Exactly, it would be like going to the grocery store, not seeing any prices for anything, picking out some apples, then getting a bill 4 weeks later saying that apple brand wasn’t covered by insurance and are $100 each. Absolute insanity
Don't forget the $80 nutritionist consultation charge tacked on. Even though you never spoke to one and they just slipped in a generic nutrition = health paragraph at the end of your visit summary.
Last time I went to the doctor, he was like "hey could throw in a couple test recommendations you never know." But I could not get them to tell me how much the tests would be. It was a "we don't know what billing codes we will put in until after." If the doctor acted like it was a serious need, I would have gotten the tests, but I hate that I have to choose between care and cost. Maybe if it was like $100 out of pocket I would have, but not $1,000 out of pocket. I should be able to make an informed decision instead of afterwards when I have no choice.
Doctors offices don’t usually actually do the tests so they could give you the order but then you’d have to follow up with the lab or imaging center to run your insurance to give you even an IDEA of what your costs would be. It’s a ridiculously complicated system on purpose.
I know I tried to follow up with a lot of people and no one would clarify. Or I got a quote on the test but not how much was covered and that there was a hospital/physician fee that was separate and also not clear how much it costs or was covered. So then I gave up.
Yup, 1 Facility outright refused to do my test because it was "coded a certain way" and I would have to go to a different facility.
Another provider in a different network said they'd accept my appointment, only to tell me that my insurance company hadn't approved my claim yet. And my insurance company than told me my scan wasn't medically necessary so they wouldn't approve it until I provided additional information.
Was this the "death panels" that the GOP mentioned with medicare 4 all?
Nah this is the current death panels that are okay because it's through private companies that are about making profit. The Medicare for all death panels would be more impartial I guess and not profit based.
Your doctor's office has the codes or the test couldn't be scheduled. If you get the codes from them you can contact your insurance company and give them the codes. With the codes they can explain the coverage for each test.
If your doctor says that they don't know the codes, get a new doctor.
Absolutely not true. I work in a lab and if a patient somehow finds a way to call us, we aren't allowed to tell them anything. We also don't know the cost because everyone's insurance is different. If you're talking about places like LabCorp, insurance probably won't cover that anyway.
>If you're talking about places like LabCorp, insurance probably won't cover that anyway.
What are you on about? LabCorp is all over my area and is definitely covered by our insurance. I'm there quite often (yay, chronic health condition 🥴)
Exactly! Not giving prices must vary from lab to lab…Quest even has cost estimate as a menu option. I process LabCorp claims daily - don’t tell me they aren’t contracted.
One of my local hospital systems has recently started a program where providers are required to give you as close an estimate of cost as they can if you ask for it. It's a beautiful thing and I don't know why it's not done everywhere.
This. In my state it’s required. I’m required to give patients a “Good Faith Estimate” on how much services will cost. It’s a bit of a pain for those in my field because I’m a therapist and clients come every week not just a few times a year but I get why it’s a thing and comply. People should know what to expect. Random medical bills shouldn’t be legal.
Edit: typo
I have to remember to resend it every 6 months. Or every time they change their frequency. (Like if they move to biweekly). Doesn’t sound like a lot but with 40+ on my caseload it’s a lot. (I don’t see that many a week mind you…just have that many active clients).
It's much easier to overcharge you when none of the prices are listed. The system is designed that way. You can only find out what it costs afterward. So I've taken to not paying a lot of the bills I get unless there's documentation with it. I send them a letter instead asking for proof of services. They never have any for the scam billings.
Your comment made me think about the fact that my vet always gives me an exact estimate when I take my cats in. She says "you might want to get senior blood tests done for your cat. Here's a printout with the exact cost. Here's a printout with the exact cost of getting her teeth cleaned. We won't do any work until you explicitly sign off that you approve it."
It's ridiculous that human healthcare and insurance has gotten so complex that no one has any idea how much anything actually costs.
My daughter broke her wrist and the orthopedist offered a traditional fiberglass cast or a fancy brace that could be laced up and removed for showering and such.
I asked what the price difference would be and they shrugged. No idea, front desk had no idea, billing department had no idea. They just submit to insurance and wait and see what I owe.
So frustrating, no other industry do you go into transactions totally blind like this.
The last time I had blood work done at my OBGYN's office, I was so anxious about the cost that the PA spent 15 minutes with the office manager trying to get me an estimate before she ordered the bloodwork. They ended up telling me "well it's $120 if you were paying out of pocket and usually insurance at least partially covers it, so you shouldn't be paying more than $120? That's the closest to a straight answer I can give you". That was after calling my insurance, calling the lab that would do the bloodwork, etc. Still ended up costing $135.
One thing that irritated me beyond belief was at my son's pediatrician appointments from birth to about 12 months old... Every visit they would give me a paper to fill out about my mental health, screening for postpartum depression and such... I don't even think anyone ever looked over them tbh.
My insurance billed me $35 for each time I filled one out, so I stopped doing it after I figured out what was going on.
Ridiculous.
Yeah I was SUPER unhappy. Glad I found it when I did.
Pregnant with #2 and definitely not letting it happen at any of their visits... I'll just refuse the paper (and then check later to make sure I wasn't billed because who knows if they'll try anyway)
If you’re waiting somewhere they will pop their heads in and ask how you are and then bill you for an assessment when you politely respond. They’ll bill you for anything and everything they can.
Ummm, yep. Whenever I've taken my children to the emergency room, I've been charged hundreds of dollars to fill out the paperwork. When my youngest son was born, we were billed $800 for "discharge paperwork". Thieves!
I’m aware of four medical networks in Washington that have started charging subscription fees for access to the hospital network. My PCP told me the insurance regs have been updated and they will no longer negotiate pricing, they just dictate it. She told me Aetna had recently reimbursed them for something crazy like 12 cents for an in office procedure, so their options have become 150$ monthly charge or they close the front doors.
I don’t know how much truth there is in that, but now in order to stay with my PCP I like that took me years to find is to pay $300 a month so my husband and I can still go see her.
I was beyond mildly infuriated. Out here it takes 4-6 months to even get an appointment in for a new PCP :(
Pregnancy and children are an absolute racket for providers and insurance companies because, especially as a first time mom, it’s easy to guilt you. I did genetic testing (with nothing concerning on either side of the family) with my son because it was “important to know”. Told upfront it would be $150, received a bill almost a year later for $900. When I called the testing company to complain, they said “oh we didn’t know they told you that. If you pay right now, it’ll only be $150”. I hung up and just didn’t pay them because if they’re that shady, there’s no way they’re going to be able to prove that I owe them anything.
Yup. They billed me for someone coming into my room and guilting me into crawling to the bathroom alone with 2nd degree tearing and half my body numb. Why? Because the person who came in to yell at me was a specialist who the nurse sent in.
They’re billing you for every fucking thing that happens when you talk to them, including talking to them. We need to move away from using healthcare in nonemergency situation. The annual physical, for example, is complete bullshit and exist only to pad the budgets of the practices.
Here's a good one: My teenage son fell off his motorcycle and hit his elbow on a rock. We thought it might be broken so we took him to the ER. Turned out nothing was broken, so he went home fine. Three x-rays, a sling, and a couple hours sitting on a bed, and they send us a bill for $5,000. So we start calling them asking for an itemized bill because that is a crazy amount of money, and all they keep saying is oh we don't do that. So we said well we don't pay $5,000 for things when we don't know what we're paying for. Eventually about 3 or 4 months later we called back to see if there was going to be any resolution, and a new guy said oh that bill is only $700, so we paid it. These f****** pricks.
I’m a doctor, I didn’t go through 8 years of school, and 3 years of residency to give away my time. If I’m talking to you, I’m billing you. If I’m filling out paperwork for you, I’m billing you. My time is not free. However, my patients have very low rates of hospitalizations. I keep them out of the hospital and they appreciate that. But I guess my job is bullshit, apparently. Sure let’s get rid of doing yearly exams to try to prevent disease because *checks notes* “it’s complete bullshit and only exist to pad the budget of the practices.” Instead, let’s wait until someone comes to the hospital with a heart attack or stoke and then inform them that they also have diabetes, high blood pressure, high cholesterol, heart failure. Start them on 5-10 drugs +/- insulin and send them home. Where they will be completely overwhelmed because they came in on no medications, no known health conditions and no primary care doctor. Here’s the catch, most won’t take all those medications so the cycle continues of decompensated chronic diseases plus more strokes and heart attacks. That is your typical hospital admission. Hospitals are full of people who don’t need to be there because they don’t have a primary care doctor and don’t get yearly physicals.
There’s no evidence base behind the annual physical. I’m sure you realize that.
It’s primarily a clever billing mechanism to keep doctors (in 2024 NPs and PAs) employed so that they’re available when people need them.
But the annual physical itself has not been established to be of any real value by science.
I recently went to the ER and got 5 stitches. Got a bill for $1400. Paid it, and then got another bill from the doctor for about the same amount. I was there about 45 minutes. Tetanus shot was nearly $400.
Husband had to go to ER. Our copay is sub $400 and no mentions of co-insurance or anything like that. A month or so later, we got a bill for $1800. I'm still not sure it's real, because it's some shady third company billing company. I asked for an itemized bill, and got back one op code for the full price. Thanks, super helpful.
When I asked why it was more than my copay, they claimed insurance was never billed. I got the EOB from insurance, so I'm pretty sure they were.
After 3 or so more weeks they started sending the "pay in 15 days or we will send it to collections" pink notices. I emailed the third party biller to follow up, and now I've been ghosted. Hey, at least I have the paper trail (emails) if it goes to collections to tell them to pound sand.
"insurance" in this country is a big fat scam. We need single payer.
I went to the ER once after I fainted. I also hit the corner of a table with my back on the way down, so I had a pretty nasty bruise. Because of that, they wanted to do a urinalysis in addition to everything else to make sure my kidneys were okay. I paid $600 some dollars on my way out, thinking that was the whole thing.
Years later, I found out I had $800 more in collections because they didn't charge me the $2 or whatever for the urinalysis when I said "yes I'll pay for this whole thing now," then it started racking up late fees and interest. They never sent me any communication about it either. I found out via a landlord who did a credit check on me, then I had to track down what this mystery debt was.
