dealing with medical costs in an HDHP

[JHZR2]

Hi,

I have an HDHP, and have seen some doctors for routine stuff.

Generally, I provide my insurance card, knowing of course that it doesnt make any difference given that Im below my deductible.

I recently got a bill from a specialist that wanted over $300 for the 15 or so minutes that I spent there. They provided an adjustment of $83 or so, which brought the bill to around $245.

I assume that the adjustment was based upon the negotiated rate that my insurer has with the provider. But how do I knw that Im getting an optimal deal?

If I just had insurance with a copay, Id pay my copay and then anything else was between the provider and the insurer. Now, I need to essentially take their word for it that what Im being charged is the right rate that the insurer would otherwise pay.

Im almost tempted to not give out insurance cards anymore, and just say that Im self paying. Will this give a better rate? If I offer to pay cash, will they provide a better rate?

I really am not keen on making someone's boat payment because they can pull a fast one and tell me that they are charging a negotiated rate that in reality is far higher than what insurance would regularly pay to the provider.

Thoughts?

 

[wkcars]

I have a HDHP plan as well and it does suck paying for everything under the deductible, and of course it resets every year so it stars all over. One good thing is the HSA, I don't know if your plan has one or not, but the one I have passes a portion of the premiums to my account, and I'll use that to pay for out of pocket expenses. I don't know if you will get a lower price for paying cash or not, it's worth checking if you want to go that route, but you take the risk of paying for stuff and not having it count towards the deductible and if you do have an emergency having to pay the entire deductible anyway.

 

[AdRock]

Saying that your a cash customer can help. A few years ago I lost my insurance and I have MS. I thought I was screwed.

My copay when I had ins. was $20 per visit.

Without ins. as a cash customer my regular doctors appt's were $40, my neurologist appt's were $50. Granted, it was moe than my copay but a lot less than I thought they would be.

I also got lucky with my MS meds. Themanufacturer called my to reorder and when I told tham I didn't have ins. anymore they lady automatically put me into a plan they had, where if I made below a certain amount of money I got the meds straight from them for only the cost of shipping. That was $75 a year instead of $1200 a month.

Also, a good amount of doctors are somewhat flexible on their prices when they know you're a cash customer. You could probably make things cheaper by just going in and talking to the doctor. Explain the situation and the money aspect that burdens you and ask them if they'd be willing to move on the cost a little. Chances are they'll help you out.

My wife is seeing a doctor/therapist for some ocd issues and our ins. won't cover it. His rate is $140 an hour. After meeting with him and discussing things he dropped his rate to $60/hr for her. He's a really nice guy.

 

[PandaBear]

JHZR2,

You wouldn't know if you got the best deal or not because the doctors wouldn't know either until they charge your insurance. Usually, insurance co pay the same rate to the same type of service in the same area. So unless you switch plan or go out of town, you will be paying the same if the doctors charge the same services.

Basically, the doctors will do all sorts of stuff and charge the insurance, and depends on the plan they negotiate upon, they may get paid for some but not all, or all for a very low price. Usually if they call you and tell you that you have to pay for what the insurance company do not agree to pay for, balk back at them and tell them you are not responsible for it.

Medical pricing is a mess in this country and the only thing you can go by if you have insurance, is to find a good doctor that support your insurance, and pick a plan that the doctor you like will take. Any doc that has been around will know what insurance is money loser and refuse to accept, and the problem is to find these honest doc and a plan that is just right.

My chiropractor's assistance would routinely charge for all sort of procedures and my insurance would approve. Then I switch insurance from a low paying PPO to a HDHP and all of a sudden my plan don't last for 1/2 of what it used to be. I have to complain to the chiropractor to have the charges to insurance less, as they were used to cheap skate insurance that pay 1/2 of what they are asking and now they feel bad "over charging".

Tell your doctor that you are on HDHP and do not want services unless he specifically tell you what he is doing and ask you whether you agree or not, and whether it is necessary or has a good value for the treatment or diagnosis.

It is a mess.

