Health Care Costs - Still A Mystery

I injured my knee/leg last weekend, and have had a lasting weakness/pain in my right leg since. It's getting better, but its still a bit concerning.

I'm on a HDHP, so I'm watching my costs closely. I called a On-Call Nurse. Her suggestion? See a doctor. I called my doctor, the receptionist said she'd have him call me, but no call yet received.

AZ Blue Cross has a website where you can find out costs of surgeries...except it doesn't list the costs of anything outside of surgery or other procedure.

I'm trying to find a doctor who doesn't charge an arm and a leg. My current doc costs $110 after insurance discount. To me, if we want to make a change in how we handle healthcare costs, these things need to be easy to find and up front.

If you're in a HDHP then 1) your premiums should be pretty low, and 2) you should be saving what you'd otherwise pay in premiums to pay your medical expenses up to your deductible. Most HDHPs are paired with a Health Savings Account to facilitate this. Given that it's the end of the year, you should either have a bunch of money in your HSA or have already spent it and met your deductible. In either case, there should be no reason not to visit your doctor...

But since you're asking, I would assume that you haven't funded an HSA and have no cash set aside to cover medical expenses up to your deductible?

Good luck on finding the surgery costs. I was given an "estimate" by my surgeon, but even he said it was still a shot in the dark. I got bills from the surgeon himself, the anesthesiologist, and the hospital, all for amounts that were never mentioned nor found on the insurance website. And after reading my insurance paperwork I'm truly on the hook for all the additional costs thanks to my 80/20 coverage.

I have plenty of money in the HSA to cover these types of costs, but since I'm only 4 months into an HSA I don't have anywhere near my family deductible of $3500.

So, going to a doctor who's expensive who sends me to get a ultrasound that's expensive will quickly deplete the HSA and likely go over.

If it turns out to be nothing, that's more out of pocket this year than a PPO would have cost. I'm trying to avoid that.

Just be glad it isn't a hospital billing service repeatedly sending your auto insurance the bill versus the regular heath insurance plan you initially told them to use.....morons still haven't gotten it right in 3 months.

The best part about having the HDHP and an HSA is the incredulous and dumbfounded looks you get from the people at the hospital or doctor's office when you say the magic words "how much does that cost?" I've had every manner of response (including "why would that matter?") except for an actual dollar figure or even a range. At one point, my orthopedic office told me that they actually weren't allowed to tell me what the cost would be until after I had the service done and they sent me a bill.

The outfit I work for has a contract with some site called "castlight" that is supposed to be able to tell you what things should cost but I haven't needed to use it since they rolled it out so I can't really vouch for it. I don't even know if it's something that you can use independently.

wae wrote: The best part about having the HDHP and an HSA is the incredulous and dumbfounded looks you get from the people at the hospital or doctor's office when you say the magic words "how much does that cost?" I've had every manner of response (including "why would that matter?") except for an actual dollar figure or even a range. At one point, my orthopedic office told me that they actually weren't allowed to tell me what the cost would be until after I had the service done and they sent me a bill.

This, in a nutshell, is what is so heinously wrong with healthcare in the US today. I am NOT in favor of Obamacare or any other wealth redistribution scheme, but the way the system works today is a total scam.

My wife had a bit of a self-propelled crash about a month ago and ended up with a broken nose that needed surgery. I have to say that, as someone who grew up in a single-pay system, it's been quite an eye-opening experience. Multiple surprise bills from multiple sources, bills that keep changing as the doctors and insurance companies play some sort of chicken, loads of errors - and this was for a fairly simple procedure with good insurance. Quite a difference from my previous life.

1988RedT2 wrote:

wae wrote: The best part about having the HDHP and an HSA is the incredulous and dumbfounded looks you get from the people at the hospital or doctor's office when you say the magic words "how much does that cost?" I've had every manner of response (including "why would that matter?") except for an actual dollar figure or even a range. At one point, my orthopedic office told me that they actually weren't allowed to tell me what the cost would be until after I had the service done and they sent me a bill.

This, in a nutshell, is what is so heinously wrong with healthcare in the US today. I am NOT in favor of Obamacare or any other wealth redistribution scheme, but the way the system works today is a total scam.

