Medical billing - call around before signing up for non-emergency services

[OlongJohnson]

Thanks to 44care, my health insurance doesn't cover most diagnostics. The doctor needs some information to decide what/whether/how to treat me, so I require some diagnostics. Scheduled the procedure there at the hospital. They called me back the morning of the appointment and told me I would owe them $1580.

I went online to my insurer's web site and found several outside sources for the same standardized procedure in the local area. The most expensive was $570, the least expensive was $250. So I'm saving $1330, or about $100 per brief phone call, including the ones to my insurer to make sure I wasn't creating problems for myself and the ones to loop back with the doctor's office and get the orders sent over to the lab.

Similar thing happened to another guy I work with. His bill went from ~$2k to $4xx.

It pays to shop around.

(To add some more on-topic content, I did spend a few minutes thinking that with the money I saved, I could buy a Dan Wesson Valkyrie Commander 9mm, but then I stopped being stupid.)

[RoyGBiv]

We've been much better consumers of medical services ever since we switched over to a HDHP and HSA a few years ago. And we don't put up with shitty service or long waiting room TIME BS either.
You want to fix Healthcare costs? Require all providers to post rates online.

[blues]

I've spent more time in the past week or two making health insurance election decisions than I have over the past many years and I still can't clear my head from the whole miasma. It's like "heads we win, tails you lose".

[OnionsAndDragons]

Yep. I ran into this years back when I needed a follow up MRI.

My 30% copay was about $200 more expensive than paying outright in cash. They were even happy to let me make 3 monthly payments to not deal with insurance billing.


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[Paul D]

We've been much better consumers of medical services ever since we switched over to a HDHP and HSA a few years ago. And we don't put up with shitty service or long waiting room TIME BS either.
You want to fix Healthcare costs? Require all providers to post rates online.

With medicine, the rule of: good, fast, cheap...choose two still applies. In general, I never send my patients to a hospital based imaging center since they charge "hospital rates". There are places that have 'reasonable' cash pay rates. Even some labs charge cheap cash pay rates. I offer cash pay rates because sometimes I have to pay my billing girl $3 to collect $5 from the insurance company; cash cuts out the middle man. As far as posting rates of services publicly, that will happen in the future. Your insurance company will tell you who is the best doctor (a lot of times this means who is cheapest for THEM). I don't post a menu of prices because it is different with every patient depending on their insurance. They can opt to go elsewhere within their network but the price is already pre-negotiated by the contract the provider has with the plan. In the future, to help keep costs down all doctors and other providers will probably be employees of a large regional medical network that can keep cost controls tight. It's like only being able to buy guns at a big store: kinda okay selection, kinda okay service, but CHEAP! The LGS of the medicine world will be gone. Remember when there were 20 different different airlines you can fly on? Now there are just 4 big ones, and if you don't like their service, tough shit. I currently own my own practice and am doing well, but I will probably sell out to a conglomerate before I retire because I'll be too old fight the system.

[DocGKR]

Well said. I will note that some (not all) outside, non-academic hospital based imaging we view are of inferior quality and do not work as well diagnostically for solving complex issues...

On the other hand, pricing varies dramatically. I recently noted a price differential of over $6000 on a scan done at a major hospital vs. an equivalent much better quality, faster, less radiation, better diagnostic quality scan done at a private, free-standing imaging center for a fraction of the price...

[Ed L]

Yep. I ran into this years back when I needed a follow up MRI.

My 30% copay was about $200 more expensive than paying outright in cash. They were even happy to let me make 3 monthly payments to not deal with insurance billing.


I have been in this situation where paying cash was cheaper than letting insurance cover it and paying the deductable.

One important bit of warning. Be sure to get the full name and title of the person who approves it, and if you are doing it in the medical office or hospital I would go as far as to record it with your smart phone.

I had a situation where I agreed to pay privately at the hospital, only to have the hospital bill me later for the full cost of the procedure as the insurance company would have paid. After a phone call or two were they said they would take care of it, they transferred it to their outside billing company in another state. When I called this company they asked me for the name of the person who approved it and when I could not provide it, they said I would have to pay. I told them I would take them to court for bad faith. After this I contacted the billing department of the hospital directly and finally got them to recall it from their out of state billing office and straighten it out.

[OlongJohnson]

Well said. I will note that some (not all) outside, non-academic hospital based imaging we view are of inferior quality and do not work as well diagnostically for solving complex issues...

On the other hand, pricing varies dramatically. I recently noted a price differential of over $6000 on a scan done at a major hospital vs. an equivalent much better quality, faster, less radiation, better diagnostic quality scan done at a private, free-standing imaging center for a fraction of the price...

Yes. The hospital had a list of three outside imaging centers that produce unusable materials. The one they specifically recommended as good was still only $500. If I have to go back and get it done again by them, I still save $830 versus the hospital.