Deleted
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Post by Deleted on Aug 5, 2017 13:11:00 GMT -5
I'm so glad this is on the way to a good resolution for you.
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milee
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Post by milee on Aug 5, 2017 13:12:05 GMT -5
I'm really happy it worked out for your but re: the huge difference between negotiated prices for the insured and the prices the un-insured are expected to pay in this country. There is something hugely wrong with our system. People with little to no $$/resources should not logically be expected to pay more. it's the difference between wholesale and retail, insurers buy in bulk where a consumer doesn't. Not to mention it's a way for doctors to attract patients so the discount is worth it to them. It has nothing to do with trying to screw over the little guy anymore than b2b wholesale buyers pay less than an individual retail buyer. Not only that but it reflects a difference because so few uninsured actually pay any of their bills. When we were doing turnarounds of troubled facilities, private insurers paid 60% - 70% (gross averages obviously varies hugely by procedure type), Medi/Medi was 40%, self pay less than 10%. So people who pay their bills also pay more because of all the people who don't. And it's much less expensive for the providers to perform collections activities with insurers than to try to chase down individuals for the amounts they owe.
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Post by The Walk of the Penguin Mich on Aug 5, 2017 14:14:25 GMT -5
I saw this when I was rehabbing after my infection. I had a $50 copay for each appointment and the EOB I got from my insurance company told me that they paid the facility $90.
So when I ran out of PT benefits, I asked what the cost for me would be to continue on as self pay. I offered $150/session, thinking they'd jump at it. They wanted to charge me $300. I simply could not afford that, so stopped until my insurance year turned over again.
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Works4me
Senior Member
Someone responded to your personal ad - a German Shepherd named Tara wants to have you for dinner...
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Post by Works4me on Aug 5, 2017 18:24:43 GMT -5
The one advantage to the current system is it creates a larger loss write off for health care providers. This provides tax benefits and also makes it easier for non-profit and not-for-profit facilities to keep,their status.
If I'm not going to pay my bill, the facility would rather be able to write off $500 versus $50.
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Deleted
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Post by Deleted on Aug 5, 2017 19:34:18 GMT -5
it's the difference between wholesale and retail, insurers buy in bulk where a consumer doesn't. Not to mention it's a way for doctors to attract patients so the discount is worth it to them. It has nothing to do with trying to screw over the little guy anymore than b2b wholesale buyers pay less than an individual retail buyer. Not only that but it reflects a difference because so few uninsured actually pay any of their bills. When we were doing turnarounds of troubled facilities, private insurers paid 60% - 70% (gross averages obviously varies hugely by procedure type), Medi/Medi was 40%, self pay less than 10%. So people who pay their bills also pay more because of all the people who don't. And it's much less expensive for the providers to perform collections activities with insurers than to try to chase down individuals for the amounts they owe. Yes, but some of us DO pay our bills. And we are getting majorly screwed. I finally saw the payment today. The negotiated charge for that $4500 claim is $599.92. I am actually paying most of it because I had to meet my deductible. My actual copay is a manageable $325. But the idea that without the insurance company wielding its clout that I would owe $4000 more is obscene. You cannot possibly defend that by saying "so few uninsured actually pay any of their bills." If the uninsured could also pay $600 instead of the list price of $4500, they might just pay it! But, no, we tell the have-nots that they have to come up with more money than the haves.I am grateful that it worked out to my benefit, but it could easily not have.
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Deleted
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Post by Deleted on Aug 5, 2017 19:44:55 GMT -5
I'm really happy it worked out for your but re: the huge difference between negotiated prices for the insured and the prices the un-insured are expected to pay in this country. There is something hugely wrong with our system. People with little to no $$/resources should not logically be expected to pay more. it's the difference between wholesale and retail, insurers buy in bulk where a consumer doesn't. Not to mention it's a way for doctors to attract patients so the discount is worth it to them. It has nothing to do with trying to screw over the little guy anymore than b2b wholesale buyers pay less than an individual retail buyer. If the doctor wanted to attract patients, he would, in this case, price it competitively. What you mean is that doctors want to attract patients with good insurance. They want to scare away the uninsured by saying, "You can't possibly afford this." I don't buy the comparison to wholesale/retail. Wholesale is so that the retailer can resell it for a profit. Insurers aren't doing that. The uninsured are getting screwed. The major reason for personal bankruptcies are medical bills. If the therapist had billed $600 for 8 therapy sessions, I would probably have just paid it. That's not even $100 a session. Instead they billed $4500 for those 8 sessions so closer to $650 a session. How can that possibly be fair to the uninsured? It isn't a small difference. It is a huge one.
