I need to know why I had to pay $5,000+/- for an operation I had insurance for?

Howdy DUers I have something that I need to get off of my chest.

This past fall I had to have a partial hysterectomy due to a football size fibroid that was wreaking havoc on me. I am employed full-time and have health insurance. However, I ended up having to pay close to $5000.00 out of my own pocket for it. :wtf:

I bet if we had a system like Canada - that operation wouldn't have cost me that much had it been taken out of my paycheck as tax. And how many of my fellow citizens have 5 grand lying around to spend on a routine operation?

What I'm getting at is that this is so fucking wrong that I don't even know where to begin.

Best health care in the world my ass.

:nuke:

Did you ask your elected state representatives to look into it?

five grand in their pocket. It also helps to keep workng people in debt so they never really get ahead.

the five grand goes to the doctor and/or hospital not the insurance company

A significant portion goes into the pockets of a few at the top, the rest is divided among minimum wage or so secretaries and a slightly higher-paid managers.

What you pay to the doctor and hospital are the dollars the insurance company refused you for health care.

Government would charge about 3-5%, insurance company sticks their slimy hand in for 15-35%, with no one really overseeing how they account for that.

Not being enough, they are now going to get 44 million new customers. So, say 15% of $6000/yr times 44 million people. That's $39,600,000,000 brand new dollar bills they can put in their pockets without breaking a sweat. Talk about getting a new pony...while kids in the families of 44 million people on food stamps look forward to school lunch Monday, 'cause they may not eat all weekend.

The million seniors who can't afford food? Well, maybe there will be a lunch at the Senior Center on Thursday.

That's the amount that you have to pay before your insurance kicks in with benefits.

If you have employer sponsored insurance, the deductible is a way to keep the premiums down.

If you want the insurance to start paying sooner, then the monthly premium is going to be higher.

Sucks.

"I bet if we had a system like Canada - that operation wouldn't have cost me that much had it been taken out of my paycheck as tax."

But someone would be paying for it. It's still not free healthcare in Canada.

is pooled from everyone. They also do not have multi-layers of obscene profits, such as their drug prices.

When the costs of procedures and drugs are regulated and kept under control and access is not ruled by greedy profit-hungry cartels, then the cost is much more reasonable.

That's all we are asking for.

I'm just curious, since that's what I would have to pay. One wonders if a complete hysterectomy wouldn't be cheaper.

:wow:

My policy has a high deductible, pays only 65% of covered expenses, but has an out-of-pocket cap of $5,000.

That's typical of low-premium options in group plans.

who knows what the actual cost was.

Feel better?

price and cost. Price is the variable. One patient gets a price for the same procedure that may vary widely from the price another patient gets depending on insurance carrier.

There is a difference btw the 2.

No need to F bomb. Drink a smoothie or something.

:blush:

I'll have to go on it in Sept because I'll be losing my current insurance.
There are also copays!
This is from a Fortune 50 company! And he's a retired professional!

I think this is becoming more the norm.....insurance companies & corporations shifting more & more of the financial responsibility back onto the insured.

Welcome to the new world of complete corporate-control of our lives.x(

Most insurance has such a co-pay.

it most likely is deductibles, copays, coinsurance, and this year, everyone that I know says that their insurance is now charging them separately for lab and xray fees...and they have their own set of copays, coinsurance and deductibles.

I know. My medical bills in 2010 were about $350K.My drug bills were about 10K.My out of pocket was 15K, altogether.It wiped me out.

On the other hand, if I didn't have insurance, I'd still be having about 300 seizures/week.

The ones who really suffer are those with NO insurance.

Actually,we all suffer so a few healthcare CEOs can make their multi-millions.

as if were an a la carte meal.

Our hospital now leases IV pumps so the patient has to pay a rental fee on them. There are people who's entire job is to keep track of every pump each shift and to note what patient has one and how many are being used by each patient. They work for the IV pump company, not the hospital. If I were a patient and just getting fluids, I'd ask the nurse to just run it by the drip factor and to not use the pump. Nurses used to do that.

Yes, we did used to do that...and I still can...and I am sure many other nurses can as well. BUT..the problem is the understaffing and IV bags running dry and losing IV sites and fluid overload...etc.

If you are running plain fluids, no problem, but with additives, etc. it can be dangerous.

Years ago, it would be UNHEARD of for a patient to turn up his IV fluids so that his narcotic ran in faster. However, today, it is not.

That being said...we've always charged for IV pumps in a round-about manner. Many facilities will be sure that you chart "1/2 NS running at 25 cc/hour per Plum pump" at least once per shift...and that is strictly for charging purposes. The charges used to be done by other staff members...but as the cuts get deeper and deeper to staff, that is something that is being noticed whereas it might not have been noticed before.

