How much did you pay for your medical procedure?
May 13th 2009, 1:17 am
#31
Who?
Joined: Oct 2004
Location: Stepford
Posts: 3,098
Re: How much did you pay for your medical procedure?
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
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
Recently I had a recall on a mammogram and had to have an ultrasound and core biopsy. One of the big bills was from the hospital with the 15% discount, the other big bill was from the radiographer...no discount.
So I rang them and asked for a discount to match the hospitals. They said yes and gave me 15%. It pays to ask, all they can say is no.
And all the tests were clear
May 13th 2009, 2:10 am
#32
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Joined: Jan 2006
Posts: 0
Re: How much did you pay for your medical procedure?
No 2 policies are ever the same but my last policy was flat co-pay only for doctor visits, labs which was $25 and included everything done on that day, vaccines etc all included in the co-pay.
Prescriptions were $25 co-pay for up to a 90 day supply, name brand was more, I think a $50 co-pay but I always got generic.
ER visits were a flat $50 co-pay, and hospital stays were a flat $75 per day for 3 days and then $0 co-pays from day 4 on.
The monthly premium was $25 a month for a single, no clue what families paid.
Prescriptions were $25 co-pay for up to a 90 day supply, name brand was more, I think a $50 co-pay but I always got generic.
ER visits were a flat $50 co-pay, and hospital stays were a flat $75 per day for 3 days and then $0 co-pays from day 4 on.
The monthly premium was $25 a month for a single, no clue what families paid.
Last edited by scrubbedexpat091; May 13th 2009 at 2:18 am.
May 13th 2009, 4:40 am
#33
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Joined: Feb 2004
Posts: 23
Re: How much did you pay for your medical procedure?
Thanks for all your replies. My husband's employer has an open enrollment coming up in June so we'll have to re-evaluate all our options. I have a PPO also (Aetna) but compared to the Kaiser HMO my employer offers, there is very little difference in costs, for me anyway, so it wouldn't be worth switching. We do realise that HMOs are not as good as PPO plans but we were very shocked to find that his co-insurance percentage on the PPO plan is so high, even for emergency care. He is a very healthy person (hadn't been to the ER or A&E for 18 years) so we obviously didn't expect this. I already told him, no more fainting! 
May 13th 2009, 3:29 pm
#34
Joined: Apr 2002
Posts: 35,082
Re: How much did you pay for your medical procedure?
No 2 policies are ever the same but my last policy was flat co-pay only for doctor visits, labs which was $25 and included everything done on that day, vaccines etc all included in the co-pay.
Prescriptions were $25 co-pay for up to a 90 day supply, name brand was more, I think a $50 co-pay but I always got generic.
ER visits were a flat $50 co-pay, and hospital stays were a flat $75 per day for 3 days and then $0 co-pays from day 4 on.
The monthly premium was $25 a month for a single, no clue what families paid.
Prescriptions were $25 co-pay for up to a 90 day supply, name brand was more, I think a $50 co-pay but I always got generic.
ER visits were a flat $50 co-pay, and hospital stays were a flat $75 per day for 3 days and then $0 co-pays from day 4 on.
The monthly premium was $25 a month for a single, no clue what families paid.
May 13th 2009, 7:28 pm
#35
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Joined: Nov 2007
Location: Northern California
Posts: 381
Re: How much did you pay for your medical procedure?
Don't shoot me (well, I guess you could since I have great coverage).
I've had 3 procedures (1 overnight, 2 out patient) in the past 4 years and have had no out of pocket pay. We pay $15 co-pay for Dr visits and Urgent care since our Dr's office and Urgent Care are on the same site. ER is $35, that is waived if either one of us is hospitalized. Again, no costs for hospitalizations. $0 costs for labs, shots, x-rays, medical equipment (ie crutches, etc.), physical therapy (must be prescribed for at least a week or more). $10 for generic prescriptions ($10 for 90 days worth if done by mail).
We have an HMO and my employer pays for my coverage. I pay just over $500 more a month for my DH (the cost is the same whether I have one dependent or 10 dependents). I'm really looking forward to the day my DH finds a job with his own health coverage (or a rebate for not needing coverage since mine is so good), that's $500 a month back in our pockets!