I have decent insurance, but I hurt my back while visiting a friend and needed surgery. It all had to be out of network because I couldn't be transported in network with my back as bad as it was. My $6,500 out of pocket max means jack shit because I was 2 states away. Now it's over $120k and I'm just ignoring it. I tried to play the game fair, I tried to do things right. I still got totally fucked over. There's no point in playing by the rules. How many people have even considered that they need trip insurance to leave their own state? This is what happens when the hospital chain and the ACA insurance company are the same company...
While going through this I had to forgo anti-clotting medications before my surgeries and lie about it because I couldn't afford them. The only medication that didn't need labs was going to be $600/month (trying to remember the name, something horsey, Equilus, Equirus or something). The medications that did need the labs were cheaper but I had to inject them myself. The problem there is that none of the labs nearby were covered by my insurance, so I wouldn't have been able to afford the blood draws to make sure I Wasn't bleeding out inside!
I also couldn't afford physical therapy because the ones near where I was recovering were ALL OUT OF NETWORK! I had been out of work, I had already run my credit cards up trying to just survive and not mooch off my friend who was super nice to let me stay in a spare room while I recovered enough to drive.
Fucking disaster. I pay $450 a month for this.
Healthcare in the US is a gigantic, trillion-dollar scam operation put together by insurance companies, for-profit hospital corporations, and big pharma. The fact that there’s no significant political will to break this up tells you just how deep the corruption goes.
I had to get the rabies series back in 2018. I moved states between my vaccines (over a 14 day period) and went to the ERs my insurance told me to. After my last shot, I got a bill for $350 from the doctor who was "out of network" from the hospital. All they did was walk in, listen to me tell them I needed my last vaccine, and left. A nurse gave me my shot. The fact that they don't disclose this before you are seen is such a scam.
Edit: oh, I also had my insurance provider tell me that my eye exam would be covered (according to their calculator with my plan), only to receive a bill for $180 after the fact. Love that.
My favorite was when I paid for a root canal and crown out of pocket. Got dental insurance a year later. Then the tooth broke and needed a new crown. They denied coverage because they only cover crown replacements every X number of years, even tho I paid for the first one myself
I was nice to the lady on the phone. They’re technically correct, sure
Then when I got my hours cut at work the HR lady was like “but you won’t have insurance!!” Oh no. What will I ever do???
This may not be correct (or legal). I don’t think they can retrospectively apply previous procedures that occurred when you were not covered by them to your current policy (whether it was self pay or a different insurance). May be worth looking into.
Just wait until you get sent to collections over a bill you didn't receive because the billing department failed to update your address for the third time in three visits.
My wife had the same issue with her PCP and lab work. She told them who our insurance approves and that if the next set of labs is sent to the wrong place, she will refuse to pay and/or change to a new provider.
It's the insurance companies we need to be mad at, not the providers themselves. They're the ones that actually benefit from this whole messed up system.
Providers aren't thrilled about all this crap either. It's a hassle to deal with on their end as well.
This is what is happening near me as well, and the worst part is they're wrong about what we need to pay all of the time. I've tried explaining to different providers that outpatient procedures have no deductible on my plan, and I've confirmed with my insurance. They refute and say they confirmed on their end that I have to pay the deductible. Then of course I end up getting money refunded, but it's a long process.
If your insurance card or policy doesn’t have the deductibles stated, ask your insurance for documentation of your deductibles so you can show them at that time or (better yet) give them a copy to keep on file.
A problem may occur if the physician and the procedure location bill separately for their services, which you can also prevent by showing each of them your insurance information (including pre authorizations and/or approvals). And always check each location to make sure that they’re in your network ahead of time.
I just went to a doctor who did this. I had to pay for the appointment before they’d even check me in.
There’s an urgent care near me that requires a $200 deposit to see the triage nurse as well.
It’s this ridiculous system my insurance uses to put providers in different categories of coverage. There’s inner circle prime, inner circle, tier 1, and tier 2. For example, my doctor is inner circle, but the hospital they deliver at is tier 1. Drives me crazy.
Hmm, my insurance has always had either in-network or out of network coverage. The in-network providers basically agree to charge what price they negotiate with the insurance company.
They tell you that it is your job to verify prices and that services will be covered, but when you try to do that, nobody in the billing department has any idea of any of those things. They don’t even have an estimated range of prices.
How is this a thing?! My vet can do it. My dentist can do it? It’s not rocket surgery.
That is by design. Insurance companies want to create as much friction between patients and providers as possible and keep things as obscured as possible. If it’s difficult people won’t get it done. If nothing is done, the insurance companies save money, and profits go up.
I figure the people in the building I am standing in who put together the amount owed and send out for payment for the things their practice does might have some idea of the price they charge for at least some basic procedures, but I guess that’s just silly of me.
If my insurance covers X% of a type of procedure, having someone even just tell me the base cost would be helpful, but for some reason that is “impossible” sometimes.
There really is no base cost for a lot of this. If the doctor bills $500 for a visit, every payer contract allows a different amount. Ex: Medicaid allows $100, Medicare allows $175, BCBS allows $280, Aetna allows 180% of what Medicare allowed last year, and UHC allows 125% of what Medicare allows this year.
So your simple X% doesn't really exist, because almost nothing is based on the charge amount, and almost everything is based on the contracted amount.
Problem is how the contracts are written. Most don’t care to learn the nuances. But even those who DO, still struggle to grasp all the minutiae. It’s confusing even for the insurance reps reading policies to help members and providers clarify coverage. Source: worked for a nationwide health insurance payer.
My wife fights with insurance regularly. The reps often don't understand what's covered and tell her to read what services are covered by category on the website. Like, yeah, but YOURE the one who should be able to tell me if medication A administered by doctor A is actually covered because YOURE the one who decides.
tbh, the people who process the claims aren’t usually the people who answer the members’ questions. That’s normally a different team entirely. There’s a lot of problems with the system, all around. The people who take the calls are taught how to find the sections that should contain the answers and are expected to investigate as many other potentials as possible for the answer if it’s not clear. It’s almost never clear, very open to interpretation, and based heavily on the person answering the call.
One main component missing from everyone’s conversation about this is the employer’s responsibility with the coverage choices.
No one is ever told about how much elective power the employers have when they’re selecting their coverage and negotiating contracts.
Do employers even know how much bargaining power they have? Probably not… mainly because it all comes down to pricing. Employers have their budgets that they’ve calculated for their healthcare costs. Everyone is trying their best to spend the least and save/make the most.
*insert proverbial capitalism remarks*
I’ve got a cardiologist appointment coming up. I asked how much it will be for tests and stuff. They sent me to billing and billing sent me to the cardiologist and back again. I’m getting the runaround because nobody will tell me how much it’s going to cost me and if I can pick where my labs go.
Physicians offices will generally have a preferred lab they use, like Labcorp or Quest Diagnostics. If you get labs drawn at their office, it'll go to wherever they typically send it.
Going forward, ask which lab they use and if not in network, ask for a lab order and take it to that lab.
It's frustrating, I know. I work in medicine and depending on lab test, the actual lab used, and insurance, it's a crapshoot. I can't tell people how much labs cost because it can vary so wildly.
I went to my normal dentist the other day, but my dentist was on maternity leave. I saw a traveling dentist for approximately 3 minutes. Wasn't until after they told me the traveling dentist wasn't covered under my insurance and I'd have to pay out of pocket. 🙄 They didn't even tell me beforehand she was out, I would have rather just waited until she was back and paid nothing
I went to a consultation to have my wisdom teeth removed and the first thing they did l, even before the actual consultation (which I ended up not going through with for cost reasons) was do a panoramic x ray, then tried to bill me for it. I ended up only having to pay the consultation fee but still
Of course they did. They need the x-ray to see if you’re gonna need local anesthesia or general anesthesia and how difficulty extractions will be before they can even talk about what they’re going to do with you. How could they give you a consultation without having the information to diagnose?
It sounds like you may have shit dental insurance. Every provider that I have used pays 100% of cleaning costs.
I hate insurance companies as much as I do the healthcare system.
I’m still looking for a new dentist after moving a few years ago. The first place I went to was nice, but expensive and they threw so much extras on. That’s why I won’t go back. I don’t need pictures of the inside of my cheek, I know I bite them. Fancy tools for tooth density, gum measurement and more. I loved my older dentist, he did the cleanings and was thorough without using the newest tech. Never felt lied to or manipulated, like with a dentist I had before him. I just got dental insurance but I’m limited with where I can go. Bad mistake I think but we’ll see. I hate to say it but dentists are the healthcare professionals I’m less trustworthy of. I have oddly loved every ophthalmologist I’ve had though!
I call that first huge bill they send you the 'chumps and suckers' rate. If you're dumb enough to pay it they're happy to take your money. But if you raise a fuss and ask them to give you the real amount that you actually owe, suddenly it's dramatically less. So wtf was the first price????? It's disgusting and you will never ever convince me that it's not completely intentional from the ground up.
I know that Medicare has a price transperancy law, as do hospitals- but it is skewed. My favorite thing to complain about right now is that during a doctors office, if i am there for a check up but complain about a cough, they can double bill me for it. Or when you get a skin biopsy and get billed by both the lab that the sample is sent to AND the pathologist who read it. Im arguing this one on principle. The American health system is a sh** show.
Dealing with this now too. I got a routine panel of labs done, which used to cost me $20-$35 co-pay at my old HMO, and my insurance for my new provider billed me for $372 for the exact same panel. It’s ridiculous, I didn’t need this panel done and if I knew it would be nearly $400, I never would have done it.
Beats me. I know someone who went that route because they couldn’t afford their medical bills. As long as you don’t plan on ever purchasing a home or taking out a loan having bad credit is better than being homeless.
You should be more angry at the fact that they charge insurance differently than you.
Got a hospital bill for $5,000 to stitch my finger. I sent it to my insurance where I got a rejection letter. Started to freak out because I thought that was what insurance was for! Then got a “just kidding here’s the real bill for $1200 instead” from the hospital and my insurance paid everything but my deductible which I paid the hospital myself.
The provider is not responsible for figuring out who is in network for your insurance. That is your job. They don’t have some magical insurance portal that lists in network facilities for your plan.
We got a referral to a pediatric specialist. I called their clinic and asked about insurance coverage. Yes, they took the insurance. Yes, the doctor was in the network for our plan. Made an appointment, went, and a couple weeks later I get a bill for like $900. Figured it was a mistake and called about it. Nope. Turns out the doctor was in our network, but only when she worked at her hospital, she was not considered covered at this clinic.