+1

My stepDad is right now not receiving a test because it requires him to pay $500 upfront, whereas another test, reported to do the same thing, is $90. The Doctor won't do that one first, so he gets neither.

Also, we just switched Tunakid #3 to a different OT. OT#1 charged $450 per visit. OT #2 charges $95. Same exact diagnosis and treatment.

It's ridiculous.

tuna55 wrote:

1988RedT2 wrote:

wae wrote: The best part about having the HDHP and an HSA is the incredulous and dumbfounded looks you get from the people at the hospital or doctor's office when you say the magic words "how much does that cost?" I've had every manner of response (including "why would that matter?") except for an actual dollar figure or even a range. At one point, my orthopedic office told me that they actually weren't allowed to tell me what the cost would be until after I had the service done and they sent me a bill.

This, in a nutshell, is what is so heinously wrong with healthcare in the US today. I am NOT in favor of Obamacare or any other wealth redistribution scheme, but the way the system works today is a total scam.

+1 My stepDad is right now not receiving a test because it requires him to pay $500 upfront, whereas another test, reported to do the same thing, is $90. The Doctor won't do that one first, so he gets neither. Also, we just switched Tunakid #3 to a different OT. OT#1 charged $450 per visit. OT #2 charges $95. Same exact diagnosis and treatment. It's ridiculous.

Your insurance covers OT? Ours actually spells out in the fine print that our son's sensory integration disorder is NOT covered for OT in any form. However, we are welcome to get him blanket diagnosed as ADHD and they will happily pay to drug him into a stupor. My credit card is still smoldering from paying for an OT out of our own pocket for as long as I could.

In reply to wae:

"how much does that cost?"... Yeah, I asked that at a hospital once. The lady looked at me like I had just sprouted two heads and informed me there was no way to know (and her attitude loudly communicated even asking was highly inappropriate). The really crazy thing is (as others have already mentioned above) is that no single person at the hospital could probably even ballpark it even if they wanted to. If you spend any time in the hospital and have an HDHP plan that will have you actually writing checks for charges, you will see the ugly truth when you get bills from multiple doctor's practices who did nothing for you but apparently wandered into you room so get to bill you. Those are in addition to the hospital's own outrageous bills for your stay of course.

I just switched from cdhp to the ppo, all the cdhp did was make me 2nd guess going to the doctor. I burned through the $500 provided hsa quickly. Doctors visits are $60 and if I hit my deductible I'd still have to pay 20%.

This year there is no provided hsa, so the cost for the cdhp and $1300 hsa (to cover up to the deductible) was more expensive than the ppo with the same deductible, and a $300 hsa to cover copays.

My per paycheck amount went up $50, but I can finally get the wife off my back for not going to the doctor except when I need a note for work.

There was a really eye-opening article I read some time ago about the completely unregulated and unreasonable state of medical billing where they gathered the data from a number of different hospitals and patients for the exact same procedures being performed (and in some cases at the same hospitals by the exact same staff) and it was completely nonsensical with a massive variation even within the same hospital for the exact same care. And the charges tacked on- at one point in an itemized bill they realized that the patient had been charged like $20 apiece for 'absorbent pads', which they noted the hospital (or the patient themselves) could buy for about $10 for a BOX of 100 of them.

Despite having decent health coverage (and having been putting money into our HSA for long enough to cover at least the deductible in an emergency) I very solidly fear either SWMBO or I getting seriously injured or sick.

slefain wrote:

tuna55 wrote:

1988RedT2 wrote:

wae wrote: The best part about having the HDHP and an HSA is the incredulous and dumbfounded looks you get from the people at the hospital or doctor's office when you say the magic words "how much does that cost?" I've had every manner of response (including "why would that matter?") except for an actual dollar figure or even a range. At one point, my orthopedic office told me that they actually weren't allowed to tell me what the cost would be until after I had the service done and they sent me a bill.

This, in a nutshell, is what is so heinously wrong with healthcare in the US today. I am NOT in favor of Obamacare or any other wealth redistribution scheme, but the way the system works today is a total scam.