 

[JHZR2]

Originally Posted By: PandaBear
JHZR2,

the doctors wouldn't know either until they charge your insurance...

Basically, the doctors will do all sorts of stuff and charge the insurance, and depends on the plan they negotiate upon, they may get paid for some but not all, or all for a very low price. Usually if they call you and tell you that you have to pay for what the insurance company do not agree to pay for, balk back at them and tell them you are not responsible for it.

...

Tell your doctor that you are on HDHP and do not want services unless he specifically tell you what he is doing and ask you whether you agree or not, and whether it is necessary or has a good value for the treatment or diagnosis.



The issue is that with an hdhp, the insurance is by definition going to pay nothing.

So the benefit of giving an insurance card at all is to get the "negotiated" rates that are established, at least as I understand it... but how do I know if that is really what Ive gotten?

It would be nice if the insurance company had a table of agreed rates available (Aetna in this case) to compare to be sure that Im getting the right price. Kind of like you can look up MSRP and invoice price for a car online.

Because the insurance company is not going to pay for anything until I hit deductible. That said, if I came in as a "cash customer" and kept all receipts and documents, why wouldnt it count towards my deductible? After all, an HDHP is self-directed, its my decision, not some requirement to have a referral, etc.

My issue is really that I dont have any issues, or need any services, but even still, just going for routine exams and checkups costs bigtime, especially when a specialist is involved. I want to be sure that Im not overpaying because they have an assumption of a multi-step insurance negotiation while Im paying from my HSA.

 

[stockrex]

[free market hat on] dude, you should be glad they gave you a little break, pay the darn money and be happy you are paying for the best healthcare in the world [free market hat off]


Call the office and ask them what is the lowerst medicare office visit reimbursement they would received that billing codes for your visit and politely tell them that is all you will pay.

 

[Scooby]

I also have a HDHP. With two kids, we go to the pediatrician often. The lady AT THE OFFICE told us she was going to show us as self-pay from now on. We pay MUCH less now.

Example: Vaccinations last year under the HDHP plan was going to be just under $200. Self pay, we payed UNDER $20!!

 

[Cutehumor]

I have a HDHP with a health savings account. it's really a health plan to make us pay out of pocket. The theory behind it, if the people pay for the expenses up front, they are less likely to use healthcare services unless absolutely necessary. It's not an ideal plan for someone with no health issues.

 

[JHZR2]

Originally Posted By: Cutehumor
It's not an ideal plan for someone with no health issues.


Huh? Id think it would be. In ours, preventive care for certain things (teeth cleaning, eye exams, physical every other year) are free. I think well-baby stuff is too.

So as long as nothing else is necessary, it is a good plan as it keeps costs down unless something major comes up. Plus the return of premium adds up in the HSA until something is needed.

Id think it would be bad for someone with lots of ailments.

 

[Cutehumor]

I guess following up with my lung doctor at his doctor's office isn't preventative care. I had no issues. I still had to pay around 250 bucks in my HDHP

 

[Bamboooo]

There are two kinds of people in this world - The kind that make boat payments for others, and the others. You fall into the first. Your choice. No, really, it is YOUR choice. get used to it. Walmart always has positions open for door greeters.

 

[CivicFan]

It's a free market, you pay what they charge you.

 

[JHZR2]

Originally Posted By: Bamboooo
There are two kinds of people in this world - The kind that make boat payments for others, and the others. You fall into the first. Your choice. No, really, it is YOUR choice. get used to it. Walmart always has positions open for door greeters.


What are you talking about???!?

Do you even understand the reality of the insurance and medical billing game in this country?

It is absolutely stupid to shut up and accept what they arbitrarily put down on paper to charge. Its not fighting to fight, its negotiating because they purposely charge multiple times what they are willing to accept, because they know that insurance is going to come back with another amount.

Its really like buying a car. They give MSRP, so when you go in and get a few thousand off, you feel like youre getting a deal. Of course someone once in a while comes in willing to pay MSRP and cuts a check.

