I am following my own advice at the moment. I am due to have a procedure just prior to Xmas. I have had a consult with the specialist and an MRI already and have not had to pay more than a copay - all good.
So now I want to know how much this procedure is going to cost me - my out-of-pocket cost. I ask the specialist office - they tell me they do not give out estimates, give me some codes they will use to bill insurance, and to contact the physician’s group. So I contact the physician’s group with those codes and they tell me my share will be 10% coinsurance (whatever that means), but but when pressed for a dollar amount, they tell me they do not give out estimates. So I contacted my health insurance with those codes, and they seem to understand what I am asking, but are unable to give me a straight answer on the spot, and said they would get back to me this week. Still waiting.
But, I am going to keep badgering the insurance, and I have a pre-op consult in a couple weeks, and will make a painful point to the specialist about this, if I have to. Not that I don’t want the procedure, but I am asking a simple effing question here to avoid surprises - “How much is this going to cost me?”, and it should not be this effing difficult for one of the entities involved here to provide an answer.
Back in Sep I had an MRI of my head. They were trying to decide what sort of rocks were in there; turns out to be mostly granite.
I got the bill today. $4,646.00. Yowza!
But … because I have insurance, the “negotiated” price to the insurer is just $238.75. Of which they chose to pay $190.22 leaving me owing the MRI clinic $48.53. IOW 80%/20% split of the negotiated price between insurer and me.
The other $4,407.25? It just vanished into thin air, paid by nobody.
I don’t know what a “fair” price for an MRI is. But I bet it’s more than $238 and less than $4600. If you have insurance you get the too-cheap price. If you don’t, you get the too-expensive price so you can subsidize all the people (& insurance co’s) paying the too-cheap price.
Don’t be that person if you can possibly avoid it.
I found out the premiums for continuing the policy I had this year will be much less than I’d feared, so I won’t be that person.
But I think the entire system should be burned to the ground and we should go with Bernie’s plan of Medicare for all. Make it cover EVERYONE, plug all the loopholes, and let the health insurance industry figure out some other way to make a living because this one is a steaming hot pile of cow excrement.
The very nice woman helping me with my insurance is so ridiculously stressed out I can’t believe it: she is literally considering going back to smoking cigarettes when she quit 14 years ago. “a pack will last me months!” which is obviously a slippery slope. I am sad, besides angry as all this pain is completely unnecessary.
Nope. That’s the amount which is hidden in the contracts between the insurer and the clinic - the part that is not exposed to prying, public eyes (note: they each made money from you having this procedure).
IANA expert, but perhaps we’re saying the same thing from different POVs. If you disagree, please explain in more detail so I/we can all learn.
My understanding is the various insurers negotiate a set of prices. My insurer can no kidding get an MRI from that hospital from $290, not $4,646. That’s all the money that changed hands. There’s no hidden other payments that flow between that insurer and that hospital in respect of this treatment event.
The hospital’s price list is kinda like airfares. There are lots of fares for the same seat. The hospital cares about the total AKA average fare, not any particular one. Of course for the average to be a number the hospital / airline is happy with, there better be a bunch of people paying full price to offset all much of the discounts to everyone else.
Here is my understanding of some of the terms you may see on your medical bill (not an expert):
Copay: The fixed amount you’d have to pay anyway based on your health plan to access the service.
Billed Amount: What the provider billed your insurance for the service.
Allowed Amount: This is how much your insurance will pay for a specific service (which can differ from the Billed Amount - guess who gets to pay the difference? And this is the area that offers the biggest surprise for the insured, which is very opaque!). Insurers use their size to generate a lower rate they will pay for services - the provider can accept these terms, or be booted out of the network.
Network Savings: The feel-good part the insurance will share with you to make you feel like you are saving money by accessing your insurance network by paying your premium each month (which you are, since you are using their contracted network, versus walking into any random clinic).
Other paid: Amount paid by other payor (e.g. Medicare or other insurer).
Paid amount: Amount paid by your insurer. Another “wow!” façade to make you feel good.
Not covered: Anything not covered by your insurance that you have to pay for.
Deductible: Anything that was applied to your deductible (once you reach the deductible amount, some of the above terms will change).
Patient Responsibility: How much you have to pay for your service, after all the math for the above.
Incentives: This is hidden from public view - insurers will incentivize via bonuses in-network providers, pharmacies, hospitals, medical equipment suppliers, etc. to charge lower than the Billed Rate you may see.
Rebates: Also hidden from public view - drug manufacturers and medical equipment suppliers will offer cash to insurers who favor their drug or equipment usage. Granted, insurers are responsible for justifying what drugs and equipment they cover and they should be equivalent, but the specter of money being involved with these decisions makes it seem dirty.
So, when you look at your medical bill, you only see what your insurer wants you to see, but there is some other stuff going on that is not visible to you that ensures both the insurer and the provider make a buck.
In any civilized country that extortionate practice should be illegal! But then, any civilized country will have UHC and the whole issue would be moot.