I've had 3 procedures (1 overnight, 2 out patient) in the past 4 years and have had no out of pocket pay. We pay $15 co-pay for Dr visits and Urgent care since our Dr's office and Urgent Care are on the same site. ER is $35, that is waived if either one of us is hospitalized. Again, no costs for hospitalizations. $0 costs for labs, shots, x-rays, medical equipment (ie crutches, etc.), physical therapy (must be prescribed for at least a week or more). $10 for generic prescriptions ($10 for 90 days worth if done by mail).
We have an HMO and my employer pays for my coverage. I pay just over $500 more a month for my DH (the cost is the same whether I have one dependent or 10 dependents). I'm really looking forward to the day my DH finds a job with his own health coverage (or a rebate for not needing coverage since mine is so good), that's $500 a month back in our pockets!
May 13th 2009, 7:29 pm
#36
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Joined: Aug 2004
Location: MA, USA
Posts: 92,170
Re: How much did you pay for your medical procedure?
May 13th 2009, 7:35 pm
#37
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Joined: Oct 2002
Posts: 875
Re: How much did you pay for your medical procedure?
Actually you are getting majorly ripped off if you are paying $500 for your husband on the HMO, as that is totally outrageous. Have you tried to get an independent quote to see if you can do better than that thru an insurance broker?
Last company we were paying $660 per month for a PPO which also included dental, chiro etc. HMO should be way cheaper than what you are paying.
We pay $320 a month, not sure what the company pays, but we are on a Plus PPO. It's a $20 copay with a $300 deductible and annual out of pocket max of $2000 per individual. We are probably over insured, but chose this option because we had so many medical bills last year.
Last company we were paying $660 per month for a PPO which also included dental, chiro etc. HMO should be way cheaper than what you are paying.
We pay $320 a month, not sure what the company pays, but we are on a Plus PPO. It's a $20 copay with a $300 deductible and annual out of pocket max of $2000 per individual. We are probably over insured, but chose this option because we had so many medical bills last year.
May 13th 2009, 7:40 pm
#38
Lapine Member
Joined: Nov 2004
Location: Austin, Texas in my own little world
Posts: 21,691
Re: How much did you pay for your medical procedure?
Daughter had severe abdominal pain; went to ER and they did one x-ray and some bloodwork. She was at a slight risk of having pancreatitis, but got the all-clear.
Cost to insurance company: $2,500
Cost to me: $250
Cost to insurance company: $2,500
Cost to me: $250
May 13th 2009, 9:00 pm
#39
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Joined: Nov 2007
Location: Northern California
Posts: 381
Re: How much did you pay for your medical procedure?
Unfortunately, my employer does not have "tiers". It's either me by my lonesome (and they pay cost of insurance) or it's me + dependent(s) which includes spouse and/or umpteen number of kids/aging parents, etc. if I had them, all for $250 twice a month. While looking at other brokers may be cheaper, in the long run, I prefer what I know (and I know my HMO inside and out) rather than maybe have to find a different provider with different rules etc. We have no deductibles and reasonable co-pays. Anything we pay for can be reimbursed through our FMSA which is great too.
May 13th 2009, 11:03 pm
#40
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Joined: Sep 2003
Location: Grand Rapids, MI
Posts: 4,525
Re: How much did you pay for your medical procedure?
When I was really ill last summer, in extreme pain. I waited over an hour for my hubby to drive home and take me to the ER.
I have used 2 different hospitals in GR, Spectrum and St Mary's, both gave me a 10% on their bills for paying in full.
May 14th 2009, 1:08 am
#41
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Joined: Feb 2004
Posts: 23
Re: How much did you pay for your medical procedure?
Don't shoot me (well, I guess you could since I have great coverage).
I've had 3 procedures (1 overnight, 2 out patient) in the past 4 years and have had no out of pocket pay. We pay $15 co-pay for Dr visits and Urgent care since our Dr's office and Urgent Care are on the same site. ER is $35, that is waived if either one of us is hospitalized. Again, no costs for hospitalizations. $0 costs for labs, shots, x-rays, medical equipment (ie crutches, etc.), physical therapy (must be prescribed for at least a week or more). $10 for generic prescriptions ($10 for 90 days worth if done by mail).
