Deductibles-vent

[puppylove64]

So the dr called Dh today and said he needs to pay $1300 before his appointment tomorrow for a MRI. Or he can pay half and set up a payment plan. How does the average person do this?! They gave him no warning until the day before! Wtf is insurance for. He is getting a MRI due to back pain and the dr suspects a squished disk. The thing that aggravates me is that dh will likely do nothing after the results anyway. So he will pay the money for nothing. He always does this. But if I say don’t go, “omg I’m in so much pain and you want me to just forget about it?!”

[Leeham Rimes]

The average family can’t afford it. Our deductible is $16,000. I hate American “healthcare”. It’s garbage. When I was a bankruptcy paralegal, the majority of the people we saw were in there due to medical bills, and Nearly all of them had insurance.

[sapphireblue]

Jun 26, 2019 18:38:07 GMT -5 Leeham Rimes said:

The average family can’t afford it. Our deductible is $16,000. I hate American “healthcare”. It’s garbage. When I was a bankruptcy paralegal, the majority of the people we saw were in there due to medical bills, and Nearly all of them had insurance.

This is so wrong. Our healthcare system is so fucked.

[whitemerlot]

It’s crazy. We spend thousands on medical care every year and are generally very healthy. We pay a decent amount for our insurance too.

[cherry1111]

Yep, I had a colonoscopy last week and had to pay the facility $1,000 that morning. I haven’t gotten a bill from the doctor yet.

[woodgnome]

Jun 26, 2019 20:47:13 GMT -5 cherry1111 said:

Yep, I had a colonoscopy last week and had to pay the facility $1,000 that morning. I haven’t gotten a bill from the doctor yet.

I thought colonoscopies were covered as part of preventative healthcare!

[killercupcake]

Jun 26, 2019 20:50:26 GMT -5 woodgnome said:

Jun 26, 2019 20:47:13 GMT -5 cherry1111 said:

Yep, I had a colonoscopy last week and had to pay the facility $1,000 that morning. I haven’t gotten a bill from the doctor yet.

I thought colonoscopies were covered as part of preventative healthcare!

Not before a certain age, I believe. My insurance is similarly priced.

[katespade]

Jun 26, 2019 20:50:26 GMT -5 woodgnome said:

Jun 26, 2019 20:47:13 GMT -5 cherry1111 said:

Yep, I had a colonoscopy last week and had to pay the facility $1,000 that morning. I haven’t gotten a bill from the doctor yet.

I thought colonoscopies were covered as part of preventative healthcare!

Only if they’re done as a preventative procedure. If a doctor orders one because they’re trying to diagnose health issues, it becomes a diagnostic procedure. Also, most insurance companies have age and frequency restrictions for when they’re considered preventative.

It’s dumb.

[readyin07]

Jun 26, 2019 21:06:58 GMT -5 killercupcake said:

Jun 26, 2019 20:50:26 GMT -5 woodgnome said:

I thought colonoscopies were covered as part of preventative healthcare!

Not before a certain age, I believe. My insurance is similarly priced.

Yep. Our insurance allows them as routine preventative care after 50. My H has a history of hemorrhoids and they wanted him to have one a few years ago. NOPE! Can't pay out $1k right now thanks.

[readyin07]

It's insane. My son broke his arm last year. $200 right off the bat at the Urgent Care. $150 office visit the next day at the Ortho. Surgery scheduled for 2 days later. Call the day before that we owe $2,000, we must pay half to schedule with the rest due at the surgi center. It's...a lot.

[fumbalina]

The costs are out of control in all aspects. I take maintenance medicine for my thyroid condition and honestly I do not file with my insurance because I pay less and have fewer restrictions by using a pharmacy discount card. Thyroid pills are pretty cheap, but it should not cost more to use your insurance. Also, I have had a lot of experiences where something was pre-approved and then after it was done was no longer approved. This requires a lot of appealing and getting it straightened out, and these usually are at stressful times so I suspect most people do not have enough energy to argue with them.

[FishChicks]

With three hospitalizations for me and preemie twins, we hit our out of pocket max of $10,800 in February. That's on over 900k billed and over 525k paid by insurance. I am so grateful we can afford it, but I know many others can't. Neither the babies nor I would have survived without this care, so I don't want to complain, but this system doesn't seem sustainable.

[skidunks]

When I had to have my gallbladder removed it was over two calendar years (2017-2018) One year I had an ER visit and a colonoscopy/endoscopy. The next year I had a HIDA scan and the gallbladder removal. We will be done paying those bills this fall and we have insurance. It’s ridiculous.

[cherry1111]

Jun 26, 2019 21:10:32 GMT -5 katespade said:

Jun 26, 2019 20:50:26 GMT -5 woodgnome said:

I thought colonoscopies were covered as part of preventative healthcare!

