dbj1000

All the figures I quoted in my case are what was paid by my medical insurance, not what was billed.

CarrotCruncher

My 5yo son fell off of his scooter in the summer, and gave himself a nasty gash on his leg. The bill was $900 for him to have 5 stitches. We were there for about 30 minutes. I tried to haggle, and the only movement I got was payment by installments. My UK arranged insurance, refused to pay, because I hadn't called them before I took him into the emergency room. Calling them was the last thing on my mind!

starky

I recently Broke my leg, having just moved here, I was hoping to avoid any medical complications, but of course accidents happen, and after the whole experience I can say that as far as is humanly possible I will always try and have some kind of insurance while living here!

I had the accident last year, dec 20th, so at that time I was on Blue Cross Blue Shield. I had a visit to ER and follow up visit with an orthopedic surgeon, total billed cost was bout $800. I had to pay two separate co-pays of $15 for that part.
Then on the 1st of Jan, due to the fact that my company was acquired. I moved to Aetna for my insurance. The doctor told me that I had to have surgery on my leg, but I was away for the holidays, and did not get back to Boston till the 30th and it took a week to get an appointment with a doctor and then another week to get in for surgery. Thank god Aetna did not give me any pre existing condition issues, they said they would cover me.

So far: 8500 has been billed. However Aetna has agreed contract rates with my doctor so the actual charges are only 4800.

With my policy, I only have to pay $10 a paycheck, every two weeks for my insurance, which is really good, but as I found out It means that I have a high deductible, $1000, that is split 50/50 with my employer (so 500 for me), then I have to pay 10% of the rest of the costs. There is an annual out of pocket max, which is 2000 for me including my deductible, so in total its cost me about $900, and my total out of pocket is up to $1400. so if I did need to hit it again this year for some reason max I would have to pay would be an additional $600. MAN this stuff is complicated.

So I had a plate and four screws fitted to my distal fibula, and the bone reset. Total cost including ER $5500 I have paid about $900.

I have to say the care I got was off the planet. I was In and out in 4 hours. They even called me when it was time to go in, save me sitting around the place waiting. I felt like royalty in the hospital, it makes the hospitals that I have been in Ireland look like ones out of some third world country. The Attitude and professionalism out of every one was mind bending. I am use to doctors mumbling at me, not answering my questions, and fobbing me off, and general medical staff with rotten attitudes. The experience was a real eye opener for me into a private medical system, something I have never experienced before. I am almost on the mend now, should be back walking next week, only two long months later ....

MsElui

my recent (and very straightforward/simple) home birth cost $2900 which included all prenatal and post natal visits and 2 midwives in attendance. My insurance said it was out of network - so we had a $600 deductable and then recieved 60% refund on the rest of the cost. The original OB that I was with wanted to charge $3500 for the birth and visits - but that obviously didnt include the seperate hospital charges and any costs had there been an emergency. (as the OB was in network we would have had to pay 20% of that - and 20% of the hospital charges too).

One thing to bear in mind - my in network OB sent my lab tests to an out of network lab - so i was hit suddenly with a $160 bill for those. So dont assume your in network doctor will use in network sub contractors!

Michael

I've worked most of my life in the Silicon Valley and Silicon Valley companies have always provided very good health insurance coverage. All of the companies that I have worked for have always paid 100% of the cost of the insurance for me and my family. The last company that I worked for had PPO insurance with AETNA that required a $10 office visit co-pay in network (lab work was free) or 20% out of network and $5 for generic drugs and $10 for brand name drugs.

About 7 years ago I retired but had not yet reached 65 for medicare benefits but discovered that I was eligible for free Veterans Administration (VA) health coverage. Co-pay office visits are $15, $50 for a specialist, lab work is free, and drugs are $8 per month. Hospital co-pay is $1066 per visit for up to a 90 day stay.

Currently I spend between $325-$400 per year for 2-4 office visits per year and 3 prescription drugs.

Advantages of VA verses medicare:

• Cheaper than medicare for outpatient care, labs, drugs, and hospital. Medicare charges monthly payment for Part B (outpatient care) and requires applicant to sign up for Part D (drugs) to get reduced price for drugs.
• Provides nursing home care (21 days free and a maximum of $97 per day after that) where medicare does not cover nursing home care.
• Very good next day appointment (usually can get same day if serious problem) and is charged the same as normal office visit ($15 co-pay).
• Emergency care is similar to private ER (long waits if your not dying) and the co-pay is for specialist care ($50).
• Usually the doctor sees the patient at time of the scheduled appointment and is seldom more than 20 minutes behind schedule.
• Routine appointments are usually scheduled for a fairly long time of at least a half an hour but sometimes for an hour or more.
• Drugs are reordered via the internet and shipped via mail.
• Lab work is done very quickly and is normally performed and put on the system within 2 hours.
• Medical history is available on the system to any VA hospital/clinic nationwide.