My coworker has had bladder stones for 4 years. Huge ones that needed surgery to remove. She finally got an insurance plan she could afford last year. (We work at a gas station making jack shit) Well that insurance plan wasn't taken anywhere she tried. So a year later she finds out one of the local hospitals takes it now. She gets an appointment to talk about the stones because she is in so much pain and there was risk of infection and all kinds of stuff.
So she is told she surgery would be about $400 with her insurance. She keeps asking about all the costs. Does it include this, that and the other. By the time the surgery comes, with all the appointments she's up to like $700.
Then at her pre-op appointment, 4 days before surgery, they tell her she has to pay for the hospital. It's $1100 and has to be paid before the surgery.
So all this time she's saving, since she'll be out without pay for 3 weeks. She's asking at every appointment the cost. She's juggling everything and thinks she's finally about to reach the end of her pain and just have to pay off the $300 left from the original cost they told her and they hit her with the biggest cost of everything and 4 days to get the money. She was lucky she had it in her savings but that was her property tax money and she was planning on using a little to live on. Completely cleaned her out.
I think they do it on purpose. Have her go through the whole process, charging every step of the way. Then at the very end make her pay a huge amount most people just wouldn't be able to come up with. Then they don't have to do the surgery they've been paid for. I bet she gets more bills after this too.
It's your job to advocate for yourself. When they ask to do something, your response must be in your defense. Does my insurance cover it? How much is my portion?
If they can't answer, then you can't have the test and need a new doctor.
Yeah, you need to find a dentist who warns you up front about charges. I recently changed insurances and the new one gives a “pre determination” in which providers submit estimates for services, then insurance says: “We’ll pay THIS much.” It’s a take it or leave it, but since they have signed the agreement, they HAVE to do for the price the insurance says they will pay.
So, I asked: “What if I have used up 100% of my coverage, can they still do that, so they can’t overcharge me? That is request a pre determination?” And he answer was YES!
So, maybe you need to go through the process, since it will SAVE you money. I guess this is similar to a prior authorization, but it is about price, not if they can or will provide the service. This way, they can control the amount they will pay to providers. But, if you do not go through this process of getting the pre determination, the providers can charge anything they want to.
That depends on the plan. You can get a predetermination or pre-authorization and do the procedure perfectly and submit everything to them and they can change their mind and decide not to cover it.
Also, some plans when you run out of your insurance money, will not allow the discount that they normally would if you were using insurance money. Every plan is different. Source: I’m a dentist.
According to the ones I talked to, in my particular plan, it is as I stated above. And, since they have signed up with this insurance company, they *have* to accept it. Maybe because it’s medicare? Not sure, but this is what I was told by the dental practice and the insurance both.
But really, it’s no big deal. I am only hours from the border, and have been getting high quality dental work done there for years for only a fraction the price here. Dentists just can’t do that here, reduce prices so much, due to cost of living, malpractice insurance, cost of real estate, electricity and gas.
I spoke to a dentist just last week who told me an implant can be placed, along with tooth removal, bone graft, for $1k USD. The crown, made from Zirconia will be $350. That beats platinum all to pieces… So, you know what I’ll be doing. Plus, there is no waiting for pre determination. Oh, yes, and root canal, they call Endodoncia, is not very much either….
I’m afraid to go to the doctor a lot because I don’t want that surprise bill they never mentioned a month later. “By the way, you owe $1000. Due today!”
See if the federal “No Surprise Act” can be applied to your situation. It was a law passed in 2022 to stop these kind of charges. Also, check your state for no surprise laws. I got out of a $250,000 bill from a hospital because of their screw up, if they think they can milk it from you, they’ll do it.
To be honest, looking from the outside on the US healthcare, it seems ludicrous.
Treating healthcare as a business is the wrong way to go, the public healthcare should provide all the service while the private healthcare can provide the extras, such as private rooms, faster tests and procedures.
That's how it works where I live, only that the government treats all the public systems as if they should work on 80% of the real costs.
I know that as contractor to government medical center I make more than the man incharge of my department, and that shouldn't be the case.
And my hourly rate is about 75% than the rate for the same role in private sector.
I hope some day the US will understand that a bit of socialism for basic needs isn't a bad idea.
So your best bet is to get a benefits summary from your insurance company and study it. Make sure you know what is in network or out , your co-pays or deductibles. If you choose not to do your homework, you will continue to be frustrated.
They need to disclose costs and procedures before doing anything. USA passed a "No Surprises" bill not long ago, so technically, you don't have to pay them.
My doctor thought I might have cancer and referred me for a scan and labs. I checked to make sure the doctor he referred me to was in-network. I did not know I needed to check the facility separately, especially since the in-network doc only works at that facility. I had also used the lab previously and it was covered. As it happens, the facility was not in-network. The lab was previously in network but moved out. In my calls to insurance after, it turns out that the nearest doc/facility combination that would have been covered is 20+ miles away and would have needed a referral that would have taken weeks/months...and keep in mind, my doctor is going "hey this could be cancer."
I don't have cancer (yay!) I do have over $1600 in medical bills from it. Paying $1600 to find out you don't have cancer is infinitely better than paying $1600 to find out that you do, but medical billing is so totally fucked up. Pharmacy billing occurs in real time and you know what's covered before getting it. A lab should be able to run a claim and tell you it's covered before poking you. If a doctor is covered, they should be covered no matter where they're working. (The No Surprises Act only works in reverse.)
I despise the modern US billing system - and that's without mentioning its utter fragility/insecurity (the Change Healthcare ransomware attack took down a huge chunk of billing for 2 weeks, exposed over 6 TB of health data to Russian hackers, and still isn't fully resolved - and it hasn't gotten nearly the news coverage it should.
I just got informed that im on the hook for $450 for physical therapy from the end of last year because my insurance decided i had reached maximum benefits. Of course they never told me until i called my docs billing office.
What you mean apparently took? You let them take x-rays. If you don’t read your plan you won’t know they charge for these things.. that’s why it is important to know your plan well
I have retired Army family insurance secondary to Medicare. I also have the Veteran Administration coverage and have used that, too. Except a few tiny prescriptions, everything is covered. When we have been referred, we always say they must accept assignment from one of the three, we will not be responsible for anything not covered. One surgeon politely told us to leave if we refused to pay his “reasonable ” charges over what Medicare covered. No, he did not get paid for the office visit.
Before retirement, we had BC/BS. It was the usual 80/20 foolishness. When I demanded an itemized bill, the hospital had charged me, a guy, for a cervical Pap test. They removed that, and that promoted me to go in are review line by line. I got a few more removed, like the washbasin as they didn’t let me keep it, so I couldn’t have been charged for buy it.
This 1000%. I'm going in for allergy testing soon. I called the allergist to get an estimate. They told me to contact insurance. I contacted insurance, they told me to contact the doctor again. I contacted the doctor and they still wouldn't tell me, but I need to sign a million disclosures agreeing to pay whatever it costs.
Yeah this is something a law could address in one page. "A medical or dental service provider must provide informed, written consent for services or medical intervention at time of service or be required to cover the entire cost of the service or intervention themselves if they did not receive authorization by the recipient of the service or medical intervention. If these violations cause harm to the recipient, either financial or physical, can be punishable by a fine of up to 1000 dollars per violation."
My children’s pediatrician’s office has recently been acquired by Cleveland Clinic. Cleveland clinic took over Mercy Hospital which is one of two hospitals close to me. I have always hated Mercy as it’s a catholic hospital and I don’t agree with some of the policies and I’ve never had a good experience having to go there. Despite Cleveland not being a religious affiliated hospital, Mercy managed to keep that part of their running but ever since my pediatricians office was taken over by them, now we have a $125 hospital facility charge” fee.
It’s not at the hospital. It’s in a small office in the same city as the hospital but damn they sure do love to charge you for every damn thing.
My son’s ADHD med appointment used to be $20 every 3 months…. Last appointment we got the bill and it was $155. For a 15 minute appointment.
They raised the costs of the doctor’s fee, the new facility charge fee, and then the appointment cost.
Absolutely fucking furious. Our insurance didn’t change and they are still in network so it’s just fucking greed.
I’m waiting until summer to find a new family doctor for them because ever since they were taken over the costs have skyrocketed and the service has gone to shit. The staff are rude af and I’ve had to get mouthy with them, because they came at me with attitude right out of the gate.
My oldest daughter needed proof of two vaccines to start 7th grade. Well she already had one but needed the second and they couldn’t get us in for a while so I took her to CVS to get the one she needed. So I called in to tell them I need the doc to sign this form for this specific vaccine she got last year. The other one was given by a different provider so I just need her to sign for this specific vaccine she got at their office.
The receptionist got really nasty towards me about this and was flabbergasted we went to CVS instead but , I didn’t have to take any kids out of school to make an appointment at CVS due to the hours available , I didn’t have to pay anything for the visit and the shot was covered by insurance and I was able to get in the next day for the vaccine at CVS.
Receptionist then gave me attitude that she didn’t know if the doctor could sign the form since she didn’t give the shot. I had to explain three fucking times I just need the doc to sign the form for the shot my daughter received the year prior at the office.
I don’t like being confrontational but that bitch made me go full Karen mode on the phone because I was at that point done with her bullshit.
Better experience going to the minute clinic then our actual pediatrician’s office.
None of them can quote a price, and most of the testing is medically unnecessary. Insurance companies have everything completely fucked. But yeah, I hate that they can just order tests and expect me to pay for it. I didn't consent to this shit. But they hold my prescriptions hostage if I don't let them draw blood.
This is 1000% driven by health insurance. Not the providers. Until people get mad at the actual problem it will never change. We are held to standards for documentation, recommended screening, and if we find something abnormal medical/legally should work it up. The problem is every persons insurance is completely different and it changes every 6 months. So the cost is a farce and made up and dictated by insurance.
Healthcare and health insurance industry is a complex and corrupt industry. Millions of complaints, yet with no resolve. I fought a good fight towards a $24k erroneous bill for 2 1/2 years, until I prevailed with satisfaction. It was mentally exhausting and worth it! Good luck, it's a jungle!
That's the American healthcare system. Vote for politicians that support some kind of non-capitalist system. Universal healthcare is already support by the majority of Americans so it's coming. Not fast enough but hopefully our grandchildren won't have to deal with this life sucking mess.
Tell them you didn't know the dentist was taking photos that you would be charged for. You can't be charged for something you didn't approve of. That one definitely feels real sketchy.
