Biggest Medical Rip Off?

[Dakota731]

I know people who don’t hesitate to pay $7000 for a Disney vacation or $35000 for a new car, but if they have to pay a few hundred for a co-pay think it’s the end of the world. We don’t think twice about a $200 a month cable bill or $150 a month for a cellphone bill, but if we have to pay that for prescriptions you would think it’s the end of the world.

 

[kymom99]

Please note that with some health insurance policies in some states, if the pharmacy knows that you could pay less if you pay cash? The pharmacy can't legally tell you that, plus if your insurance info is already in the system, they cannot charge you the non-insurance price.

In those situations, it's best to go to another pharmacy and say you don't have insurance at all.

That's not the case in Kentucky. I used a coupon for my son's acne cream. They just informed me it wouldn't go through insurance and therefore it wouldn't count towards my copay. With my migraine meds, they seriously cost $2 for a month supply. That's what I am charged. I don't have to ask.

 

[lanejudy]

if your insurance info is already in the system, they cannot charge you the non-insurance price.

Not true. They can re-run it, changing the insurance or removing it for a cash transaction. They just choose not to do so unless pushed. A member of my family has dual coverage with 2 different plans, and occasionally we have to ask them to re-run with the other insurance because it's lower. One time a prescription was lower-cost using some discount card, and they told my DH who signed up on the spot and they re-ran it that way.

When I had a flat copay, I would pay the lesser amount -- copay or cash. And it still showed towards my insurance OOP.

 

[Tiki_Sara]

I don't know how long it is since you left the UK, or what part of the UK you are from, but you sure as heck aren't getting a crown from an NHS dentist for $60 anymore - not in England anyway. My last NHS crown several years ago cost me almost £200 ($260). According the the NHS 'price list' - a crown is currently £256 ($330).

Granted - still a bargain compared with US prices.

I've been living in the States full-time since last year and until then had NHS dental treatment. I,ve never had a crown on the NHS but I believe there are three levels of treatment with fixed prices and thought a crown came under the middle band, which was 50-odd quid last year but obviously I was wrong and it's in the third band, which is currently 256 GBP, so I got that bit wrong. Apologies for misleading anyone here!

 

[fortwildernessishome]

Chemo!!! When I received chemotherapy 7 years ago it was a little over 35,000.00 per session!!!

 

[star72232]

Any health care in the US?

 

[lambdabeta]

I can guarantee you that human doctors have a better financial outlook than vets. Most vets are coming out of school with around 200k in student loan debt, and the median salary is only around 80k, and that is after practicing for years. Both are incredibly demanding fields, but people have very little understanding of why veterinary medicine costs as much as it does. When you go to your primary care doctor with an ear infection, you’re often out a co-pay and maybe a prescription because your insurance will pick up a large portion of the balance or at least have possibly negotiated rates for you to pay that are lower. You’re not often paying the billed cost entirely out of pocket outside of exceptional circumstances. If you take your dog to the vet for what the owner believes to be an ear infection, you’re paying everything at cost including the cost for the appointment, the ear cytology, any other diagnostics the doctor feels is appropriate, possibly an ear cleaning, and then any other medications they need to go home immediately at the time of the appointment. That was my point about why going to the vet seemingly costs so much because a lot of people look at how much a similar procedure costs them at their human doctor and don’t understand why the vet is so much more. I met plenty of people who just could not understand why their dog’s ACL equivalent survey cost more than their own ACL survey out of pocket. They couldn’t wrap their head around insurance picking up huge portions of the cost for them so that they were only paying a fraction of the actual costs.

You're implying that I said Vets and MD's make the same salary. It was quite the contrary. I said they had similar situations and understood what you were saying about Vets. Both graduate with about $200,000 in student debt. Yes Vets make less money but the average salary is closer to $100,000 according to the bureau of labor statistics. The point I was making is most people don't understand the cost of medical care for people or pets. You said that Vet hospitals were not a rip off. Most human hospitals and doctor's offices aren't either. Yes people have insurance for themselves that covers most of the cost of their care but that has been changing. Most people now have very high deductibles so their care comes out of their pocket. Things are also changing in veterinary medicine because now there is pet insurance that covers the cost. So whether or not you are paying the bill out of pocket or with insurance there are reasons medical care is expensive that doesn't make it a rip off.

