The title says it all.
Some examples:
Just curious…
MtM
It varies wildly by what, exactly, you’re having done, who you’re having it done by (primary care doc vs. specialist vs. mid-level provider like a nurse practitioner), where you are, whether you have insurance or are paying cash, what type of insurance you have, and if a given provider has a contract with your insurance provider.
Doctor, $55. Specialist $150. ER is hard to say but we have after-hour medical facilities that extend the basic services as a primary physician. You can’t estimate surgery because of the nature of it but I had Kidney stones removed and I think it was something like $2500 total. At the time I had insurance through my work so I paid $800. got tired of waiting for the stones to pass after 2 weeks so it was done on-demand (that day).
That greatly depends on what kind of insurance, if any, you have.
I am very well-insured and for that reason have paid very little out of pocket for medical care. My biggest expense was when I had my wisdom teeth removed – $600.
And vision is also expensive. My most recent trip was $400 for new frames and new contacts.
Routine doctor visits usually cost $50. Same for dentist.
However, for uninsured people the medical industry is a nightmare. I had two knee surgeries in high school – $10,000 a pop. I had two colonoscopies/upper endoscopies – also about $10,000 each. I had one ‘‘overnight’’ stay in the ER which included a CAT scan – you guessed it, about $10,000. It cost me next to nothing. But I weep for anyone without insurance.
I have insurance, but it’s the type with a high deductible, so I end up paying for a lot out of pocket every year.
The way it works is that the doc bills my insurance company the “rack rate”, the insurance company re-prices it based on their contract with the doc, and then, if I haven’t hit my deductible that year, I pay. If I have, the insurance company pays.
This is in a small town with a high population of low-income people.
Costs (based on some of my visits last year)
Seeing my primary care doc: Rack rate $105, negotiated rate $95
Seeing a specialist (endocrinologist): Rack rate: $400, negotiated rate: $360
Lab tests: vary depending on test, tend to be discounted about 25%.
I haven’t had any surgeries, ER visits, or babies, so can’t help you there.
In the last few years, I have had minor (hernia) surgery, an endoscopy (over 50) and an annual checkups. As noted by others, the billing is perverse - there is what the provider bills, a discounted price paid by insurance and then the out of pocket cost to the patient (a portion of that discounted amount).
Annual checkup: (glaucoma and blood tests included)
Billed: $411 Paid: $171
Surgery:
Hospital Billed: $8500 Paid: $7285
Anesthesia Billed: $558 Paid: $384
Surgeon Billed: $1061 Paid: $722
Total Billed: $10119 Paid: Paid: $8391
My out of pocket amounts for these depended on whether I hit my deductable in a given year and the co-insurance percentage I paid. I had pretty good coverage at work. For the surgery, my portion was about $450.
If you are uninsured, you pay the ‘Billed’ amount, usually upfront…
I pay $37 every 2 weeks, max of $500 out of pocket per year. No HMO and can choose to see any specialist I want for $25 extra.
I had a cholesystectomy (gall bladder removal), with complications that resulted in pancreatitis. I was in the hospital for 11 days, 3 of them in the Intensive Care Unit. The bill from the hospital was for something like 97,000 :eek: , the negotiated amount for the insurance company was about 28,000 – rather like a “list price” and a real-world price.
I don’t recall the amounts billed by the various physicians (surgeon, anesthesiologist, pulmonologist, etc.) but those were not included in the above.
I think the amount we paid for this was capped at 2,000. Without insurance it would have been bankrupting.
In addition, there were some follow-up visits with the surgeon, an ENT specialist (due to another complication), and my primary physician. These typically had a co-pay of 15 or 20.
Hospital charges are amazing. I assume that some of this is to be able to cover unreimbursed ER services from uninsured patients. Has anyone seen any details on this?
In my area, the leading group of surgeons has refused to accept my Blue Cross insurance. So if I need surgery, I pay what the surgeon asks with no insurance coverage at all. I believe that hospitals can also refuse to contract with an insurance company if they don’t like the reimbursement rates.
A friend paid $9,000 for 5 minute ER visit (3 hours waiting) in Las Vegas for possible kidney stones. He was given two pills (one for pain, one for the stone), saw the doc for 5 min… oh and was given a glass of water too.
This was many years ago (1989) but I had gone to a doctor to have a cyst removed. I have insurance so this was covered. My doctor told me to come back to have the dressing changed daily for the next three days. I reminded him it was a holiday weekend and his office would be closed. So he told me to go to the hospital ER next door and have it done there.
So I went the first day. Obviously not being an emergency, I ended up sitting around for about an hour before somebody was able to change the dressing. I decided this was ridiculous and did it myself the next two days.
A few weeks later I got a bill from the hospital (see, this story did have a point). I was being billed for my trip to the emergency room because my insurer said that having a dressing changed was not an emergency so they weren’t covering it. The cost of getting a bandage changed was $1250.
I was able to appeal it, based on the fact that I had been told to go to the ER by my doctor, and after a year or so the insurer agreed and paid.
So how much does insurance cost? Or, in most cases, is it provided by your employer as a benefit? If so, is it a taxable benefit?
