Medical rant

[npaden]

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 instead places.

Go to 16? Pay for 30, etc.

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

You say you jave 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 wofe 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.

I think over the 7 years we've saved a LOT. The knee surgery coming out below the deductible was crazy. I'm not sure how they get away negotiating that down so low. The radioactive brain scan was about the price it should have been, the cash price was just super low and we missed out on it.

Medishare has been good to us even if they haven't paid a dime in the 7+ years we've had it. The PPO discounts have saved us tens of thousands and like I mentioned before the premium savings has been over $50,000. But we don't get to pay $25 co-pays for a doctor visit and we don't get "free" preventative checkups.

You mention all those variables, but the PPO does adjust them to a basic procedure and pays the same thing to the provider no matter if you are 5' tall and 98 pounds or 8' tall and 500lbs. You would think they could look up what the PPO would pay them and quote a cash price based on that.

 

[mevertsen]

I think over the 7 years we've saved a LOT. The knee surgery coming out below the deductible was crazy. I'm not sure how they get away negotiating that down so low. The radioactive brain scan was about the price it should have been, the cash price was just super low and we missed out on it.

Medishare has been good to us even if they haven't paid a dime in the 7+ years we've had it. The PPO discounts have saved us tens of thousands and like I mentioned before the premium savings has been over $50,000. But we don't get to pay $25 co-pays for a doctor visit and we don't get "free" preventative checkups.

You mention all those variables, but the PPO does adjust them to a basic procedure and pays the same thing to the provider no matter if you are 5' tall and 98 pounds or 8' tall and 500lbs. You would think they could look up what the PPO would pay them and quote a cash price based on that.

You have saved a lot.

But you are thinking by numbers and not reality.

One cancer diagnosis (that's the reason for the colonoscopy) WILL ELIMINATE THE MONEY SAVED.

 

[mevertsen]

For example.

I'm on dialysis. Home dialysis. Here's a photo of my January bill just for my clinic. With insurance.

Cancer is just as expensive

Edit. I'm also on medicare. So I jave that premium. Plus my income is such that the clinic is able to waive wahts left over. Its a complicated mess.

Plus I have cardiology, various other specialists. And general practitioner. And that if no er visit.

Got sent out last fall. Flight alone was 35k.

 

[WapitiBob]

I’m sitting in the office waiting for my dr to walk in, 6 month checkup; $19 co pay. Colonoscopy is free thanks to Obama.

I put 450,000 miles on my father in laws dream truck because he didn’t get a colonoscopy and died a slow miserable death.

 

[mevertsen]

I was on insurance committee at work when I was working.

Not uncommon to see bills of 3 and 400,000 for a year.

So hard to predict. So many variables.


Even with my bills at one hospital I've always been able.to cash discount my portion.

 

[SaskHunter]

The more I read, the less I understand.

Medical billing shouldn't be a game that one gets good at.

What about the majority of people who don't have the time or capacity to play "billing games"...

Edit: My kids love telling their friends, and joke about, the time "dad got a camera up his butt". It cost me nothing and got it scheduled 3 months after I had a routine medical appointment which also cost me nothing. I know I'm adding absolutely nothing to this convo, but JFC...

 

[mevertsen]

The more I read, the less I understand.

Medical billing shouldn't be a game that one gets good at.

What about the majority of people who don't have the time or capacity to play "billing games"...

That's what billing agents at the clinic and insurance company get paid to do

 

[npaden]

For example.

I'm on dialysis. Home dialysis. Here's a photo of my January bill just for my clinic. With insurance.

Cancer is just as expensive

Yes. That's why I have Medishare. It isn't insurance but is very similar. You can choose to have a lower deductible, I just choose to have a high one. There is no top sharing limit. Lot's of insurance has a maximum of like $1,000,000 payout total.

I was wrong on our previous numbers, the year my wife had the radioactive brain scan we actually DID go over our deductible and they ended up paying $6,600.


The year of the knee surgery, even though the costs were much higher, we still didn't meet our deductible.