+1 My stepDad is right now not receiving a test because it requires him to pay $500 upfront, whereas another test, reported to do the same thing, is $90. The Doctor won't do that one first, so he gets neither. Also, we just switched Tunakid #3 to a different OT. OT#1 charged $450 per visit. OT #2 charges $95. Same exact diagnosis and treatment. It's ridiculous.

Your insurance covers OT? Ours actually spells out in the fine print that our son's sensory integration disorder is NOT covered for OT in any form. However, we are welcome to get him blanket diagnosed as ADHD and they will happily pay to drug him into a stupor. My credit card is still smoldering from paying for an OT out of our own pocket for as long as I could.

Yes, BCBS, though it was difficult. I had to call doctors and therapists and the insurance company with diagnostic codes and treatment codes and whatnot, and even then they could not promise that it would be covered.

Silly.

Keith Tanner wrote: My wife had a bit of a self-propelled crash about a month ago and ended up with a broken nose that needed surgery. I have to say that, as someone who grew up in a single-pay system, it's been quite an eye-opening experience. Multiple surprise bills from multiple sources, bills that keep changing as the doctors and insurance companies play some sort of chicken, loads of errors - and this was for a fairly simple procedure with good insurance. Quite a difference from my previous life.

At this point, even though I'm against universal healthcare, it would be better than what you just described.

When you get your "final" bill, always contest it. It can be lowered.

Ashyukun wrote: There was a really eye-opening article I read some time ago about the completely unregulated and unreasonable state of medical billing where they gathered the data from a number of different hospitals and patients for the exact same procedures being performed (and in some cases at the same hospitals by the exact same staff) and it was completely nonsensical with a massive variation *even within the same hospital* for the exact same care. And the charges tacked on- at one point in an itemized bill they realized that the patient had been charged like $20 apiece for 'absorbent pads', which they noted the hospital (or the patient themselves) could buy for about $10 for a BOX of 100 of them. Despite having decent health coverage (and having been putting money into our HSA for long enough to cover at least the deductible in an emergency) I very solidly fear either SWMBO or I getting seriously injured or sick.

Sick Around America is a PBS Frontline episode that showed how much healthcare costs shifted based on zip code. I believe it was based on a written article in TIME.

Sicko is also a good breakdown of the horrors of American healthcare. It's a Michael Moore film, so I would guess the majority here wouldn't even consider watching it.

So basically, you may need an orthopod - your knee is either not healing or you have concerns there's damage. Option 1, wait a few days and see if improvement continues or condition declines. Option 2, have a physician take a look if there is a diagnosable condition. Within option 2 there are a bunch of uncontrolled variables that can have an effect on your wallet - what diagnostic tools will be used - x-ray or MRI ($250 vs $1800) - what do the results show and what treatment if any would be appropriate - ibuprofen, pt, surgery... About the only thing that is predictable is the cost of an office visit at this point. You can tell the doc you have a high deductible plan and that may help out - although cost may not always factor in what the most appropriate care is (MRIs and x-rays aren't really interchangeable for each other).

As far as healthcare in general - I'm not even sure where to start. Our system is the result of decades of voters, lobbyists, politicians doing a big old mash up of socialism, free market forces, influence peddling and science. It's a mess and there's no easy way out. There are some trends - cost shifting from employer and insurance to employee/patient - the patient as consumer is one that will drive more price transparency - but it's going to take a while.

typical stuff for a surgical procedure is surgeon fee, facility fee, anesthesiologist, supplies and parts, recovery, surgeon follow up. The aggravating part is having some of the services in network, some out of network and you don't get a say in the matter.

At the end of the day no one other than the patient & their family give a damn how much the out-of-pocket expense will be: Not the healthcare provider, the insurance carrier, their bill-review department, them employer(if you're lucky enough to have the employer contribute to your premiums at all), or the government give a damn about it.

And that will never ever change in the USA because there's too much $$$ tied up in the system supporting too large a portion of our economy.