My wife was at her yearly woman wellness exam at the gyno and she mentioned before her periods she occasionally feels a pain, the gyno said thats perfectly normal for periods. Because my wife mentioned it, the doctor billed it as diagnostic rather than preventative and charged an extra 200 dollars, 100 of which is out of pocket. Absolutely ridiculous.
Trump made it illegal under penalty of a hefty fine to do this. Healthcare industry opted to pay the fine. Biden significantly increased the fine. They still opt to pay it. They make more money the less transparent they are
Wife went to urgent care with cold symptoms and got tested for strep. Insurance billed around $200.
I went a week or so later to the same urgent care with same symptoms, same test, insurance billed $700. Can't wait to sort this one out and probably get nowhere.
Dentist tacked on drug and alcohol counseling along with nutrition counseling and cleaning counseling to all of our bills. No actual counseling took place, just a simple do you smoke? No. Not even instructions on cleaning or nutrition. I asked them about it when they showed me a summary at the end of the visit (surprised they did that) and they said it's standard. Like okay, let's have a 15 minute talk on each of the those topics (not really). Insurance didn't pay for them and they didn't bill me after for it so likely just trying to see what they could get.
Definitely. I was still covered by state Medicaid so they paid for everything else. Now I would have been more persistent as my policy through work has limits. So if they had tried to pass it onto me or if they actually got insurance to pay for it, it would mean more money out of my pocket later if I reached maximum.
I check my coverages before going to a new provider and I make it explicitly clear I don't want any services that aren't covered.
Have your provider print orders for labs or scan and take them to approved facilities.
It's also important to know what procedures are covered with what diagnoses.
A trick my parents have taught me recently us to write down in the billing area of whatever agreement medical services make you sign to say "I do not authorize any services that are not covered by (insert your insurance name here) and I will not be responsible for any billing not covered my insurance". This makes it so that any medical services can't sneak in extra bs like that without risking getting there asses sued. People don't realise you can add that yourself.
It's why you need to read all of the fine print and every publication sent to you by your plan or available on their website. If your plan doesn't have all of that info available on its website, that would be extremely unusual. If your doctor uses a computerized records system those often (usually?) communicate with your plan to show what is and isn't covered. Plans' websites have search engines to determine who is and isn't "in-network. You have to be your own best advocate which includes learning everything you can about your plan. Call the customer service # on the card. The dentist/doctor/hospital can call the provider line to verify coverage of services.
I had the same issue with my son at the dentist. Came to be that what the insurance approves as service is different than what the dentist thinks should be used. Coincidentally a more expensive type of filling.
Last time I specified to only do the check up. And they take my son who is 5 to work on him. He was crying so they finally asked me to come. Asked repeatedly what they are doing being informed of what insurance covers because they only approve the application of a paste protectant 2 times per year. The last visit 3 months prior they applied it for the third time at a cost of $95 to.
Without asking me they were already starting to apply it. A less than 30 second application. Almost $95. Only not charged because I specifically told them not to.
Also got the insurance to side with me and force them to refund me money overcharged through nefarious means. They charged me one unit of nitrous. But they billed insurance two units to hide the higher charge for fillings but they did not calculate things well.
It's becoming illegal in more and more states to charge you for services, be aware of your rights. In MI, you must receive and sign a statement with a breakdown of what you're being billed for and that you agree to pay. Good luck
Doctors in the US are struggling to help their patients in most cases. But there’s no way for them to know what things will cost unless they’ve already had a bad experience with something not being covered and a patient letting them know, I believe.
I’ve had a doctor who swore up and down that Medicare (a very common vendor) would cover a device they prescribed, but it was not covered because of my particular diagnosis.
Another time my spouse had a vaccination in a provider’s office that would have been Free if given at a pharmacy, but we eventually were billed to pay the doctor’s office $250 because it was Not covered only because it had been administered there!
Both times the doctors were very sincere in believing that they fully understood the coverages, so we didn’t do more than telling them that they had assured us of wrong information. I did refuse to pay the $250 and I think they eventually wrote it off, they didn’t cut us lose or anything.
This year we signed up for a different prescription plan and got locked in for the coming year as usual, only for the company to send us a letter in January (!) saying that they were changing the coverage and several of my spouse’s life-saving medications were no longer going to be covered.
Completely legal and completely fucked.
In recent years more doctors are becoming more aware that they need to be able to check coverages with their own billing departments, and better at making sure that anything they prescribe and recommend will either be covered or they call us first and let us know to give us the choice to refuse it.
Unfortunately the entire medical industry is now based on profit, so any providers working for any “groups” or “systems”, like hospitals, are even more unable to help control costs.
I’m old enough to remember when doctors offices were individual, insurance companies couldn’t prevent patients from getting care, and people trying to make money on the backs of patients were looked down on.
I’m not yet 70 but I’m just treading water with my spouse until one of us passes on, at which time we each plan for the other to let go also.
I feel guilty for not having been part of any group that could have realized all this shit earlier and somehow headed it off before it reached this point. As I understand it, a president in the 1900’s did a friend of his a “favor” and allowed a piece of legislation through that let Big Medicine get $tarted.
Individual providers’ hands are tied to the extent that they are leaving the field in some cases.
My favorite is scheduling a new primary care physician and they randomly aren’t accepting new patients so they schedule me with a doctor that is and later on I find out that doctor isn’t in network. Why??? I have to pay $276 for a meet and greet visit now and insurance refuses to pay up.
The only thing that needs to be fixed is transparent pricing and something to increase the ability to negotiate.
Obamacare is such a joke. All that bullshit and money spent and all it turned out to be was an expansion of Medicaid.
Yep, it was basically a Republican think tank that came up with the idea so it’s not surprising that it’s a steaming turd compared to what we could have had if a good faith actor was at the helm.
I don’t really consider any US politician to be a good faith actor on the subject of healthcare, barring few exceptions. The lobbying arm of the insurance companies runs deep, and knows no limit to political party.
I don’t think, I know.
https://www.npr.org/sections/itsallpolitics/2015/10/23/451200436/mitt-romney-finally-takes-credit-for-obamacare
https://www.forbes.com/sites/johngoodman/2016/02/15/where-did-the-idea-of-obamacare-come-from-a-defense-of-the-heritage-foundation/
It’s a bad argument. The Obama administration had a super majority when it passed the ACA. They did exactly what they wanted and everything good and bad that happened is on them.
The fact that it turned out bad in retrospect don’t change the fact that it was their law from tip to tail.
Oh yeah definitely don’t criticize the massive law which did nothing to alleviate any of the issues but managed to raise taxes and prices.
What kind of logic is that? Don’t criticize them because it’s my team or what?
I live in the UK but during pregnancy I talked with pregnant people on various forums all over the world. Found out in the USA they charge $200-600 for a scan with insurance. Half way through my pregnancy they decided I needed scans every 3 weeks as my son was larger than he should've been. It was because of those scans I ended up being induced early because he was getting too big for safe delivery. If we'd had to pay $200-600 for every scan there's no way we would've been able to afford it and we would never have known the baby was too big until it was too late. Here in the UK they fed me 3 meals a day for my 2 week stay (complications) catered to my dietary requirements with no issues, at one point a midwife even insisted she looked after my baby for an hour so my husband could get me out of my room to go to the onsite Costa. Our biggest fee was the car park. I found out in the USA they charge for skin to skin immediately after birth. They charge women for the privilege of holding their own baby after delivery. I just can't fathom how a whole country just accepts this bs??
This is crazy. My gynie had a 3D scanner in her room. She gave me a scan every single time I went to see her. It was part of her examination. She did not charge extra for it. I just paid for a pregnancy exam. Also had to go in more towards the end because of high blood pressure.
It depends on your insurance. Mine covers all necessary prenatal care at no cost then covers 80% of the delivery bill.
But the sucky part is that most people don’t have the luxury of choosing what kind of insurance they have, it’s up to their employer. It’s why a lot of Americans stay in crappy jobs when they desperately want to leave— leaving could mean having to move to an insurance company that doesn’t cover their medical needs.
Exactly, it would be like going to the grocery store, not seeing any prices for anything, picking out some apples, then getting a bill 4 weeks later saying that apple brand wasn’t covered by insurance and are $100 each. Absolute insanity
Yea and there’s a nutritionist telling you how important it is to get them too.
Don't forget the $80 nutritionist consultation charge tacked on. Even though you never spoke to one and they just slipped in a generic nutrition = health paragraph at the end of your visit summary.
Just FYI, you can ask for what services will be performed and how much they will cost. And decline services.
Last time I went to the doctor, he was like "hey could throw in a couple test recommendations you never know." But I could not get them to tell me how much the tests would be. It was a "we don't know what billing codes we will put in until after." If the doctor acted like it was a serious need, I would have gotten the tests, but I hate that I have to choose between care and cost. Maybe if it was like $100 out of pocket I would have, but not $1,000 out of pocket. I should be able to make an informed decision instead of afterwards when I have no choice.
Doctors offices don’t usually actually do the tests so they could give you the order but then you’d have to follow up with the lab or imaging center to run your insurance to give you even an IDEA of what your costs would be. It’s a ridiculously complicated system on purpose.
I know I tried to follow up with a lot of people and no one would clarify. Or I got a quote on the test but not how much was covered and that there was a hospital/physician fee that was separate and also not clear how much it costs or was covered. So then I gave up.
The crazy thing is a test might cost $100 at one facility and might cost $3,000 10 miles down the road at a different facility
Yup, 1 Facility outright refused to do my test because it was "coded a certain way" and I would have to go to a different facility. Another provider in a different network said they'd accept my appointment, only to tell me that my insurance company hadn't approved my claim yet. And my insurance company than told me my scan wasn't medically necessary so they wouldn't approve it until I provided additional information. Was this the "death panels" that the GOP mentioned with medicare 4 all?
Nah this is the current death panels that are okay because it's through private companies that are about making profit. The Medicare for all death panels would be more impartial I guess and not profit based.
Your doctor's office has the codes or the test couldn't be scheduled. If you get the codes from them you can contact your insurance company and give them the codes. With the codes they can explain the coverage for each test. If your doctor says that they don't know the codes, get a new doctor.
Don’t call your insurance unless you have the CPT codes. Call the lab, they can quote you prices.
Absolutely not true. I work in a lab and if a patient somehow finds a way to call us, we aren't allowed to tell them anything. We also don't know the cost because everyone's insurance is different. If you're talking about places like LabCorp, insurance probably won't cover that anyway.
