Shocked by medical billing.

[HoosierDaddy]

I've been pretty much immune to illness. Always had insurance thru employer or now Medicare but never even saw a doctor between some time in the 90s and last year when my wife told me to pick a primary care doctor just in case. So, I did and got a bunch of tests and a #%$^ load of vaccinations. Which was nice because now I can tell how many toothpicks are laying on a floor just by a glance. But I digress.....

A while ago, I had a pain in the abdomen and chills in the middle of the night. The insurance nurse hotline said to call an EMT but since I live within a stone's throw of the Mayo Hospital, I asked if I should just go there instead and they said yes.

I went and they diagnosed a kidney stone and told me to see a urologist. But I've had no symptoms in the almost 2+ months since and never bothered. But again, I digress....

Last week I got a statement from my Medicare Advantage plan with United Healthcare.

Mayo billed UHC $7,722. They accepted $1,399 as payment in full . That's less than 20% of the amount billed. I am sure if I didn't have insurance, I would have been billed for the $7,720 (at least) instead of a $50 ER deductible.

Some of the items:

Walking in the door: Mayo billed UHC $2,880; were paid $100.
CT scan: Mayo billed $952; were paid $86.

This is outrageous. If I dented a fender on my car and paid to have it fixed myself, I sure as hell wouldn't get billed for FIVE+ times what they would bill an insurance company for the same job.

The system is F'ed!

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[samd1351]

Yep. My wife tripped over a laundry basket and broke her leg. Split the lower bone and dented the top of the lower bone in the knee cap. Total hospital bill for surgery was $113K or $133K, can't remember. Insurance discounted it all down to about 25 grand, IIRC.

She broke (destroyed) her arm and shoulder in a car accident back '01. The orthopedic doctor said he loves car accidents. He said there's no haggling or negotiated fees. He bills the auto insurance company, and they pay the full amount. I don't remember what that cost was. I'm sure it was well over 100k. Orthopedic and plastic surgeons. Hospital stay of 3 days. Follow up care with both ortho and plastic for almost 6 months.

 

[JCFoster]

HD, did you pass the stone? My last one got hung up in the track and didn’t move. The urologist had to go in to break it up so I could pass it. Lots of fun things happened that I wouldn’t bore you with. If you didn’t pass it I would get them to look at it. Good luck

 

[HoosierDaddy]

HD, did you pass the stone? My last one got hung up in the track and didn’t move. The urologist had to go in to break it up so I could pass it. Lots of fun things happened that I wouldn’t bore you with. If you didn’t pass it I would get them to look at it. Good luck

Unless they can pass without notice OR Mayo misdiagnosed, I must still have it. But its been a long time without a symptom. Since I still have the filled (but unused) Oxycodone (sp?) prescription they gave me, I might just wait and see. If it flairs up again, I'll open the bottle and make an appointment.

Mayo does share info with patients. So, I can pull up over 4,000 CT scan frames. Problem is, it takes seconds to jump from one to the next on their web site and no way for me to know what range included kidneys.....

I am also unsure about their diagnostic ability. I mean their notes about the CT scan included a lot of such-and-such was/were unremarkable. I could buy that until I saw they said the same thing about my sexual organs.

 

[Shifting_Gears]

And we wonder why people forego doctors, hospitals, etc. sheesh.

 

[HoosierDaddy]

And we wonder why people forego doctors, hospitals, etc. sheesh.

Yeah.

While these particular doctors and nurses seemed medically competent, the price structure/gouging is terrible. And the administrative side wasn't much better for my visit.

I didn't mention before that my pain wasn't very bad when I went in. But it steadily got worse until they had to give me some serious pain killer. It worked and when they finally discharged me they gave me a prescription for Oxy. I asked how long until what they gave me wore off and they said a few hours.

So I had them call the prescription to the closest pharmacy. I check in an hour after not getting a notice I can pick up and am told they can't fill the prescription. So I take it to another pharmacy. A little later they say the same thing. Turns out the prescription was for too many pills or called for them to be taken more often than some govt guideline to reduce drug abuse allows! Now I'm getting worried that what's in me is about to wear out and I'll have to go back to the ER. I call Mayo and they said they will take care of it.

More time passes and the pharmacy says they haven't received a replacement prescription, so I call Mayo again. I get told the doctor who wrote the prescription is off duty and they can't reach him. I tell them that doctor never even saw me and must have based the prescription on test results that any other doctor could use to issue a prescription. Nope. Never gonna happen. The phrase "would take an act of congress" was used (I have the recording).

At that point I suspect the problem is they don't have a way to bill insurance to PAY two different doctors for writing a prescription. So, I go up the chain of command and finally get someone who envisions a visit by 3-on-your-side or 60 minutes and fixes this.

After all that, it turns out I never needed the Oxy because the pain never returned. But I did not appreciate the bureaucratic hoops.

 

[HoosierDaddy]

Also forgot that a week after my visit I get a letter from Mayo saying I had to fill out and return a form or I would be billed personally for the visit because there is no way they can submit an insurance claim without the signed form.

I look at the form and its a general admitting form. Apparently they forgot to ask me to fill one out when I went in despite me sitting in a waiting room for 15 minutes before seeing anyone.

The form has all sorts of microscopic size disclaimers/releases/etc. that I suppose I would sign if needed to get treatment but sure wouldn't after the fact if I didn't have to. It included things like I won't sue them if they screw up in this OR FUTURE visits (paraphrased) and agree to pay if they chose to not go thru insurance. One of the numerous agreements was that I authorized them to bill my insurance. I initially was just going to line out everything else and return the signed form but some more fine print said any alterations would be ignored. The point is they had a team of lawyers generate that form. Why take a chance I didn't fully appreciate all the implications if I didn't have to.