This wasn't intended to be a discussion about insurance vs. Medishare, just a rant about not being able to get a quote for a cash price for a medical procedure but I don't mind explaining about Medishare.

 

[mevertsen]

Yes. That's why I have Medishare. It isn't insurance but is very similar. You can choose to have a lower deductible, I just choose to have a high one. There is no top sharing limit. Lot's of insurance has a maximum of like $1,000,000 payout total.

I was wrong on our previous numbers, the year my wife had the radioactive brain scan we actually DID go over our deductible and they ended up paying $6,600.
View attachment 366415

The year of the knee surgery, even though the costs were much higher, we still didn't meet our deductible.
View attachment 366416

This wasn't intended to be a discussion about insurance vs. Medishare, just a rant about not being able to get a quote for a cash price for a medical procedure but I don't mind explaining about Medishare.

Didn't intend to be a debate.

You asked a question.

I answered it.

You are asking about a procedure that has so many variables, challenges, unknowns and outcomes, that's its like coming on here and asking how much an F150 costs.

There are so many variables its impossible to answer.

Easy button, and less stress.

Buy the best insurance you can afford, and don't skimp. It will catch up sooner or later.

We did look into medishare several years ago. If you are healthy, its good. One bad report and your screwed.

FYI. That max has been lifted.

 

[npaden]

I'm going to go get a colonoscopy just because everyone is telling me I really need to.

I double checked Treesharks link and there is a place in Abilene (only 143 miles away) that will do the upper GI scope and a colonoscopy for $2,750. Dr. thought it would be a good idea on the upper GI scope since my dad had stomach cancer so I'm getting that done too. Still calling around here in town as well.

 

[mevertsen]

Also, don't just get those done.

See a GP every year for lipid panel, all the normal stuff.

At your age, things can pop up fast.

Good luck

 

[WildWill]

That's what billing agents at the clinic and insurance company get paid to do

Yeah we do!

Didn't intend to be a debate.

You asked a question.

I answered it.

You are asking about a procedure that has so many variables, challenges, unknowns and outcomes, that's its like coming on here and asking how much an F150 costs.

There are so many variables its impossible to answer.

Easy button, and less stress.

Buy the best insurance you can afford, and don't skimp. It will catch up sooner or later.

We did look into medishare several years ago. If you are healthy, its good. One bad report and your screwed.

FYI. That max has been lifted.

In fairness you can give a base quote or average quote for a F150 but not if the person he talked to generally didn't know. I would be able to give him a ballpark but I'm the billing agent, one of our receptionist or nurses wouldn't know where to start.



Couldn't agree with you more for the most part though seen things go south one to many times.

 

[npaden]

Okay, calling around seemed to be the right call.

The place where my wife had hers done quoted me a fixed fee for everything except for the anesthesia. They said that would vary but shouldn't be more than $500.

Cash price quoted was $210 for an initial visit, then $950 for the colonoscopy and $650 for the upper GI endoscopy. That's actually cheaper than the place that treeshark linked.

Hope they use a different camera for each procedure!

The Dr. doing the procedure has a shocking 5.0 star rating on Google with 300+ reviews. He gets a 4.8 on Healthgrades so evidently he is good.

 

[WildWill]

And before someone jumps down my throat I'm not encouraging him to not get a colonoscopy just cracking a joke.

 

[SaskHunter]

I'm going to go get a colonoscopy just because everyone is telling me I really need to.

I double checked Treesharks link and there is a place in Abilene (only 143 miles away) that will do the upper GI scope and a colonoscopy for $2,750. Dr. thought it would be a good idea on the upper GI scope since my dad had stomach cancer so I'm getting that done too. Still calling around here in town as well.

Got both done and happy I did. Getting colonoscopy done every five years from now on since there's colon cancer history in the fam.

Gotta make sure that turd-cutter won't kill you, and also, check you nads!

 

[SaskHunter]

View attachment 366420

And before someone jumps down my throat I'm not encouraging him to not get a colonoscopy just cracking a joke.

