It’s not just annoying, it cannot be done. As I said above, the insurance companies will not divulge that information. I’ve called, I’ve emailed, I’ve written, I’ve been escalated and escalated. They refuse to give over the information to the patient. This is with the multiple insurance companies I’ve been enrolled in over the years.
If you have had a different experience, please give me the name of your insurance company. I would love to know where I could find one so transparent.
Also, your pay out of pocket idea? Doctors are no less opaque about their fees. “How much will you be billing my insurance company” is not a question they will answer.
Thisthisthis. I went to a doctor’s office to get tested for STDs when I began a new relationship a little while ago. I called the office before scheduling the appointment to make sure they took BlueOptions by Blue Cross/Blue Shield of Florida. I called BCBS to confirm. All well and good.
Went to the appointment, doctor wrote script for blood testing, which was going to be done in their in-office lab.
Went over to lab. Sat on paper-covered bed while nurse swabbed wrist, etc. While the nurse was prepping the needle to draw blood, she remarked to an observer that “the other girl had to cancel her appointment because we just stopped taking BlueOptions”.
“BlueOptions by Blue Cross/Blue Shield?” I asked.
“Yeah.”
“But I have BlueOptions!”
“Are you sure?”
“Yeah, look, here’s my card.”
“Oh, yeah. Well, we just stopped taking this last month. You’ll have to go to a different lab.”
“…”
And that is why we need socialized medicine. Had I let her jab me with that needle, I would have been on the hook for $750.
No. The insurance company works for themselves. Their only motivation is to take in as much money as possible and pay out as little as possible. Since most of us can only afford insurance through our employer, and we only get one choice, the insurance company has little incentive to give us good service. They have every incentive to fuck us.
My mother in law, who has been deemed “disabled” by every neurologist who has examined her for the past 6 years was just booted off her insurance. Why? Because some doctor at her insurance company looked at her paperwork and decided she could go back to work. She just got a summary dismissal letter, which arrived 14 days after her insurance was terminated. She’s fucked now. Not all bad news, though. Her (former) insurance company posted a $1.3 billion profit in 2008. Good for them!
They may well be motivated, but they suck at it. My wife is a wonderful doctor. Her partners are nice men and fine physicians. Most of the doctors I’ve run into in my healthcare career are decent enough, I guess. But not a one of them knows how to run a business. They each spent a decade learning how to make people better, not learning how to manage a business. Example: my wife’s practice entered into a contract such that they would be paid based on the number of days my wife spent at a certain facility. Not the number of patients she saw or the amount billed. The number of days. WTF? So, if my wife wanted to see five patients in a week, the contract motivated her to schedule them on five separate days, not put them all on the same day. Even better, my wife’s boss didn’t tell her. So, here she was, happily scheduling patients in the most efficient way possible, and screwing her practice out of thousands of dollars. Really, who would agree to a contract like that?
You want to know what’s worse? Sometimes we don’t find out that a contract has expired until months afterward. The businesspeople on the doctor and insurance ends wrangle over a contract sometimes long after it’s officially expired. They let things slide, unofficially keeping the contracted rates in place, until it becomes clear there’s not going to be a renewal. Then we have to tell patients, “Oh, by the way, you know how I told you yesterday we had a contract with X? Well, today they decided the contract is nullified as of three months ago.”
And even when there is a contract, not every insurance company has the same database. Company A has us listed as a facility: Joe Blow Medical Consortium. Company B has us listed as individual practitioners: Joe Blow MD, Harvey Ball MD, Ed Cox MD, etc. So if you call up the insurance company and ask “is Joe Blow Medical Consortium a preferred provider?” they say, “Hell if we know. What doctor are you seeing?” and how is the patient supposed to know that? Who the hell puts on their schedule, “Surgery today: Joe Blow, surgeon; Max Feel, anaesthesia; Henry Fart, respiratory therapist, et al.” Nobody.
It frustrates me to no end, and I work in this industry. The industry is in the hands of bureaucrats who see patients as little stacks of money to be moved around from bank account to bank account, not as human beings who are sick and who need treatment.