Only if they’re done as a preventative procedure. If a doctor orders one because they’re trying to diagnose health issues, it becomes a diagnostic procedure. Also, most insurance companies have age and frequency restrictions for when they’re considered preventative.

It’s dumb.

This. I’m only 37. It would be covered if I was 50 AND not experiencing any symptoms.

[Deleted]

I hate that health insurance is so effed up in this country. We are fortunate that we have pretty decent coverage and only pay $65/week for a family of 6. And by decent coverage, I mean that we have no deductible and no co-insurance. Our co-pays however, suck ass. My daughter broke her arm a few months ago and between the urgent care and several visits to the orthopedic, we paid over $700 in copays. It's $40 just to go to the doctor when sick, and honestly, for my kids I'll pay it no matter what, but for myself? I seriously struggle with it and ask myself "how sick are you really?" With my gallbladder a few years ago I knew I was really sick because I willingly forked over the $500 ER co-pay. But even with illnesses and injuries, we generally pay less than $1,000 out of pocket in copays each calendar year. Which is still a lot, but could be worse.

Our insurance is through my husbands employer which is a small family owned business that prioritizes good insurance for their employees. I work for a huge multi-national insurance company and our insurance is junk. It would cost us twice as much for me to carry our benefits AND we would also have a deductible. It's just insane.

[shauni27]

Not only the deductible but the max OOP expenses. I hit my deductible having emergency surgery this spring, but then I still owe 3K to the hospital to reach my out of pocket max. Huh? I pay a good amount for my insurance each paycheck, now it is going to take me at least a year to pay this off, too. We simply do not have 3K lying around.

[msmerymac]

I reached my OOP max in February and I still have a bunch of OOP testing and crap that won't be covered by insurance coming up. We max out an HSA every year and that doesn't even cover the OOP max, so we're paying it off monthly.

[megstoo]

It sucks. It's even worse when you're going through IVF treatments and insurance covers jack shit. No meds, no treatment, nothing. Sadly I don't want to tell you how much we've spent on fertility treatments in less than 1 year.

We're penalized if we want to have a kid yet people who can't take care of the ones they have get knocked up and the government pays for them.

[puppylove64]

Jun 26, 2019 20:50:26 GMT -5 woodgnome said:

Jun 26, 2019 20:47:13 GMT -5 cherry1111 said:

Yep, I had a colonoscopy last week and had to pay the facility $1,000 that morning. I haven’t gotten a bill from the doctor yet.

I thought colonoscopies were covered as part of preventative healthcare!

Dh’s wasn’t because he wasn’t old enough. even though colon cancer is a leading cause of death for men his age

[Deleted]

Have you checked with your insurance company? I got an MRI recently. The hospital called and told me my estimated portion was like $900 and asked if I wanted to prepay. I said no because I know that my insurance only requires a $150 copay for outpatient radiology studies. Providers’ quotes prior to actual insurance processing of claims is not always accurate.

[mrssandro]

We set up payment plans. Always interest free. I have a SN kid and we have just adjusted to knowing that we have to meet the deductible every year.

[formerlyak]

Jun 27, 2019 9:31:23 GMT -5 @angryharpy said:

Have you checked with your insurance company? I got an MRI recently. The hospital called and told me my estimated portion was like $900 and asked if I wanted to prepay. I said no because I know that my insurance only requires a $150 copay for outpatient radiology studies. Providers’ quotes prior to actual insurance processing of claims is not always accurate.

This is a really good suggestion. So many times the biller that calls from the office or medical facility makes it sound like your only option is to pay. But, it sometimes isn't. When DS needed to be seen by an asthma specialist at the children's hospital, the bills we got were so screwy and we have really amazing insurance so our co-pay should have been $40. That's it. $40 for each visit because the doctor was a specialist and his office happened to be in the hospital so it was an office visit not a hospital visit. I would pay the $40 at the start of my appointment and then I'd get bills. I called the billing people and had to work through everything. They realized there were errors in the insurance credits and put a hold on my account so it didn't go to collections while the straightened it out. Someone missed the hold note and sent it to collections. I called and got it taken out of collections and had my insurance company call the biller to straighten everything out. The billing supervisor apologized and said she understood how confusing it all was because bills come from the hospital and the doctor and they use different billers so things get crossed and the insurance isn't always credited correctly. She also told me that so many people don't keep records like I do to straighten it all out, so I was "lucky". This is a hospital with a very high Hispanic patient base, many of whom do not speak English. How in the world would they even know to begin to advocate for themselves!?

The whole experience taught me that you always need to call and get all your options where paying for healthcare is concerned. 

[scout8]

I would like to join in the complaints. After my mammogram this year, the doctor and radiologist suggested I get an ABUS ultrasound because my breasts are dense and they will be able to see more this way. I still need to meet my deductible this year so I would like to know my cost before I make a decision about whether to have this done. No one can tell me my OOP cost! I can get the billed rate, but I can't seem to get anyone to tell me the contracted rate which is what I will actually be billed. It's nuts. Why can't I get this information?

