Posted on 10/28/2021 4:30:55 PM PDT by nickcarraway
Do not ever go to an ER if there is an alternative has been my advice for a long time.
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I’m not sure about most group insurance companies, but my medical insurance pays better if I go to an ER rather than one of those emergency clinics.
Any ER doc or and someone else on call could have stitched that up, then you use Vitamin E to take care of the scarring. But NO, you had to have a plastic surgeon to do that. WELL Baby you pay it, you wanted it.
The "usual and customary" fee for the test was let's say $750. The Insurance negotiated rate is $500, which was paid.
The testing facility is coming after me for the remaining $250. That's wrong. They negotiated the rates with the insurance company and I've met my max out of pocket deductible.
Up to this year, my understanding has always been once I've met my max out of pocket deductible, I'm "done." The negotiated rates between the insurnace plan and the doctors that accept those insurance plans are what they get paid (minus any deductible I have left, which is $0.) There's something going on here that I'm not quite understanding, and typically I'm not a dumb guy. I don't think this is right.
The numbers I used above aren't the real numbers (those are significantly higher ..) and not knowing what I'll have to pay to repair the AC Joint in my left shoulder (it's completely separated and painful to reach across my chest or push from any direction) means I'm not going to do it until I know what it's going to cost.
“.) There’s something going on here that I’m not quite understanding, and typically I’m not a dumb guy”
“Insurance” (investment) Lobby = Congress, Mitch Nancy and the RICO.
“I can’t even get a straight answer if the anesthesiologist and recovery room staff are on hospital staff or paid contractors (which my insurance won’t cover.)”
At least for the anesthesiologist, they should have a list of those who are under contract with the hospital. But, overall, maybe call BCBS, I have them too, and I remember being told not to worry, as long as I use an in-network hospital.
4 years ago I shredded my finger in an electric hedge trimmer. The doc in a box sent me to the ER. X-ray and 10 stitches was $2,000. A month later I was sent another $230 bill for a “Doctor’s fee”.
Another example of why we should learn to code.
Just becuase you use an in-network hospital doesn't mean the anesthesiologist, recovery room nurses & staff, etc.. are also in-network.
That bit me in the ass when I had to have wrist surgery to re-attach my right wrist back to my arm with two titanium plates and 12 screws. $8k worth of bit me in the ass.
What happened to the good old days? My youngest son was born in the early 90s and I had the standard work provided health care where I paid $200 a month for a then family of three.
Younger son’s birth including all prenatal visits and an overnight in the hospital was around $300.
I accidentally stabbed myself in the wrist back in July. Deep wound about 1/2 inch long that would have taken at least 3 stitches. Cleaned it out with peroxide and sealed it up with super glue. There is a nice scar but it healed up just fine.
ROFL! You forgot the cold beer!
I use a .32 hilti gun with purple charges and four prong three inch beam fasteners for all my medical stitching. They stay stitched and don’t come back.
When I had some surgery the list price was $24k, with the negotiated payment of $8k including my $2000 copay, so the the hospital only had a 3x factor for that vs. 20x for the tests. Looking at my lifetime of medical bills, I got far more value from the difference between the MSRP and negotiated rate than I got from the amount the insurance company actually paid. My ideal insurance would be lower payments per month to get the negotiated rate plus payments for catastrophic bills and they wouldn't pay anything most years like car insurance.
wrong type of coding.. sorry
by coding i meant diagnosis coding, huge books just filled with the proper code that needs to be used for payment of services
100% to everything you said especially about benefitting from the negotiated rate.
Maybe it’s a good analogy maybe not but it’s a bit like paying to join a “buyers club” as opposed to a straightforward indemnity.
The dirty secret is that the “MSRP” can often be whatever the billing entity says it is. In many cases (some cases) it can border on a scam which you escape if you get the negotiated rate.
Two things. Deductibles max out for a given uear. Copays may (if you really have a max out of pocket provision) but also may not (if you don’t).
You EOB (Explanation of Benefits) from your insurance company is the “source of truth”.
If it says you don’t owe an in network provider anything but they are still coming after you then you’re on very solid ground in fighting it.
I was trying to be funny, dammit. :)
LOL, i knew you were :-)
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