Pretty soon you're talking about real money
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wrote on 22 Jul 2020, 17:12 last edited by
Yes I agree that Xenon makes valid points. I've been commenting on the grotesquery masquerading as a free market in health care for many years here on the TNCRs.
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wrote on 22 Jul 2020, 17:18 last edited by
I just paid the $1400. The place is indeed out of network, while literally all the surgeons they work with are in network. They have a strict 15 day policy from the date they mail the first statement, which I am unaware of ever receiving but which they say they mailed on June 29. They bill the insurance company as out of network. Their business model is apparently to get the tiny fraction that the insurance company pays out of network providers, and a little bit more from the patient. It is unclear to me whether my insurance company would have covered 100% of this had they been in-network - I think they would have, since my deductible is covered. The surgery center gave me a story the morning of the surgery that they would be charging 15k to insurance, who would cover 90% and I was responsible for 10%. That story was completely fabricated as far as I can tell.
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@Copper Is there cost competition on standard of care?
I thought there would be tiered healthcare in the U.S. when I moved here (as in better stuff for people who had more money and better insurance). But if you're insured, everyone seems to get the "gold standard of care". Your insurance just tells you how much out of pocket you're going to pay.
And the U.S. definitely has the best of the best in terms of equipment, drugs and services. (doesn't always equate into best healthcare outcomes though)
A lot of this perspective is from listening to a recent talk by Vivian Lee
The interesting insight for me is that on standard of care - typically physicians aren't looking at cost effectiveness, they're looking at efficacy.
We have physicians here - I'd love to hear from @George-K if he ever thought about treatments and made decisions on the dimension of how much they would cost?
There's competition in the system - but not necessarily in the places that are driving the cost increases.
wrote on 22 Jul 2020, 17:48 last edited by@xenon said in Pretty soon you're talking about real money:
@Copper Is there cost competition on standard of care?
There's competition in the system - but not necessarily in the places that are driving the cost increases.
Of course there is competition.
And of course the better doctors cost more.
Here is a program I used up until last year.
It was not covered by insurance, I paid for it myself so I could have access to the doctor I wanted. Believe me, this was a cost increase.
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@xenon said in Pretty soon you're talking about real money:
@Copper Is there cost competition on standard of care?
There's competition in the system - but not necessarily in the places that are driving the cost increases.
Of course there is competition.
And of course the better doctors cost more.
Here is a program I used up until last year.
It was not covered by insurance, I paid for it myself so I could have access to the doctor I wanted. Believe me, this was a cost increase.
wrote on 22 Jul 2020, 18:15 last edited by@Copper The most expensive thing we've done in the U.S. is have kids.
In SF our OB gyn's resume was ridiculous (Harvard, Standard med school, head of OB at UCSF... lots of other prestigious positions).
In Seattle our OB was fantastic - but a bit more "normal" on the qualifications and earlier in her career (we actually loved her, since she had more time to spend with us).
Don't know what they cost - wasn't any different for us.
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wrote on 22 Jul 2020, 18:49 last edited by
I don't doubt it.
One doctor's story doesn't define the USA healthcare system.
And, by the way, there is no such thing as the USA healthcare system.
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wrote on 22 Jul 2020, 18:59 last edited by
That was just for the surgery center facility. There is another bill for the surgeon, another for the anesthesiologist. Those are all covered directly by my health insurance but there's always a portion I am responsible for, even after the deductible is covered. I figure the whole thumb thing will cost me about 10-15k out of pocket when it's all done.
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wrote on 22 Jul 2020, 22:56 last edited by
Ah I see, kind of like dental insurance on special procedures (like an implant) but way bigger bills.
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That was just for the surgery center facility. There is another bill for the surgeon, another for the anesthesiologist. Those are all covered directly by my health insurance but there's always a portion I am responsible for, even after the deductible is covered. I figure the whole thumb thing will cost me about 10-15k out of pocket when it's all done.
wrote on 23 Jul 2020, 00:34 last edited by@Horace said in Pretty soon you're talking about real money:
That was just for the surgery center facility. There is another bill for the surgeon, another for the anesthesiologist. Those are all covered directly by my health insurance but there's always a portion I am responsible for, even after the deductible is covered. I figure the whole thumb thing will cost me about 10-15k out of pocket when it's all done.
If they are in network, that would seem to be a bit high for your part. Have you received your EOB's on their services?
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wrote on 23 Jul 2020, 00:45 last edited by
I mean across all three surgeries and including all doctor visits, physical therapy, etc.
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wrote on 23 Jul 2020, 00:51 last edited by
@jon-nyc Dont know if you would be willing to share, but what was the gross cost for your medical procedure?
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wrote on 23 Jul 2020, 00:53 last edited by jon-nyc
Around 900k.
But that’s everything, all the visits before and after, special tests (a heart cath can be 10-15k and I’ve had 4 of them), rehab and ‘prehab’, surgery, ICU time, hospital time, etc.
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wrote on 23 Jul 2020, 00:56 last edited by jon-nyc
I don’t know what I spent, it was probably capped at a few grand per year for co-pays.
We even had some reimbursement for relocation, but I was listed long enough that we burned through it. So I probably spent 20-30k of my own money (over, say, 2014-16) if I had to guess.
Most of it didn’t feel like medical bills. Like buying a home oxygen concentrator or paying rent or renting furniture.
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wrote on 2 Aug 2020, 01:29 last edited by
@89th I paid the $1433 and am now hoping the 98k bill just magically disappears. I received no receipt of payment, though the woman on the phone said she'd send me one. Nor have I ever received a bill. The only bill received so far is the one sent to my insurance company. So basically the process is that this surgery center sends a huge out of network bill to the insurer, gets pennies on the dollar for it, and accepts some other "small" amount from the patient. I have to trust the system that the balance of the 98k bill is not legally passed on to me. Having seen no paper yet, I really don't know.
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wrote on 2 Aug 2020, 02:00 last edited by
Horace said, "I have to trust the system..."
No kidding. He actually said that. Look at his post!
It looks like his typing, far as I can tell.Scary, might be Covid-20 or something.
Too much sun? Bad water. Drunk on Jon. Found religion.Ax, help him help him!! Soon he'll be drowning in trust, and then, blam! No return from utopia.
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wrote on 2 Aug 2020, 03:00 last edited by
You either trust the system or you move to Canada.
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wrote on 2 Aug 2020, 04:06 last edited by
It's unbelievable that we have to live with this shit.
You get a bill for $100K, and are told 'not to worry, it's an administrative error'.
Yeah, that just fills me with confidence. I really hope the same people doing the accounting aren't the same ones wielding the scalpels.
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It's unbelievable that we have to live with this shit.
You get a bill for $100K, and are told 'not to worry, it's an administrative error'.
Yeah, that just fills me with confidence. I really hope the same people doing the accounting aren't the same ones wielding the scalpels.
wrote on 2 Aug 2020, 04:13 last edited by@Doctor-Phibes said in Pretty soon you're talking about real money:
I really hope the same people doing the accounting aren't the same ones wielding the scalpels.
OR SURGEON to nurse: "Remind me again, which side is the appendix on? Left or right?"
(With apologies to Bach.
)