Can you imagine if I tried to tell my clients that I can't give them my commission rate until after I sell their house. Oh, well, I'll let you know then. Or, if you go to put a new roof on your house and the roofer says, I'll let you know after it is installed. Nothing else works this way.

[rubytue]

I have a 30% copay on medications. Never been an issue until now, when 30% on $40,000 every 3 weeks! Thanks goodness for OOP max. The pharm company had a copay assistance plan, which I don’t qualify for. But why not just reduce the price of the meds to something reasonable?! I’m lucky in this just replaces our summer vacation. But I can’t imagine if we didn’t have good jobs.

[starburst604]

I’d suggest calling your insurance company to ask who their preferred radiology center is. It’s crazy but the cost for an MRI can vary wildly depending on how they are contracted with insurance companies. Around here generally it’s less expensive to have one done at a dedicated MRI center vs at a hospital. The doctor’s office cannot dictate where you have this done, as long as you are able to bring them a disc of the images if they want to view them (usually they will want to). When it’s non-urgent it’s worth it to shop around.

[isabel]

Jun 27, 2019 10:31:59 GMT -5 scout8 said:

Can you imagine if I tried to tell my clients that I can't give them my commission rate until after I sell their house. Oh, well, I'll let you know then. Or, if you go to put a new roof on your house and the roofer says, I'll let you know after it is installed. Nothing else works this way.

It’s insane. I really don’t understand how medical care and insurance in this country continues to function this way.

[sent]

Jun 27, 2019 10:52:52 GMT -5 isabel said:

Jun 27, 2019 10:31:59 GMT -5 scout8 said:

Can you imagine if I tried to tell my clients that I can't give them my commission rate until after I sell their house. Oh, well, I'll let you know then. Or, if you go to put a new roof on your house and the roofer says, I'll let you know after it is installed. Nothing else works this way.

It’s insane. I really don’t understand how medical care and insurance in this country continues to function this way.

It's the insurance company's advantage to keep you in the dark. Fewer claims paid, more $$$$$$$$$ for them. 

I do all the insurance stuff in my dental practice. Granted dental is not as complex as medical but it is by no means simple. I'm the doctor and I own the practice but after my disability, I settled on focusing mainly on the insurance. It is maddeningly confusing. You really need a sharp person to understand and maneuver through their shenanigans. For example, it should be really simple to look up what is covered, what's not covered, age limits, etc. in this day and age of the internet. But the insurance company websites are sparse and you are often forced to call them to get this info. Then they don't volunteer a single iota of relevant information to you unless you know to ask the right question.

Easy example I get all the time - new adult patient thinks they have an orthodontic benefit. We log in with their insurance info and see "$2000 Orthodontic" and the patient is ready to do a happy dance but we say "wait" because nowhere will you find the age limit until you call. When you call, then they will tell you the age limit is 19 so the adult patient actually has "$0 Orthodontic." How simple would it be to just put that upfront? 

[isabel]

Jun 27, 2019 12:22:31 GMT -5 sent said:

Jun 27, 2019 10:52:52 GMT -5 isabel said:

It’s insane. I really don’t understand how medical care and insurance in this country continues to function this way.

It's the insurance company's advantage to keep you in the dark. Fewer claims paid, more $$$$$$$$$ for them. 

I do all the insurance stuff in my dental practice. Granted dental is not as complex as medical but it is by no meals simple. I'm the doctor and I own the practice but after my disability, I settled on focusing mainly on the insurance. It is maddeningly confusing. You really need a sharp person to understand and maneuver through their shenanigans. For example, it should be really simple to look up what is covered, what's not covered, age limits, etc. in this day and age of the internet. But the insurance company websites are sparse and you are often forced to call them to get this info. Then they don't volunteer a single iota of relevant information to you unless you know to ask the right question.

Easy example I get all the time - new adult patient thinks they have an orthodontic benefit. We log in with their insurance info and see "$2000 Orthodontic" and the patient is ready to do a happy dance but we say "wait" because nowhere will you find the age limit until you call. When you call, then they will tell you the age limit is 19 so the adult patient actually has "$0 Orthodontic." How simple would it be to just put that upfront? 

Really simple. It would also probably decrease a significant number of the claims they can reject because a lot of people don’t realize they need to be that detailed. It’s really shady.

[BicycleBride]

Jun 27, 2019 12:22:31 GMT -5 sent said:

Jun 27, 2019 10:52:52 GMT -5 isabel said:

It’s insane. I really don’t understand how medical care and insurance in this country continues to function this way.

It's the insurance company's advantage to keep you in the dark. Fewer claims paid, more $$$$$$$$$ for them. 

