Yet another healthcare/insurance rant

[robinb]

That totally sucks .

I had an MRI when I was diagnosed with breast cancer and my DH called in advance to see how much it would be. The insurance company said $3k. The hospital said $3k. I was billed $7500. When we complained we were told 'it was just an estimate.' I totally feel your pain. It turned out that my treatment cost more than $100k and I maxed out my oops either way so it didn't make a difference to my pocket book. I was still pissed and refuse to work with that hospital to this day.

 

[Kristina]

I used to work for an Oral Surgeon years back, and many patients would ask to be "insurance only", and if they asked, they got just that. I don't know if all practices work that way but he did. He was concerned about his relationships with the referring Dr's if he didn't take a case. Now being a dentist it may be different but after that I'd ask if I could beforehand if I could. If it helps at all, because these stories and situations are just awful. I mean if your illness doesn't get you the stress from these bills just might!

 

[firecracker725]

Change, they claim this is what we owe after ins.

Check with your insurance. After I had my 3rd child, I got hit with an enormous amount of bills from about 4 different places; however, my insurance stipulated that I was only responsible for a $200 inpatient co-pay. Turns out that the people billing me were trying to see if I'd pay up anyway, even though they knew I was only supposed to pay the co-pay. They got a nice letter from my insurance's legal team reminding them of their contractual obligations.

 

[jerseygal]

So, I had my colonoscopy a few weeks back. When it was scheduled, they had my insurance info. So, they tell me even with the best insurance my employer offers, I owe them nearly $1,200 for this 40-minute test at the outpatient clinic. Ouch, I use to pay $75 for this. Oh well, it is what it is.

Oh, but it isn't. Since that day, we have received more than $2,800 in additional bills. And I really don't know if more bills are coming or not.

How is that even remotely acceptable? If my mechanic said he needed $1,200 for a repair, the bill would be $1,200. And if at the end of the day he tried to stick me for 4 grand, I'd tell him to pound sand. And then I'd find a new mechanic. But in the medical World, this is par for the course. Unbelievable.

Just had mine. I thought that through the Affordable Care Act, colonoscopy and mammograms were supposed to be "covered procedures"...Look into it!

 

[Dawnlight]

I'm sorry.

I'd also check with the insurance, again and again if necessary.

When I had my twins prematurely, when they were ready they were sent from the NICU at one hospital to a special care nursery at another, my local hospital.

I got a huge bill for their care. It turns out that one of the doctors caring for them was out-of-network even though the whole facility was in network and supposedly covered. It was an oversight on someone's part, and we didn't have to pay that outrageous bill.

I hope it all works out for you!

 

[shortbun]

Have you gotten a statement of benefits from your insurance company? Seems like you should be meeting your deductible soon so the rest of the year will be paid.

 

[robinb]

Just had mine. I thought that through the Affordable Care Act, colonoscopy and mammograms were supposed to be "covered procedures"...Look into it!

I know they are under my insurance as long as they are regular screenings. Additional follow-up procedures are coded differently and we are charged for them. Gumbo, maybe someone made a mistake in coding your procedure and coded it as a follow-up. It happened to my DH and it took him a while to get it straightened out.

ETA: I just read that a colonoscopy can change from a "screening" to "diagnostic" under some insurance plans if a polyp is found. I wonder if that's what happened to you Gumbo.

I find health care to be one giant shell game.

 

[Gumbo4x4]

Just had mine. I thought that through the Affordable Care Act, colonoscopy and mammograms were supposed to be "covered procedures"...Look into it!

Unfortunately, "covered" doesn't mean "free".

 

[The Mystery Machine]

So, I had my colonoscopy a few weeks back. When it was scheduled, they had my insurance info. So, they tell me even with the best insurance my employer offers, I owe them nearly $1,200 for this 40-minute test at the outpatient clinic. Ouch, I use to pay $75 for this. Oh well, it is what it is.

Oh, but it isn't. Since that day, we have received more than $2,800 in additional bills. And I really don't know if more bills are coming or not.

How is that even remotely acceptable? If my mechanic said he needed $1,200 for a repair, the bill would be $1,200. And if at the end of the day he tried to stick me for 4 grand, I'd tell him to pound sand. And then I'd find a new mechanic. But in the medical World, this is par for the course. Unbelievable.

Wow. Can't wait to see what mine will be later. I am sure I will have polyps removed.