If Obama is saying that the medical industry needs to be forced to move to a single, unified standard of information exchange, I am 100% all for it. It would make things SO MUCH EASIER to be able to look up a patient’s medical records without having to call 50 different doctors. To look up what a patient’s insurance is, whether there is a deductible and how much of it has been met, without having to send the patient a bill.
A) Depends on the tests, and
B) it’s a lot more complicated that that.
I have blood drawn at least four times a year to check three different thyroid levels. The costs of the individual tests vary. The charges are $17 for the blood collection, $29 each for two tests, and $68 for a third test. Total of $143 for some very basic tests. I had to undergo an extensive set of testing a couple of years ago when my husband and I went to a fertility clinic, and I assure you that $750 for a whole panel of tests is not unusual.
Now the fun part. My insurance company has a contract with the provider, and so they have set prices that they pay for specific services. For the charges totaling $143 above, the insurance company is contracted to pay a total of $20.11 (9.62, 3.94, 3.70, and 2.83 respectively). Their deal with me is that I pay 20% until I reach my deductible, so the insurance company sends the provider a check for $16.09, and I send the provider a check for $4.02. Remember, that’s on a total charge of $143.
That’s a fairly easy incident to follow. Most of them are more complicated. If you want to figure out what’s really going on, you need to be tenacious, organized, and willing to commit a lot of time to it. Our family had a lot of medical stuff last year, and keeping up with insurance and making sure we were paying only what we were supposed to pay was like having a part-time job.
I would think the office would have been out the money, not you. Their contract with the physician obligates them to refer to participating facilities.
I have never heard of such a thing. I can’t imagine it is legal. I’ve worked with most of the major carrier…Blue Shield, Aetna, United Healthcare, Humana, Tricare, Cigna and every one of them provides this information to the patient.
As a matter of fact, many allows access to your benefits and co insurance on line.
Can I rant on the other end of this for a moment? I am a health insurance agent. I work for a non-profit administrative company designed to help provide affordable health care options to employers with 50 or fewer employees so that people who couldn’t/didn’t have coverage last year due to the cost can now offer health, dental, and AD&D benefits to their employees. Our goal as a company is to get you affordable, high quality coverage. We are NOT out to fuck anyone out of their money…we don’t deal with the claims and the payouts and that kind of thing, our sole purpose is to help those people who need coverage. So why don’t people fucking listen to what I tell them? I had this discussion with a woman earlier today:
Customer: I need for my employee to have coverage from May 1st forward.
pbbth: Well, according to the waiting period your company chose this individual is not eligible for coverage until June 1st because they haven’t worked for you for 90 days yet.
Customer: Oh, well then just change the hire date on the form then so she can get coverage in May.
pbbth :dubious: Ma’am, if I do that and this woman has any kind of major claim at all in the next year it will be denied. When carriers get sent claims they review all of the paperwork on that individual, including their enrollment forms and tax documents from your company. If they find out that you lied about the hire date on the enrollment form, which they will because it is accurate on the tax paperwork we have, they will deny her claim due to fraud. It doesn’t benefit her to lie about that.
Customer: Well, just change it anyway. She needs the coverage.
pbbth: Ma’am, I can’t do that.
Customer: Can I speak to someone else in your office?
…and how about the lovely labs that are all outsourced to private clinics. Our favorite was the MRI clinic technician that overruled the referring doctor with his own “diagnosis” and intentionally decided (yes, in writing on paper) to give a different MRI instead. A wasted visit and day off work that the insurance company got billed for and counts against our annual limit. Then they did it again on our repeat visit!
We expect it was intentional, so that the clinic can earn extra billing for “oops” procedures with no repercussions.
So, when in the training do they go to business school? It’s not part of medical education in the US, unless someone has gone on their own, before or after medical school.
Ah, so a surgeon who performs a finite number of operations happens to know their cost. What about a GP - prescribing a multitude of different drugs? Do you think they know the difference between Antibiotic A and B? how about the liquid form vs the pill form? The dozens of different diabetes and hypertension drugs? The difference in blood draw price between lab A and lab B? There are ways to look this info up, but it’s not something that is formally taught. Specialists in their fields might know a little more, particularly for something they do all the time, but not always. It’s a problem. I’ve run into people afraid to mention how expensive something is, and the doc carries on, unaware this is causing a problem, or could possibly even be a problem.
