BigDavyG

So about a month back I had my first dealings with the US healthcare system when I had to get a blood sample taken for some tests.
I was amazed when my insurance company sent me a breakdown of the charges - $338 for the blood work and a $91 fee from some doctor I have never even met.

So that's basically $430 for a blood test. Obviously my insurance covers the vast majority of that but I find that amount for some simple lab work to be absolutely disgusting.

Still, I guess this is America - land of the free - free to fleece anyone and everyone that is.

Jerseygirl

I suppose it depends how many tests were done and what for.

BigDavyG

1 blood sample, 3 tests itemized on the bill.
Fairly standard stuff.

For starters where does some doctor get off sticking the arm in for $90 for doing absolutely nowt.

Of course the other interesting thing on the bill is the amount billed to the insurance company and the "negotiated" rate they actually pay - also unbelievable.

penguinsix

This is a very important point. That billed rate and the rate that the insurance company actually pays are both far different from the 'walk-in' rate that you would get if you had no insurance. The insurance companies twist arms and bitch and moan with doctors on a weekly basis lowering prices (or at least what they pay), whereas some expat who has no insurance has no bargainning power and really can get zapped.

hcj1440

The lab charges are always the craziest and biggest disparity for some reason. I frequently get "explanation of benefit" statements saying that the lab's "rack rate" is $661, insurance's "negotiated rate" is like $61, and charges to me are $0. I mean, literally the negotiated rate is 10-15% of what the lab tried to bill.

I also know this -- because of the negotiated rates, some providers will jack up the amount they bill in order to get the insurance company to pay up what they actually want to be paid. So for example I paid around $1200 for some really expensive medication, but when the pharmacy billed the insurance company on my behalf, they billed more like $3600. That way if we got reimbursed we would get reimbursed around $1200 which is what we wanted.

Jerseygirl

I agree it doesn't seem at all fair...the difference the doctor's etc charge the insurance company vs the patient...not right at all.

A few weeks ago I got a bill for $200...which the insurance company refused to pay. When I called them to ask why...they said it was for a blood test which in their opinion wasn't necessary.

NC Penguin

The cost of the three tests seems a little steep but you don't mention what tests were being performed. Perhaps something a little unusual?

Thydney

Usually runs $1000/night in hospital excluding doctors/labs etc. I can hardly wait for our next bill.

Thydney

Well do you have aids Davy?

Jerseygirl

Yikes...that adds up. So sorry Thyd.

elfman

Oh yes. In my own experience:
bill for having a baby (totally uncomplicated delivery, two nights in hospital): $22,000.

We had to pay about $1,100, the insurance company paid about $4,000 "negotiated" rate.

Elvira

Having to pay sums like this out of pocket - it's not just insane but obscene. I hope whatever it is resolves itself.

BigDavyG

No - it was a paternity test.
I threw one into Anna Nicole Smith a while back.
Don't worry though - it was safe sex - I tied a plank to my back first.

BigDavyG

Now that would seriously crack me up. You've either been screwed by the doctor or the insurance company - either way its indefensible.

Duncan Roberts

Was in the hospital for about 15 hours a couple of weeks ago. Grand total, just under $5000. The interesting thing I saw on the insurance claim was the specialist who spent about 5 minutes asking questions and another 5 minutes looking at test results billed for $300, $40 of which I have to pay. My GP paid me a visit, spent about half an hour talking to me and my wife and went through everything billed for $120, $0 of which I have to pay.

When I worked in medical billing I saw some insane things, especially when you look at the Medicare and Medicaid contracted rates,