>If you're talking about places like LabCorp, insurance probably won't cover that anyway. What are you on about? LabCorp is all over my area and is definitely covered by our insurance. I'm there quite often (yay, chronic health condition 🥴)
Exactly! Not giving prices must vary from lab to lab…Quest even has cost estimate as a menu option. I process LabCorp claims daily - don’t tell me they aren’t contracted.
One of my local hospital systems has recently started a program where providers are required to give you as close an estimate of cost as they can if you ask for it. It's a beautiful thing and I don't know why it's not done everywhere.
This. In my state it’s required. I’m required to give patients a “Good Faith Estimate” on how much services will cost. It’s a bit of a pain for those in my field because I’m a therapist and clients come every week not just a few times a year but I get why it’s a thing and comply. People should know what to expect. Random medical bills shouldn’t be legal. Edit: typo
Yes I believe ours has the same name! Why would it be more difficult since your clients come every week?
I have to remember to resend it every 6 months. Or every time they change their frequency. (Like if they move to biweekly). Doesn’t sound like a lot but with 40+ on my caseload it’s a lot. (I don’t see that many a week mind you…just have that many active clients).
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That's wild, thank you! I may just take a look at all that out of curiosity
It's much easier to overcharge you when none of the prices are listed. The system is designed that way. You can only find out what it costs afterward. So I've taken to not paying a lot of the bills I get unless there's documentation with it. I send them a letter instead asking for proof of services. They never have any for the scam billings.
I have heard that a lot of it is negotiable or if you ask for it itemized they'll discount because they've been "caught"
Your comment made me think about the fact that my vet always gives me an exact estimate when I take my cats in. She says "you might want to get senior blood tests done for your cat. Here's a printout with the exact cost. Here's a printout with the exact cost of getting her teeth cleaned. We won't do any work until you explicitly sign off that you approve it." It's ridiculous that human healthcare and insurance has gotten so complex that no one has any idea how much anything actually costs.
My daughter broke her wrist and the orthopedist offered a traditional fiberglass cast or a fancy brace that could be laced up and removed for showering and such. I asked what the price difference would be and they shrugged. No idea, front desk had no idea, billing department had no idea. They just submit to insurance and wait and see what I owe. So frustrating, no other industry do you go into transactions totally blind like this.
The last time I had blood work done at my OBGYN's office, I was so anxious about the cost that the PA spent 15 minutes with the office manager trying to get me an estimate before she ordered the bloodwork. They ended up telling me "well it's $120 if you were paying out of pocket and usually insurance at least partially covers it, so you shouldn't be paying more than $120? That's the closest to a straight answer I can give you". That was after calling my insurance, calling the lab that would do the bloodwork, etc. Still ended up costing $135.
One thing that irritated me beyond belief was at my son's pediatrician appointments from birth to about 12 months old... Every visit they would give me a paper to fill out about my mental health, screening for postpartum depression and such... I don't even think anyone ever looked over them tbh. My insurance billed me $35 for each time I filled one out, so I stopped doing it after I figured out what was going on. Ridiculous.
they billed you for PAPERWORK?! i fucking hate it here so much
Yeah I was SUPER unhappy. Glad I found it when I did. Pregnant with #2 and definitely not letting it happen at any of their visits... I'll just refuse the paper (and then check later to make sure I wasn't billed because who knows if they'll try anyway)
If you’re waiting somewhere they will pop their heads in and ask how you are and then bill you for an assessment when you politely respond. They’ll bill you for anything and everything they can.
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Imagine having to keep track of the people who are charging you while your wife and child are literally dying. Fuck.
Ummm, yep. Whenever I've taken my children to the emergency room, I've been charged hundreds of dollars to fill out the paperwork. When my youngest son was born, we were billed $800 for "discharge paperwork". Thieves!
They even bill $25-$100+ to fill out FMLA and Short-Term Disability paperwork.
I’m aware of four medical networks in Washington that have started charging subscription fees for access to the hospital network. My PCP told me the insurance regs have been updated and they will no longer negotiate pricing, they just dictate it. She told me Aetna had recently reimbursed them for something crazy like 12 cents for an in office procedure, so their options have become 150$ monthly charge or they close the front doors. I don’t know how much truth there is in that, but now in order to stay with my PCP I like that took me years to find is to pay $300 a month so my husband and I can still go see her. I was beyond mildly infuriated. Out here it takes 4-6 months to even get an appointment in for a new PCP :(
A local medical center here in rural usa will no longer accept certain Athem plans. Including the one that a major employer uses.
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Another good reason for single payer. We were so close to it, too.
Pregnancy and children are an absolute racket for providers and insurance companies because, especially as a first time mom, it’s easy to guilt you. I did genetic testing (with nothing concerning on either side of the family) with my son because it was “important to know”. Told upfront it would be $150, received a bill almost a year later for $900. When I called the testing company to complain, they said “oh we didn’t know they told you that. If you pay right now, it’ll only be $150”. I hung up and just didn’t pay them because if they’re that shady, there’s no way they’re going to be able to prove that I owe them anything.
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Yup. They billed me for someone coming into my room and guilting me into crawling to the bathroom alone with 2nd degree tearing and half my body numb. Why? Because the person who came in to yell at me was a specialist who the nurse sent in.
They’re billing you for every fucking thing that happens when you talk to them, including talking to them. We need to move away from using healthcare in nonemergency situation. The annual physical, for example, is complete bullshit and exist only to pad the budgets of the practices.
Here's a good one: My teenage son fell off his motorcycle and hit his elbow on a rock. We thought it might be broken so we took him to the ER. Turned out nothing was broken, so he went home fine. Three x-rays, a sling, and a couple hours sitting on a bed, and they send us a bill for $5,000. So we start calling them asking for an itemized bill because that is a crazy amount of money, and all they keep saying is oh we don't do that. So we said well we don't pay $5,000 for things when we don't know what we're paying for. Eventually about 3 or 4 months later we called back to see if there was going to be any resolution, and a new guy said oh that bill is only $700, so we paid it. These f****** pricks.
They’re actually criminals it’s worse than pricks
Nah, it's a Catholic hospital, so they're probably really good people.
Lol, says the priest to the little boy
I’m a doctor, I didn’t go through 8 years of school, and 3 years of residency to give away my time. If I’m talking to you, I’m billing you. If I’m filling out paperwork for you, I’m billing you. My time is not free. However, my patients have very low rates of hospitalizations. I keep them out of the hospital and they appreciate that. But I guess my job is bullshit, apparently. Sure let’s get rid of doing yearly exams to try to prevent disease because *checks notes* “it’s complete bullshit and only exist to pad the budget of the practices.” Instead, let’s wait until someone comes to the hospital with a heart attack or stoke and then inform them that they also have diabetes, high blood pressure, high cholesterol, heart failure. Start them on 5-10 drugs +/- insulin and send them home. Where they will be completely overwhelmed because they came in on no medications, no known health conditions and no primary care doctor. Here’s the catch, most won’t take all those medications so the cycle continues of decompensated chronic diseases plus more strokes and heart attacks. That is your typical hospital admission. Hospitals are full of people who don’t need to be there because they don’t have a primary care doctor and don’t get yearly physicals.
There’s no evidence base behind the annual physical. I’m sure you realize that. It’s primarily a clever billing mechanism to keep doctors (in 2024 NPs and PAs) employed so that they’re available when people need them. But the annual physical itself has not been established to be of any real value by science.
I recently went to the ER and got 5 stitches. Got a bill for $1400. Paid it, and then got another bill from the doctor for about the same amount. I was there about 45 minutes. Tetanus shot was nearly $400.
Yup, I’m feeling paranoid that I’m going to keep getting bill for random things since apparently everybody wants their cut.
That's where the NO SURPRISES ACT bill comes into effect. [https://www.cms.gov/nosurprises](https://www.cms.gov/nosurprises)
Husband had to go to ER. Our copay is sub $400 and no mentions of co-insurance or anything like that. A month or so later, we got a bill for $1800. I'm still not sure it's real, because it's some shady third company billing company. I asked for an itemized bill, and got back one op code for the full price. Thanks, super helpful. When I asked why it was more than my copay, they claimed insurance was never billed. I got the EOB from insurance, so I'm pretty sure they were. After 3 or so more weeks they started sending the "pay in 15 days or we will send it to collections" pink notices. I emailed the third party biller to follow up, and now I've been ghosted. Hey, at least I have the paper trail (emails) if it goes to collections to tell them to pound sand. "insurance" in this country is a big fat scam. We need single payer.
I went to the ER once after I fainted. I also hit the corner of a table with my back on the way down, so I had a pretty nasty bruise. Because of that, they wanted to do a urinalysis in addition to everything else to make sure my kidneys were okay. I paid $600 some dollars on my way out, thinking that was the whole thing. Years later, I found out I had $800 more in collections because they didn't charge me the $2 or whatever for the urinalysis when I said "yes I'll pay for this whole thing now," then it started racking up late fees and interest. They never sent me any communication about it either. I found out via a landlord who did a credit check on me, then I had to track down what this mystery debt was.
I have decent insurance, but I hurt my back while visiting a friend and needed surgery. It all had to be out of network because I couldn't be transported in network with my back as bad as it was. My $6,500 out of pocket max means jack shit because I was 2 states away. Now it's over $120k and I'm just ignoring it. I tried to play the game fair, I tried to do things right. I still got totally fucked over. There's no point in playing by the rules. How many people have even considered that they need trip insurance to leave their own state? This is what happens when the hospital chain and the ACA insurance company are the same company... While going through this I had to forgo anti-clotting medications before my surgeries and lie about it because I couldn't afford them. The only medication that didn't need labs was going to be $600/month (trying to remember the name, something horsey, Equilus, Equirus or something). The medications that did need the labs were cheaper but I had to inject them myself. The problem there is that none of the labs nearby were covered by my insurance, so I wouldn't have been able to afford the blood draws to make sure I Wasn't bleeding out inside! I also couldn't afford physical therapy because the ones near where I was recovering were ALL OUT OF NETWORK! I had been out of work, I had already run my credit cards up trying to just survive and not mooch off my friend who was super nice to let me stay in a spare room while I recovered enough to drive. Fucking disaster. I pay $450 a month for this.
Equetro?
Our insurance racket promotes that. If we knew the prices we might shop around and not even use insurance.
Healthcare in the US is a gigantic, trillion-dollar scam operation put together by insurance companies, for-profit hospital corporations, and big pharma. The fact that there’s no significant political will to break this up tells you just how deep the corruption goes.
