Keeping medical costs down. UPDATE #10

[MariesMama]

I recently had a pap, then a biopsy, then (apparently) a ton of tests that I didn't quite realize were going to be performed. Now I'm getting the bills.

While I know I can refuse tests, ask for them to be done later, or call my insurance to find out how much I'm going to have to pay, how do I do this while my feet are in stirrups? If I say, "No, I can't have this done right now because I don't know how much it's going to cost," I have to pay an additional charge for another office visit later. Also, it seems like my doctor's office (actually the whole medical center) has a policy where, once you sign a form authorizing lab work, it authorizes ALL labwork. Last year a doctor did an entire STD panel AFTER confirming that all I had was a yeast infection. $400 later I threatened to take my business elsewhere and they waived the bill.

I'm very confused, and I do know it's my responsibility to know how much things cost and to pay for them. I really don't need a lecture on that. What I do need is the knowledge of HOW to find this out, and what to do when things come up while I'm in the exam room.

(I don't mean to sound emotional, but I asked this on another non-MDC board and was told to whip my cell phone out in the exam room and call my insurance company for every.little.thing, then berated for being irresponsible.)

[cristeen]

Well, i would start with a frank discussion w your dr. If you see the same doc each visit, expect to have to remind them each time. If you see different doctors, you'll have to have the whole convo each time. Basically tell them before they do anything that you pay out of pocket for everything and need to be consulted before they order or perform anything over and above the basic visit fee. That if you haven't been informed of the charge, its purpose and approved it prior to its being done, then you will dispute it every time, and they will lose money. You will probably have to be a hard@ss about it, but stand your ground. Ultimately, the dr works for you, and if they cant understand/accept that you have to live within a budget, then you have the option of finding a doc who does.

I had to have a similar convo w our ped about WBV. DS' insurance is high deductible, so i only take him in when necessary, and WBV aren't IMO. When a 5 minute visit I requested/felt was necessary costs me almost $200, i'm not about to attend visits i dont feel are necessary.

[texmati]

It's a huge pain in the butt.

I'm so sorry you got berated on the other board-- this medical billing is complete and total garbage. Dr's are used to billing insurance companies for things, and jsut letting the chips fall where they may. I'm pretty proactive about this and I think I"m pretty smart, and it's nearly impossible to get a straight answer about this from anyone. It really makes me angry that medical professionals can be so blase about charging people these ridiculous amounts without letting them know upfront what it will cost. The reason they can get away with it is that most people do not pay outright for their medical care. When you do, and *try* to be responsible, you get the run around.

Now *I'm* getting emotional.

Do you have insurance? You mention insurance, so I'm going to assume you do. If you don't, it does make things simpler, because the dr's office will handle all the billing, and give you discounts. You negotiate only with them.

I'm pregnant, so it's a little different than one-off illness. Anything that I can possibly plan, I do the following:

Call the insurance company and ask them what I need to do to find out how much X is going to cost. Normally, they tell me that they need the med. billing codes.

Then I call the Dr's office and ask them what codes they would use to bill my insurance company. Sometimes people are a pain in a butt about this, but i make it clear that I need this info to budget. If they tell me now, then it will be easier to get paid later.

Then I call the insurance company back, and get the prices associated with the codes, along with a lecture on how this is all an estimate.

Even then, none of it is a guaranteed price.

To minimize costs, try to do the following:

Really, really, really understand how your insurance works. For example, are well visits covered, but not the lab work? What is your deductible, max out of pocket etc. This year, I learned a new word, co-insurance! I didn't understand exactly how my insurance worked at the beginning of the year, and it could cost me a few thousand dollars with this pregnancy.

Really, really understand how your ped/primary care physician/ and ob work. If you get blood taken in office, who bills for that? Who is the person you need to talk to for billing issues at the office? (make friends with them).

Finally, I would do as cristeen said above, really have a frank conversation with your Doctor and billing person at the office, that you pay out of pocket for these items and it matters to you what it costs.

This was really hard for me to do, especially since I have always had the luxury of no deductible/only copay plans before this year. My ob's office is really good about informing me of every time I will have lab work or a procedure out of the ordinary. With sick visits, ask each time they do a procedure if there is a cheaper option-- not saying that you have to take that option, but you should at least know about it. Again, this was very, very difficult for me to get a handle on this year-- It's hard, especially when you are sick and scared, to bring up finances in the middle of a medical decision.

[Arduinna]

Drs don't do the billing, and in fact they often don't even know the costs. You need to talk to whoever handles the insurance billing and reimbursement at their office. Their office policy is seriously lacking if they are making you sign a form that gives them blanket authority to do whatever they want.

[MariesMama]

I do have insurance - BCBS "Flexible Blue 1500," which doesn't cover much but does get me a discount, and my state's Plan First, which is Medicaid that covers family planning and related things.

I did find a list of the Plan First billing codes online. Can I send this to my doctor's billing office? Would it help me?

The bills for the biopsy and related BS are trickling in now. The lab bill for the biopsy shows two identical charges. I really only authorized ONE biopsy. I was not aware they were just going to send in as many samples as they wanted. They only "snipped" once, AFAIK.

I think that having insurance, crappy as it is, makes it harder to find out how much things are going to cost. If I paid cash, it would just be one flat amount. But with the insurance, it seems like they charge BCBS a crazy inflated price, BCBS pays some, then I pay the rest. Am I really off base there?

[texmati]

Originally Posted by Arduinna

Drs don't do the billing, and in fact they often don't even know the costs. You need to talk to whoever handles the insurance billing and reimbursement at their office. Their office policy is seriously lacking if they are making you sign a form that gives them blanket authority to do whatever they want.

