How to Avoid Getting Screwed -Healthcare Costs, Mole Removal

[bennymac]

My 38 year old daughter had a massive stroke 3 weeks ago. 3 weeks in the ICU so far with so many MRI & CT scans, spinal surgery, etc, etc her bill will be millions. I sure hope her husband has the best insurance out there or their portion of the bill will crush them. Welcome to Murican health care.

Wow crazy - sorry to hear that. Positive healing vibes to her and your whole family.

[Kevo]

My 38 year old daughter had a massive stroke 3 weeks ago. 3 weeks in the ICU so far with so many MRI & CT scans, spinal surgery, etc, etc her bill will be millions. I sure hope her husband has the best insurance out there or their portion of the bill will crush them. Welcome to Murican health care.

Fuck. So sorry Jim. I really hope she makes a full recovery.

[liv2ski]

Thanks guys, it has been a very emotional roller coaster ride. One day we think she is dying and the next maybe she is getting better. Really frustrating how little Drs know or can do with some illnesses (like hers).

[old goat]

My 38 year old daughter had a massive stroke 3 weeks ago. 3 weeks in the ICU so far with so many MRI & CT scans, spinal surgery, etc, etc her bill will be millions. I sure hope her husband has the best insurance out there or their portion of the bill will crush them. Welcome to Murican health care.

I'm so sorry to hear about your daughter. What a nightmare, and of course the bill isn't the worst part. Medical bills are the number one cause of bankruptcy in America.

When I broke my back skiing the bill from the non-Kaiser hospital was 400K. Kaiser paid them 100K and apparently they were happy with that. Maybe because I;m Medicare? I did get a bill from an ortho for two comprehensive hospital visits. He came once, for less than a minute, to tell me I had a chip fx of my acetabulum, don't put weight on it, see an ortho. I told Kaiser, they said we'll take care of it and I never heard more. I'm pretty sure they told him to pound sand.

When my kid crashed his bike on a XC bike trip in MD the ER sent Kaiser a bill for a full trauma visit. Diagnosis--road rash. Kaiser paid a fraction, I paid zero.

[byates1]

Randomly clicking on this thread. Wow liv2ski, very sorry to read that. Best wishes.man.

[Yukonrider]

Seems to be some folks that know some stuff here, and good information is next to impossible to find, so I'll ask here.

I'm on an ACA plan through BCBS, PPO, 8k deductible, 8k max out of pocket. I'm under the impression that I can walk into any hospital and once I spend 8k everything else is covered, be it ambulance, air ambulance, overnight stays, whatever.

How close to correct am I on this assumption?

[mcski]

Getting popcorn ready now

[Yonder_River]

Seems to be some folks that know some stuff here, and good information is next to impossible to find, so I'll ask here.

I'm on an ACA plan through BCBS, PPO, 8k deductible, 8k max out of pocket. I'm under the impression that I can walk into any hospital and once I spend 8k everything else is covered, be it ambulance, air ambulance, overnight stays, whatever.

How close to correct am I on this assumption?

You are correct. We have a 10K family max which we are about to exceed and I'm looking forward to now scheduling some semi-elective surgeries, massage therapy, p/t, to cash in some "freebies".

[liv2ski]

Merica You may be spending $1k+ a month for that coverage, still have to pay out $10k in deductibles and then you finally qualify for coverage. Unfucking believable.

[jono]

You are correct. We have a 10K family max which we are about to exceed and I'm looking forward to now scheduling some semi-elective surgeries, massage therapy, p/t, to cash in some "freebies".

Is he though? Walk into any hospital? I feel like the phrase "in network out of pocket max" is in my vocabulary.

[Yonder_River]

Well, sure. Just keep it to in network care and he'll be fine. If you have a cancer diagnosis and not happy with in network options, that's a different story.

But if you have a medical emergency and arrive at a hospital e.r. that is out of network, the law says it has to be treated as in network. Unfortunately, learned that through experience.

[Yukonrider]

To further muddy the waters for my specific situation.. I spend 6 months in one state, and 6 months in another. So yes the ER visit is covered they're clear on that, but follow up visits "in network" may be a plane ride away. I was under the impression the PPO plan was the way around this in network stuff.

[mcski]

Nope. Ppo still has in and out of network coverage differences.

[Conundrum]

PPO is preferred provider organization meaning you are part of a network. Luckily for you, each state's BCBS (speaking very generally) participates in the BCBS Association so they "lend" each other their networks forming one of the more comprehensive networks in the US and they allow you to travel across state lines for care. But, there is probably an out of net benefit on your plan so worth checking that.

The only real issue you might have have is living in two different zip codes. If you run everything through your primary address as your home state, should be okay.

[Yukonrider]

"in network out of pocket max".

More research shows my "out of network out of pocket max/deductible" is $16k.

Neat. Glad I thought about this now instead of in a stressful situation.