We have an HMO and my employer pays for my coverage. I pay just over $500 more a month for my DH (the cost is the same whether I have one dependent or 10 dependents). I'm really looking forward to the day my DH finds a job with his own health coverage (or a rebate for not needing coverage since mine is so good), that's $500 a month back in our pockets!
I've had 3 procedures (1 overnight, 2 out patient) in the past 4 years and have had no out of pocket pay. We pay $15 co-pay for Dr visits and Urgent care since our Dr's office and Urgent Care are on the same site. ER is $35, that is waived if either one of us is hospitalized. Again, no costs for hospitalizations. $0 costs for labs, shots, x-rays, medical equipment (ie crutches, etc.), physical therapy (must be prescribed for at least a week or more). $10 for generic prescriptions ($10 for 90 days worth if done by mail).
We have an HMO and my employer pays for my coverage. I pay just over $500 more a month for my DH (the cost is the same whether I have one dependent or 10 dependents). I'm really looking forward to the day my DH finds a job with his own health coverage (or a rebate for not needing coverage since mine is so good), that's $500 a month back in our pockets!
I will get my husband to call the hospital and ask for a discount. Blue Cross weren't very helpful, they just confirmed how the treatment was coded on the bill and now it's up to us to haggle it out with the hospital. And I presume the ambulance service as well at some point.
May 14th 2009, 3:30 pm
#42
The Kwisatz Haderach
Joined: Aug 2008
Location: North Wales
Posts: 8,080
Re: How much did you pay for your medical procedure?
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.
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.
I called the Chiropractor on this too. Before we had insurance he used to charge me $40 a visit cash and $1 per year of age for the kids. We got insurance that covered Chiro and suddenly he was getting $60 from the insurance and wanting $50 from me too. Since I said something I haven't had a co-pay bill from him and he takes whatever the insurance pays him as paid in full.
Our local doctor charges $50 flat rate for doctor visits if you don't have insurance. He doesn't usually bother billing for the $5 or $6 owed by us if the insurance has paid most of the bill.
May 14th 2009, 3:36 pm
#43
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Joined: Dec 2005
Posts: 88,017
Re: How much did you pay for your medical procedure?
I know.
I called the Chiropractor on this too. Before we had insurance he used to charge me $40 a visit cash and $1 per year of age for the kids. We got insurance that covered Chiro and suddenly he was getting $60 from the insurance and wanting $50 from me too. Since I said something I haven't had a co-pay bill from him and he takes whatever the insurance pays him as paid in full.
Our local doctor charges $50 flat rate for doctor visits if you don't have insurance. He doesn't usually bother billing for the $5 or $6 owed by us if the insurance has paid most of the bill.
I called the Chiropractor on this too. Before we had insurance he used to charge me $40 a visit cash and $1 per year of age for the kids. We got insurance that covered Chiro and suddenly he was getting $60 from the insurance and wanting $50 from me too. Since I said something I haven't had a co-pay bill from him and he takes whatever the insurance pays him as paid in full.
Our local doctor charges $50 flat rate for doctor visits if you don't have insurance. He doesn't usually bother billing for the $5 or $6 owed by us if the insurance has paid most of the bill.
May 14th 2009, 3:56 pm
#44
Who?
Joined: Oct 2004
Location: Stepford
Posts: 3,098
Re: How much did you pay for your medical procedure?
I didn't have to pay anything so ,in theory, do I care.
But I do care and so I rang Aetna and asked them why they had paid more than they were billed and was just told that $140 is the negotiated amount and so that is how much they pay!
I could not get an explanation as to why they had paid $100 more than they needed to.
May 14th 2009, 4:52 pm
#45
Joined: Apr 2002
Posts: 35,082
Re: How much did you pay for your medical procedure?
That whole story is scandalous, grrrr!
It's stuff like that that keeps insurance premiums so high.
Oooh, this is going to be an interesting year, to see what Washington turns out. Obama seems firm to have it done this year.
It's stuff like that that keeps insurance premiums so high.
Oooh, this is going to be an interesting year, to see what Washington turns out. Obama seems firm to have it done this year.