Doctor's don't handle the billing, but they should know about alternative treatments. For example, for the yeast thingy, if they were going to order a test, talking to the doctor about costs should have prompted a discussion about limiting the number of tests preformed, to those that would actually have a bearing on the diagnosis.

I get so riled up about this-- it's such a racket!!

[Ygle]

I had an HSA with high deductible ($10000/yr) for awhile and trying to get cost info on anything drove me bonkers honestly! When I didn't have insurance I couldn't get the discounted rates and when I did have insurance it was insanely expensive so I figured the HSA was a fabulous option, but I just could not get information from anyone on costs. I would talk to billing, but they wouldn't be able to give me info w/o hearing from the doctor first, but of course the doctor had no idea how much things cost and then the insurance company would say I'd have to check with the doctor to see how it gets billed, but they would refer me to billing, who would refer me to my insurance.... I would spend literally hours on the phone trying to get answers. Is there any other service industry that works like this? I mean I understand they can't predict what you might need before seeing you... but not to even be able to give you some basic numbers for things you know you will need? Even for blood tests they would tell me they couldn't give me that info w/o an order from the doctor... and then even when I would explain how something wouldn't be covered the doctor's office would insist it would be... it was just maddening.

So I have no answer for you, but I definitely know how challenging it all is... I've had an office visit where from my end it was exactly the same as a previous office visit but for some reason gets billed in such a way that it costs three times as much, so even when I think I know what cost is involved I get surprised. Why they can't just charge everyone a basic rate and have simple standard charges for everything boggles my mind... I know the insurance companies all have standard rates they pay out so I don't know why they refuse to just give customers those numbers. I'm pretty excited that I now can almost plan for dental care at least because my dentist gives me the codes and fortunately the insurance phone system is automated so I can just lie and put in a previous date even though I haven't yet done the work to get the amount they will pay... I don't know why they won't tell you until afterwards..???

[Ygle]

Oh, another thing that frustrates me is how the different insurance companies have different rates for procedures, so I've seen with different companies the same thing at the same place has a radically different cost... same when I've compared with friends and family... so that can really make a difference when you go to purchase insurance however the insurance companies won't tell you any information at all unless you are already a customer, making it absolutely impossible to shop around intelligently, argh! I almost think they do this on purpose, I mean make it frustrating in general to get easy answers even when you are enrolled with them, just for that reason, so no one can compare apples to apples.... like when product lines will just alter one or two numbers with a certain model depending on which store they are selling at so that you can't make a direct comparison.

[bobandjess99]

If you have a doc who really cares, thety should be willing to help you.
We had no insurance for a while, and our doc knew we had to pay OOP for every single thing, and so she did her best to help us and recommend the options/alternatives which were the cheapest, etc.

[MariesMama]

UPDATE: I've called the billing offices for the departments that have billed me so far. If that makes sense. And wow. Rude, misinformed, and rude.

Plan First covers family planning services, including BC, paps, and related services. I have six pages of billing codes associated with Plan First. One woman told me that Plan First ONLY covers birth control and NOT my pap smear or anything else. Wrong. Then I find out that my doctor didn't code anything as "family planning services," so stuff that would be covered, isn't.

Can I have her re-code these bills? I'm going to have over $600 in charges if she doesn't. And yes, I did tell her about my insurance and the family planning coverage before all of this started.

[texmati]

Originally Posted by MariesMama

UPDATE: I've called the billing offices for the departments that have billed me so far. If that makes sense. And wow. Rude, misinformed, and rude.

Plan First covers family planning services, including BC, paps, and related services. I have six pages of billing codes associated with Plan First. One woman told me that Plan First ONLY covers birth control and NOT my pap smear or anything else. Wrong. Then I find out that my doctor didn't code anything as "family planning services," so stuff that would be covered, isn't.

Can I have her re-code these bills? I'm going to have over $600 in charges if she doesn't. And yes, I did tell her about my insurance and the family planning coverage before all of this started.

you can ask. They may be willing to accommodate.

I should eat my words... I ended up in L and D yesterday because of a fall. I asked repeatedly if i could come into the office for a sono and nst, but they wouldn't let me.

In the end, they didn't wait for the results of the sono or blood test before releasing me. What was the point? It was just CYA on the part of the Dr's office. It makes me so mad!

[MariesMama]

L & D? Like at the hospital? I really hope the bills for your visit aren't astronomical.

[Ellien C]

Originally Posted by MariesMama

Can I have her re-code these bills? I'm going to have over $600 in charges if she doesn't. And yes, I did tell her about my insurance and the family planning coverage before all of this started.

Absolutely, yes, yes, yes. They should be willing to work with you. I have good insurance and I had to do this twice - once for an eye problem and once after birth for durable medical equipment.

Let your doctor know up front that you have lousy insurance and you need to know how much everything will cost before they do anything.

Always ask if there are alternatives? What would happen if I didn't do X procedure? Are there alternatives? What will you do differently if you find out the results of X procedure versus what you are doing now?

A lot of procedures are done to rule out things but have no affect on the treatment. You can decide to have X procedure if the current tx protocol doesn't resolve the problem.

Nothing wrong with saying - Before I schedule this I would like to talk more about it. Or, I would like to think about it and do some research before we schedule. I'm concerned about costs.

I'm doing this now with my dental care because I'm not convinced I need the procedure recommended by the dentist. Nothing wrong with asking lots of questions and going slow.

My doctor has also waived some co-pays for me when I came back for follow-up visits with my baby. It was an ear infection and I only paid the co-pay for the first visit. The next 2, each 5-days apart she coded as part of the first one or something.