 

[Happy Snowman]

Insurance company couldn't tell me squat ahead of time. Despite being the best my employer has, it's still pretty crummy.

They did find one small polyp and that IMO justified the $2-300 the lab wanted after the fact. That still leaves about $2,500 completely unexplained.

And yes, I will be expecting a very complete explanation for each of these additional charges. Unfortunately, I'm well versed in the "shut up & pay" scenario they're hoping for

And I go back in 5 years.

Oh, and it wasn't even at the hospital, just the outpatient clinic.

Have you gotten your EOB from the insurance company yet? Many providers send a bill when they send the insurance claim but that doesn't mean that is what you actually owe in the end. Did you price out the various clinics and hospitals in your area before you had the procedure? Was the place you had the procedure done in network? Often the out patient clinics are more expensive then having the procedure done in a hospital. Also keep in mind, this is not an "insurance" issue, this is the plan your employer choose for you and your beef needs to be with your employer, not your insurance company. They just process the paperwork.

Just had mine. I thought that through the Affordable Care Act, colonoscopy and mammograms were supposed to be "covered procedures"...Look into it!

They are if it is preventive care and you are over 50 but not if it is diagnostic.

 

[Happy Snowman]

Unfortunately, "covered" doesn't mean "free".

Yes, they are 100% FREE IF it is a preventive screening and they do not find polyps or have to do anything else while they are in there. Again, this is a plan your company picked. They could have added in that all colonoscopies are covered at 100%...our insurance plan is that way...but your company did not choose to do that. I had a colonoscopy a couple months ago, they took out a polyp, it was all covered at 100%. Complain to your HR.

 

[gwynne]

Yes, they are 100% FREE IF it is a preventive screening and they do not find polyps or have to do anything else while they are in there. Again, this is a plan your company picked. They could have added in that all colonoscopies are covered at 100%...our insurance plan is that way...but your company did not choose to do that. I had a colonoscopy a couple months ago, they took out a polyp, it was all covered at 100%. Complain to your HR.

Just to add a bit more information:
http://www.ncsl.org/research/health/american-health-benefit-exchanges-b.aspx#15

"The federal Affordable Care Act (ACA) includes a special focus on providing newly required coverage for a wide range of health preventive and screening services. In particular, the 63 distinct preventive services listed below must be covered without the enrollee having to pay a copayment or co-insurance or meet a deductible.

 

[Gumbo4x4]

Have you gotten your EOB from the insurance company yet? Many providers send a bill when they send the insurance claim but that doesn't mean that is what you actually owe in the end. Did you price out the various clinics and hospitals in your area before you had the procedure? Was the place you had the procedure done in network? Often the out patient clinics are more expensive then having the procedure done in a hospital. Also keep in mind, this is not an "insurance" issue, this is the plan your employer choose for you and your beef needs to be with your employer, not your insurance company. They just process the paperwork.



They are if it is preventive care and you are over 50 but not if it is diagnostic.

We really have 2 options here - doctor A uses the hospital, Doctor B uses the clinic. And getting a straight price out of either is a joke. It's not like shopping a car where you get a real, up front price.

And really? I should be mad at my employer instead of the mess that is insurance as we know it now? You want to know the sad part? My insurance is better than the plan my wife & kids are on. And I pay $7,400 a year for their plan.

 

[robinb]

Yes, they are 100% FREE IF it is a preventive screening and they do not find polyps or have to do anything else while they are in there. Again, this is a plan your company picked. They could have added in that all colonoscopies are covered at 100%...our insurance plan is that way...but your company did not choose to do that. I had a colonoscopy a couple months ago, they took out a polyp, it was all covered at 100%. Complain to your HR.

My DH's insurance also covered his procedure 100% even though they found and removed polyps. We had to pay for part of the follow-up procedure.

 

[Happy Snowman]

We really have 2 options here - doctor A uses the hospital, Doctor B uses the clinic. And getting a straight price out of either is a joke. It's not like shopping a car where you get a real, up front price.

And really? I should be mad at my employer instead of the mess that is insurance as we know it now? You want to know the sad part? My insurance is better than the plan my wife & kids are on. And I pay $7,400 a year for their plan.

Yes, really. How this works, your company contacts several insurance companies (usually through a broker) and asks for bids on insurance plans each year. The companies then submit bids based on the information your company provides--they want this covered but not that kind of thing. Your employer has a sent price they will pay for benefits and they start taking away coverage to meet that price. They could cover all medical care at 100% if they wanted to, but no one will pay that, nor should they. Yes, you ended up with a sucky plan, but it is not because the insurance company only offered that plan, it's because your company picked how and what they would cover. Same with the plan YOU picked for your family. You picked a plan you could afford, or mostly afford, and not a plan with low out of pocket costs, etc.