I do all the insurance stuff in my dental practice. Granted dental is not as complex as medical but it is by no meals simple. I'm the doctor and I own the practice but after my disability, I settled on focusing mainly on the insurance. It is maddeningly confusing. You really need a sharp person to understand and maneuver through their shenanigans. For example, it should be really simple to look up what is covered, what's not covered, age limits, etc. in this day and age of the internet. But the insurance company websites are sparse and you are often forced to call them to get this info. Then they don't volunteer a single iota of relevant information to you unless you know to ask the right question.

Easy example I get all the time - new adult patient thinks they have an orthodontic benefit. We log in with their insurance info and see "$2000 Orthodontic" and the patient is ready to do a happy dance but we say "wait" because nowhere will you find the age limit until you call. When you call, then they will tell you the age limit is 19 so the adult patient actually has "$0 Orthodontic." How simple would it be to just put that upfront? 

I’m sure it looks that way from a doctor’s point of view but there are very good reasons why some of this is the way it is. You should only ever pay a bill based on the insurance EOB you receive. If your doctor is demanding more money then you call up your insurance and they have a whole department to handle it for you.
One big reason why you can’t go online and see what the cost would be for anything is because contracting is a major part of insurance and a big part of the benefit of having insurance because the insurance company negotiated on behalf of their subscribers with each hospital/doctor/group etc for the contracted rate. Contracted rates are proprietary information and it’s in the best interest of the provider not to let their contracts be public knowledge because if they make a deal with Company A that a service will be $100 then every other insurance company will want that rate and they can make more money by telling Company B who maybe has fewer subscribers and therefore less bargaining power than the lowest they can go is $500.
But that’s part of what makes the whole system terrible and why we need to start talking about healthcare from scratch instead of just “improving” on the current system.

[sent]

Jun 27, 2019 13:10:36 GMT -5 BicycleBride said:

Jun 27, 2019 12:22:31 GMT -5 sent said:

It's the insurance company's advantage to keep you in the dark. Fewer claims paid, more $$$$$$$$$ for them. 

I do all the insurance stuff in my dental practice. Granted dental is not as complex as medical but it is by no meals simple. I'm the doctor and I own the practice but after my disability, I settled on focusing mainly on the insurance. It is maddeningly confusing. You really need a sharp person to understand and maneuver through their shenanigans. For example, it should be really simple to look up what is covered, what's not covered, age limits, etc. in this day and age of the internet. But the insurance company websites are sparse and you are often forced to call them to get this info. Then they don't volunteer a single iota of relevant information to you unless you know to ask the right question.

Easy example I get all the time - new adult patient thinks they have an orthodontic benefit. We log in with their insurance info and see "$2000 Orthodontic" and the patient is ready to do a happy dance but we say "wait" because nowhere will you find the age limit until you call. When you call, then they will tell you the age limit is 19 so the adult patient actually has "$0 Orthodontic." How simple would it be to just put that upfront? 

I’m sure it looks that way from a doctor’s point of view but there are very good reasons why some of this is the way it is. You should only ever pay a bill based on the insurance EOB you receive. If your doctor is demanding more money then you call up your insurance and they have a whole department to handle it for you.
One big reason why you can’t go online and see what the cost would be for anything is because contracting is a major part of insurance and a big part of the benefit of having insurance because the insurance company negotiated on behalf of their subscribers with each hospital/doctor/group etc for the contracted rate. Contracted rates are proprietary information and it’s in the best interest of the provider not to let their contracts be public knowledge because if they make a deal with Company A that a service will be $100 then every other insurance company will want that rate and they can make more money by telling Company B who maybe has fewer subscribers and therefore less bargaining power than the lowest they can go is $500.
But that’s part of what makes the whole system terrible and why we need to start talking about healthcare from scratch instead of just “improving” on the current system.

I understand your explanation of why patients can't know the fees online. But there shouldn't be a reason to hide the contracted rates from the doctor's office so the office can predict how much the office will be paid and how much the patient owes. I know as a doctor, I can not share with another office what my contracted rates are. Again, I'm dental, so many fewer codes than medical. Also in dental, costs are often known upfront because most companies do give me a fee schedule after negotiations and we are contracted and the paperwork is done. My example was for the other side when I'm checking patient benefits. Like I know the contracted fee for adult braces is $5000. What I don't know is if the "$2000 Orthodontic" that I see online for this adult has an age limit or not until I call. So I can't tell this adult if their treatment will cost $5000 or $3000 out of pocket until someone calls because the insurance company website is (intentionally?) not clear.

Private medical practices are disappearing in droves as doctors go work for the big giant hospital system or medical corporation in the area. The business of running a practice has become too complicated for a small office. Convoluted insurance policies and unpredictable reimbursements is probably one of the biggest reasons.