Medical rant

[npaden]

Why is it so hard to find out a price on a medical procedure? And why can't you just get a medical procedure done? I'm paying cash so no insurance to blame or anything like that.

I'm over 50 so I need a colonoscopy. So they won't do one unless you are referred by a general practitioner. So I spend $275 getting a checkup for the first time in like 10 or 15 years. That was a crazy deal too, first they said it was $275 for a full blown checkup with an EKG, labs and everything. I said I probably didn't need the EKG so they said it would just be $145 plus labs. I had to pay the $145 up front. After the checkup they charge me for the labs... $130. So I could have got the EKG for free...

The whole point was to get the referral to get the colonoscopy so the colonoscopy place calls me to schedule an office visit. I'm like, I just had an office visit to get the referral to get the colonoscopy. Yes but we need to have an office visit to make sure we agree. Like everywhere it says you are supposed to get a colonoscopy after you turn 50, I'm 56 so I think I need one. "We don't do colonoscopies unless you have had an office visit with us first". Okay, how much is an office visit to tell me I need a colonoscopy? $350! That's crazy, how much for the colonoscopy? We can't tell you. Really? You can't tell me how much it is going to cost? There are variables. Okay, so how much is a normal basic one. Well it depends on your insurance. I'm paying cash, so it shouldn't matter, how much? They never would give me even a ballpark price.

I'm checking around now. I had forgotten but this is why I didn't get one back when I first turned 50.

 

[Sheltowee]

Shouldn't be as difficult as they are making it: https://www.tdi.texas.gov/health/healthprices.html

I'd call back (or better, e-mail) and request an itemized estimate setting forth discounted cash prices as required by Texas law.

 

[TOGIE]

insurance isn't to blame, but yet, it is.

 

[noharleyyet]

Doesn't matter, play their shell game and do the c-scope sooner than later...trust me.

 

[SaskHunter]

My universal healthcare mind cannot comprehend this.

 

[brymoore]

You don’t have health insurance?

Medical billings are a game. Practices know they will not get reimbursed by health insurance at the asking rate. Practices bill the asking rate and settle for payment at a much lower allowed rate. One of my health customers was an orthopedic clinic. Business manager said the bill to paid amount was around 50%. Ask for $100, accept $50 from the health insurance is the allowed payment amount. The percentage may be higher now.

You’re probably overpaying by a large amount paying with cash without the buffer of health insurance.

 

[Treeshark]

@npaden, check this out:

Cash Colonoscopy

Good luck, I hope this turns out for you. Cash services are becoming more common for many specialties.

 

[npaden]

I have Medishare which covers pretty much everything except preventative care. They do have a PPO thing but my deductible is so high I try to just pay whatever the cash price is since I never meet the deductible.

When my wife had her knee surgery the bills added up to just over $30,000 but the PPO adjusted it down to $9,900 and our deductible was $10,000.

When she had the fancy radioactive brain scan to check to see if she had Parkinsons the cash price would have been $2,000 but since she told them she had Medishare they charged Medishare $15,000 and they adjusted it down to $9,900, again, just under the deductible. Would have been better off just paying the cash price.

I always try to get the cash price first.

 

[npaden]

@npaden, check this out:

Cash Colonoscopy

Good luck, I hope this turns out for you. Cash services are becoming more common for many specialties.

Yes, I almost ended up going that route when I checked into this last time. It's a 6 hour drive each way to Dallas but might be worth it to just get it done. My wife had it done a couple years ago and with the PPO discount from Medishare it ended up being about $2,000 if I remember correctly.

We have a MRI place here that really has the cash services figured out. By the time you figure the salaries and benefits of the number of people it takes to bill and collect from insurance cash would be a much easier deal for the clinic. But we see more and more people opting for dental insurance than ever. Of course dental costs are starting to grow rapidly now that everyone has dental insurance.

 

[Treeshark]

We have a MRI place here that really has the cash services figured out.

Yes the SmartMRI has it dialed, around $500 last time I heard.

Starting to see more of this in the total joint arthroplasty/sports med space as well. The more cash options, the better imo.

Some providers do this because they are good enough and well-known enough that they can, and some do it because they have to. Quality varies like anything else.

 

[Treeshark]

It's a 6 hour drive each way to Dallas but might be worth it to just get it done.

Dude… hear me out: you are going to have to fast and purge in preparation for this. Make the drive, get it done and hit Hard 8 after for some Q!

 

[WildWill]

insurance isn't to blame, but yet, it is.

