Outragous medical bill

[Sailorsong]

First off Thanks Lulu for your comment in my journal.

So do you really want to know why medical insurance preiums are so high? I'm not talking about the profit they make but what is being charged.

Last month I went to Vanderbilt for a neurology referal from the VA. Vanderbilt sent me the bill for the lab work which consisted of 2 blood tests. I am still in shock for what they charge. The total bill was $322.

$30 to transport the specimen.
$35 to take the blood
$42 for Angiotensin convert blood (what ever that is)
$215 to have the blood test done.

Then after all that if you don't have insurance they take off $129. So if you have insurance they end up paying (and you if your policy requires it) that much more.

So why if you have insurance do you have to pay more? It sure doesn't cost $129 to fill out a form and send it to an insurance company. As you might guess this is one of my pet preevs with the medical establishment and has been since my daughter had the tonsils removed many years ago. Even though it was scheduled as day surgery they ended up keeping her over night. Because they kept her over night the bill (by state law) was increased by $8000.

Dennis

[Fluffysmom]

Wow, looks like I got a deal, compared to you, Dennis!

Laboratory                114.00

Lab Chemistry            43.00

Lab Hematology          31.00

Lab Urology                14.00

Total:                         202.00

This is before my insurance pays; I hope they pay it all.  This was done where my new neuro is, outside my usual system, but should still be covered by my insurance.

[PastorDan]

I'm of the opinion that the state laws -- and soon the federal ones -- are a major part of the problem.  When Loretta was in customer service for a small-group carrier, she found she couldn't take off the maternity coverage for her 65-years-and-older customers in Massachussetts.  State law required them to have it.  In adjoining states, dropping that coverage saved them a tidy sum, but not in MA.

[saveone]

I had an Rx for a knee support.  I went to one store.  The support was 42.00.  I thought that was outrageous.  The support was not the one the insurance paid for.  In order for the ins to pay it had to been at the joint.

Off I go to another medical store.  They had one.  A perfect fit.  I signed the paper for the insurance to pay.  I had to pay 20 dollars I believe.  The insurance had to pay 232.00.  Same brace, except for the joint.  It cost an additional 190. 00.

Go figure.

terry

[deborah0904]

Insurance companies have contract agreements with their in network providers.  Insurance company says to provider, "when a patient sees you for this particular procedure(procedure code) and you charge $???, when you submit the claim, we will only pay you $??? for that procedure(procedure code).  If it is a very common procedure, the insurance company will pay less.  If it is a very rare procedure, the insurance company may have an agreement to pay them more than what is billed.

Now, when the insurance company sends you the explanation of benefits, you will see what the contract write off was.  In other words, the Dr. or facility really didn't make that much off of the procedure you had because of the contract they have with the insurance company.  I feel like the Dr.'s and providers are charging so much more because the insurance companies are not paying much.