Amazed by medical costs

Thankfully I have insurance coverage (but not like days of lore as it's a high deductible plan backed up with a self funded HSA), but is anyone else shocked by the amounts billed and paid for treatment?

Is it just crazy CA prices, or is it this bad everywhere?

I'm into six figure territory paid by insurance this year (billed has been 2x six figures) -- and this is without this week's LDR treatment.

Yes there is a significant difference between the amount billed and then reimbursed. It is because the provider establishes different reimbursement rates with all the different third party payors.

Wife of Pie, it is a myth that there is a write-off of the difference. You can only write-off actual expenses against actual income. By accepting a payment for less than the billed amount subject to a standing reimbursement agreement in no way constitutes a write-off. Just like when a car dealer sells a car for less than the MSRP or your department store sells an item for sale for less than the original listed price, neither produces a write-off. And remember, most all hospitals and large clinics are set up as non-profits. So a write off would be meaningless fr them.

I stopped counting when Randy's bills topped a million dollars, before the first anniversary of his diagnosis. We are blessed. We have "good" insurance. Even though the deductible is $2500, we haven't been denied anything ordered by our docs. However, I can't help but think about where we'd be if our old $2million lifetime max was still in place. Without becoming too political - it just seems wrong for any person to suffer or die from lack of medical care in a country as wealthy as ours.

Medical insurance is a total and nearly indecipherable mystery. I'm enrolled in a clinical trial but was told that because my Firmagon is considered standard treatment I would have to pay whatever are the standard co-pays under my BC/BS Medicare Advantage plan. Medicare is then supposed to cover all else - CT and bone scans, blood tests etc. Fair enough. The paperwork arrives in the mail, but so far I've been billed nothing other than the usual $40 and $20 copays since I started the trial in May. I still wonder every time I open the mail I'll find some kind of whopping bill, but so far it hasn't happened.

In August I got a statement from Medicare for Part B coverage that showed about $14,000 in Medicare approved payments and stating the total I may be billed at just $435.38 - and to-date I've not even been billed for that.

Then I got a statement from BC/BS "Summary of Your Out-of Pocket Spending for Medical and Hospital Claims" It shows for the 2018 calendar year through Sept 30: Amount providers have billed the plan = $75,159.33; Total cost (amount the plan has approved) = $44,635.43; Plan's share $8,529.64; Your share = $11,237.28. Needless to say none of these numbers make any sense. They don't even add up. Go figure. At this point I'll simply keep all this paper on file and assume I'll not actually be billed $11,000. And If I am billed $11,000, how would that square with Medicare's "total you may be billed of $435.38.

I'll steer clear of political commentary. But it makes one wonder how much human time and computer time goes into building this labyrinth of numbers and then decoding it again.
Jim

Bohemond said...
Then I got a statement from BC/BS "Summary of Your Out-of Pocket Spending for Medical and Hospital Claims" It shows for the 2018 calendar year through Sept 30: Amount providers have billed the plan = $75,159.33; Total cost (amount the plan has approved) = $44,635.43; Plan's share $8,529.64; Your share = $11,237.28...

Fortunately my wife had Obamacare and our only payment in 2016 was the $6,700 deductible. Still nothing to sneeze at. Later we received a letter from BC/BS stating that with her insurance we had "saved" over $300,000. Yikes!

I am new here and female. Chiming in because this topic makes me so very angry and sad. It has cost my family so much just to have the few replacement surgeries that I have had. I am now on a PAP program that is extremely costly. Yes, they will pay until Dec. 31, 2018. I also have a Medicare, Medigap plan. I still spend most of what my retirement and pension should be on insurance. Why is this so hard? I understand socialized medicine in other countries may not be the answer. However, what Is?

browntrout said...
RobLee: I am relatively new at the Medicare game and have purchased a Medigap (supplemental) to pay for copays, deductibles, etc. Just wondering if you have a supplemental plan that might pick up some of potential out-of-pocket expenses you have mentioned?