I saw a Dr offer free nads check with a cardboard sign on the side of the road. Who would turn down free medical checks? So, I obliged.

His prognosis; "nice, man!". I don't know what it means but I must be gtg?!?!

 

[npaden]

I forgot about the prostrate exam. I did get one of those at 40, the guy doing my checkup this morning didn't mention it so I'm not going to complain.

Am going to try to be better about getting an annual checkup.

 

[Gulf of America]

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!

@npaden if you go this route, do the drive before the prep. 6 hour drive will turn into 12 if you're having to stop every half hour to crap yellow gatorade out.

 

[Big Sky Guy]

Yes. That's why I have Medishare. It isn't insurance but is very similar. You can choose to have a lower deductible, I just choose to have a high one. There is no top sharing limit. Lot's of insurance has a maximum of like $1,000,000 payout total.

I was wrong on our previous numbers, the year my wife had the radioactive brain scan we actually DID go over our deductible and they ended up paying $6,600.
View attachment 366415

The year of the knee surgery, even though the costs were much higher, we still didn't meet our deductible.
View attachment 366416

This wasn't intended to be a discussion about insurance vs. Medishare, just a rant about not being able to get a quote for a cash price for a medical procedure but I don't mind explaining about Medishare.

@npaden have you looked at Samaritan Ministries? I had an acl replacement and meniscus repair in summer of 2023. Followed with nearly a year of physical therapy. Total cost of office visits, surgery, and PT was just under $40k. Total out of pocket expense was $574.70 (that's less than 2% "deductible"), and that was even with some of my months of PT getting pro-rated due to the amount of needs exceeding the amount of shares. I paid everything with a credit card that I get 2% back in miles so I actually came out slightly "ahead" as I paid the card off each month.

I believe initial unshareable amount has been increased to $750 now. Our monthly premium is $591.

HDHP's are great for the rare events @mevertsen keeps bringing up. We had an HDHP before this and while we were paying like $150/month out of pocket, my wife had a kidney stone and that $3500 ER visit was ALL out of pocket.

Our experiences really opened my eyes up to the meidcal billing like you are talking about. Most everything was 20% off the top when I told them I'm paying with cash. They also wouldn't give me a price for the surgery up front but required a $7k down payment. When wife had kidney stone, they kept giving her IV Ibuprofen (I forget what it was actually called) and the nurse even said "this doesn't really help much but is the best we can do for pain." I think those IV doses all added up to like $1k of the bill, so like you have found seems super shady they can just treat you without discussing cost. If it's not helping why pay for it!?

I think these sharing ministries are about the best thing going since Obama Care ruined health insurance (if you can agree and abide by their "rules"). Also seems like a must to be decent with finances and have a pretty good nest, I realize not everyone can front $7k, there is about a 3 month delay from services to being redeemed. I know of someone with cancer and it has worked "well" for them with the hardest challenge being large upfront costs (i.e. I think it was like $80k for chemo so they had to get a loan for that, but even then with a loan for 2 or 3 months it's likely going to be cheaper than HDHP's. Further, there is no network BS, can be in any state (or even Canada and Mexico) and just pay the bill and get reimbursed. Lastly, no one manages your money as cautiously as you. So, when you have to "pay" you are actually looking at and questioning the bills. Something no one does with insurance. It also encourages us to attend church regularly. I believe there are secular sharing things now that don't have same requirements.

Overall I think (but don't actually know because never been anywhere else) we have some of, if not the best, health care in the world, but man it's a pretty messed up system.

 

[npaden]

I did look into Samaritan Ministries when I was trying to decide back in 2018. I think at the time Medishare was quite a bit larger and seemed like the safer option. When I first switched to them I think my premiums were only $350 or so a month. Now that we are both over 50 the premiums have gone up a bit.

When my son turned 18 he had to sign off on some things agreeing to be a good boy and all that but it was pretty painless. As long as he is a full-time student he can stay on our plan with us.

Before Obamacare I had individual health insurance that was only around $600 a month with a big deductible. After Obamacare that policy jumped to over $1,000 per month so that's when I switched to Medishare.