I remember several years ago when our oldest two were in high school, we’d go shopping at JCPenney. I was always frustrated when I shopped there. We lived far away and didn’t really know what would or wouldn’t be on sale that day. Everything was always 20% off or some percentage off.
It was so frustrating. Most everything in the store was on sale. I would be calculating in my head what the price would be. How annoying! I often thought they should lower all the prices and have “real” price.
Lucky for me…they later did that. Sadly, it was about then that the girls grew up, and we didn’t shop at JCPenney much longer.
I’m facing a similar dilemma again. This time it is with health insurance. In full disclosure, I buy my health insurance through the Marketplace (Obama Care). This came in the mail the other day…
These are the charges for ONE DAY of MRI and CT scans along with bloodwork and a consultation. All of it happened on March 20th. The total was 54,517.35. But look…being my insurance is through Wellmark, there was a $49,773.31 “savings”.
So Wellmark had to pay $3,320.83.
I have to pay $1,423.21.
This is all so dumb. I want “real” pricing.
Trust me, when I opened this, I had sticker shock for a minute. I saw the $54,517.35 and thought no way. I’m only supposed to have a $3500.00 out of pocket, and I know I already paid part of that.
Then I looked more closely and was relieved that I have to pay $1,423.21.
Don’t you think there should be “real” pricing with health insurance? How much does it really cost for an MRI? I’d really like to know.
No fears…I have the money in savings to cover the bill. I just wanted to know if I’m the only person frustrated with this type of pricing…and I wanted to bring it to the attention of people who are fortunate enough not to be dealing with documents from doctoring.
I’d love to hear your thoughts …but please don’t make it political. I almost didn’t write about this as I was scared it might get political.
I 100% agre. It’s hard because hospitals have to pick up the cost of under-insured/not insured patients and Medicare limits what they will reimburse. It’s a quagmire for sure.
We have that issue with labs. Every other year our insurance drops out lab coverage. If we do it through insurance when they are covering it, my labs are over $800. This year, I had to go to an independent lab because they rent covered by insurance, and it was $104. What gives! Medical in the US is nuts!
It’s so hard to figure the billing out. I am doing chemo and got a bill that I owed $3073.04 from a bill after insurance paid their amount. Went online to look at the bill and it said I did not owe anything. Called the hospital and they claimed they are still working with insurance company, so I did not owe the $3073.04 at this time. Called the insurance company and said they paid their amount and the hospital saying that the insurance company took the money back. Then the hospital says I am the rude one. They said most of their calls are incorrect bills they send out. What a waste of postage. It’s upsetting dealing with cancer and then not knowing what you will owe and constantly thinking how much this is going to be. That bill was from October. So, I guess I have November and December chemo bills not sent yet. Drives me nuts
Health care costs have gotten out of hand. Crazy the amounts they charge now. But I guess there are lots of doctors, nurses, technicians, etc to pay. I was lucky when I was employed, my health insurance was fully paid by my employer. Of course, the premiums were so much lower than they are nowadays. Thankfully, my only hospital stays were for two childbirths in a private room. I even got to stay 5 nights lol. I think my part was under $500. I hate to think what it costs now. No wonder they send new moms home after a day or two. I’ve seen our local hospital give a discount for payment in full.
I work in healthcare, but don’t know the answer to this question: Do hospitals get to write off the unpaid portion of the bill somehow? They charge $ 53,000, only recoup around $5,000, and then can claim a $48,000 loss? That is the only way it makes sense to me.
You’re right that the amounts charged shouldn’t look so different than the amounts the insurance company pays plus our payment. The whole system needs to be overhauled. When you figure in what Medicare and Medicaid add to the complications it’s impossible! Our son and his wife would retire but can’t because they are too young for Medicare and can’t afford private insurance.
There is supposed to be a transparency act where hospitals and insurance companies are to show costs for items and services. H.R.410 – Health Care PRICE Transparency Act I have no idea how to get those lists. I am sure the hospitals and insurance companies make you jump through all kind of hoops to get it. This looks like just a summary of your EOB (explanation of benefits) . Do you have a more detailed one that breaks everything down for you? It is really sad that they make this all so complicated for us. And heaven forbid they made a mistake on their billing.