A little different than documenting the route of medication. But I concur, with the kind of staffing we have today, there is a risk of running dry. That must be why I hear the pumps alarming so frequently. I was trying to say if it is just fluids-- NS or such and they are ordered to get it continuously, why charge the patient when you don't have to? We are supposed to provide care economically.

Worked an environmental booth in a town directly across from Victoria BC. A Canadian man stopped to tell me that his daughter has been teated for breast cancer and has not had to pay a dime out of pocket. They also do not determine treatment according to the kind of insurance people have. He said that the US has it all wrong when they criticize the Canadian system. They are proud of their system and are offended by the way politicians describe their system.

Anyway - I know what you are saying - I just got hit with the co-pays and deductibles it took to get the diagnosis. I can't afford to proceed any further because that would pile on more costs.

--who make a lot of money out of the mass murder of 44,000 people a year.

According to a news article posted in 2009, “illness and medical bills were linked to at least 62.1% of all personal bankruptcies in 2007. Based on the current bankruptcy filing rate, medical bankruptcies will total 866,000 and involve 2.346 million Americans in 2009 – about one person every 15 seconds. Most medically bankrupt families were middle class before they suffered financial setbacks. 60.3% of them had attended college and 66.4% had owned a home; 20% of families included a military veteran or active-duty soldier. 78% of the individuals whose illness led to bankruptcy had health insurance at the onset of the bankrupting illness; 60% had private insurance. 69% of debtor families had coverage at the time of their bankruptcy filing; 60% of families had continuous coverage.”

http://www.bankruptcyhome.com/bankruptcyblog/2011/03/10/the-effects-of-medical-bankruptcy/

Blue Cross Anthem drops the price hospital is allowed to charge. Then I pay 20% of the lower amount.

In the new insurance law. Forced to buy insurance that many can't afford to actually use, and that will probably find an excuse to deny care when your life depends on it.

There are a number of factors you'd need to look into.

Question 1: You need to check and see the extent to which your insurance covers surgery. This various by plan. Its possible that you have a plan that covers 75%, and you cover 25%. If so, and the surgery was 20k, and you had to pay 5k.

Q2: For a surgery of that nature, there were probably many groups involved ... the hospital, the surgeon, the lab, the anesthesiologist. The billing from these folks is often not coordinated. As such, some of them might not have your insurance info, and so they would bill you directly. You need to make sure that they have your info and that they filed it.

Q3: Sometimes, a provider will bill you for the differences between what they would charge YOU, and the amount they contracted with your insurance company. I had this happen. The insurance company contracted for $1500, said the procedure was really $2000, and billed me for the difference. They are not allowed to do that, although many people fall for this.

Bottom line ... you need to go LINE BY LINE and make sure you are not being charged for things that should have been covered.

We used to have insurance plans that you paid a premium for, and then when you used it, the insurance company paid 80% and you paid 20% after a small deductible, usually about $200. These were always capped at a certain amount of out-of-pocket, then when you paid that, services were paid 100%. So, including prescriptions, you never had to pay more than $3k-4k a year out of pocket.
So, when you had a $40 office visit (yes, Virginia, there was a time when you could see the doctor for $40)...then you paid your $8 and moved on.
But, if you had a surgical procedure, you would almost always hit your maximum out of pocket, so even if you had to pay $3k, that was it for the year...you were home free.

Then, insurance companies morphed into "managed care" entities. The biggest scam...uh I mean sell..was NO DEDUCTIBLE! Yay us! We went to the doctor, plopped down our $10...and walked out feeling like we just won the lottery.

Then, HMO's were born...same theory.

Now, as we have come down the pike...doctors visits are around $100...we pay $25 and our insurance company pays the rest of "the negotiated rate"...which is usually just a few dollars...and guess what?
The doctor usually ends up getting about $40 out of the deal--the majority of it your money.
But now, there are additional fees for labwork, XRAYs, copays, coinsurance...etc...very little of which is actually credited toward the "out of pocket" expenses. In fact, it is really a joke.

We are getting so screwed by the insurance companies...in fact, with our deductibles and fees, we are paying the majority of what the doctor actually receives in renumeration--while paying out the nose for premiums...that basically amounts to paying a kings ransom to the insurance company for the privilege of paying the doctor the majority of the bill.

In other words, we are being fucked over.

in my finger - wouldn't stop bleeding a lot for hours so i had to go to the emergency room. WITH INSURANCE i have to pay $1,200!!!!!!!!!!! When we lived in St. Lucia, i had to have 6 stitches - total cost for stitches, tetanus shot, and return visit in a week to have stitches removed - with no insurance: $14.

