[///M///]

Some brief background:
So I work for pretty good company with good benefits and I consider my employer provided Blue Cross Blue Shields PPO insurance to be pretty decent considering what else is out there. I have a 3k deductible (me and 2 kids) with a 20% coinsurance after deductible is met.

Was in a motorcycle accident many years ago where I broke my ankle and now it is getting arthritic so my doc advised we should try some Synvis shots in the joint.

Okay no biggie, just three injections just like getting Cortisone....or atleast that's what I thought

Now the ranting….

I made the appointment late last year for the three shots, a week apart in Jan 2020 as they have to be administered 3 weeks apart. Went there is Jan this year 3 consecutive weeks and today I get a bill for $2,895 for those 3 visits Never in the last 20 years have I gotten such a ridiculous medical bill. I was like “what the fuck”? This can’t be right.
So here is how they billed me….

Note: Please bear in mind the below charges are agreed to rates with the insurance and not what they billed the insurance which was even higher. You don't even want to know that number

Physician Bill:
Doc Medical Visit : $80 (normal)
Doc Surgery (yes, they call an injection "surgery". WTF?): $65 (normal)

Hospital Bill:
Medical visit: $55 (Yes, they double bill for the same fucking reason, one for physician and one for the hospital. Talk about double dipping.okay but the billed amount is still normal)

Operating Room (Fake): $765 (This is freaking seriously insane)

So looking at this bill, anyone outside of the US would probably pass out just looking at the first 3 lines but since we have been so normalized in this country, the first 3 lines are no big deal and that’s what we expect to pay more or less.

It’s that fucking operating room charge that blew a fuse in my head. For starters, I was never in a frickin operating room. I was just getting a shot, like a fucking flu shot. It was a non-sterile doc office, you know that little room they put you in with or without a window while you wait for the doc to arrive?:m and rotate multiple patients through the day for consultation: When I called the billing department and challenged them on it, they stated that per the billing, when an injection or anything that involves breaking the skin is administered in that room, the charge is considered that of an OR . Whoa?
Are you serious????????
What in the world classifies that small room where people walk in with shoes sneezing coughing all over the place, as a OR? What the fuck? The billing folks insisted that’s how it is billed and I checked with my insurance and it’s all legal. They can call it whatever they want as the medical coding allows it per their agreed to contract. I am so fucking mad because this is a serious rip off. How in the world is an average everyday citizen supposed to know that the small doctors office can be considered an OR for billing purposes?

Now I know some of you might say I should have done my due diligence and gone to an outpatient facility or if I was going to the hospital, I should have checked what they would charge, etc. And yes I do that but for actual serious procedures like a surgery or something that involves a real OR, anesthesia, etc. not a frickin shot. . I was okay if it came out to $300-$400 pre visit even though that's over the top but almost 1k per visit is mad.

Planning on calling their risk management division tomorrow and seeing if I can negotiate with them. Any of you more familiar with how this works care to provide some input?

Any guidance is much appreciated.

Thanks.

End of Rant

[NickyC]

It's completely out of control, the system is broken. I went to the ER for the first time in around 20 years about six months ago. I got a piece of chicken lodged in my throat and it felt like it wasn't ever going down. I waited it out for about 4 hours, then went to the ER around midnight.

I was there for 45 minutes. During that time I had two chest x-rays, and was given a cup of Maalox. Luckily the food went down on it's own, so no scoping or anything was needed.

I got the bill about a month later, that 45 minutes, two chest x-rays, and cup of Maalox cost me nearly $2k. My deductible is $2,500, so I had to write a check for the full amount.

What a complete rip off scam health care is in this country. Burn it down and start over.

[243Racing]

Originally Posted by NickyC

It's completely out of control, the system is broken. I went to the ER for the first time in around 20 years about six months ago. I got a piece of chicken lodged in my throat and it felt like it wasn't going down. I waited it out for about 4 hours, then went to the ER around midnight.

I was there for 45 minutes. During that time I had two chest x-rays, and was given a cup of Maalox. Luckily the food went down on it's own, so no scoping or anything was needed.

I got the bill about a month later, that 45 minutes, two chest x-rays, and cup of Maalox cost me nearly $2k. My deductible is $2,500, so I had to write a check for the full amount.

What a complete rip off scam health care is in this country. Burn it down and start over.

Does your plan not have an ER copay?

A lot of these new “high deductible” health plans don’t have any copays which leaves people with a big surprise after a seemingly routine visit

[NickyC]

Originally Posted by BeastieBombRacing

Does your plan not have an ER copay?

A lot of these new “high deductible” health plans don’t have any copays which leaves people with a big surprise after a seemingly routine visit

$100, yep. Not a new plan either, had it for years.