If you have already paid your deductible are the extras you have to pay now because you are out of network? Good luck with everything.
If you are lucky enough to find the list of costs, you have to agree to this legal document (I think it basically says you can’t hold them to the ESTIMATE you are looking up) that was not clear….frustration set in and I gave up looking for the cost of an MRI. So much for transparency in pricing.
Same thing happens with all my medicines. Almost all of them are older medicines and my co-pay is usually $0. The retail price on the ticket when I pick them up shows the price between $99-$199, and I pay 0. When I get the paperwork from my insurance company, they show the total cost somewhere between $.oo and $.90 and that is the amount that they pay. I cannot figure out how the pharmacy is only getting under $1.00 for each of them.
So basically, you would have to ask for an itemized report of all charges for that day. It would then list charges for everything that was done or used. (band-aid, if you got one would most likely be $3-$4, Ha!) But yes, you can ask, might take a bit to get it, but pretty sure they cannot tell you no.
They can’t tell you no but they can charge your for it.
I agree with you. I take 5 different medications currently, I am a type 2 diabetic, have high blood pressure, high cholesterol, etc. I get my medication in a 90 day supply every time it is a different price. I have Medicare and a supplement policy I never know what it is going to cost. I know I have a deductible, but I can never figure out the cost I just pay for them. Thankfully I can afford them.
My husband and I are retired and have to deal with Medicare and a secondary insurance…it’s a nightmare! Prior to retirement, my husband needed to be airlifted by helicopter from one hospital to a specialized hospital. Fifteen minutes by air. Total cost to the insurance company…. over $37,000 ! Luckily he has been fine since his procedure…but $ 37,000….crazy!
Healthcare has become a nightmare in many ways and billing is one of the areas. Insurance has driven up the cost of the services. Recently (2 years ago) I had plastic surgery after cancer removed. One and half years later I received a bill. When we checked, we were told insurance had paid and then took money back! My husband has had calls with both insurance and provider and we haven’t heard any more for maybe 4 months.
I agree. I cut my finger cutting fabric.. Was in the ER for just over 3 hours. Ended up with an 11K bill. I said, “for what?” I sat on a bed holding my finger so it wouldn’t bleed. After a while I refused to pay. They wrote it off. I think I agreed to pay the doctors who saw me and about $500. I never did figure out what it REALLY cost.
Insurance make everything harder. My dental insurance doesn’t cover everything. The dental office sent me three different bills until they got it right. I would call the office and they would have no idea why the two wrong bills were even sent out. It’s all messed up. On the good side, when I had my colonoscopy I got a letter telling me how much the procedure would cost before it happened. Wasn’t expecting that.
Jo, if you have a hard time understanding this bill, if when you get on Medicare, do not under any circumstances get an advantage plan. They double trouble trying to figure out. I explained to my mother to keep traditional Medicare & a supplement, I could easily explain that to her. Our hospitals here in Memphis abide by the transparency act. They tell you how much your bill is going to be & how much ins is going to pay.
It’s hard to figure out medical expenses. I had surgery last year and from March to October, I argued on almost a $1000 charge that I owed which should have been covered by insurance completely (I had met out of pocket). The charge was for a medication for a block for the surgery (numbing agent). I spent time calling the hospital & insurance companies and got nowhere. I called the clinic to get a letter from them to explain why I needed it. I sent letters to the State of Insurance in Idaho (where I’m at) and Utah (where the insurance company is). It ended up being a bill code change which I found during a Google search. At the first of the year, it was XYZ before that it was ABC. I also called the hospital on the “no surprise act”. On the estimate, everything was lumped together – prescriptions, lumped together; certain surgical items- lumped together. Nothing was broken out pacifically. At the end, I didn’t have to pay it. But the stress, time and headaches, I went through. I just had an MRI done on my knee today-$1857; insurance covers $1778. I owe the rest (this is an estimation). This doesn’t include for anyone to read the MRI.