Yep. The medical billing field is so use to playing the back and forth game with insurance that when someone ask for a cash quote it blows their mind. I guarantee the person @npaden talked to genuinely had no clue what the cash price would be and probably didn't know how to figure it out.

 

[jimh406]

Fyi, even high deductible insurance on the government insurance exchange (ACA) covers procedures like that. You might considering signing up the next time open enrollment is available.

 

[npaden]

Fyi, even high deductible insurance on the government insurance exchange (ACA) covers procedures like that. You might considering signing up the next time open enrollment is available.

If this ends up costing $3,000 it would take less than 5 months of premium differences between the $600 I'm paying for family coverage with Medishare and the $1,300 the last quote I had for family coverage on the ACA exchange with a similar deductible.

I'll stick with Medishare and paying for my preventative care out of pocket.

 

[Bonasababy]

insurance isn't to blame, but yet, it is.

How? He said he doesn't have insurance.

I wonder how he gets by with that in this day of the ACA, not easy to do and it shouldn't be easy to do.

I think it's reasonable for someone who hasnt had a checkup in MANY years to be asked to get a general physical first. There may be something discovered there that makes a colonoscopy not the priority at this time--or may suggest something be done and tried before a colonoscopy occurs. Probably a number of other reasons for it.

If I sound harsh on this it's because I am--seen too many people refuse to see a doctor for years then find out it's too late, something that could have been treated is now going to kill them in short order.

 

[Beignet]

Oof. No help, but do have an anecdote. I’ve had to be screened at a younger age and more frequently than most.

Made an appointment for one last year, right on schedule. No one could tell me if it would fall under preventative care, which would’ve covered most of the cost, or some kind of continuing care which would’ve cost me whatever it took to meet deductible. I think, because no one could even tell me if every provider involved was going to be considered in network. I’m not flush enough and the latter would’ve required some budgeting on my behalf. I spent many frustrating hours trying to find someone from the TN based PE owned (big surprise) corporate hospital’s billing department and/or my insurance company to just give me a damn ballpark figure. No dice.

Someone from the hospital’s billing called me less than 24 hours before the procedure (from likely a Philippines call center) with a magically procured price and said they’d knock off 20% if I paid in advance. I went ahead and did that. Only to get a check in the mail three months later because it actually got billed as preventative in the end.

The whole dystopian mess made Kafka’s “The Castle” look like a routine trip to renew my car’s registration.

 

[npaden]

We pay for employee health insurance for our employees and somehow have a "grandfathered" pre Obama care insurance that is actually really good. It is Just over $1,300 a month for family coverage and has office visit co-pays, etc. If I went the insurance route, that's the direction I would go. Since I'm a partner I have to pay 100% of the premium so I've been on Medishare instead since January 2018. In those 7+ years we've saved over $50,000 in premiums. Plenty to pay for a checkup, just not my favorite thing to do.

 

[mevertsen]

I could see all kinds of reasons unable to give you a cash price. Its not like your buying an item off the shelf and they offer a 3 percent discount for cash vs card.

Height and weight are going to factor in to amount and types of drugs used.

Previous reactions to certain medications, might require a different approach.

I've had many procedures done over the years. Colonoscopy, endoscopy, surgeries, scopes, scans, all different. There is no "basic"

One little thing, one hiccup, a weird reaction, a pollup found, an extra biopsy here or there, all kinds of little issues can add time to your table time.

How long you wake up, everything adds up.

They might need able to give you an idea of what each part of each procedure might be, but then it would all be a guess as to exactly what you would need.

For example, anesthesia is billed by 15 minutes in most places.

Go to 16? Pay for 30, etc.

If there is a pollup, they need to remove, that's an extra biopsy and lab visit they need to send off for. More money.

You say you have medishare. Not sure exactly how it works. But from the sounds of it, it seems everything gets negotiated to the point you have to pay out of pocket max.

Our total cost for my wife and daughter is $1k a month for the health exchange. Most we have paid is $75 for urgent care. Preventative stuff like you are talking, paid 100 percent. If we can get into the clinic non urgent, no co-pay.

You may think it's coming out cheaper, but it doesnt seem like it is.

 

[mevertsen]

One more thing. When a major medical issue hits, you will wish you have the best insurance available, if you dont have good insurance.

One trauma, flight and ICU stay will cost $250k.

Cancer diagnosis if you get one on this colonoscopy, it WILL test your finances no matter how well off you are.

Good luck, and get a check up every year.

 

[Laelkhunter]

When you get the final bill, go to the hospital billing department and tell them you have no insurance and you want to settle the balance in cash. They will usually give you a discount if you are paying in cash. Worth a try.