I tried to, and it came back to bite me.
On my last Dr. visit, I asked that my prescriptions be written for 90 day’s worth instead of the previous 60 days - so I’d have a cpl less co-pays a year.
The clinic called the new prescriptions into the pharmacy. When I went to pick them up; they weren’t paid for by my insurance at all.
Getting the Dr. on the phone to straighten it out and get a new prescription if needed is getting to be a challenge because we’re playing voice-mail-tag.
But how do you know that every procedure and test the doctor does will be covered by the insurance?
I don’t have to , Canadian.
Because I use “in network” doctors. If the doctor is covered by the insurance plan, then so are the services performed (though some services may need to be pre-certified). The only time something odd came up was after my wife had surgery. We got a note from the insurance company saying that the anesthesiologist used by the hospital was out-of-network and I would have to pay a much larger share of the bill. I contacted the insco and let them know that we had used an in network doctor, an in network hospital and got the procedure pre-certified. As we had no choice in who the anesthesiologist would be and followed all the insurance rules, I submitted that they were on the hook as if it were all in network. They agreed.
The fact that a particular practice is in your network doesn’t mean all the services it offers are too. You’ve been lucky.
Not anymore.
I was unemployed and therefore uninsured in Arizona at one point, and ended up in the ER. I told everyone who got a hold of me that I had no insurance and no income. They all immediately understood that meant not to order any tests that weren’t life-and-death necessary, and that if they prescribed me anything that cost more than $20 at Walgreens, the prescription would not be filled. The ER staff were wonderful to me, but all the non-emergency personnel I dealt with were horrible as soon as they heard that I was a low/no-income patient trying to get state health insurance. At one point, one of my friends paid $25 at a clinic for me to speak to a nurse practitioner, and another $25 on the way home to buy me some small furry animals for company. We agreed later that the rodents were by far a better investment.
I was just barely employed and not yet insured in Massachusetts, and ended up in the ER here as well. I told everyone who got a hold of me that I had no insurance and no income. All of them looked confused, and none of them had any idea why I thought that was relevant to the “emergency services” portion of the evening. State health care in MA, while not quite as simple as universal healthcare in places like the Commonwealth countries, is still much more comprehensive, and more consistent, than the HMO I was on as a kid. Yankees consider it rude to just sort of let people die.
So, it varies from place to place even here in the US. I used to discuss costs – mainly I just repeated ‘I cannot pay for that’ a lot – but now I don’t have to, unless i decide to go in for elective cosmetic surgery.
If you follow the precertification rules of your particular plan, you will know in advance if any particular service or treatment is not covered. I don’t discuss fees with my doctor, as I said above that is the job of the insurance company, but I do discuss treatment plans - including what procedure(s) we need to follow in order to stay within insurance guidelines.
Well, that’s fine as long as you know exactly what procedure or service the doctor is going to recommend in advance. And if you do you probably don’t need a doctor.
That’s exactly what a friend of mine did. His wife is Aussie, and they lived in PA with 3 kids. He lost his job during the downturn, and insurance, and calculated that they’d be dead broke in no time paying COBRA.
The wife and kids moved to Australia while he kept the home fires burning, trying to get a new job, when that didn’t work out, after 6mo or so, he moved.
If we had universal health care, like every other first world nation, he wouldn’t have had this problem.
This is true, and is a prime reason why our HC system is ridiculous.
If I want to find out how much a procedure is, I don’t talk to the person performing the procedure. I talk to the insurance company. I’m not a medical expert, so the conversation is a joke. I go back and forth a couple of times and eventually get a number for the procedure. Then, when it’s done, it’s 20% more expensive because I didn’t tell the Ins Co. about this prep work item and that followup work item and the lab result, that I really had no idea was going on.
You have to bust your fucking ass just to get a sense of the cost of any procedure. I guess that’s the price you pay to get the benefits of choice, that and paying 2x the price of other countries.
… broker than they were making two rent or mortgage payments? :dubious:
I don’t see why you find this so difficult. I talk to the doc about what needs to be done. I then talk to the folks in his office to see what the insurance requires in order to cover it. If it turns out it’s a procedure they don’t cover I go back to the doc to discuss options. It’s really that simple.
How much do you think COBRA is, or was at the time, for a family of 5? He did the math, and decided the cost of the move was the better deal. Now, they may have been able to stay with family in AUS, since it was intended to be a temporary move, only getting their own place after he moved there as well.
Family COBRA coverage can be in the $1000 range - or at least what it costs to rent a home you can fit five people in.
It really isn’t that simple, unless your doctor only accepts one or two insurance plans. Most practices accept dozens and have almost no idea what is covered by each specific one. Again, you’ve been lucky.
Underlining mine. You keep misspelling “well prepared”.
Either that, or I have a “lucky” streak that extends over 30 years, 5 family members and dozens of combinations of doctors and insurance plans with only the one hiccup mentioned in my first post. Maybe I should go to Vegas…
Raises hand
I can explain that, after 20+ years in the healthcare industry.
Healthcare providers don’t have a set cost or charge, is the short answer. Below is the long answer.
They fucking make it up. Hospital charge masters are the worst because they are so inflated.
Basically, health care providers have many “prices”. They have one for insurance A, one for insurance B, and one for Insurance C. They have another for HMO Q, Auto Medical Company X, and Workers Comp P. And then finally, they have the price they charge to an uninsured patient, which is normally the highest.
Insurance companies never know what something costs. they only know their own reimbursement schedule.
In medical settings, there’s no accepted standard way to calculate how to determine cost for a procedure. This is utterly ridiculous, since healthcare seems to be the only industry this happens in.
[ul]
[li]If you make a widget, there’s an accepted formula/method of determining pricing so that a reasonable profit is made. [/li]
[li]If you run a restaurant, ditto. IIRC, something that costs $3 to make would be priced at $9 (Gordon Ramsey math there). [/li]
[li]If you run a cleaning business, you figure out the general range of per-hour/per-service charges in your area, then price based on that.[/li][/ul]
But healthcare? No one knows. This is one of the biggest barriers toward payment reform. For every GP who can’t make ends meet on a $20 reimbursement per patient, you have a damned hospital charging $30 for a Tylenol and $50 for a finger splint.