Call/write your government folks — state/ local and DC folks. Alsi, negotiate w your hospital and med group w what you are willing to pay, and make it low ball. Then pay it. These folks are usually willing to negotiate – be sure you talk w “office managers” remembering they are not always thd brightest bulbs in the pack. Be sure to get everything in writing, sending confirmatory email “this was our conversation on day/time and this is what we agreed to”. If you don’t have a energy to do this find someone who does.
i will hold my thoughts on health insurance as i have already hit my max out of pocket for this year and have very little nice to say about my coverage! yup.. imagine that fun.
as for shopping discounts? ..lol..
whenever my girls asked to be home schooled, i would tell them that the only education they would get was the ability to confidently take percentages off prices!! (thank goodness i liked math!)
We had a friend who had surgery on his neck in TN. He went into the billing department a week before the procedure to pay his part of the deductible in full and to do the lab work. Surgery went well. Then 4 months later he received a bill for just 14,000 for a piece of machinery used in the surgery that was owned by an independent company, not the hospital. The hospital said he was responsible for the full amount. What a joke! how is one supposed to know what machinery is going to be used and who own it. He argued it, took it to arbitration and then the state medical association. It was resolved almost 2 years later but first they threatened to send it to collections etc….totally harassment. I don’t know what the answer is to health insurance, but our medical billing is a total mess.
I know universal care like they have in Canada is not the answer, but honestly, not having to deal with doctors, hospitals, and insurance would be a blessing for most Americans. As we age and need more medical assistance, dealing with these payment issues tarnishes our golden years.
My husbands first hip replacement including hospitalization was almost 100k. The insurance paid 7k or so. We paid a few hundred. The markup is ridiculous. I agree with you. What is the REAL price?
Health care billing is so very complex, even for those working in the system. The only comment I have is to urge all those contemplating retirement and Medicare to choose traditional Medicare and stay away from the Advantage plans. In addition, of course, purchase a good Medicare supplement.
No politics here either – we get “this is not a bill” in the mail about hospital and doctor costs. I’m amazed at “how much you’re charged” and what they’ll accept through insurance. We go to the VA but occasionally outside due to not having the resources there. Still, you see the bill and go “WOW”. What could have been…
I concur with the frustration of pricing, insurance, OOP etc. As a RN who ran a surgical facility and negotiated contracts with insurance, I can tell you they force they game. If we needed to be paid $1500 for a procedure, we might have to charge $2550 because they would pay only 60% of billed charges. Then some would pay for implants (plate, screw, tendon anchor etc) and others said it was included.
An MRI and its special lead lined room and staff safe space can cost 3 million to install.
One of my surgeons said he could drop his fee by 50% if insurance weren’t involved. He had 2 office employees just to do insurance (he was a very busy surgeon) and that requires bigger space and equipment and software etc.
Frustrating indeed!
You are absolutely correct about the cost of installing an MRI. Plus, in a few years that MRI has become outdated and is replaced by the latest model with all the improvements.
What anything costs depends on insurance plan under which you are a member and the individual facilities who participate in the plan. It’s ridiculous that 10 people can go have the exact same procedure perform the same day at the same facility and there could be 10 different prices.
I have actually price shopped my imaging. I have insurance but of course deductibles and such. But it is possible to get the prices and choose someone less expensive. Just because your doctor wants to order imaging from the hospital doesn’t mean you have to go there. Often times, an imaging center is less expensive. Generally, a call to your insurance company is the easiest way to get the answer as to which provider is least expensive as they know the co tractor limits for services with each provider. Hospitals nearly ALWAYS cost more because they can tack on all kinds of extra fees, facility fees is one of the it’s madness, and legal corruption in my opinion. If all the aspects of Obamacare were still intact and everyone had to carry insurance, premiums would be balanced and much more affordable. When it was stripped of the participation mandate but insurers still were required to accept all pre-existing conditions at re-enrollment, it really broke the design and is breaking our pocketbooks.