Varies widely by region etc. but some figures from our expenses so far this year (I happen to have a spreadsheet of it on this computer):
Primary care doc visits, somewhat extensive in nature: 100-125 “rack rate”, insurance negotiated rate to something like 80% of that, 60-90 dollars total paid.
Specialist visit: 150 rack rate, insurance negotiated rate 87.51, of which I paid 21ish.
Surgeon office visit: 200 rack rate, insurance negotiated rate 118, of which we paid 29.50
Uncomplicated abdominal surgery (gallbladder): 16,300. Negotiated rate 8040, of which we paid roughly 1700 (that includes the hospital, the surgeon, the anesthesiologist, the radiologist, the pathologist, and probably a few others).
Unpleasant procedure involving cattle prods: rack rate 670, negotiated rate 151.85, we paid 30.00.
Tolerable procedure involving radioactivity and a nap: rack rate 1270, negotiated rate 497, we paid 90ish.
Labwork: 350. Negotiated rate 40ish. We paid 8ish.
As you can see, with these in-network procedures there’s always some discount, often a really massive one.
Can’t answer as to the raw cost of insurance since mine is indeed provided by my employer. Typically if you do have employer-paid insurance, they pay some and you pay some, plus you get group rates.
Right now I’m paying 60 a month, just for me (since I don’t have the family on my policy, my employer covers most of the cost; they chip in less for dependents). My husband pays something like 300 a month for himself and the kids through his employer. The employer portion is not a taxable benefit; in fact the portion we pay ourselves is not taxable.
Someone self-employed does, I believe, have to pay income taxes for insurance costs, but I suspect someone with more knowledge will chime in here.
My wife and I are covered (poorly) for $350 a month. Many businesses pay most or all of the insurance for their full time workers. Although the number of businesses that do this is decreasing and many businesses keep people at part-time so they don’t have to pay them benefits.
As an aside, I knew a guy who worked for the small business I managed who had to quit, because the cost of putting his daughter (who was deaf as I recall) onto his medical insurance was more than his paycheck.
Just as a data point, I paid $2,600 for full coverage for myself, wife and 3 kids for 2009. This covers all doctor expenses and medication except for the co-pay. This also includes dental and vision coverage.
My co-pay for a doctors office visit is $10 ($50 for ER) and $15 for a prescription.
As a family we had 4 ER visits and multiple (at least 10) office visits.
In addition I have 2 small children in speach and occupational therapy - completely cover by insurance. The kids have had at least 2 medications each (small stuff like pink eye med or antibiotics)
All 5 of us have been to the dentist at least once and one daughter had a cavity filled.
All 5 have had vision tested and wife and I both get glasses every year.
Total out of pocket was under $1,200 and with the flexible spending plan we have those are pre-tax dollars.
Cost varies widely by age and location.
About 60% of those who are employed in private industry get some form of employer sponsored coverage - which may involve some premium sharing. For example, mine was free but I paid $50/month for my wife (and more if we had minor children).
I am now unemployed and pay $460/month for an extension (COBRA) to my employer’s insurance and would pay a similar amount for my wife, but she switched to her own employer policy. It would cost me $450/month to go on her policy. When I have to purchase on the individual market, it will cost more and I may go on my wife’s policy.
It is not a taxable benefit - a big point of controversy and unfairness in the system.
Like everyone has said, it varies a lot. Here are some of the charges I’ve actually had to pay for my prenatal OB visits at this point (5 months) - I have good insurance:
$15 co-pay for the first visit
$80 for an ultrasound
I was not charged for bloodwork at all. Most of the actual birth will be covered, too, but offhand I can’t remember how much it should actually cost me - I will also get a bill for some of my prenatal care after the birth (that’s typical).
It would be a lot more if I was paying out of pocket - the statement for my first appointment alone (which included the ultrasound I’ve been charged for already, and the bloodwork) added up to nearly $1600 total.
A regular checkup for me is $15, and prescriptions are generally $10 or less per refill.
I have good insurance - $154 every two weeks, plus another $55 for medicare Tax which I will probably never see any return on, for a family of 3.
A typical Doctor visit - minor accident - costs $20 co-pay and I usually end up pitching the doctor another $20 - $100 after insurance, depending upon how many tests he does. Unless I pursue the matter it is hard to tell what he is billing for exactly other than “Diagnostic testing.”
A thorough checkup can cost up to $500 out of pocket. This sort of stuff is now covered somewhat but that is new.
Surgery and ER visits are covered very well by my insurance and I don’t usually have to pay any more than a $100 - $200 out of pocket if memory serves.
Went to a foot doctor the other day - Three X-rays in her office and maybe 15 minutes of her time - Total bill $320. Insurance denied $108, I paid a total of $68, Insurance paid the rest. That was just an initial inspection. If I had wanted her to actually DO anything it would have been a lot more.
I recently had to take someone without local insurance to the emergency room in my neighborhood in suburban Mexico City. It’s a private, luxury hospital (Angeles, and stars and famous people go there). The final posting on my credit card bill was $112 USD. Half of that was the emergency room fee, and the other half the doctors’ consultation fees. No other procedure was necessary, luckily. My co-pay when I had crappy insurance in the States was higher than that for an emergency room visit years ago. I guess also in comparison, the cash price for my wife’s dental implant (at a different private clinic) was only $1200 (charged in dollars), and most of that was the purchase price of the post from the United States.