Now the Bills come/insurance payments

[old goat]

My bill from the hospital was about: $60,561.51. This was just the first day with the surgery. The insurance company only “allowed” $28.536.00. I think the prosthesis was about 30K if I can figure out what they mean. How can they only pay for half of an operating room? Or half of a prosthesis? Or half of a recovery room? I can see where the health care in our country is in bad shape. In all they are saying I owe the hospital about $283.00. Those people saved my life so to speak. I had no choice in this surgery. I had done years of work to save my knee, but with sports, and my arthritis is just wasn’t so for me. I am not complaining about my costs, but I wonder in the future who will still be in health care? Will there be as excellent workers, nurses, and others as I found? Who will want to go into health care? Am I reading these numbers right? No wonder doctors overbook themselves. If you are a good doctor then you probably have an efficient office maybe with up to 10 good workers, nurses included. There is a lot of over head in that office. I see what they paid my surgeon too, only half of what he billed. I am glad I have some secondary insurance, and I guess the primary is thinking lets share this with them too, perhaps in how they pay their bill. Price should not be a part of the decision to do this, yet I know for many years I pondered upon this before the knee was done. Thank God I have insurance, but a lot of people do not. I just feel like in the final end I am still going to get some really large bill, even though everything was pre-certified, authorized, and in-network. I was VERY careful to try and do this by the book. This is not what I want to be thinking about with recovery. This forum is very encouraging, thanks for any who share your thoughts on this side of the process.

 

[Texas]

I agree my Ins didn't pay much at all either. I don't have a second insurance. So I have alot of medical bills. Before the surgery my Ins said that would pay one thing then at the end it all changed. Your right I had it done, and I am greatful for all the poeple that helped me as well. And I will continue to pay. I just wonder whay they charged me 7.95 for an aspirin.....?

 

[Josephine]

With all it faults, I thank God for our NHS.

 

[FrogFeathers]

I have medical coverage through the Veteran's Administration because my husband is a 100% service-connected disabled veteran. He spent 8 1/2 years in the Army, six months of that time in the Persian Gulf War. When he had his stroke, we had to fight for every bit of disability and benefits we got (we... I, I had to fight... he just signed the forms and went to appointments that I dragged him to).

I can't remember what my bill was- it gets broken down in the statement, but I do recall one being near $50,000. We have to pay around two grand of that. The good thing about our insurance is when we reach a certain amount, everything that follows is free. So for the rest of the year, any medical visits or prescriptions are of no cost to us.

Of course, the lame part is having to have that massive bill happen... I'd rather do the cost-share amount and not worry about that massive bill.:hehe:

 

[Coppernob]

Me too, Jo. Linda x

 

[loggon]

Old Goat

First the Doctors set up a contract with the Insurance Companies.
They agree to what they will receive. As well do the hospitals
set up a contract with Insurance Companies.

Those bills you get with such large amounts area a forest and a joke. The doctors and hospitals know exactly what they will get for each procedure.

As for as your insurance. You said you had a secondary policy, so I am assuming you are on medicare as the primary.

I don't know what plan you have of course, but you should have a
"Stop Loss" meaning the total amount you pay out of pocket for the year.

You said you expect a bill for $283. from the hospital. Has your secondary insurance company kicked in yet?

 

[old goat]

No, I don't have medicare or medicaid. I wondered if they marked up the bills. So maybe I will not feel so badly for them now. I am waiting for my secondary to see what they do. I am very vigilant on all of this. I hate it when someone makes the wrong code and then insurance doesn't pay right. I can see on line the primary insurance but the secondary does not do this...rats. It makes it so easy to keep up with all this when you can see it on line. thx. old goat

 

[Linda2]

Heck, if you're not eligible for Medicare, you are only an aging goat, not really and old goat!

 

[Motherofmany]

My knee has cost close to $65,000 before the MUA yesterday. Fortunately/unfortunately we have a $5000 maximum for the year, so anything over that is on the insurance company. I have been astounded by the bills and what they charge for certain items also. I make sure I check all bills and BCBS explanation of benefits so they match. I also called to question some items to get full explanations.

Since my left knee will be done this year also, it's like a buy one, get one free! :D That's one thing I can be thankful for.

Although everything was preapproved, my insurance company still stalled by sending out accident information forms even though they were well aware it was not. I was rather infuriated to have to deal with that right after arriving home, since they denied all claims until I spoke with someone to clear that up! Don't understand all the unneccessary paperwork that was involved. Looks like they would want to be more cost effective and not waste money.

Also, even though my OS, hospital, labs, pretests, etc. were in network, the anestesiologist were not. Go figure. That's one choice you don't get to make. I did find out however if you send them the check the insurance company sends to you with your explanation of benefits statement, they will work with you on matching benefits. It never hurts to be diligent about these things. Can only save you money, so be bold and ask!

 

[loggon]

mother

If that is the anestesiologist the hosp. uses and it was not just a choice, you need to fight the insurance company on this.

I have gotten several clms paid on this very thing for folks. Just keep on the ins. co. as you did not have a choice and the hosp. is in network as well as your OS. I know BSBS and a lot of the Companies will try to get out of pmt. But you need to fight it.

 

[Motherofmany]

Pat,

They have been good to match the benefits thus far. Meaning we still owe them money, but not as much as they originally request. Am wondering about the ones at the Surgery Center from yesterday though. Different group that with the hospital. Not sure if they are in network. Guess we will see.

Rick does not ask, he just pays, that's why I handle these bills. If I let him, we would have to pay the full amount. Guess I don't care what they think, but he works hard to support our large family and any money I can save by making a phone call is a blessing. Have a folder about 2" thick with all the bills, etc. A lot of work, but well worth the savings.

The most awesome thing about my HUGE hospital bill was that we have a $200 copay per stay and all the surgery, 4 day stay, inhouse pt, medicines, labs etc. all fell under that $200 co-pay. Isn't God amazing! That is where we saved the most cost.

 

[NLVCa]

Seconding Jo's comments, with all its faults, our Canadian system (administered by our provincial governments) is a God send. My only charge for the operation and hospital stay was for the use of a telephone and that was about $50 for 3 1/2 days. Mind you I was in a 4 bed ward and didn't have a TV. Still that's not bad. As a senior (over 65) I pay a flat $100 per yr for all prescriptions plus $7.00 per prescription. When you are taking Crestor, + an arthritis drug and a high blood pressure prescription + all the pain killers after the operation, the med's could bankrupt you without some type of coverage.

 

[Judles]

Our healthcare system is very inequitable as well! Unfortunately, the people who need it the most, have the least access to it! So sad! VERY unfair!!! :(

 

[brs0660]

Amen to everything said..I have noticed that a numbarer of the drug have been giving unemployeed or indigent families drugs for free or at discounted rates.
Barb