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Deleted
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Post by Deleted on Aug 5, 2017 20:42:12 GMT -5
If the doctor wanted to attract patients, he would, in this case, price it competitively. What you mean is that doctors want to attract patients with good insurance. They want to scare away the uninsured by saying, "You can't possibly afford this." I don't buy the comparison to wholesale/retail. Wholesale is so that the retailer can resell it for a profit. Insurers aren't doing that. The uninsured are getting screwed. The major reason for personal bankruptcies are medical bills. If the therapist had billed $600 for 8 therapy sessions, I would probably have just paid it. That's not even $100 a session. Instead they billed $4500 for those 8 sessions so closer to $650 a session. How can that possibly be fair to the uninsured? It isn't a small difference. It is a huge one.I mean that in network doctors attract patients by the nature they are in an insured's network, therefore they are automatically preferred over an out of network doctor. Except for the collections problems that milee mentioned, no doctor cares if they treat an uninsured patient waving a fistful of cash or an in insured patient. Actually in that instance they would prefer the cash paying patient, as evidenced by the emergence of concierge medicine. It's the risk of the billed patient who may or may not pay and the money spent on collections to get paid. The price difference is neither fair or unfair to the uninsured, the doctors are willing to negotiate their rate for insurance providers in exchange for being a preferred doctor for the insurance company's clients. The thing is that most of the cash-paying customers aren't waving fistfuls of cash. They aren't Donald Trump or Bill Gates or whoever. In a best case scenario, they are ordinary people like me for whom $4500 (or $650 a session) is an enormous amount of money. I barely make $5000 a month before taxes. If that is what it costs, then I should deal with it. But apparently it costs less than $100 a session if you are represented by BCBS. Same therapy. You cannot tell me that it is "fair" for me or anyone to pay 8x more if the insurance company isn't paying. I might understand a discount, but not that large a one.
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Lizard Queen
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Post by Lizard Queen on Aug 5, 2017 20:52:23 GMT -5
I saw this when I was rehabbing after my infection. I had a $50 copay for each appointment and the EOB I got from my insurance company told me that they paid the facility $90. So when I ran out of PT benefits, I asked what the cost for me would be to continue on as self pay. I offered $150/session, thinking they'd jump at it. They wanted to charge me $300. I simply could not afford that, so stopped until my insurance year turned over again. Rehab after my c sections was the opposite. I had a 20% copay for those, but since it wasn't one of things with a fixed copay, it went towards my max OOP. Well, I had easily maxed my OOP, so it was free to me. If it had been otherwise, my PT agreed to accept a $35 copay. It was definitely beneficial for my insurance for me to have done the PT, I continue to learn. I think it helped me to avoid further problems.
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Deleted
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Post by Deleted on Aug 5, 2017 21:55:30 GMT -5
The thing is that most of the cash-paying customers aren't waving fistfuls of cash. They aren't Donald Trump or Bill Gates or whoever. In a best case scenario, they are ordinary people like me for whom $4500 (or $650 a session) is an enormous amount of money. I barely make $5000 a month before taxes. If that is what it costs, then I should deal with it. But apparently it costs less than $100 a session if you are represented by BCBS. Same therapy. You cannot tell me that it is "fair" for me or anyone to pay 8x more if the insurance company isn't paying. I might understand a discount, but not that large a one. If you are a doctor and if you lower your price by $600, and you are guaranteed payment, and you would be opening the door to a possible pool of patients wouldn't you do it? How many more insured people are there compared to uninsured. Why wouldn't a doctor negotiate that rate. You seem to be under the impression that the negotiated rate is somehow coming at the expense of the the uninsured rate. They are separate and independent of each other. You are probably right. It is fair that John pays $100 for a service while Joe pays $650. The service actually costs $650 or he wouldn't be charged that, right? He is only charged what it is worth, right? The provider decided to take a $550 hit because John has insurance. Joe needs to be punished (times 6) because he doesn't. Haves and have-nots. Stand in the have-not list just once and get back to me.