 

[lookame]

I have crohns disease and one of my meds was lialda. The copay for one months worth of pills (4 pills daily)was $1000...for one month. When I told my doctor I couldn't afford $1000 per month her jaw dropped and she said 1)it does not cost remotly close to that much to make and 2)it's cheaper to buy it out of pocket for 1/2 the cost ($500 a month). Sill $500 a month is not affordable for us.

Neither are my infusions at a copay of $2,000 every 6 weeks. My insurance refuses to approve it anymore even though it is the ONE DRUG that has me in remission. They want me to go back onto a drug that I'm allergic to and almost killed me...

 

[apollodi]

My younger son had tubes inserted in his ears and the procedure lasted all of 15 minutes. We were in and out of the outpatient offices (it was not done in the hospital) in 3 hours for both. My then 1 1/2 year old's anesthesia was $6,000

This happened to me, too. Except it was DD's second round of tubes, and she got them the first week of January!! The ENT was booked through December. So we got to pay off another $5000 deductible.

But my favorite is the pending charge for genetic testing. DD's neurologist wanted to do a genetic test on her last year. I confirmed with the hospital that they pre-approved it with insurance. Then I asked how much it would cost if insurance refused to pay anyway, and was told "we don't know the exact amount, but 1,000 or $2,000." Then I called insurance and they said the same thing. We did the test over a year ago, and an $8,000+ bill is still pending with the hospital that insurance is rejecting. I am so afraid that bill will land in my mailbox.

 

[OrangeBirdGirl]

DH needed to go to ER and get liquid stitches in one finger. We have high deductible plan and the hospital was not in our network. Bill for $1,622.87. In one aspect I should be upset DH was in and out of ER in 20 mins for this high of a bill. But I am glad we were not sitting there for hours for this.

 

[ZephyrHawk]

Cancer drugs.

Oh, I know what you're thinking. How can cancer drugs be a ripoff? When the company that makes them marks them up 1000%. Oh, I know what you're thinking. ZephyrHawk accidentally put an extra zero on her percentage.

I didn't.

/Full disclosure, I'm not a cancer patient
//I just buy drugs on behalf of the hospitals that use them
///You can't negotiate against "If you don't buy my product your patients die".

 

[yeahdisney]

Apollodi. DS genetic test was $9999 for one test / one tube, which we did not know ahead of time. The doctor actually drew it herself and shared her office had a very generous reimbursement policy and she said if we had a bill higher than $100 for it with our insurance to contact them and would pay it. The doctor said she was doing a study. Check with them.

 

[samandryanmom]

Do NOT get me started on this!! My college age son was recently transported to the ER by ambulance in his college town. We just started receiving his bills. I noticed insurance didn't pay anything towards the ambulance. I called insurance figuring it was wrong. Nope. They don't want to pay anything because the ambulance company is not in their network.

 

[SafariFan1984]

I’m a cancer survivor so I’ve seen some crazy doctor bills ($500,000 for 6 weeks of treatment 3 years ago). Even with that, it shocks me every time the one office bills two blood tests at $1200. The insurance company pays a total of $12.50 for both.

Oddly enough, this place charges a very reasonable $400 to see the oncologist. Hard to believe given the crazy amounts they charge for standard things like blood tests.

 

[MrsPete]

Look around: What companies are housed in some of the biggest buildings in your town? With the plush offices and the big expense accounts? Whose executives are making astronomical salaries? INSURANCE COMPANIES.

 

[maxiesmom]

Steroid inhalers. I have to get them every Spring, and even with insurance it is $100 a pop.

My dad is on various heart medications, and thank goodness he is covered by my mom's awesome drug coverage. Saves him thousands a month.

 

[lambdabeta]

I’m a cancer survivor so I’ve seen some crazy doctor bills ($500,000 for 6 weeks of treatment 3 years ago). Even with that, it shocks me every time the one office bills two blood tests at $1200. The insurance company pays a total of $12.50 for both.

Oddly enough, this place charges a very reasonable $400 to see the oncologist. Hard to believe given the crazy amounts they charge for standard things like blood tests.