Disadvantages of VA verses medicare:

• Only 2 VA hospitals and 1 VA clinic within 25 miles of where I live. I drive about 20 miles each way for my office visits instead of using the clinic (5 miles away) since the clinic seems to be very bureaucratic. However I do use the clinic for my lab work.
• VA hospitals are usually only in the major cities in the US but does have many rural clinics.
• Patients get assigned a primary care provider which usually must be seen prior to seeing a specialist.
• Must speak with a phone nurse prior to getting next day appointment.
• Most drugs are prescribed where the patient must cut the drugs in half. This is because many drugs cost almost the same price for the VA no matter what is the dosage.
• Doctors prescribe from a list of approved drugs (most drugs) and must get a second doctors opinion to prescribe drugs that is not on the list (primarily brand name drugs that the VA could not negotiate a good price).
• Receptionist can be bureaucratic like post office personnel. When you check in, you have to line up in a queue and hope for the other receptionists to open a second window or wait for the one receptionist to put on her lipstick.

Recently I turned 65 and signed up for medicare. I signed up for medicare Part A (hospital coverage) but didn't sign up for Part B or D since I would pay a monthly premium and still have a higher co-pay than I would have with the VA. So I am covered whether I use either a private hospital (medicare) or the VA hospital but if I use private outpatient services, I will have to pay the full cost.

Since I am in the lowest catagory (can afford other insurance and no military related disability) there is always the possibility that the VA could cancel my health coverage in the future (currently the VA is no longer enrolling new applicants in my catagory). However if that happens, medicare gives me 63 days to sign up for Part B without paying the normal penalty (10% additional premium cost for each year not covered under Part B).

Does anyone see any advantage to signing up for medicare Part B and D if they have VA health coverage?

Mallory

My hubby just had outpatient surgery this week. He had an abscess on his leg. Went to urgent care last weekend. They personally called a surgeon, and he gave him an apt at the office for the next day. Went to surgeon's office, and he arranged outpatient surgery at the hospital for the next day.

Went to local hospital, and met the volunteer (pink lady). Given a pager, and a card with his hospital number on. There was a large plasma screen on one wall (like an airline arrivals/depart), whereby you can follow the patient through all the levels of care by the hospital by hospital number. Starting from the prep room through the OR, to the PACU, and back to the recovery room.

He went to prep room. Then I was paged, and I went to the room. We met one-by-one, the anesthesiologist, the CRNA (asst anesthesia), the OR nurse, and the surgeon. All explained everything they would do, and asked for any questions we had.

I went back to waiting room with pager. Free coffee and papers. Watched the plasma screen to see where he was. Pager went off, and I was shown to a consultation room, off of the waiting room. Surgeon came, and explained every little detail.

Back to waiting room, pager went off, and called to private room where he was recuperating, and to have a snack and fluids, put clothes on, and ready for home. Wheelchair comes, and takes him to the door. Nurse gives us bandages and supplies, and a prescription. I think we were there about 4 hours.

Hospital was spotlessly clean, and floors so VERY shiny, I couldn't help but comment to the pink lady on how clean and shiny the floors were. She laughed and said, it stays like that all the time, and wished they would go and do her kitchen floor!

Next day, nurse from hospital called to see how he was doing.

Surgeon's office arranged for home health nurse come out to change dressing. He has a hole in his leg, which has to heal from the inside out, so no sutures. A big roll of twine-like bandage has to go in this hole for 2 weeks -very gory! She said she would come every day, or she could train me. She trained me - gory doesn't upset me too much. She left all supplies, gloves, etc. She will call daily and check.

Back to surgeon in 2 weeks, and hopefully off the hook.

Insurance hopefully to pay most of it. Very satisfied so far. No complaints.

nethead

I had my twins at home in 2006. Total cost to us (we paid out of pocket insurance didn't cover it) $3000. Includes 2 midwives and an apprentice at the birth, prenatal care, post natal care for 6 weeks, ultrasound scan at 20 weeks, and blood work for me and the babies.

HighSpeedGrandma

I had a colonoscopy in January this year. By far the worst thing of all was drinking the foul liquid beforehand. It was gobsmackingly awful. The procedure a piece of cake though.
Anyway,....enough of colonoscopies...for another 10 years anyway.

ukintexas

My son cut his hand after falling of his bike last year and he had to have about 10 stitches. The ER, plus Doc, plus visit was about $1,500 of which we paid $150.