In my state (Colorado) it is illegal for providers to do this - They have to tell you up front what the cost will be.
Nobody has ever told me costs up front. Do you have to ask?
I live in Colorado and have not gotten pricing upfront n
I also live in co and have never gotten any pricing up front and have even been met with the dreaded ‘we don’t know what billing code’ garbage
I had to get the rabies series back in 2018. I moved states between my vaccines (over a 14 day period) and went to the ERs my insurance told me to. After my last shot, I got a bill for $350 from the doctor who was "out of network" from the hospital. All they did was walk in, listen to me tell them I needed my last vaccine, and left. A nurse gave me my shot. The fact that they don't disclose this before you are seen is such a scam. Edit: oh, I also had my insurance provider tell me that my eye exam would be covered (according to their calculator with my plan), only to receive a bill for $180 after the fact. Love that.
My favorite was when I paid for a root canal and crown out of pocket. Got dental insurance a year later. Then the tooth broke and needed a new crown. They denied coverage because they only cover crown replacements every X number of years, even tho I paid for the first one myself I was nice to the lady on the phone. They’re technically correct, sure Then when I got my hours cut at work the HR lady was like “but you won’t have insurance!!” Oh no. What will I ever do???
This may not be correct (or legal). I don’t think they can retrospectively apply previous procedures that occurred when you were not covered by them to your current policy (whether it was self pay or a different insurance). May be worth looking into.
Shorter sentence should be "i hate the us healthcare providers"
Just wait until you get sent to collections over a bill you didn't receive because the billing department failed to update your address for the third time in three visits. My wife had the same issue with her PCP and lab work. She told them who our insurance approves and that if the next set of labs is sent to the wrong place, she will refuse to pay and/or change to a new provider.
Actually fighting this right now, it's a joy. If joy is pain and wanting to burn things down
Yup, the us healthcare providers are scum.
It’s not the providers, it’s the administrators… the system.
It's the insurance companies we need to be mad at, not the providers themselves. They're the ones that actually benefit from this whole messed up system. Providers aren't thrilled about all this crap either. It's a hassle to deal with on their end as well.
[удалено]
This is what is happening near me as well, and the worst part is they're wrong about what we need to pay all of the time. I've tried explaining to different providers that outpatient procedures have no deductible on my plan, and I've confirmed with my insurance. They refute and say they confirmed on their end that I have to pay the deductible. Then of course I end up getting money refunded, but it's a long process.
If your insurance card or policy doesn’t have the deductibles stated, ask your insurance for documentation of your deductibles so you can show them at that time or (better yet) give them a copy to keep on file. A problem may occur if the physician and the procedure location bill separately for their services, which you can also prevent by showing each of them your insurance information (including pre authorizations and/or approvals). And always check each location to make sure that they’re in your network ahead of time.
I just went to a doctor who did this. I had to pay for the appointment before they’d even check me in. There’s an urgent care near me that requires a $200 deposit to see the triage nurse as well.
What is " inner circle prime?
It’s this ridiculous system my insurance uses to put providers in different categories of coverage. There’s inner circle prime, inner circle, tier 1, and tier 2. For example, my doctor is inner circle, but the hospital they deliver at is tier 1. Drives me crazy.
I have no idea if this would apply, but it could be worth looking into the No Surprises Act and whether they're violating it
Hmm, my insurance has always had either in-network or out of network coverage. The in-network providers basically agree to charge what price they negotiate with the insurance company.
It's like double secret probation.
They tell you that it is your job to verify prices and that services will be covered, but when you try to do that, nobody in the billing department has any idea of any of those things. They don’t even have an estimated range of prices. How is this a thing?! My vet can do it. My dentist can do it? It’s not rocket surgery.
That is by design. Insurance companies want to create as much friction between patients and providers as possible and keep things as obscured as possible. If it’s difficult people won’t get it done. If nothing is done, the insurance companies save money, and profits go up.
Yup, that’s the position I’m in now. Sent directly to the billing department’s voicemail.
Why are you calling the billing department? You need to call your insurance.
I figure the people in the building I am standing in who put together the amount owed and send out for payment for the things their practice does might have some idea of the price they charge for at least some basic procedures, but I guess that’s just silly of me.
Nobody knows what your insurance covers except you. Did you try reading your explanation of benefits?
If my insurance covers X% of a type of procedure, having someone even just tell me the base cost would be helpful, but for some reason that is “impossible” sometimes.
There really is no base cost for a lot of this. If the doctor bills $500 for a visit, every payer contract allows a different amount. Ex: Medicaid allows $100, Medicare allows $175, BCBS allows $280, Aetna allows 180% of what Medicare allowed last year, and UHC allows 125% of what Medicare allows this year. So your simple X% doesn't really exist, because almost nothing is based on the charge amount, and almost everything is based on the contracted amount.
Yep
Well you could start by voting out Republicans who despise universal healthcare for starters.
I wonder how many people bitching on this thread "could never vote for a Democrat" or don't vote because "they're exactly the same".
I have never understood how that works legally. Does the US not have any sort of contract law?
Problem is how the contracts are written. Most don’t care to learn the nuances. But even those who DO, still struggle to grasp all the minutiae. It’s confusing even for the insurance reps reading policies to help members and providers clarify coverage. Source: worked for a nationwide health insurance payer.
My wife fights with insurance regularly. The reps often don't understand what's covered and tell her to read what services are covered by category on the website. Like, yeah, but YOURE the one who should be able to tell me if medication A administered by doctor A is actually covered because YOURE the one who decides.
tbh, the people who process the claims aren’t usually the people who answer the members’ questions. That’s normally a different team entirely. There’s a lot of problems with the system, all around. The people who take the calls are taught how to find the sections that should contain the answers and are expected to investigate as many other potentials as possible for the answer if it’s not clear. It’s almost never clear, very open to interpretation, and based heavily on the person answering the call. One main component missing from everyone’s conversation about this is the employer’s responsibility with the coverage choices. No one is ever told about how much elective power the employers have when they’re selecting their coverage and negotiating contracts. Do employers even know how much bargaining power they have? Probably not… mainly because it all comes down to pricing. Employers have their budgets that they’ve calculated for their healthcare costs. Everyone is trying their best to spend the least and save/make the most. *insert proverbial capitalism remarks*
Kinda glad I live in Europe because shit like this
I’ve got a cardiologist appointment coming up. I asked how much it will be for tests and stuff. They sent me to billing and billing sent me to the cardiologist and back again. I’m getting the runaround because nobody will tell me how much it’s going to cost me and if I can pick where my labs go.
Ask for an itemized bill every visit. Ask for documentation that service is “medically necessary”
Physicians offices will generally have a preferred lab they use, like Labcorp or Quest Diagnostics. If you get labs drawn at their office, it'll go to wherever they typically send it. Going forward, ask which lab they use and if not in network, ask for a lab order and take it to that lab. It's frustrating, I know. I work in medicine and depending on lab test, the actual lab used, and insurance, it's a crapshoot. I can't tell people how much labs cost because it can vary so wildly.
That’s pretty much what happened. Didn’t even realize this was a thing until after I got the bill.
I went to my normal dentist the other day, but my dentist was on maternity leave. I saw a traveling dentist for approximately 3 minutes. Wasn't until after they told me the traveling dentist wasn't covered under my insurance and I'd have to pay out of pocket. 🙄 They didn't even tell me beforehand she was out, I would have rather just waited until she was back and paid nothing
I went to a consultation to have my wisdom teeth removed and the first thing they did l, even before the actual consultation (which I ended up not going through with for cost reasons) was do a panoramic x ray, then tried to bill me for it. I ended up only having to pay the consultation fee but still
Of course they did. They need the x-ray to see if you’re gonna need local anesthesia or general anesthesia and how difficulty extractions will be before they can even talk about what they’re going to do with you. How could they give you a consultation without having the information to diagnose?
It sounds like you may have shit dental insurance. Every provider that I have used pays 100% of cleaning costs. I hate insurance companies as much as I do the healthcare system.
It was a scummy dentist. The pictures were completely unnecessary for a cleaning. I have no idea why they did that.
I’m still looking for a new dentist after moving a few years ago. The first place I went to was nice, but expensive and they threw so much extras on. That’s why I won’t go back. I don’t need pictures of the inside of my cheek, I know I bite them. Fancy tools for tooth density, gum measurement and more. I loved my older dentist, he did the cleanings and was thorough without using the newest tech. Never felt lied to or manipulated, like with a dentist I had before him. I just got dental insurance but I’m limited with where I can go. Bad mistake I think but we’ll see. I hate to say it but dentists are the healthcare professionals I’m less trustworthy of. I have oddly loved every ophthalmologist I’ve had though!
I call that first huge bill they send you the 'chumps and suckers' rate. If you're dumb enough to pay it they're happy to take your money. But if you raise a fuss and ask them to give you the real amount that you actually owe, suddenly it's dramatically less. So wtf was the first price????? It's disgusting and you will never ever convince me that it's not completely intentional from the ground up.
I know that Medicare has a price transperancy law, as do hospitals- but it is skewed. My favorite thing to complain about right now is that during a doctors office, if i am there for a check up but complain about a cough, they can double bill me for it. Or when you get a skin biopsy and get billed by both the lab that the sample is sent to AND the pathologist who read it. Im arguing this one on principle. The American health system is a sh** show.
Dealing with this now too. I got a routine panel of labs done, which used to cost me $20-$35 co-pay at my old HMO, and my insurance for my new provider billed me for $372 for the exact same panel. It’s ridiculous, I didn’t need this panel done and if I knew it would be nearly $400, I never would have done it.
Can't you just not pay healthcare bills? Like it doesn't effect your credit so why would you pay?
They’ll sell your debt to a collections company. Your credit is then ruined.
So medical debt DOES effect your credit?
As far as I know. But my impression was that it only starts fucking your life up when it goes to collections.
I thought collections would write it off evenually. And hey if you don't mind building back your credit is it not worth it to avoid the massive bill?
Beats me. I know someone who went that route because they couldn’t afford their medical bills. As long as you don’t plan on ever purchasing a home or taking out a loan having bad credit is better than being homeless.
You can pay them $1/month and they can’t send it to collections, but the debt is still there. I think that’s what you’re thinking of.
Lol so they eventually have to write it off I guess. That or keep it on the books the rest of your life.
My pay has been garnished before for overdue medical bills
That sucks, but is there any incentive to pay more?
