“Your cost may actually be less out of network, but that isn’t mentioned.”
You are entirely correct. As being one who is quite healthy, my need for anything other than catastrophic insurance is not worth the regular expense. My GP only charges me $90 per visit if I pay cash. To get added to my wife’s insurance plan my portion is over $730 a month. I may go to see the doctor for a physical but that is it.
So recently I had surgery for a hernia that required mesh. I went to the hospital connected surgeon who did my insurance paid umbilical hernia at the end of 2006 for a consultation. Just that visit cost me $318 and that was his cash price for what amounted a 5 minute consultation. Nothing other than his opinion that I indeed had a hernia above the umbilical. When I questioned why so much for a simple visit, they said I was a new patient. I was told that if I did not have another surgery in three years that automatically made me a new patient. but, they had all of my information at hand from the previous procedure.
Next came the scheduling person who gave me the procedure codes and if paying with insurance, the surgeon’s fees would have been about $3800, cash at $2400. Then I took those same codes to the hospital for their estimates and was told the facility fee would be in the neighborhood of $35,000 with insurance payment and $12,200 with cash. I never got to the estimate for the anesthesiologist.
So, I just happened to drive by an ambulatory surgical center and decided to go-a-callin’. I contacted three different ones and they referred me to surgeons approved to practice there who were also on at some hospitals as well.
After doing the homework on each and also checking into the surgeons, I came up to what I felt was the way to go. Since I already had the codes, I was able to get estimates for the facility fees.
I found a surgeon that ironically was a member of the same surgical group as the first surgeon. I was very impressed with his consultation as he took the time to explain the procedure in detail and I left his office very high in confidence, especially only having to pay $160 for that visit.
The bottom line is that if I were to have used insurance that would have cost me over $8700/yr, I had the entire procedure done for $4200 and that included the charges for the anesthesiologist, surgeon and facility fee. The estimate cost of the hospital with insurance paying would have been near $50,000. BTW, I have only been to a doctor maybe four or five times since that umbilical procedure, since the end of 2006.
So in my view, if we depend on the insurance companies and their monthly charges, we are still paying the bill eventually for this huge discrepancy. Mostly because of the rules and regulations the insurance industry has to operate under from government regulations. Eventually, I would summarize the insurance lobbyists and our corrupt government have conspired to break the system so they alone could be depended upon to be the only ones to fix it. Nothing else explains where we are today.
I think we are in agreement. Unfortunate this thread started so early in the morning. It needs a large dose of experience like yours to add to the opinion.
It just hit me why the insurance is billed so high... First they bill a huge amount but then the cost is drastically reduced when paid by insurance companies. But here’s the catch on why they do that. They want consumers with insurance to think they can’t afford to lose their coverage. That $50k bill looks scary, but in reality it can be only about $6K.
Good news for those that pay directly. Now you are forced to buy Obamacare and pay more for something you don’t use. It is only fair you know.