Maybe some of this stuff is regional - my local hospital is a major empire that pretty much does everything and is very centralized. I’d never heard of private practice anesthesia, but I guess it’s common. Go figure.
Does someone have to be formally taught something in order to know it? My husband never took business classes, but you better believe that when he worked for a company that focused more on profits than patient outcomes, the Powers That Be made it clear which treatments the therapists were “encouraged” to bill to pretty much everyone, whether it was wholly necessary or not. My husband no longer works for this company because he found them unethical (and so did the federal government, by the way).
Our friend who owns his own practice (along with a group of other doctors) never took a business class, but he is a business owner and a businessman. He absolutely knows how much money he’s going to get back from Blue Cross Blue Shield vs. Medicare. Does he withhold or prescribe treatments based on that? No, but he certainly knows he can’t build his business on Medicare patients and he’s going to bill out every possible item he can while still trying to remain ethical. I’ll give you a for instance that I recently discussed with him. He was complaining that the reason national healthcare would not work is that people would come see him every time they twisted an ankle. If there was no out-of-pocket expense, there would be no disincentive to treat minor stuff yourself. He used an example of a Medicare patient who came to him with a stubbed toe. I asked him, if you knew this person could treat this himself, did you send him home and not bill Medicare? He said, “Of course not!” He looked at it, did basic first-aid, gave advice for at-home care, and billed Medicare for all of that.
Does a doctor have to know all the different pharmaceutical charges? No, because that doesn’t affect their bottom line. Do they know which items they can legitimately tack onto the bill that will be paid by the coverage provider and will maximize their profits? Absolutely. I’m not saying they’re making stuff up or giving care that isn’t helpful to the patient, but if they have the choice of putting a band-aid on someone and billing it or sending the person home to put a band-aid on, they’re going to do the thing that’s going to bring them more money.
Frankly, doctors really have to be businessmen, if they want to stay in business for very long.
Fortunately (for me and many like me) doctors are terrible at business but are wise enough to hire people that aren’t. Healthcare Administration degrees are becoming more common and many larger groups insist on an MHA from their administrator. Most if not all successful group practices have a business person running the show.
It is the rare doctor indeed that knows much about insurance or even how much their services cost. They have a general idea but in my experience, treat the patient and allow the staff to worry about the bills and paperwork. The docs have a vague idea that one code pays better than another code but knowing exactly how much each contract allows?? I’ve never met this wonder doc.
I think that small offices with one or two physicians are probably more likely to try to keep up on trends and their business issues only because they cannot afford to pay someone to do it. Those physicians would still be better off hiring a professional.
There’s an entire industry built up around this stuff. An incredibility complex, detailed industry. I’d say yes…yes they do. We can’t even agree in this thread how it works. And you’re saying that a group of people with no formal training and an entirely separate job (actually seeing patients) should be able to do both, just like that?
I think when people discover the wait to have their stubbed toe treated is three weeks, they’ll treat it themselves. If care is nationalized, a better system of allocating resources will need to be developed. And that is why I believe it will never happen - a lot of Americans are too determined to do everything possible, regardless of the outcome or quality of life. Look at the battle over Terry Schivo. As a society, we’re not prepared to have a mature discussion on this topic. I think something catastrophic will have to occur to make any serious changes.
Or they could just hire someone to do it for them.
I see your point. The problem goes back to people not understanding their insurance plan. One call to Blue Options from the patient, if they had performed a non authorized service, would result in the lab writing off the fee or being contractually non compliant.
If the billing department refuses to write the bill off, that would be the next step. It never should get to an agency.
Workers’ compensation physicians know how much a procedure costs to the penny, IME. Or at least, they know exactly how much it’s costing them to accept the fee schedule payment instead of the full amount.
I work in your area so I find this post interesting. I’ve done consults with most of the specialists associated with ORHS and Florida Hospital and have never met one that knew what an office visit paid under FWC let alone what a surgery reimburses. Again, they have a vague idea that surgery pays better under workers compensation insurance and visits reimburse better under Blue Shield but to the penny?
I can only guess you mean small primary care offices because I do not work with those types of practices.
Good point, but wouldn’t we have received some kind of correspondence from Medicare, or her secondary insurer? Or the hospital and doctors? No one has sent anything to her, and that seems odd.