Just received my bill for my overnight sleep test

[johnthomasmacdonald]

JfK medical center for the one night Billed $8,138

My insurance company paid $2,348.53 ( i wonder where they come up with the 53 cents? )

The hospital writes off $5,759.47 as a REWARD for having insurance

Leaving me with a copay of $30

Do people really think that this system makes any sense and that people who can't afford insurance should pay more than TRIPLE what people with insurance pay ( co-pay plus insurance company)

[DiverCTHunter]

Just wait for the next bill, where they try to charge you *puts pinky to lip* One meelion dollars!

[jdr999]

Yeah, it's crazy.

I think providers fear that if they reduce their rates the insurance companies will cut allowables even more. Currently it doesn't really matter what they bill -- the only numbers that matter is what the insurance company allows for that procedure code. The system is quite broken and needs a complete overhaul.

I personally know several doctors who have switched to private-pay only and will not even consider current insurance reimbursements. They are more than happy to be out of that rat race and in turn can spend more time actually treating patients.. Crazy.

BTW, at least you were able to have a lab study. My insurance wouldn't even consider it. I was only able to have a home test which doesn't give a whole heck of a lot of information to work with!!

[laserjobs]

With my insurance I only had to pay $1150 out of pocket. I must have got a deal!

[drj130]

My insurance company paid $2,348.53 ( i wonder where they come up with the 53 cents? )

I'm guessing that is what it cost the hospital to send the bill to the insurance company. (I've no clue what stamps are going for these days. lol)

[123.Shawn T.W.]

0bama care will fix all those silly problems ... < sarcasam off, for now!>

[Stormynights]

It is the working people that are really being hurt by this. I paid for all my doctor visits and lab work for years because I couldn't afford insurance. I put aside just in case money. I was fortunate that I was healthy. I was paying $50. to see a student doctor and routine lab tests were over $100. that I had to pay up front. I was blessed to be able to have that but it irks me to know that if I had insurance the insurance company would have had to pay less than I did out of pocket. I understand paying more if the visits are charged but I don't understand paying more on cash visits.

[zorki1c]

I'm really fortunate. I have a Medicare Advantage program (which Obamacare seems to be trying to eliminate) and although I have a sizable deductible for most procedures I have only had to pay a couple of hundred dollars out of pocket for two sleep tests, the "interpretation" and my ResMed 9 Autoset (It's actually on a two-year rent to own). Had I done this before I retired using my employer-supplied insurance my cost would have been at least $1,000. I'm also fortunate that my DME doesn't try to low ball me on equipment.

[Sir NoddinOff]

The whole system is in chaos. Somewhere along the line on my last sleep test, I saw a bill for $800 for the sleep study and thought to myself ... wow, that's pretty reasonable in view of what hospitals etc usually charge. Later when I got the full bill (of which my insurance and Medicare (you guys BTW) paid virtually all of it) ... in reality I saw it was a bill of $3500 for one night's study, not including the doctors followup!!! I asked the person who does the billing at the sleep clinic and she said they bill HealthNet, my insurance provider, then HealthNet bills Medicare and that the clinic would be lucky to get a couple of grand out of it. Still, you know the system's out of whack when that sort of thing is going on. Yeah, now I see why people without insurance are struggling with crazy high prices and medical bills.

[Stormynights]

It would have cost me over $500. A month for insurance because of preexisting conditions. I didn't have that much money for coverage so I just put away all I could to be able to pay for medical care. Because I was healthy if I had been able to save $500. per month I would have been ahead.

[djhall]

The current system is designed to prevent anyone from knowing or comparing prices in order to obtain maximum value for their healthcare dollars. The doctors don't know what anything really costs, and if you track down the billing folks and get the listed price it doesn't mean anything anyway since no one pays that price. If you are insured there a secretive contract price agreed upon between your insurance company and the provider, but that varies by provider and even by plan so no one want's to disclose exactly how much they agreed to accept or pay in case that gets used against them in other negotiations. If you aren't insured then you get some other pricing worked out between you and the hospital based upon your individual situation which makes comparing private pay bottom line prices between individuals meaningless and between providers incredibly difficult. You couldn't design a system to be less friendly cost containment efforts.

[Sir NoddinOff]

The current system is designed to prevent anyone from knowing or comparing prices in order to obtain maximum value for their healthcare dollars. The doctors don't know what anything really costs, and if you track down the billing folks and get the listed price it doesn't mean anything anyway since no one pays that price. If you are insured there a secretive contract price agreed upon between your insurance company and the provider, but that varies by provider and even by plan so no one want's to disclose exactly how much they agreed to accept or pay in case that gets used against them in other negotiations. If you aren't insured then you get some other pricing worked out between you and the hospital based upon your individual situation which makes comparing private pay bottom line prices between individuals meaningless and between providers incredibly difficult. You couldn't design a system to be less friendly cost containment efforts.

I'm thinking djhall is a whistle-blower... how'd you get to know so much about the system, unless you're an 'insider'??? Tell us some more dirty little secrets

[chunkyfrog]

The inflated charges and "creative accounting" mean that the DME's and sleep labs get to operate pretty much tax-free.

[Cutnstuf]

Do you ever feel like you're living in the matrix?

[NateS]

Yes, it is a ridiculous system!

Medicare is much more sensible - the medical providers know in advance what they are going to get paid, and when they submit that bill and get paid by Medicare they are prohibited from billing you the balance.

And if the medical providers offer or agree to provide a service not covered by Medicare, they are required to notify you in writing in advance of the service, give you the estimated cost you will be charged and only if you sign and go ahead with the procedure are you responsible. If they fail to do so, the cannot charge you for the service nor Medicare.

All you pay is your annual deductible and 20% of Medicare's approved charge or carry Medigap for about $200 or less monthly and your second carrier will pick up the annual deductible and the 20%.

Now wouldn't that be a better system for everyone? (If it was extended to under age 65 you would have to pay a monthly premium for the coverage but all studies show it would be less than what private insurance co.s charge you now.) But it will never get approved by the politicians, who owe their souls to the private health insurance industry. And they have to protect those million-dollar CEO salaries, too.

Regards, Nate