As for Doctor A or Doctor B, you have a 3rd choice, drive farther for Doctor C, D, or E. You can price procedures out online, except sometimes in smaller towns, etc., they don't have enough data to get a price.

 

[gwynne]

We really have 2 options here - doctor A uses the hospital, Doctor B uses the clinic. And getting a straight price out of either is a joke. It's not like shopping a car where you get a real, up front price.

And really? I should be mad at my employer instead of the mess that is insurance as we know it now? You want to know the sad part? My insurance is better than the plan my wife & kids are on. And I pay $7,400 a year for their plan.

As I read your first post and this one, you've received a bunch of bills. Do you have your EOB? Maybe the next step is to call the billing office and get their take on the situation. Do they beilieve they have the "final" word from your insurance, or are the bills still being processed? Also ask how does this bill fit with the rules regarding ACA preventive and screening procedures?
Be sure to keep a file as you work through this, who you talked to when and so on.
Occasionally I wil ask the billing folks what is their advice as far as the next step. I try to be patient, listen, and let them guide me a bit. I've found it helpful in getting complicated billing errors corrected.

 

[Happy Snowman]

Just to add a bit more information:
http://www.ncsl.org/research/health/american-health-benefit-exchanges-b.aspx#15

"The federal Affordable Care Act (ACA) includes a special focus on providing newly required coverage for a wide range of health preventive and screening services. In particular, the 63 distinct preventive services listed below must be covered without the enrollee having to pay a copayment or co-insurance or meet a deductible.

People should note the word "screening" in most of those. Mammograms and colonoscopies are the 2 most confused procedures under the ACA coverage. If you go for your annual mammogram, having never had any issues in the past, that is covered at 100%. If you had a funky mammogram 2 years ago and are now being watched, that mammogram is not diagnostic and you can be charged for it. If you had breast cancer, you are looking at about 10 years before it is no longer diagnostic and now is preventive. Colonoscopies, if you are over 50 and they don't find anything, it's covered at 100%. If they find a polyp, you could ask them not to do anything with that and then it would be covered at 100%, but you would have to have a second one and have the polyp removed. I don't know anyone that wants to do that so they take care of it the first time. It's not procedural and not preventive and they can charge you for that.

 

[Gumbo4x4]

Yes, they are 100% FREE IF it is a preventive screening and they do not find polyps or have to do anything else while they are in there. Again, this is a plan your company picked. They could have added in that all colonoscopies are covered at 100%...our insurance plan is that way...but your company did not choose to do that. I had a colonoscopy a couple months ago, they took out a polyp, it was all covered at 100%. Complain to your HR.

Obviously you're wrong. It WAS a preventative screening & yet I had to cough up the $1,200 before I ever took off my pants. I am not however over 50. I have a family history, so my screenings started sooner.

The employer comment is out of line. I know I work for a small company. I know they cannot afford to put me on a $20,000 a year plan. It's not even relevant to the point. The point is I SHOULD HAVE GOTTEN THE REAL COST WHEN I ASKED, not after.

 

[Southernmiss]

Op same thing happensed to dh last year. We paid out of pocket $3000. Dh was only 45 and had some issues. So a colonoscopy was a diagnostic tool for him and since he was under50, not considered a routine preventive procedure.

Stinks, to think you're doing the right thing, but getting charged so much.

Thankfully your test and dh's test didn't find anything.

 

[robinb]

We really have 2 options here - doctor A uses the hospital, Doctor B uses the clinic. And getting a straight price out of either is a joke. It's not like shopping a car where you get a real, up front price.

And really? I should be mad at my employer instead of the mess that is insurance as we know it now? You want to know the sad part? My insurance is better than the plan my wife & kids are on. And I pay $7,400 a year for their plan.

Whoops! Nevermind. I see that you're not 50 yet. That explains it why it cost you something.

You're right. The insurance industry is a mess (you can't price things out in advance, every entity charges separately, bait & switch between screening and diagnostic) but they have been up to these kind of dirty tricks forever. I think if you're trying to lay this on Obamacare's door, it's not gonna stick.

OMG. I need coffee. I had to edit this 5 times!