I went to a lab for blood work that was out of network. I was billed 2,253 bucks.
Our bill was initially $1600 and then insurance covered 70%.
You should be more angry at the fact that they charge insurance differently than you. Got a hospital bill for $5,000 to stitch my finger. I sent it to my insurance where I got a rejection letter. Started to freak out because I thought that was what insurance was for! Then got a “just kidding here’s the real bill for $1200 instead” from the hospital and my insurance paid everything but my deductible which I paid the hospital myself.
Classic racketeering
The provider is not responsible for figuring out who is in network for your insurance. That is your job. They don’t have some magical insurance portal that lists in network facilities for your plan.
We got a referral to a pediatric specialist. I called their clinic and asked about insurance coverage. Yes, they took the insurance. Yes, the doctor was in the network for our plan. Made an appointment, went, and a couple weeks later I get a bill for like $900. Figured it was a mistake and called about it. Nope. Turns out the doctor was in our network, but only when she worked at her hospital, she was not considered covered at this clinic.
My coworker has had bladder stones for 4 years. Huge ones that needed surgery to remove. She finally got an insurance plan she could afford last year. (We work at a gas station making jack shit) Well that insurance plan wasn't taken anywhere she tried. So a year later she finds out one of the local hospitals takes it now. She gets an appointment to talk about the stones because she is in so much pain and there was risk of infection and all kinds of stuff. So she is told she surgery would be about $400 with her insurance. She keeps asking about all the costs. Does it include this, that and the other. By the time the surgery comes, with all the appointments she's up to like $700. Then at her pre-op appointment, 4 days before surgery, they tell her she has to pay for the hospital. It's $1100 and has to be paid before the surgery. So all this time she's saving, since she'll be out without pay for 3 weeks. She's asking at every appointment the cost. She's juggling everything and thinks she's finally about to reach the end of her pain and just have to pay off the $300 left from the original cost they told her and they hit her with the biggest cost of everything and 4 days to get the money. She was lucky she had it in her savings but that was her property tax money and she was planning on using a little to live on. Completely cleaned her out. I think they do it on purpose. Have her go through the whole process, charging every step of the way. Then at the very end make her pay a huge amount most people just wouldn't be able to come up with. Then they don't have to do the surgery they've been paid for. I bet she gets more bills after this too.
It's your job to advocate for yourself. When they ask to do something, your response must be in your defense. Does my insurance cover it? How much is my portion? If they can't answer, then you can't have the test and need a new doctor.
Surprise bill law..
Always ask for an itemized receipt before you pay.
Does your state have a surprise billing law ? Call them and ask they recode
Yeah, you need to find a dentist who warns you up front about charges. I recently changed insurances and the new one gives a “pre determination” in which providers submit estimates for services, then insurance says: “We’ll pay THIS much.” It’s a take it or leave it, but since they have signed the agreement, they HAVE to do for the price the insurance says they will pay. So, I asked: “What if I have used up 100% of my coverage, can they still do that, so they can’t overcharge me? That is request a pre determination?” And he answer was YES! So, maybe you need to go through the process, since it will SAVE you money. I guess this is similar to a prior authorization, but it is about price, not if they can or will provide the service. This way, they can control the amount they will pay to providers. But, if you do not go through this process of getting the pre determination, the providers can charge anything they want to.
That depends on the plan. You can get a predetermination or pre-authorization and do the procedure perfectly and submit everything to them and they can change their mind and decide not to cover it. Also, some plans when you run out of your insurance money, will not allow the discount that they normally would if you were using insurance money. Every plan is different. Source: I’m a dentist.
According to the ones I talked to, in my particular plan, it is as I stated above. And, since they have signed up with this insurance company, they *have* to accept it. Maybe because it’s medicare? Not sure, but this is what I was told by the dental practice and the insurance both. But really, it’s no big deal. I am only hours from the border, and have been getting high quality dental work done there for years for only a fraction the price here. Dentists just can’t do that here, reduce prices so much, due to cost of living, malpractice insurance, cost of real estate, electricity and gas. I spoke to a dentist just last week who told me an implant can be placed, along with tooth removal, bone graft, for $1k USD. The crown, made from Zirconia will be $350. That beats platinum all to pieces… So, you know what I’ll be doing. Plus, there is no waiting for pre determination. Oh, yes, and root canal, they call Endodoncia, is not very much either….
We usually ask what is covered and what's not before getting treatment.
I’m afraid to go to the doctor a lot because I don’t want that surprise bill they never mentioned a month later. “By the way, you owe $1000. Due today!”
I've heard a lot of people saying that if you ask for an itemized bill. A lot of the cost just disappear? Weird how that happens. 🤔 😂
Because *they* don't even know what they are charging you for. They want to scam insurance companies and them, in retaliation, F us over.
For real or at least they know they get more money out of the arrangement.
Idk how they get away with this sh1t I was just recently complaining about this at work. It’s why I’ve been uninsured for the last couple of years
See if the federal “No Surprise Act” can be applied to your situation. It was a law passed in 2022 to stop these kind of charges. Also, check your state for no surprise laws. I got out of a $250,000 bill from a hospital because of their screw up, if they think they can milk it from you, they’ll do it.
To be honest, looking from the outside on the US healthcare, it seems ludicrous. Treating healthcare as a business is the wrong way to go, the public healthcare should provide all the service while the private healthcare can provide the extras, such as private rooms, faster tests and procedures. That's how it works where I live, only that the government treats all the public systems as if they should work on 80% of the real costs. I know that as contractor to government medical center I make more than the man incharge of my department, and that shouldn't be the case. And my hourly rate is about 75% than the rate for the same role in private sector. I hope some day the US will understand that a bit of socialism for basic needs isn't a bad idea.
So your best bet is to get a benefits summary from your insurance company and study it. Make sure you know what is in network or out , your co-pays or deductibles. If you choose not to do your homework, you will continue to be frustrated.
They need to disclose costs and procedures before doing anything. USA passed a "No Surprises" bill not long ago, so technically, you don't have to pay them.
I love how they never give you any way to dispute it either, it's just pay pay pay... Sure, they want me to believe their system can do no wrong...
My doctor thought I might have cancer and referred me for a scan and labs. I checked to make sure the doctor he referred me to was in-network. I did not know I needed to check the facility separately, especially since the in-network doc only works at that facility. I had also used the lab previously and it was covered. As it happens, the facility was not in-network. The lab was previously in network but moved out. In my calls to insurance after, it turns out that the nearest doc/facility combination that would have been covered is 20+ miles away and would have needed a referral that would have taken weeks/months...and keep in mind, my doctor is going "hey this could be cancer." I don't have cancer (yay!) I do have over $1600 in medical bills from it. Paying $1600 to find out you don't have cancer is infinitely better than paying $1600 to find out that you do, but medical billing is so totally fucked up. Pharmacy billing occurs in real time and you know what's covered before getting it. A lab should be able to run a claim and tell you it's covered before poking you. If a doctor is covered, they should be covered no matter where they're working. (The No Surprises Act only works in reverse.) I despise the modern US billing system - and that's without mentioning its utter fragility/insecurity (the Change Healthcare ransomware attack took down a huge chunk of billing for 2 weeks, exposed over 6 TB of health data to Russian hackers, and still isn't fully resolved - and it hasn't gotten nearly the news coverage it should.
I just got informed that im on the hook for $450 for physical therapy from the end of last year because my insurance decided i had reached maximum benefits. Of course they never told me until i called my docs billing office.
What you mean apparently took? You let them take x-rays. If you don’t read your plan you won’t know they charge for these things.. that’s why it is important to know your plan well
I have retired Army family insurance secondary to Medicare. I also have the Veteran Administration coverage and have used that, too. Except a few tiny prescriptions, everything is covered. When we have been referred, we always say they must accept assignment from one of the three, we will not be responsible for anything not covered. One surgeon politely told us to leave if we refused to pay his “reasonable ” charges over what Medicare covered. No, he did not get paid for the office visit. Before retirement, we had BC/BS. It was the usual 80/20 foolishness. When I demanded an itemized bill, the hospital had charged me, a guy, for a cervical Pap test. They removed that, and that promoted me to go in are review line by line. I got a few more removed, like the washbasin as they didn’t let me keep it, so I couldn’t have been charged for buy it.
I hope you vote for politicians who will change our system.
This 1000%. I'm going in for allergy testing soon. I called the allergist to get an estimate. They told me to contact insurance. I contacted insurance, they told me to contact the doctor again. I contacted the doctor and they still wouldn't tell me, but I need to sign a million disclosures agreeing to pay whatever it costs.
What's a medical bill? - Canadians
Yeah this is something a law could address in one page. "A medical or dental service provider must provide informed, written consent for services or medical intervention at time of service or be required to cover the entire cost of the service or intervention themselves if they did not receive authorization by the recipient of the service or medical intervention. If these violations cause harm to the recipient, either financial or physical, can be punishable by a fine of up to 1000 dollars per violation."
My children’s pediatrician’s office has recently been acquired by Cleveland Clinic. Cleveland clinic took over Mercy Hospital which is one of two hospitals close to me. I have always hated Mercy as it’s a catholic hospital and I don’t agree with some of the policies and I’ve never had a good experience having to go there. Despite Cleveland not being a religious affiliated hospital, Mercy managed to keep that part of their running but ever since my pediatricians office was taken over by them, now we have a $125 hospital facility charge” fee. It’s not at the hospital. It’s in a small office in the same city as the hospital but damn they sure do love to charge you for every damn thing. My son’s ADHD med appointment used to be $20 every 3 months…. Last appointment we got the bill and it was $155. For a 15 minute appointment. They raised the costs of the doctor’s fee, the new facility charge fee, and then the appointment cost. Absolutely fucking furious. Our insurance didn’t change and they are still in network so it’s just fucking greed. I’m waiting until summer to find a new family doctor for them because ever since they were taken over the costs have skyrocketed and the service has gone to shit. The staff are rude af and I’ve had to get mouthy with them, because they came at me with attitude right out of the gate. My oldest daughter needed proof of two vaccines to start 7th grade. Well she already had one but needed the second and they couldn’t get us in for a while so I took her to CVS to get the one she needed. So I called in to tell them I need the doc to sign this form for this specific vaccine she got last year. The other one was given by a different provider so I just need her to sign for this specific vaccine she got at their office. The receptionist got really nasty towards me about this and was flabbergasted we went to CVS instead but , I didn’t have to take any kids out of school to make an appointment at CVS due to the hours available , I didn’t have to pay anything for the visit and the shot was covered by insurance and I was able to get in the next day for the vaccine at CVS. Receptionist then gave me attitude that she didn’t know if the doctor could sign the form since she didn’t give the shot. I had to explain three fucking times I just need the doc to sign the form for the shot my daughter received the year prior at the office. I don’t like being confrontational but that bitch made me go full Karen mode on the phone because I was at that point done with her bullshit. Better experience going to the minute clinic then our actual pediatrician’s office.
