Be sure to keep your health insurance

[oldbill]

I had heart surgery last month. (The last Saturday of January to be precise.) The bills are now rolling in. The hospital charge was $219,600! It does not include the doctors' charges nor the cardiac rehab center. Five days!

Between Medicare, I'm 76, and Blue Cross Blue Shield Supplemental insurance, not inexpensive either, my out of pocket expense is $0.00.

 

[PeterJ]

If my past bills to the insurance companies are any indication, if the total bills are, lets say, $300,000., the hospital and Dr's. will be lucky to get $60K to $70K.

 

[Rustyt1953]

Since 2004 I have rolled over the $1 mil mark.

Color me blessed and grateful.

 

[ladder13]

 

[cmj8591]

I had heart surgery last month. (The last Saturday of January to be precise.) The bills are now rolling in. The hospital charge was $219,600! It does not include the doctors' charges nor the cardiac rehab center. Five days!

Between Medicare, I'm 76, and Blue Cross Blue Shield Supplemental insurance, not inexpensive either, my out of pocket expense is $0.00.

You've been paying for Medicare for your entire working life and I'm sure that your BCBS supplemental costs something so your out of pocket expense isn't really 0. It's just that they have been taking it out of your pocket, and everyone else who's working, every day. The only thing free is the grace of God.

 

[Tom S.]

If my past bills to the insurance companies are any indication, if the total bills are, lets say, $300,000., the hospital and Dr's. will be lucky to get $60K to $70K.

I don't think I would use the term "lucky". Hospitals and insurance companies negotiate what actual payment will be. In other words, the insurance company will reach an agreement with the hospital on how much they will pay for each procedure. If you go in for an appendectomy and the hospital charges $25,000 but has agreed with the insurance company to accept $10,000, that's what the payment is. By the same token, if the hospital bill is $9,000, they still get paid $10,000. And yes, I have seen that happen.

In Michigan, the reverse of this practice has caused a serious problem with the state's catastrophic insurance fund. Instead of paying what insurance companies pay, the fund pays the full charge, which has caused the cost of that fund to skyrocket, resulting in our auto insurance rates being the highest in the nation. So it follows that if the insurance company had to pay the OP's full $300,000 his insurance premiums would be a whole lot higher than what they are currently. That includes Medicare premiums.

 

[Jon651]

Would you be interested in knowing that the prices hospitals, doctors, medical service providers, etc. charge will vary wildly based on whether a patient has insurance or not, or even based on WHICH insurance a patient has? It's true - any bill will be very different based on these factors and more. It's the job of an insurance company to negotiate the prices for services, procedures, etc. and the same thing will be a different cost for each provider/supplier and for each insurer based on those negotiations.

The one thing that TICKS ME OFF to no end is that many doctors, hospitals, etc. will agree to one price with the insurance company, then bill the patient for the difference! Isn't that what I pay insurance for - to negotiate a cost/price for a service that I couldn't get for myself without insurance??? At that point, then what's the use of having insurance in the first place???

 

[Tom S.]

The one thing that TICKS ME OFF to no end is that many doctors, hospitals, etc. will agree to one price with the insurance company, then bill the patient for the difference! Isn't that what I pay insurance for - to negotiate a cost/price for a service that I couldn't get for myself without insurance??? At that point, then what's the use of having insurance in the first place???

Most insurance companies have written in their agreement that outside of co-pays or deductibles, hospitals and doctors are not allowed to do this type of billing. It always pays to know in advance whenever possible however.

 

[JohnRippert]

Mom had a quad bypass operation 8 years ago. Between Medicare A & B and the Part F supplemental she also had no out of pocket.

 

[Golddollar]

Mom had a quad bypass operation 8 years ago. Between Medicare A & B and the Part F supplemental she also had no out of pocket.

Last April I spent 3 days in Hanover (PA) Hospital when I had a sudden feeling like somebody slugged me upside the head and my legs got wobbly. At the hospital they checked me out six ways to Sunday to make sure that I wasn't having a stroke. Luckily they found nothing organically wrong with me and made some adjustments to my medications. Happily I've been feeling real good ever since but it sure was scary when everything hit the fan and I ended up calling for an ambulance.

When the statements of the payments started coming in I about choked on just what the 20% not covered by Medicare would have come to. But between Medicare A & B and the Type G supplement I didn't have to pay a dime out of pocket.

(As an aside, the hospital did an MRI on my head. I figured I would never get a better chance, so I asked the reviewing neurologist if I could see the pictures. Now if anyone says to me, "You're an idiot. You don't have a brain in your head." I can say to them, "Yes, I do and I've got the pictures to prove it.")

 

[swsig]

(As an aside, the hospital did an MRI on my head. I figured I would never get a better chance, so I asked the reviewing neurologist if I could see the pictures. Now if anyone says to me, "You're an idiot. You don't have a brain in your head." I can say to them, "Yes, I do and I've got the pictures to prove it.")

Or, as Dizzy Dean once said, "The doctors x-rayed my head and found nothing."

 

[SMSgt]

The one thing that TICKS ME OFF to no end is that many doctors, hospitals, etc. will agree to one price with the insurance company, then bill the patient for the difference! Isn't that what I pay insurance for - to negotiate a cost/price for a service that I couldn't get for myself without insurance??? At that point, then what's the use of having insurance in the first place???

Not exactly how it works. The insurance company and doctor/hospital/whatever will agree on an amount for a procedure. Then the insurance company will pay the amount covered by their policy--usually about 85%--and you pay the remaining 15%. If you have a secondary coverage, it will pick up the remainder.

 

[charlie sherrill]

Or, as Dizzy Dean once said, "The doctors x-rayed my head and found nothing."

Good Ole Diz. He's buried not far from here.

 

[LoboGunLeather]

Impossible to comment without getting into the politics involved in health care and health insurance (not the same things at all), which is verboten per forum rules.

Suffice it to say that my experiences have not been good. Very expensive, but not good.

 

[BigBoy99]

The amount the medical facility bills the Gov't. and the insurance companies are NOT what they actually receive. The statements I receive from my insurance company show what the medical facility billed, how much Medicare allowed of the total bill, how much paid Medicare and how much the insurance paid. For example, on my last two bills I received, the number are: Medical Facility Billed $950. Medicare permitted $174. Medicare Paid $140 and Insurance paid $34. The other one, Medical Facility Billed $325. Medicare permitted $39. Medicare Paid $14 and Insurance paid $25.

What the Medical Facility Bill and what they actually get paid are worlds apart. For my heart surgery the Medical Facility Bill was $319K but in looking at the breakdown of the expenses actually allowed were a lot less. The surgeon who did the surgery actually received just a bit over $4000 for his work.

 

[cmj8591]

Like Lobo says, health insurance is where it is because of politics, particularly the Affordable Care Act. Which we can't talk about here. Their house, their rules. It is what it is.

 

[COFFEEMUG]

my 5 day covid stay back in December was 56K.
my out of pocket was $250-
I felt like I hit the lottery

 

[WuzzFuzz]

Since 2004 I have rolled over the $1 mil mark.

Color me blessed and grateful.

One day,,you and are are going to connect up and compare our old scars, and show them off like ole LBJ did that time.

WuzzFuzz

 

[Rustyt1953]

One day,,you and are are going to connect up and compare our old scars, and show them off like ole LBJ did that time.:

 

[Sistema1927]

It's actually a shell game.

The hospital bills $XXX, the insurer pays $X, and the hospital writes off $XX. If they do it "right" a for-profit hospital pays $0 in taxes and still makes a good profit for its investors.