I absolutely did not believe my insurance wouldn't pay them if they didn't have the form, so I called UHC and they said they would have no problem paying the claim and, in fact Mayo had already submitted it (and UHC paid Mayo a few days later).

So I sent a letter back to Mayo telling them if they want to send me a form just authorizing them to bill my insurance I would be happy to sign it. The letter also said I authorize them to bill my insurance.

Just say you forgot to get the form when I was admitted. Don't involve me in some petty CYA about someone forgetting to get an admission form.

 

[Silver Bullitt]

Not trying to turn this into a political debate, but I definitely applaud Trump on his proposal for requiring disclosure of medical costs. Having had a daughter with a lot of medical issues, I've seen the complexity and confusion the OP experienced throughout the years and overall medical costs well into the seven figures. I think this would really help the end consumer, but I'm afraid the hospitals and insurers are going to make this a long drawn out battle for full disclosure.

https://www.cnbc.com/2019/11/15/tru...nd-insurers-to-disclose-negotiated-rates.html

 

[kz]

It's an industry - starts with cost of education to become doctor or RN, ends with insurance companies (who shouldn't even exist) and hospitals focused on making money.
My wife is about to have her galbladder removed - I could fly her to Europe to have it done in a business class and would come back with money left. Procedure cost is about 6-8 times higher than elsewhere - ask yourselves why.

 

[Shifting_Gears]

It's an industry - starts with cost of education to become doctor or RN, ends with insurance companies (who shouldn't even exist) and hospitals focused on making money.
My wife is about to have her galbladder removed - I could fly her to Europe to have it done in a business class and would come back with money left. Procedure cost is about 6-8 times higher than elsewhere - ask yourselves why.

So the Doctor can keep gas in the Benz and the kids in private education, of course.

Best wishes for you wife’s procedure.

 

[Bikeman315]

Now before anyone here goes insane I DO NOT want "healthcare for all". I do not think it would ever work in the US. But based on these posts it is certainly understandable why people would think some form of National healthcare would be acceptable. Obamacare was far from perfect, in many different ways but at least it was a foundation to build on, a start, a cornerstone. Unfortunately Congress in its wisdom has done nothing for the past three and a half years to change/improve it.

 

[Cobra Jet]

The other problem is this:

Mayo may have charged the OP a cost of $7722, but stroll a few blocks or cities outside of the area and you would find 3+ or more Hospitals that would charge in excess of $7722... like 3x+ more that amount for same SAME EXACT procedures and tests.

The medical pricing structure has NO standard at all. It’s insane what these Hospitals, Pharmacies and Doctors can charge.

Ever see the multitude of drug commercials on TV? Do you ever question the fact of how can Drug Company XYZ charge $500 for prescription strength ABC, but if you call them you can get a discount code or discount to only pay $25.00 for it? The question should be - WHY isn’t the normal cost $25.00 straight up from the get go, instead of $500?

It’s all a big scam and if the patient does not review his or her bill and does not question charges on that bill or the cost of their needed drugs - guess what, they’re over paying and being flim-flammed by the Hospital, the Dr. AND their Health Care Ins. Co.

Imagine all of the people who DON’T question or call about their medical bills and just pay the dislike value seen on the statement?

Robbery in broad daylight without anyone even questioning or reporting it, that’s what is going on with medical billings.

 

[kz]

Now before anyone here goes insane I DO NOT want "healthcare for all". I do not think it would ever work in the US. But based on these posts it is certainly understandable why people would think some form of National healthcare would be acceptable. Obamacare was far from perfect, in many different ways but at least it was a foundation to build on, a start, a cornerstone. Unfortunately Congress in its wisdom has done nothing for the past three and a half years to change/improve it.

Older post but I will comment - healthcare for all would not work if there was no accountability for the cost of the procedures. Right now cost of procedure varies greatly depending on who's paying for it. You show up with no insurance, you'll pay half or less what the insurance companies are paying for the same things. There is no perfect system, but this one is entirely focused on making money for everyone in the chain and actual healthcare is just a byproduct.
Bernie - as madman as he seems to be - actually sees what the problem is. His ideas may not fix it, but certainly would disrupt status quo which is what we need. We are all being scammed and we - patients - are the one on the loosing end of this shit.

 

[Strokerswild]

The medical/insurance industry (because that's what it is) in the US is such a racket.....

 

[Biggus Dickus]

Unless they can pass without notice OR Mayo misdiagnosed, I must still have it. But its been a long time without a symptom. Since I still have the filled (but unused) Oxycodone (sp?) prescription they gave me, I might just wait and see. If it flairs up again, I'll open the bottle and make an appointment.

Mayo does share info with patients. So, I can pull up over 4,000 CT scan frames. Problem is, it takes seconds to jump from one to the next on their web site and no way for me to know what range included kidneys.....

I am also unsure about their diagnostic ability. I mean their notes about the CT scan included a lot of such-and-such was/were unremarkable. I could buy that until I saw they said the same thing about my sexual organs.

Man - they saw you coming and said let's have fun. A CT for a suspected kidney stone is overkill. A simple U/S should pick up any stone (of significance) and no radiation. A shot of Toradol for a few bucks and you can either drink lots o' water or get an IV. And if a boulder shoots out of your dick CONGRATS!. Change your diet and increase fluid intake and hopefully you won't have any more trouble.

Bottom line is this can done cheaply.

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