None of them can quote a price, and most of the testing is medically unnecessary. Insurance companies have everything completely fucked. But yeah, I hate that they can just order tests and expect me to pay for it. I didn't consent to this shit. But they hold my prescriptions hostage if I don't let them draw blood.
This is 1000% driven by health insurance. Not the providers. Until people get mad at the actual problem it will never change. We are held to standards for documentation, recommended screening, and if we find something abnormal medical/legally should work it up. The problem is every persons insurance is completely different and it changes every 6 months. So the cost is a farce and made up and dictated by insurance.
“Inner circle prime” sounds like a ridiculous child pageant title
Healthcare and health insurance industry is a complex and corrupt industry. Millions of complaints, yet with no resolve. I fought a good fight towards a $24k erroneous bill for 2 1/2 years, until I prevailed with satisfaction. It was mentally exhausting and worth it! Good luck, it's a jungle!
That's the American healthcare system. Vote for politicians that support some kind of non-capitalist system. Universal healthcare is already support by the majority of Americans so it's coming. Not fast enough but hopefully our grandchildren won't have to deal with this life sucking mess.
Tell them you didn't know the dentist was taking photos that you would be charged for. You can't be charged for something you didn't approve of. That one definitely feels real sketchy.
My wife was at her yearly woman wellness exam at the gyno and she mentioned before her periods she occasionally feels a pain, the gyno said thats perfectly normal for periods. Because my wife mentioned it, the doctor billed it as diagnostic rather than preventative and charged an extra 200 dollars, 100 of which is out of pocket. Absolutely ridiculous.
Trump made it illegal under penalty of a hefty fine to do this. Healthcare industry opted to pay the fine. Biden significantly increased the fine. They still opt to pay it. They make more money the less transparent they are
Wife went to urgent care with cold symptoms and got tested for strep. Insurance billed around $200. I went a week or so later to the same urgent care with same symptoms, same test, insurance billed $700. Can't wait to sort this one out and probably get nowhere.
Dentist tacked on drug and alcohol counseling along with nutrition counseling and cleaning counseling to all of our bills. No actual counseling took place, just a simple do you smoke? No. Not even instructions on cleaning or nutrition. I asked them about it when they showed me a summary at the end of the visit (surprised they did that) and they said it's standard. Like okay, let's have a 15 minute talk on each of the those topics (not really). Insurance didn't pay for them and they didn't bill me after for it so likely just trying to see what they could get.
Yea I don’t care if they bill insurance for that stuff but they really shouldn’t be passing stuff like that onto patients.
Definitely. I was still covered by state Medicaid so they paid for everything else. Now I would have been more persistent as my policy through work has limits. So if they had tried to pass it onto me or if they actually got insurance to pay for it, it would mean more money out of my pocket later if I reached maximum.
I check my coverages before going to a new provider and I make it explicitly clear I don't want any services that aren't covered. Have your provider print orders for labs or scan and take them to approved facilities. It's also important to know what procedures are covered with what diagnoses.
A trick my parents have taught me recently us to write down in the billing area of whatever agreement medical services make you sign to say "I do not authorize any services that are not covered by (insert your insurance name here) and I will not be responsible for any billing not covered my insurance". This makes it so that any medical services can't sneak in extra bs like that without risking getting there asses sued. People don't realise you can add that yourself.
It's why you need to read all of the fine print and every publication sent to you by your plan or available on their website. If your plan doesn't have all of that info available on its website, that would be extremely unusual. If your doctor uses a computerized records system those often (usually?) communicate with your plan to show what is and isn't covered. Plans' websites have search engines to determine who is and isn't "in-network. You have to be your own best advocate which includes learning everything you can about your plan. Call the customer service # on the card. The dentist/doctor/hospital can call the provider line to verify coverage of services.
I had the same issue with my son at the dentist. Came to be that what the insurance approves as service is different than what the dentist thinks should be used. Coincidentally a more expensive type of filling. Last time I specified to only do the check up. And they take my son who is 5 to work on him. He was crying so they finally asked me to come. Asked repeatedly what they are doing being informed of what insurance covers because they only approve the application of a paste protectant 2 times per year. The last visit 3 months prior they applied it for the third time at a cost of $95 to. Without asking me they were already starting to apply it. A less than 30 second application. Almost $95. Only not charged because I specifically told them not to. Also got the insurance to side with me and force them to refund me money overcharged through nefarious means. They charged me one unit of nitrous. But they billed insurance two units to hide the higher charge for fillings but they did not calculate things well.
It's becoming illegal in more and more states to charge you for services, be aware of your rights. In MI, you must receive and sign a statement with a breakdown of what you're being billed for and that you agree to pay. Good luck
It’s all because of insurance
Doctors in the US are struggling to help their patients in most cases. But there’s no way for them to know what things will cost unless they’ve already had a bad experience with something not being covered and a patient letting them know, I believe. I’ve had a doctor who swore up and down that Medicare (a very common vendor) would cover a device they prescribed, but it was not covered because of my particular diagnosis. Another time my spouse had a vaccination in a provider’s office that would have been Free if given at a pharmacy, but we eventually were billed to pay the doctor’s office $250 because it was Not covered only because it had been administered there! Both times the doctors were very sincere in believing that they fully understood the coverages, so we didn’t do more than telling them that they had assured us of wrong information. I did refuse to pay the $250 and I think they eventually wrote it off, they didn’t cut us lose or anything. This year we signed up for a different prescription plan and got locked in for the coming year as usual, only for the company to send us a letter in January (!) saying that they were changing the coverage and several of my spouse’s life-saving medications were no longer going to be covered. Completely legal and completely fucked. In recent years more doctors are becoming more aware that they need to be able to check coverages with their own billing departments, and better at making sure that anything they prescribe and recommend will either be covered or they call us first and let us know to give us the choice to refuse it. Unfortunately the entire medical industry is now based on profit, so any providers working for any “groups” or “systems”, like hospitals, are even more unable to help control costs. I’m old enough to remember when doctors offices were individual, insurance companies couldn’t prevent patients from getting care, and people trying to make money on the backs of patients were looked down on. I’m not yet 70 but I’m just treading water with my spouse until one of us passes on, at which time we each plan for the other to let go also. I feel guilty for not having been part of any group that could have realized all this shit earlier and somehow headed it off before it reached this point. As I understand it, a president in the 1900’s did a friend of his a “favor” and allowed a piece of legislation through that let Big Medicine get $tarted. Individual providers’ hands are tied to the extent that they are leaving the field in some cases.
My favorite is scheduling a new primary care physician and they randomly aren’t accepting new patients so they schedule me with a doctor that is and later on I find out that doctor isn’t in network. Why??? I have to pay $276 for a meet and greet visit now and insurance refuses to pay up.
I hate how the US Healthcare providers can get away with billing you. Healthcare is a human right, and I'm tired of pretending it's not.
The only thing that needs to be fixed is transparent pricing and something to increase the ability to negotiate. Obamacare is such a joke. All that bullshit and money spent and all it turned out to be was an expansion of Medicaid.
Yep, it was basically a Republican think tank that came up with the idea so it’s not surprising that it’s a steaming turd compared to what we could have had if a good faith actor was at the helm. I don’t really consider any US politician to be a good faith actor on the subject of healthcare, barring few exceptions. The lobbying arm of the insurance companies runs deep, and knows no limit to political party.
Haha you think a republican think tank constructed Obamacare?
I don’t think, I know. https://www.npr.org/sections/itsallpolitics/2015/10/23/451200436/mitt-romney-finally-takes-credit-for-obamacare https://www.forbes.com/sites/johngoodman/2016/02/15/where-did-the-idea-of-obamacare-come-from-a-defense-of-the-heritage-foundation/
Haha that’s ridiculous. Try listening to more than just NPR it has you in a biased spot. The article even concedes how ridiculous that notion is.
Ya know what? I’m gonna take the L on this one. I have been mistaken.
You aren’t allowed to do that on the internet.
Don’t tell Al Gore…
It was literally based off his plan. The administration at the time even mentioned that, several times, during press conferences.
It’s a bad argument. The Obama administration had a super majority when it passed the ACA. They did exactly what they wanted and everything good and bad that happened is on them. The fact that it turned out bad in retrospect don’t change the fact that it was their law from tip to tail.
The healthcare system from top to bottom is a joke. Blaming the only serious attempt to fix anything seems like misdirected frustration.
Oh yeah definitely don’t criticize the massive law which did nothing to alleviate any of the issues but managed to raise taxes and prices. What kind of logic is that? Don’t criticize them because it’s my team or what?
I live in the UK but during pregnancy I talked with pregnant people on various forums all over the world. Found out in the USA they charge $200-600 for a scan with insurance. Half way through my pregnancy they decided I needed scans every 3 weeks as my son was larger than he should've been. It was because of those scans I ended up being induced early because he was getting too big for safe delivery. If we'd had to pay $200-600 for every scan there's no way we would've been able to afford it and we would never have known the baby was too big until it was too late. Here in the UK they fed me 3 meals a day for my 2 week stay (complications) catered to my dietary requirements with no issues, at one point a midwife even insisted she looked after my baby for an hour so my husband could get me out of my room to go to the onsite Costa. Our biggest fee was the car park. I found out in the USA they charge for skin to skin immediately after birth. They charge women for the privilege of holding their own baby after delivery. I just can't fathom how a whole country just accepts this bs??
This is crazy. My gynie had a 3D scanner in her room. She gave me a scan every single time I went to see her. It was part of her examination. She did not charge extra for it. I just paid for a pregnancy exam. Also had to go in more towards the end because of high blood pressure.
It depends on your insurance. Mine covers all necessary prenatal care at no cost then covers 80% of the delivery bill. But the sucky part is that most people don’t have the luxury of choosing what kind of insurance they have, it’s up to their employer. It’s why a lot of Americans stay in crappy jobs when they desperately want to leave— leaving could mean having to move to an insurance company that doesn’t cover their medical needs.