on 1/23/24 at 7:29 am to GetCocky11
I can get you the same ct self pay for around 400$… you’re just going to have to play hardball and say you are not paying that much.
Posted on 1/23/24 at 7:33 am to DaBeerz
quote:
I can get you the same ct self pay for around 400$… you’re just going to have to play hardball and say you are not paying that much.
Again...if you pay the cash price it will not apply to the yearly maximum out of pocket so the deductible will end up being paid one way or the other and then you're paying the deductible AND the cost of the imaging. If it's early in the year and surgery is a legit possibility it's good to pay the deductible and have it applied to the yearly out of pocket maximum.
If this was late in the year and the deductible had not been met or something that would more than likely not lead to any additional costs or procedures, sure....ask for a cash price and go outside of your existing coverage.
But, getting a lower cost on one procedure does not equal lower overall cost.
Posted on 1/23/24 at 7:49 am to LSUfan4444
quote:
Again...if you pay the cash price it will not apply to the yearly maximum out of pocket so the deductible will end up being paid one way or the other and then you're paying the deductible AND the cost of the imaging.
Da fuq? I paid cash for an MRI because it was cheaper and then submitted the claim to my insurance company. I had not met my deductible so they didn’t reimburse me but they did count it towards my deductible. I had to spend an hour dealing with the insurance company to get it added but it was added.
Posted on 1/23/24 at 9:06 am to dgnx6
I'm going to point out like I do in every thread that comes up about some sort of universal or single payer healthcare system that we ALREADY pay for the young and poor(Medicaid) that can't afford healthcare and the old(Medicare) in our current system. Both of which are pretty universally loved by their respective users. For those keeping score at home, that's 66 million people enrolled in Medicare and around 89 million people enrolled in Medicaid.
Now ask yourself who does NOT benefit from that system? You guessed it - the people actually footing the bill....you and me. No no, you and I get the "special" insurance that is tied to a job, has high premiums, copays, prior authorizations, co-insurance and deductibles. We also get the privilege of running all of those dollars through a massive for-profit 3rd party system that makes around $60-$70 billion per year in profit. All of this because people are scared of "socialism" and their third cousin once heard that someone had to wait 3 years to get a bone scan in Canada. So yeah, let's keep throwing money at the private for profit insurance companies that stand between us(the people paying for everything) and health care.
This is really a no brainer folks....it actually astounds me that no one on this message board can do simple math.
Now ask yourself who does NOT benefit from that system? You guessed it - the people actually footing the bill....you and me. No no, you and I get the "special" insurance that is tied to a job, has high premiums, copays, prior authorizations, co-insurance and deductibles. We also get the privilege of running all of those dollars through a massive for-profit 3rd party system that makes around $60-$70 billion per year in profit. All of this because people are scared of "socialism" and their third cousin once heard that someone had to wait 3 years to get a bone scan in Canada. So yeah, let's keep throwing money at the private for profit insurance companies that stand between us(the people paying for everything) and health care.
This is really a no brainer folks....it actually astounds me that no one on this message board can do simple math.
Posted on 1/23/24 at 9:18 am to GetCocky11
Mine was 6k without insurance a few years ago. The only time in my life I never had health insurance and my first ever trip to the er. You can’t make the shite up
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