On the subject of what “you” as a consumer can do, other than educating yourself as much as possible (as already said) probably not much. Insurance companies don’t care about you as an individual because for the most part, you aren’t their customer. Employers are their primary customers, and health care providers are adjacent stakeholders (ETA: who, as @snowthx pointed out, engage in their own shady dealings). Individuals are just a nuisance costing the insurers time and money whenever they have the inconsiderate bad judgment to get sick.
would be interesting to know what is the cost for that type of (very basic) medical procedure en Mexico et al… I mean getting an IV fluid transfer it’s not exactly rocket surgery.
w/out doing a deep-dive, here are some AI blips on cost for Chile:
Cost of Iron Infusion in Chile (in USD)
Using a typical exchange rate of 1 USD ≈ 925–950 CLP, the prices convert as follows:
1. Private IV clinics / wellness centers
Iron infusion session costs:
CLP 100,000–110,000
→ ≈ USD $105–$120 per session
2. General IV therapy centers
Depending on the type of infusion:
CLP 70,000–90,000
→ ≈ USD $75–$95
3. Iron medication only (ampoule)
Buying the injectable iron separately:
CLP 19,000–22,000
→ ≈ USD $20–$24 (This does NOT include the cost of administration.)
I would add to this, use a HSA if you are eligible. It is a wonderful feeling when you have the safety net that with two major throat infections and a tonsillectomy it is basically prepaid and when you get the bill you can say, “Run the card.” And since it is a pretax deduction, I basically get a 28% savings.
I once asked my doctor that. He replied that he was a salaried doctor at a not-for-profit hospital rather than in a much more lucrative private practice so that he didn’t have to deal with that end of the business. And he had no idea.
Yes, they are the only ones who can realistically answer this question, as it’s actually incredibly complicated. Aetna’s contact to cover employees of company A will be different from their contact to cover employees of company B. And the person who negotiated between your doctor’s office and Aetna doesn’t know what side deals your employer and Aetna agreed on.
This is true, if you are “covered” you get the negotiated price, which is typically a lot lower than the nominal price. It’s a really stupid system.
Amen. Our system is totally broken. And it employs a huge swath of the population (soooo meant people needed to process each claim) and also enriches a bunch of people, both of which make it very hard to change.
If you have enough income that you’re always contributing to savings, you can treat an HSA as essentially a second traditional IRA with a separate (lower) contribution limit. Don’t ever spend any of the saved money. Just invest it. And when you retire it’s just a big blob of tax-deferred dollars.
But if you’re not already saving enough to max out your IRAs and 401ks, then yeah, use the HSA money for ongoing medical expenses, not as an additional tax deferred investment vehicle.
Most HSAs are held by banks, but most also have an arrangement with some brokerage where you can pass HSA funds through a “window” to e.g. Fidelity, then invest them however. Some token amount needs to remain back at the HSA bank.
And of course if one did have a catastrophically expensive medical event some years later and had to tap the HSA money, nothing prevents you from converting the investments back to cash, pushing them back through the window to the HSA bank, then spending them at the hospital.
The “triple tax advantage” of HSAs make them better investment vehicles than either traditional or Roth 401ks / IRAs. Seems a shame to waste that opportunity. If only the contribution limits were vastly higher they’d be awesome.
Move to a country with a better health care system (basically every developed nation and a growing list of middle income nations)
Move to a blue state with stronger protections for consumers (I think some states have stronger regulations and protections for patients)
Know which people to contact when a claim is denied. The state attorney general, the state department of insurance, etc. Hire an attorney if needed.
Try to stay in good health until you turn 65 and get on medicare.
If you need insurance through the exchange, try to adjust your MAGI so you either get medicaid or a highly subsidized silver plan. Then premiums, copays and deductibles are low.
If you need insurance before the age of 65, move to a deep blue state and go on medicaid. Medicaid in the deep blue states supposedly isn’t bad. Medicaid in red states however is generally underfunded.
Whats darkly sad is that both FDR and Truman wanted to pass UHC. But they ran into opposition from southern white politicians who were afraid it would lead to ‘free’ health care for undeserving black people, and integrated hospitals which would eventually lead to the downfall of Jim Crow. Eventually the democrats settled on a compromise. Instead of UHC, they’d just give government health insurance to people who weren’t profitable to insurance companies. The poor and disabled (who have no money and got medicaid) and the elderly (who were poor and had expensive health problems and got medicare).
Racism is expensive. It really is.
Also, FWIW, when social security was first started it was designed to exclude black people. They couldn’t legally say ‘black people don’t get social security’ so instead they found the jobs black people worked and excluded them from social security. Domestic servants and agricultural workers. In the deep south, about 80% of black people worked in these fields. These jobs weren’t added to social security until the 1950s.
I’m lucky enough that I currently have a low deductible health care plan. I didn’t have good health insurance until my 40s, and now all the health issues I ignored in my 20s and 30s are finally being treated. Which is good, I would’ve had a massive heart attack in my 50s had I not. I probably still will.
But HSAs are only for high deductible plans. If you have a low deductible plan you can get an FSA which will also cover medical bills and you don’t have to pay taxes on the money. However unlike an HSA where the money rolls over, an FSA has to be used before March 15th of the next year, or you lose the money.
Cost of Iron Infusion in Chile (in USD)