In reply to The Hoff:

Hmm... I can believe that. I went to my local hospital for my kidney stone procedure back in 2009. By that point I had been to so many doctors and had so many tests done, I was pretty close to my deductible. The procedure (stick a laser up the hoo-ha to break up the stone and remove it) cost about $25K. My portion was a bit less than $1000, which thanks to my HSA was quickly paid. It definitely helped I was a couple of years into the HSA plan (and I max out the contribution), so I had already built up a decent savings balance.

I live in a fairly blue-collar area. While I've never had a problem when going there for various things over the years, this particular hospital doesn't have a great reputation. I'm guessing it doesn't charge as much as most of the people going there can't afford to go anywhere else. It's also had financial problems and has been through a couple of bankruptcies.

Right now, I love my HSA as it means I get a Federal refund... since my company's accounting dept is incompetent and can't seem to figure out how to take the deduction pre-tax like they are supposed to...

mtn wrote:

Keith Tanner wrote: My wife had a bit of a self-propelled crash about a month ago and ended up with a broken nose that needed surgery. I have to say that, as someone who grew up in a single-pay system, it's been quite an eye-opening experience. Multiple surprise bills from multiple sources, bills that keep changing as the doctors and insurance companies play some sort of chicken, loads of errors - and this was for a fairly simple procedure with good insurance. Quite a difference from my previous life.

At this point, even though I'm against universal healthcare, it would be better than what you just described. When you get your "final" bill, always contest it. It can be lowered.

Which one's the "final" bill? Man, when I get old, I'm going to have to retire just so I can manage my heathcare as a full time job. The current setup is ridiculous.

Meanwhile, my mom was diagnosed with breast cancer a couple of years ago in Canada. She had to pay for parking. That's all. I know Americans don't trust their government to do anything more than throw a July 4th celebration but trust me - there's a better way.

In reply to Keith Tanner:

Could you retire back to Canada? (serious question).

When my father was in hospice care, he needed some common, over the counter medication. I went to the drugstore around the corner and picked some up for $7 or $8. A few days later, the hospice company sent a package that included the exact same brand of medicine in the exact same size of container. The itemized bill from hospice showed they had charged the insurance company over $200 for the exact same thing that I had paid less than $10 for.

I'm not into big government or anything, but I could really go for some government regulation of healthcare costs. I don't see why they couldn't be treated like utilities in that regard.

Heller, I usually find that local clinics or Med Check type places are often the cheapest option around, and typically have less red tape to getting face to face with a doctor.

Ian F wrote: In reply to Keith Tanner: Could you retire back to Canada? (serious question).

It should be possible and I've thought about it. I don't think I could convince my wife to leave Colorado, though.

The Hoff wrote: Sick Around America is a PBS Frontline episode that showed how much healthcare costs shifted based on zip code. I believe it was based on a written article in TIME. Sicko is also a good breakdown of the horrors of American healthcare. It's a Michael Moore film, so I would guess the majority here wouldn't even consider watching it.

I'm betting it was the TIME article since it was something I read online. Had me shaking my head at the absurdity of it all.

Tim and I paid cash for both kids, since at the time maternity insurance was only available if you bought it for the entire group, and I was the only female in our group with either the ability or the desire to procreate. So we did the math, decided to pay for it ourselves, and saved money (major medical would've covered any complications at the time). Here's what I learned:

Asking "what does it cost?" does, indeed, send everyone into a tizzy. A better approach is to say, "What does Blue Cross pay for this procedure?" and THEN (and this is the important part) say to them, "What can I pay you DIRECT, IN CASH for this procedure, no billing, no insurance runaround, no disputes?"

We ended up paying less than the insurance would've paid them--which was a lot less than sticker price--and WAY less than we would've paid to have the insurance. Since it was maternity, both times we split the doctor's fee up into payments that we made at each prenatal visit, kind of like we did the kids' braces, so that we were all paid up with the doctor when we went to the hospital.

We made a similar deal with the hospital, price-wise, with payments laid out for "standard" delivery.

I can tell you that from a cost-control standpoint, I weighed very carefully every suggested test and procedure, though in the end I did choose the epidural over the new refrigerator we needed. That felt like a hellish round of "Let’s Make a Deal,” but hey, you do what you gotta do.

Margie