About a year ago, I lost a knife fight with a watermelon. I was going to cut that sucker into chunks, but the watermelon took the knife I had, and then put a very deep slice into my finger ... the one between the pointer, and the middle finger.

I went to the urgent care down the road. I needed 8 stitches. With insurance ... total cost was about $40.

I'm no fan of the insurance companies. But 1200!!! That's probably part of why we want to get people out of the ER.

The ER should be for emergencies, and a sliced finger is rarely an emergency.

btw ... I'm not saying that you going to the ER was bad on your part ... simply showing that we could reduce overall costs by making sure that the ER becomes a place for emergencies.

in retrospect, i should have gone to an Urgent Care. wasn't thinking clearly, i guess. why are all my mistakes expensive ones........... :mad:

1) Its the same injury. The costs should not be as disparate as your and my examples show.

2) Going to the ER is more expensive, and so maybe it should be a bit more expensive for injuries that are clearly not emergencies. SO I paid $40, maybe you'd pay $100 for going to the ER ... but $1200???

3) And then ... that is only true if the urgent care, community medical center was available. Lots of folks don't have a choice ... there is no local urgent care or community medical centers they can go to, and the local ER is all they have.

And as for the expensive of "mistakes" ... we only remember the mistakes that have a significant cost anyway. Mistakes we make that have little cost are forgotten, or they become silly stories of something dumb we did.

All of this is a good argument for single payer. Hurt people don't always make perfect decisions. I've taken 2 rides in ambulances (so far) ... and it tough to make good decisions in the back of an ambulance ... like this one ... "which hospital does your insurance prefer?" ... during an ambulance ride, I prefer the CLOSEST hospital!!!

I really enjoyed my (too brief) time in Soufriere. :hi:

No scans done. Sat there for 2 hours and took a pain med until the thing passed.

Cost for 2 hours and some pain med: TWO THOUSAND DOLLARS.

(with insurance)

She lost her insurance and job last year, I could have added her to mine, but it would have cost ~$6,000 (about $500/month to add her to my insurance) but we also have to figure in that copays, deductables, and partial coverages would also factor in. In the end, we guessed that unless she had a $10,000 medical issue, it was cheaper to not get the insurance. The $500/month was well beyond our means anyway.

As luck would have it, she developed blood clots that moved into her lungs following a train trip this past spring--emergency room and related costs, ~$20,000 and rising. But in reality, insurance wouldn't have saved us even half that amount. Anyway, now we're having open enrollment again, I don't know if it makes sense this year either.

than the $5,000 you did.

I agree with you. Not many people have that $ laying around. :mad: Guess our elected officials have theirs. Why not cut their benefits since they are so eager to cut SS/medicaid?

or hurt in this country anymore. let's keep those wars going and tax cuts for the rich :eyes:

:(

prolapse surgery my wife underwent last year. We had to have 2K when we checked into the hospital and she's been paying every other thing off each month, the anethesiologist, her primary care physician, the nurses, the janitor, the girl that made her wristband and the cafateria folks as well.

I think the bill totalled about 36K but the hospital settled with the insurance company for pennies on the dollar while we can't get a cheaper settlement.

It is, as you state, "so fucking wrong".

Good luck.:toast:

2010 CEO Compensation

AETNA INC - Mark Bertolini: 8,808,852
AFLAC INC - Daniel P. Amos: 15,955,183
AMERIGROUP CORP - James G. Carlson: 10,491,542
CIGNA CORP - David M. Cordani: 15,225,584
GENWORTH FINANCIAL INC - Michael D. Fraizer: 6,932,262
HEALTHSPRING INC - Herbert A. Fritch: 5,383,377
HUMANA INC - Michael B. McCallister: 6,147,917
METLIFE INC - C. Robert Henrikson: 13,867,854
UNITEDHEALTH GROUP INC - Stephen J. Hemsley: 10,810,131
WELLPOINT INC - Angela F. Braly: 13,460,445

Thats just a sample of some more well known insurance companies. Doesn't even include the so-called "not for profits" like Blue Cross & Blue Shield.

source: http://www.aflcio.org/corporatewatch/paywatch/ceou/industry_2011.cfm

yep, as others have told me. CEOs deserve outrageous salaries because they have risked everything, yay, everything, to keep their business afloat.

I think I'm gonna go get real drunk now cause it would take about 9,000 years for me to make what steve hemsle makes in a year.

Edit - not on the AFLCIO list, but google had it. Mr. Bracken at HCA made 38,201,000 in total comp in 2010.

http://www.reuters.com/finance/stocks/officerProfile?symbol=HCA&officerId=1537891

caused the corporate board to buy him out with a 300 Million Dollar severance package, that's $300,000,000.00. He didn't know the company was cheating the government out of Medicare or Medicaid funds which is kinda strange for a guy that supposedly is hands on and detail oriented.