Im in that situation. I gave my insurance card (which as an HDHP isnt really insurance at all until I pay out $5000-10000). They therefore put in the "insurance" amount, which is marked up multiple times because in the end, insurance would be willing to pay half to a third.

I am effectively self-pay. I dont have the knowledge of what insurance really pays for the 15 minutes I was there (but Ill bet that $1000/hr, which is what Im being charged is a bit excessive). So I effectively become a "retail" customer. Had I come in and said Ill pay in advance, Ill bet the charges would be much lower, as was mentioned by others.

There are multiple scales and Im on the wrong one because I showed my insurance card while insurance wasnt going to pay. My mistake. Nothing wrong with trying to figure out the best approach for dealing with this.

 

[CivicFan]

With insurance, you get charged the negotiated rates for your deductible. So, you are effectively taking advantage of the negotiating power of your health insurer.

As self pay, you would be paying the gross charge (the basis). Some not-for-profit providers will have an adjustment for uninsured patients. Normally, this discount is less than the negotiated discount by the health insurer.

If you think that the provider did not appropriately take the discount, you could first contact your insurance company and talk to them. You need what is called an "EOB" or "Explanation of Benefits". That will spell out the gross charges and the adjustment.

It is possible that the provider has not applied the proper adjustment.

Welcome to the free market of health care.

And best of luck. This is going to consume quite a few hours of your life. just make sure you do not end up in a collection agency.

 

[JHZR2]

Originally Posted By: CivicFan
With insurance, you get charged the negotiated rates for your deductible. So, you are effectively taking advantage of the negotiating power of your health insurer.

As self pay, you would be paying the gross charge (the basis). Some not-for-profit providers will have an adjustment for uninsured patients. Normally, this discount is less than the negotiated discount by the health insurer.

If you think that the provider did not appropriately take the discount, you could first contact your insurance company and talk to them. You need what is called an "EOB" or "Explanation of Benefits". That will spell out the gross charges and the adjustment.

It is possible that the provider has not applied the proper adjustment.

Welcome to the free market of health care.

And best of luck. This is going to consume quite a few hours of your life. just make sure you do not end up in a collection agency.


But that was my point, how do I know that I am truly getting the actual "negotiated" rate for this service? Am I to just take their word for it that the adjustment they provided is correct? Seriously, $1000/hr is a bit extreme.

Or do I call the insurance company and ask them what the correct negotiated rate is?

I will ask for a complete EOB from the provider. Thanks!

 

[mechanicx]

Originally Posted By: CivicFan
With insurance, you get charged the negotiated rates for your deductible. So, you are effectively taking advantage of the negotiating power of your health insurer.

As self pay, you would be paying the gross charge (the basis). Some not-for-profit providers will have an adjustment for uninsured patients. Normally, this discount is less than the negotiated discount by the health insurer.


That's what I think. If you go to the Dr's office and tell them you are self pay first off they will bill you at a higher rate than what insurance would pay (as if you'd have deeper pockets than an insurance company). And second, they probably won't give you much treatment under the assumption you won't pay the (inflated) medical bill.

 

[JHZR2]

Yet just above scooby says that as self pay for vaccines that would be charged $200, he pays $20 as self pay.

 

[mechanicx]

Maybe he's talking about a sliding-fee clinic or something? In my experience self pay is not discounted and is more than what insurers pay.

 

[PandaBear]

Originally Posted By: mechanicx
Maybe he's talking about a sliding-fee clinic or something? In my experience self pay is not discounted and is more than what insurers pay.


HMO and EPO Insurance usually pay a "rip off" price, so very popular specialists usually do not accept some of those insurances. If you have a PPO, then the insurance will pay what the doctor demand and you have to pay a high deductible / copay.

The problem is, most HDHP I've seen are PPO.

 

[JHZR2]

Originally Posted By: PandaBear
If you have a PPO, then the insurance will pay what the doctor demand and you have to pay a high deductible / copay.

The problem is, most HDHP I've seen are PPO.


Mine is a PPO. Appears like the attempt to use these to "control" medical costs has just turned into an open invitation for doctors to charge $1000/hr. Overpaid? Id say so at that point.