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Whoo Hoo What a bill!

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Posted 4/12/2011 5:40 PM (GMT 0)
I just added up the provider charges from diagnosis through ed device. $77,724.19. Insurance hasn't finished adjusting on the largest of the charges yet, but so far their payment has been about 30% of charge.  Thank God for in-network providers.
Posted 4/12/2011 5:49 PM (GMT 0)

That's a lot of money, Low.  Just for comparison sake, you could have used that money to buy a low-end BMW 7-Series. tongue

I think my total bill ran a little over 90 thousand, and as you say, thank goodness for insurance.

Posted 4/12/2011 6:37 PM (GMT 0)
you had surgery a month ago but already have an ed device? what am I missing here?
Posted 4/12/2011 6:52 PM (GMT 0)
Why do providers calculate bills at say $90K when they KNOW they are only going to get $30K and be happy with that...? There is something WRONG with a system that demands three times the money from the self-insured..
Posted 4/12/2011 7:05 PM (GMT 0)
The medical field is definitely NOT a free market system as some like to think. More like a system of mini-monopolies. Competition is non-existent. As far as the ED device goes, they had me take it with me at catheter removal.
Posted 4/12/2011 7:10 PM (GMT 0)
what exactly is the ed device though?

I think there is a ton of competition on the field. I was stunned to learn this, but the way the radiation guys go after the surgery guys and vice versa is really evident.
Posted 4/12/2011 8:29 PM (GMT 0)
Fairwind, my wife and I had a frank and interesting conversation with a neurologist last winter about billing.  She did a nerve conductivity study and a couple of other tests at her office and came right out and told us she would be billing a certain standard amount (a lot), but that she knew in our case Blue Cross/Blue Shield would negotiate it down to a fraction of her billed amount.  She said that she really doesn't make much money on folks like us, but she does get other customers that involve on the job injuries, lawsuits, or other situations where she receives the billed amount.  Overall, it balances out and she's able to pay her bills and make a comfortable living.  That's why she bills $800 for a test, knowing she'll only get maybe $200 from the insurance company.  Once in a while, she gets the whole $800.  Does that make sense?
Posted 4/12/2011 8:55 PM (GMT 0)
My urologist told me I would be billed $2000K for my biopsy and he billed the insurance company $7500 for it! My surgeon billed me less for the robotic procedure because I wasn't covered with him.
Posted 4/12/2011 9:02 PM (GMT 0)
I had my ED device 4 weeks before surgery. My surgery was around $50k. I had to pay $2500 out of pocket and from here on out $0.
Posted 4/14/2011 10:15 PM (GMT 0)
Davidg, It is a vacuum pump. I signed a form during the consult at catheter removal that I would make up any difference in payment under 500 dollars. The doc billed 1000, insurance paid 476.24 and sent me notice that my share was 109. Nope, I will pay 23.76 and they can eat the rest. I used it one time (yesterday) and discovered I could get the same result without the pump. Not an age 16 erection,but as good as I had pre surgery. I was pleasantly surprised by that. I have ADC viagra but havent used it. The fact that I am on plavix for a previous heart attack makes me somewhat nervous about viagra or other ed meds.
DaSlink, my out of pocket max has also been reached. As soon as I'm able Im getting a bunch of testing done heartwise etc. I'm gonna use my insurance for all it's worth for the rest of the year.
Posted 4/14/2011 11:21 PM (GMT 0)
davidg - you were charged 2,000K for a biopsy, that's 2,000,000 dollars. that's some doctor's fees, lol
Posted 4/14/2011 11:41 PM (GMT 0)
Oh, ok.

Heart attack and cancer by 48, what the hell?

I wouldn't take ED pills either in your case.

I don't really buy it, but there are plenty of guys who claim to get erection with natural herbs and all that alternative stuff. Perhaps you can try that.
Posted 4/15/2011 1:18 PM (GMT 0)
I've always said I'm running 25 years ahead of schedule. The youngest city water superintendent in Ohio at 34, the youngest city manager in Ohio at 37, 2 heart attacks at 40, retirement at 42, PCa at 48. I hope I make it to 60 LOL.
Posted 4/15/2011 3:47 PM (GMT 0)
Clocknut, It certainly does not *make sense*, but the way ti works is that the insurance companies negotiate to pay a fraction of what *they* determine to be 'reasonable and customary' (R&C). The only way the MD's can keep that actual insurance reimbursement at a level they can afford to take is by having their posted rates way above. Otherwise the R&C keeps sinking lower and lower.

The kicker is that if you come to the MD NOT on insurance, they are required by law to bill you the full posted rates. They cannot cut you a break to make it closer to the insurance reimbursed rates, etc. So, it reinforces the stranglehold that Medicare and the insurance companies have on the system. Kindof like Congress voting on their own raises (statement NOT intended to take this in any political direction). Third party payment systems are trouble. But like is said about democracy, its the worst possible system -- except for all the others.
Posted 4/15/2011 4:27 PM (GMT 0)
"The kicker is that if you come to the MD NOT on insurance, they are required by law to bill you the full posted rates.

What law?? What "posted rates"??

Seems to me they all charge whatever they can get away with, and many of them make billing adjustments for their uninsured cash customers..
Posted 4/15/2011 5:08 PM (GMT 0)
I can't say that none of them ever do it, and 'Law' might have been too strong a word, rather it breaks the contract they have with the insurance providers, for which the insurance providers (and Medicare being the biggest) have legal recourse.
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