My husband decided to really test the health care here and had a brain hemorrhage followed by multiple strokes - thankfully he recovered fully. He had a helicopter flight, ICU stay, various MRI's and CAT scans and his total bill came to.............wait for it...........$264,885!!!!!!!!!

Our contribution due is just under $9,000.

I myself have had a diagnostic x-ray treatment previously for which I had to pay $1,200 as it was not covered by my health insurance as it was diagnostic and not preventative. I have a $5000 yearly deductible so had to pay the full price of the x-ray as that had not been met.

Hope some of those help - healthcare, for me at least, remains a pretty scary subject in the US. If President Obama can do one thing, I hope he can sort this out (along with the other mess he needs to deal with!).

Vicky88

My husband had heart surgery in Jan 08 which resulted in a 1 night stay in ICU. The surgery plus 1 night in hospital cost $140,000. Our co-pays cost approx. $5k for out of network, copays etc.

In Sept 08 he had a follow up surgery, once again overnight in ICU (seems as if it is the only ward they admit heart surgery patients to) - this time it was a lowly $77k. Insurance lopped off a massive $40k, paid 25k and we have a balance of just over $2k to pay.

So if anyone out there is thinking they can wing it without any insurance I would recommend you think again.

Klara

From reading all of these posts it seems my husband's coverage is rubbish. He had a fainting spell (first time ever) when we were out one Saturday night a few weeks ago and became so ill I called 911. The ambulance came immediately, took us to the nearest hospital and we spent about three hours there. They did an EKG because his heart rate was very low and gave him a litre of IV saline. He was seen a couple of times by the doctor, otherwise the nurse took care of him. They took his insurance details and now, four weeks later, we have received two bills. One from the insurance company for $750 (it would have been almost $2000 without insurance) for emergency care and "infusion". We have also received another bill directly from the ambulance services for $1100. They just asked for insurance details so I assume we'll get a separate bill for their services through the insurance company.

Nevertheless, it seems that the overall bill will be anywhere between $1000 and $1500, which strikes me as awfully high for just an ambulance ride and three hours in an ER bed with an IV hooked up. Unfortunately, his insurance company seems to have calculated the amounts according to his plan: $100 ER copay, $250 annual deductible (which he had not paid prior to the ER visit), 30% co-insurance on the first $900 and 10% co-insurance on the remainder of the medical expenses.

So I have two questions:

1. Is this type of insurance coverage rubbish and should we consider switching to an HMO plan? He currently has Anthem Blue Cross PPO, with a $50 monthly premium.

2. Should we try to get the base fees down by contacting the hospital/ambulance services and/or the insurance company so that the coinsurance amounts can be at least partially lowered? And are we likely to be successful?

I know many of you have had similar experiences and I would very much appreciate your input.

Thank you.

Klara

Vicky88

Umm that bill is relatively cheap considering what you went thru.

Do not change from a PPO to HMO. HMO is cheaper, however you are very much confined to when you can see a specialist, all your care is filtered thru a primary care physician.

The charges you have been hit with depend if you were treated in or our of network. In network is always much cheaper.

Don't waste your time trying to negotiate the co-pays as it is unlikely they will budge on the cost. As far as they will see it, is they have already offered a discount to Blue Cross so they are unlikely to offer you one. You could ask, but I know when we got a bill for $4k for an aneathtist (sp?) who was out of network, we asked if we could have a discount rate and they would not give us a cent off. What was annoying was the operation was preapproved but the hospital chose to use someone out of network.

Mummy in the foothills

We've had a fun month of doctor visits and testing in March and April.
I just got my statements in the mail.
We have wonderful insurance (Teamsters) PPO I believe it's part of Blue Cross
My OB/GYN annual visit Doc billed ins for $140 my share $55 (deductable for the year I think)
Second follow up visit he billed the ins $220 my share $0
Lab blood work they billed ins $$95 my share $0
Mammogram Yipeee (not) they billed $120 my share $44.25 (we have a lab/x-ray deductable each year too)
I have one more lab to go at the end of this month.


Dh had one doctor visit he billed $90 our share $6.79 (in network discount)
One diagnostic imaging billed ins for $239.80 our share $93.21
He still has one lab work bill and one more doctor bill to go.
Thats about 6 weeks of stuff.
To come this summer he has another imaging bill and another doctor visit

So all in all we have about $200 in bills so far and a few more to come.

Bob

$50 a month right there, your golden...you'd be daft looking for a lower monthly with shitter coverage which is what you'd be getting dropping the PPO.

meauxna

That's what I was thinking.. wow!

Mummy, I couldn't help but notice that some of the routine stuff winds up costing you the same as what I pay over the counter. That's what pisses me off, the insurance companies are billed a marked up price, customer ends up paying the same, the only ones making a profit are the insurance co.s.