Fortunately I was already on medicare when my wife and I retired, and it paid for all of my prostate cancer treatments. My wife was only 64 at the time and were fortunate to have Obamacare when she was diagnosed with lymphoma. But unfortunately that was in December so we had to pay her deductible for both that year and the following year.

We both now have traditional medicare parts A and B, plus a standard supplemental plan. There have been several threads here on HW regarding medicare and supplemental coverage if you use the search function. Basically the government provides part A which covers hospitalization for free. Part B covers doctor visits and costs an additional $130 per month (about). Note that A and B each pay only 80% of covered charges.

Supplemental plans are offered by a number of commercial insurance companies such as Aetna, Humana, United Healthcare and Mututal of Omaha. Plans are standardized by law but most people choose plan F or G. One costs slightly less but has a small deductible. Most supplemental plans pay the extra 20% that medicare A and B do no cover.

Different companies will charge slightly more or less for the same plan, so it pays to shop around. Personally I have Aetna and and my wife has Humana. Participants are allowed to change plans and companies every year from mid October into mid December, called open enrollment.

Many insurance companies offer part C or "advantage plans". They give them flashy names like "Gold" but they are actually HOM's, meaning that you are restricted to a specific network of doctors and hospitals. People who have had cancer are at a risk of recurrence and probably should avoid advantage plans because they may not cover all treatments for their particular cancer. The "advantage" of part C plans is that they are cheap and they usually throw in perks like free gym memberships or drug coverage.

Speaking of which, Part D is prescription drug coverage, which is another nightmare altogether. I won't even get started on that. Most likely some others will jump in here with additional specifics on medicare coverage.

I've got great medical insurance and I live in California. all through my treatment I never paid a single deductible or copay and never was any treatment denied and I had a very expensive treatment plan. I did pay $15 office visits tho. last year I passed out in a tire shop and busted my head open which required an ambulance ride to the hospital, eight staples, a brain scan and an ekg. the bill was more than $14k of which I paid $50.

I wish everyone had great coverage and I'm willing to pay extra to that end but now it looks like pre-existing conditions could in the future disqualify you from being insured.

I went on Medicare about 6 months before I was diagnosed. We had remained on my employer's self-funded insurance after my retirement and the coverage was excellent but the premiums were high. For me, my wife, and my son it was about $15K/year. 2-3 years ago my wife had breast cancer and the bills went over $250K but I think she told me that our out-of-pocket was about $3,000. (She's a CPA so does the money thing in the household.)

My son went off the policy when he turned 26. With my wife's pre-existing condition and that whole thing in flux, when I went on Medicare we elected to stay on my previous employer's plan by me buying my supplemental through them, which they farm out to Hartford. It is a Type F plan so it's top of the line. Another reason that I wanted to avoid an Advantage plan is that I would be limited to our local options. I live in the largest city in the state but it's still only 100,000 and options are limited. I was glad I made that choice because I after some communication issues after my biopsy (my results were sort of lost) I elected to go to Cleveland Clinic for RALP which was a real class act.

It's been 7 months and all I have paid was $300.

17% of whose income? I think the people who come up with these numbers pay much less.

RandyJoe,
Drug prices is one area that really gets my goat, probably because I’ll be going on Zytiga soon. It won’t cost me anything, but it’s going to cost the government (and thus everybody) a lot. You’re right, we don’t pay attention until it affects us, and that’s how the pharma/gov’t complex gets away with this crap!

I got to go for walk now. Get my BP down! Lol

Ease up on the politics - that will get the thread locked.

For those commenting that they are avoiding politics, too late, you already mentioned it.

John T.
I agree that some "rationing" for lack of a better word is needed. I'm not sure what that would look like, since one person might be quite old at 70, but my mom can run rings around any of us at 75. Common sense would be useful. A friend here at work cares for her 97 year old grandfather. He has dementia and heart issues. His cardiologist wants to implant a pacemaker. She's refusing, since anesthetizing him might kill him.