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Deleted
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Post by Deleted on Aug 5, 2017 22:14:38 GMT -5
You are probably right. It is fair that John pays $100 for a service while Joe pays $650. The service actually costs $650 or he wouldn't be charged that, right? He is only charged what it is worth, right? The provider decided to take a $550 hit because John has insurance. Joe needs to be punished (times 6) because he doesn't. Haves and have-nots. Stand in the have-not list just once and get back to me. Except that you are not a have not and the logic you are trying to use is emotional, there's nothing I can say that you will listen to. So on that note, I'm glad that your insurance paid and hope you have a pleasant rest of your weekend. I have always sympathized with the have-nots, particularly when DH gets a $2000 bill, and they pay $150. I have been on this band wagon for years. However, in this case I think of myself as a 'have-not." A few weeks ago I got a bill from the hospital to pay this $4500 or I would be sent to collections. They gave me only 10 days after sending the bill, and it took 3 days to be delivered. I was really upset and tried to figure out where I could even get $4500 from given the big dental bills we recently faced. As I put in a previous post, I had to remind myself to breathe. I don't think of my logic as emotional. My reaction to the bill is, but my logic isn't. Services have a cost. You can discount that cost, but you don't discount it below what it actually costs to provide it. If the therapy costs the insurance company $600, that must be the true cost. Ok, maybe they are such good customer that you give them a 50% discount. They provide volume, after all. The difference between $600 and $4500 is not explainable. I don't see how you can try to explain that. You have a good weekend, too. I'm not arguing for the sake of arguing. I just think we haves sometimes forget the have-nots. They aren't all non-payers, you know.
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midjd
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Post by midjd on Aug 7, 2017 15:15:18 GMT -5
I'm glad things worked out, SS. I was reminded of this thread today. A couple of weeks ago I got a bill from DH's orthopedist. Total due after insurance was $158. The bill sat on my desk and got shuffled under some papers, so I just noticed it today, which happened to be the due date. I logged on to the online portal to pay, and when I entered the invoice information, it took me to a screen that said "payment due: $42.47." Definitely not complaining, but clearly they made some adjustment after my bill was mailed... I wonder what the odds are that I would've been refunded the extra $100 or so if I'd paid the $158 as soon as I got the bill. In all my years of paying medical bills, I've *never* gotten a refund. ETA: So from this I've learned that I should never pay a medical bill before the stated due date. I had another set to pay today, but it's not due until 8/23, so let's see how low it can go.
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CCL
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Post by CCL on Aug 7, 2017 16:52:46 GMT -5
I'm glad things worked out, SS. I was reminded of this thread today. A couple of weeks ago I got a bill from DH's orthopedist. Total due after insurance was $158. The bill sat on my desk and got shuffled under some papers, so I just noticed it today, which happened to be the due date. I logged on to the online portal to pay, and when I entered the invoice information, it took me to a screen that said "payment due: $42.47." Definitely not complaining, but clearly they made some adjustment after my bill was mailed... I wonder what the odds are that I would've been refunded the extra $100 or so if I'd paid the $158 as soon as I got the bill. In all my years of paying medical bills, I've *never* gotten a refund. ETA: So from this I've learned that I should never pay a medical bill before the stated due date. I had another set to pay today, but it's not due until 8/23, so let's see how low it can go. It sounds like they sent the initial bill prior to receiving the insurance company payment. I've had this happen many times. I never pay a medical bill prior to seeing the EOB from my insurance company.
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dee27
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Post by dee27 on Aug 7, 2017 17:40:25 GMT -5
I'm glad things worked out, SS. I was reminded of this thread today. A couple of weeks ago I got a bill from DH's orthopedist. Total due after insurance was $158. The bill sat on my desk and got shuffled under some papers, so I just noticed it today, which happened to be the due date. I logged on to the online portal to pay, and when I entered the invoice information, it took me to a screen that said "payment due: $42.47." Definitely not complaining, but clearly they made some adjustment after my bill was mailed... I wonder what the odds are that I would've been refunded the extra $100 or so if I'd paid the $158 as soon as I got the bill. In all my years of paying medical bills, I've *never* gotten a refund. ETA: So from this I've learned that I should never pay a medical bill before the stated due date. I had another set to pay today, but it's not due until 8/23, so let's see how low it can go. It sounds like they sent the initial bill prior to receiving the insurance company payment. I've had this happen many times. I never pay a medical bill prior to seeing the EOB from my insurance company.
This is common in the ortho group that I see. Like Mid, I wait for the insurance EOB before I pay the bill. Otherwise, I pay, get a refund and sometimes another bill for a different amount months later for the same OV. It is more efficient to wait until the final bill is adjusted.
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