That was exactly my point earlier. Sometimes when you get the bill you have to look at what they receive not what they bill. If they didn't bill so high the insurance companies would think they could lower how much they pay. It has happened. So when billing and insurance company the bill has to be high to make sure you get a reasonable amount of reimbursement. That doesn't always work either sometimes insurance has arbitrary pricing and rules.

 

[Eastern]

This is peanuts compared to everyone else's stories, but for me I remember the insane sticker shock I got at CVS when I went to go refill my fluticasone (allergy nasal spray) prescription. My insurance (a very good "Cadillac" plan through work with a premium that is higher than my rent) hadn't changed, but the list of drugs they covered did. The pharmacist pulled out my prescription and said "That'll be $95, please." For one vial of generic Flonase! When it had cost me more like $5/vial just the other month. I was like "um, no thank you, why is it so expensive now?" The pharmacist explained that the formulary must have changed, probably because the same drug was now available over the counter as a generic. I ended up with the $25 vial and now try and stock up when I come across a coupon. But it was just this surreal moment, with the pharmacist holding one vial that cost $95, when the exact same medication and dosage was available for $70 less not 3 feet away from the register. I mean, can you imagine going to the grocery store and Sunbeam white bread costing $5 if you get it from a shelf, vs. $15 if you get the same product, in the same packaging, from the in-store bakery? Ridiculous.

They usually sell a 5 pack of generic Flonase nasal spray at Sam's Club for around $27 (less when it's on sale).

Download the goodrx app to check prices when you are filling prescriptions so you know what's going on.

 

[Eastern]

All of these stories sound shocking and I know people want to place blame but the issue is complicated. As the spouse of a health professional, I see how much is billed and how much is actually paid. For example, your doctor or hospital may bill thousands of dollars in charges, but actually get reimbursed pennies on the dollar. For ex a procedure is billed at $3800, and $95 is actually collected. I don't think you see that.

Who is to blame? Greed is a factor, yes. Insurance company executives are making $50 million a year. Same with drug companies. Hospital execs are making more than most of the doctors they employ.

Also the way doctors practice is changing. It used to be that doctors billed for themselves. Now many hospitals and for-profit companies are buying out practices and employing the doctors on salary. So you may think that the doctor is going home with tens of thousands of dollars that he isn't.

Another aspect to consider is that your health care and tax dollars that you work hard for, are being used to subsidize sicker, and poorer individuals. Some people are lucky and some people aren't, healthwise. But someone has to pay for it.

I understand the frustration and I feel it too, but it is disappointing when I see people wanting to blame doctors. These are intelligent people who go through many years of schooling and pay a lot of money to have a very demanding career in which peoples' lives are at stake. It's not easy. No one goes into it just for the money, I can assure you. imo most doctors truly want to help people and second guess themselves many times during the course of their careers.

I also pay a ridiculous amount for healthcare coverage, and I am also very aggravated when something is not covered due to a technicality. It's the nature of insurance. Sorry I don't have an easy answer.

 

[Eastern]

That was exactly my point earlier. Sometimes when you get the bill you have to look at what they receive not what they bill. If they didn't bill so high the insurance companies would think they could lower how much they pay. It has happened. So when billing and insurance company the bill has to be high to make sure you get a reasonable amount of reimbursement. That doesn't always work either sometimes insurance has arbitrary pricing and rules.

It doesn't really work like that. When a doctor or hospital participates with an insurance company, they sign a contract which designates how much they will get billed for different things. It may be a certain amount for a certain procedure, or it may be based on time: for ex, a surgeon spends 10 hours on a procedure, so he will collect for 10 hours at X$ per hour. The doctor can bill whatever he wants but the insurance company will pay as per their agreement.

It is different when a provider does not participate with a certain insurance company. Did you ever wonder why your doctor does not participate with every insurance company? Maybe it is because the agreement they offered compensates the doctor at a much lower rate than he/she is willing to accept. If they refuse to participate, the insurance company can't hold them to that price. Sometimes they will pay the full rate the doctor charges, and sometimes this goes back to the patient for using a doctor who is 'out of network'. But the blame seems to always go to the doctor rather than to the insurance company.