BTW, they paid a 1.7 Billion dollar settlement only due the the fact the government couldn't come up with the total number of fraud claims.

I get it back down by taking a deep breath and saying "karma" to myself while exhaling.

May this supreme asshole get his and sooner than later.

it's us little people that are bankrupting our country by paying into a miniscule retirement supplemental plan and hoping to get at least some medical treatment in our later years.

Not those guys that take billions by fraud and get a slap on the wrist and a welcome back party after the investigation.

Steal a loaf of bread, go to jail for a year. Steal millions or billions, get elected governor of the 4th largest state of the Union.

what an asinine system...works great for enriching the insurance industry though.

How much was the actual cost. 5000.00 times what? 80? Didcha stay a week?

... slighly less than half of what the average american pays per year out of pocket in premium costs and that doesn't include the $5000 you paid out of pocket.

Here's a debunked email that made the rounds about health care costs in Canada - http://www.snopes.com/politics/medical/canada.asp



The truth is that they system isn't even a system here in the US. It is broken beyond repair due to the middle men.

If its any consolation,
25 - 60 MILLION Americans will be forced into the same boat by The Mandate in 2014.
They will HAVE (junk) Insurance, but most won't be able to use it due to the Co-Pays and Deductibles.


In 2014, MILLIONS (30 - 60Million) Americans who can't afford health Insurance
will be FORCED to BUY Junk Insurance that they can't afford to use.
Some of them will get a subsidy, but MOST will be writing a BIG CHECK every year to a rich Corporation whose CEO has a villa in Aspen, a jet, and a yacht.

These 25 - 60 MILLION struggling lower Working Class Americans don't understand this part yet,
but in 2014, when they are FORCED to write that BIG CHECK for something they can't use,
they ARE going to be PISSED,
and they WILL blame the Democratic Party,
and rightly so.

The Democratic Party Leadership passed a Republican Health Insurance SCAM
without forcing the Republicans to take ANY responsibility.

Another Rope-a-Dope.
YAY!!!

Did you know that the term "Medical Bankruptcy" is unknown in civilized countries,
but even AFTER all the provisions of the Health Insurance Scam are put in place,
Medical Bankruptcy will STILL be BIG BUSINESS in the USA?

Thank You Democrats,
for another Uniquely American Solution.
And don't try to blame the Republicans.
THIS bill is 100% DEMOCRAT, signed and sealed!!!
Not a single Republican voted for it.

I don't have the full tally in front of me, but even though I have decent insurance, my "share" of costs came to several thousand dollars-- AND they misdiagnosed the injury and gave me the wrong care (diagnosed a sprained ankle when I'd broken it, did not immobilize it, etc-- and they completely missed the torn MCL in my knee even though I told them it hurt).

But as I said, not only did I end up having to pay a couple of thousand dollars in deductibles and copays-- the meaning of "insurance" is morphing as shareholders and executives demand constant profit streams-- I'm STILL getting bills from radiologists and emergency physician management companies in other states. Mostly they're nickle and dime bills-- $50 to $100-- but it seems that every time my records or xrays cross someone's desk I get yet another bill in the mail. It's damned annoying.

but to a staggering number of Americans the Insurance Industrial Complex is sacrosanct.

Our recent insurance reform should have contained real regulation of these vampires. Premiums of $1000 a month for woefully inadequate coverage---it should not be borne!

Enjoy the "freedom" and compassion.

are going way up and it's all thanks to these high out of pocket plans.

The biggest reason they're making money is not just because people are paying more themselves but, because of that, more and more people are putting off getting any care at all. The article went on to say that under the Profit Protection Act that was passed the insurance companies will eventually be limited on how much they can raise premiums when medical claims are dropping and may even have to refund some of that premium.

What really irked me was when Al Franken was quoted as saying this all proves that the bill is working :wtf:. Only in America would that fact that fewer people who are paying for "insurance" are able to actually access healthcare be considered a sign that the system is "working".

One operation on my face, and twp on one hand. Each operation was a few thousand dollars. Never paid a dime for any of those surgeries, probably because I was working at a medical center at the time and had good insurance.

Now I have no insurance, and I would have no surgery. The system is broken.

Just think of all the money they had to spend in bribes...er..campaign contributions to keep single payer off the table.

In network (which is really easy, every hospital in the city is included, as well as probably 99% of the doctors):

co-pays $0 for Primary care doctor: $20 copay for specialists: $35 for emergency room visits: Lab tests all covered no charge: All surgeries no copay.

Out of network it's 20% I would pay on all procedures up to my deductible limit of $2000.

Union sponsored plan.