Thanks mags.

[Yukonrider]

The only real issue you might have have is living in two different zip codes. If you run everything through your primary address as your home state, should be okay.

Everything goes through the "home address", no exceptions. I suppose I'll call them and double check on that, though I'm a little gunshy, Progressive was SUPER not chill about it, and I came within an inch being blacklisted for asking the wrong question.

EDIT:

Spent 3 hours on the phone this morning, will add my findings here for whoever.

Basically BCBSM will bill any expense that is out of state as "Out of network" You can submit a form to request an exemption only after service has been rendered. They cannot tell you ahead of time if the request will be accepted or not, but it seems for most emergency care for a traveling resident they would be covered under their in network deductible.
The kicker is the fine print which says "Out-of-network cost share can’t be waived for out-of-state college students and Michigan residents who live outside Michigan part of the year. The member must live in Michigan throughout the calendar year."
They couldn't tell me whether this statement means you cannot get an exemption IF you're living out of state or BECAUSE you're living out of state. |

The healthcare.gov folks are under the impression that applying for new coverage in the state I am in is the best option using a "qualifying life event" exception. Health coverage in the second state is less expensive for much better coverage, so I am probably doing that as of now.


Fuck insurance companies, and basically all agencies who go out of their way to make it an absolute nightmare for people who don't have a W2 job and only leave home to take a 1 week trip to Disneyworld every year.

[Dantheman]

Last year I had to get a shoulder MRI. I probably wasn't going to need surgery, so I insisted on at having it done at a private imaging clinic instead of my ortho's hospital. Total billed to my insurance was like $1500 and I think I paid like $900 out of pocket.

Fast forward to this year and I need another identical shoulder MRI. This time I definitely need surgery and am going to hit my annual OOP regardless so I took the lazy route and had it done at the hospital. Bill was $8400. My share after adjustments, deductible, and co-insurance is $3600.

Fuck hospitals and fuck our bullshit system. Ultimately it won't matter to me since the extra I'm paying for the MRI will get recouped in surgery costs, but the cost differential for identical procedures is fucking criminal.

[liv2ski]

Jeezuz, what BS

[Conundrum]

Dan, would you be shocked to hear you can get an MRI for $550 cash in SLC not using any insurance?

https://tellicaimaging.com/our-locat...alley-city-ut/

[Conundrum]

And yes, it does matter to you even though you’re hitting out of pocket. Every expensive charge from everyone goes into the risk pool that insurance premiums are based on.

[Dantheman]

Dan, would you be shocked to hear you can get an MRI for $550 cash in SLC not using any insurance?

https://tellicaimaging.com/our-locat...alley-city-ut/

Very aware, that's why I didn't have it done at the hospital last year. Most of those places can't do contrast injections, which I needed, that's why my MRI last year was $1500 instead of $500 (Envision Imaging, and I did ask them about paying straight cash and it was cheaper to go through insurance).

Would I have done this year's MRI differently knowing what I know now? Hell fucking yes I would. I knew it would be more at the hospital, but still did not expect it would be an 8x difference. The next time I see my ortho I definitely will be telling him that his imaging department can go fuck themselves with a cheese grater.

[Conundrum]

Makes sense. I guess more of a PSA for those that don’t pay attention that hospitals charge way too much for a lot of things and making a call or doing a google search for services can save some real money.

[Dantheman]

Not everyone has the luxury of time to shop around. Even if you do, it can be hard to be your own advocate and there's often a lot of of momentum pushing you towards the option that is most convenient for your provider (even though they aren't overtly trying to screw you). I often find myself being forced to become a very squeaky wheel and not everyone is comfortable with that.

[Yukonrider]

I often find myself being forced to become a very squeaky wheel

My experience is that asking "What am I paying, and what am I getting for that money" is enough to be considered a pain in the ass patient, and elicit eye rolls and "I don't knows" from medical staff.

[alias_rice]

Last year I had to get a shoulder MRI. I probably wasn't going to need surgery, so I insisted on at having it done at a private imaging clinic instead of my ortho's hospital. Total billed to my insurance was like $1500 and I think I paid like $900 out of pocket.

Fast forward to this year and I need another identical shoulder MRI. This time I definitely need surgery and am going to hit my annual OOP regardless so I took the lazy route and had it done at the hospital. Bill was $8400. My share after adjustments, deductible, and co-insurance is $3600.

Fuck hospitals and fuck our bullshit system. Ultimately it won't matter to me since the extra I'm paying for the MRI will get recouped in surgery costs, but the cost differential for identical procedures is fucking criminal.

Holy fuck that is insane. My kid needed an MRI on his elbow earlier this year and luckily the ortho sent us to a private company instead of a hospital. He says it’d be cheaper that way, but I was thinking maybe a few hundred bucks. I had no clue he saved me $3,000.