[///M///]

Originally Posted by BeastieBombRacing

Does your plan not have an ER copay?

A lot of these new “high deductible” health plans don’t have any copays which leaves people with a big surprise after a seemingly routine visit

The point is not about copay but more about what they bill for a frickin’ service. I can’t even comprehend it sometimes because it makes no sense. Here is an example and I’ll just talk about one of the line items because the rest will likely blow your mind....when I had my motorcycle accident, they put in a claim for $1400 for oral medication in the 1.5 day hospital stay. Just to be clear, the oral medication just involved a nurse handing me meds to swallow. $1400 for the three times she had to do that. Chew on that for a bit. Lol!

When I was in Italy during the European delivery I caught a bug and fell ill suddenly. The ER trip, seeing a doc and a course of antibiotics (no insurance) came out to 38 euros.

Last year in Switzerland my 4 year old daughter fell ill in Lauterbrunnen. Went to the local hospital where they did xrays and complete bloodwork along with medicines. Bill was 125 euros and by European standards that’s high that’s because it’s Switzerland. Compare that to here if I needed walk in doc visit, bloodwork, xrays, prescription drugs and following. Easy 4-5k.

I fucking hate the healthcare cost and hate more how the ridiculous cost is normalized in our society.

[Rmtt]

I have been with the same doctor for over 20 years. He is only a couple of years older than me, and I was the 2nd patient he ever had.

I have a $25 copay, but when I have had other services done....some of the charges were crazy. But I could just call him up, he would have the billing department change the Medical Code to something else, refile with my insurance, and I would end up without a bill.

He agrees about the way Healthcare is going...so he really helps me out as he knows the "system".

And when my wife had Botox for her Migraines, it was a $1,500 charge. However my copay for a specialist (neurologist) is $50...and that was all we paid.

My insurance is pretty good it seems.

But I agree with you.....it can be a system broken by greed and will always be tested by what they can get away with.

[243Racing]

Originally Posted by ///M///

The point is not about copay but more about what they bill for a frickin’ service. I can’t even comprehend it sometimes because it makes no sense. Here is an example and I’ll just talk about one of the line items because the rest will likely blow your mind....when I had my motorcycle accident, they put in a claim for $1400 for oral medication in the 1.5 day hospital stay. Just to be clear, the oral medication just involved a nurse handing me meds to swallow. $1400 for the three times she had to do that. Chew on that for a bit. Lol!

When I was in Italy during the European delivery I caught a bug and fell ill suddenly. The ER trip, seeing a doc and a course of antibiotics (no insurance) came out to 38 euros.

Last year in Switzerland my 4 year old daughter fell ill in Lauterbrunnen. Went to the local hospital where they did xrays and complete bloodwork along with medicines. Bill was 125 euros and by European standards that’s high that’s because it’s Switzerland. Compare that to here if I needed walk in doc visit, bloodwork, xrays, prescription drugs and following. Easy 4-5k.

I fucking hate the healthcare cost and hate more how the ridiculous cost is normalized in our society.

In Switzerland, for example, they pay roughly twice as much income tax. So you pay for it, one way or the other.

[Salty Dog]

Originally Posted by BeastieBombRacing

In Switzerland, for example, they pay roughly twice as much income tax. So you pay for it, one way or the other.

Same here in Canada, but you guy's will be fine once you elect Bernie because everything is going to be free.

[Wolf 335]

In Canada we make up for our health care through income tax and inflated car parts prices!

[zx10guy]

Practices can charge you the higher facilities rate if they have a room in their practice which qualifies. This allows the practice to bill for all services at that higher rate. Is this fair? No. But many practices do it. It's all part of the game with insurance.

You can contact the billing department of your doctor's office to have them re-examine how your bill was submitted to insurance or have them do a courtesy price bill adjustment. On the latter point, I know many doctor's offices will work with you if you have a substantial out of pocket expense. You just have to ask. My GI doc wanted me to have a particular drug for H. Pylori. My insurance at the time denied the prescrip. I was ok at paying out of pocket for it as it is what it is. My doc was so upset that he scrounged up enough free samples in his office to get me the month dosage free of charge.

On the resubmittal of the bill for insurance review. My ex had some what I consider cosmetic work done for scalp treatment/hair loss. I had a change in insurance plans which previously covered it but now didn't. I asked her to talk to her doctor's office to have them look at resubmitting the charges under a different diagnosis code which the insurance would cover. Of course the ex barked back that the doctor's office wouldn't do that, blah blah blah. Well, I refused to pay the bill. A couple of months later, I get an EOB from my insurance and low and behold, the treatments got covered because the doctor's office submitted it under a different diagnosis code.

It's all a game and you have to look at it similar to how you would approach filing a claim for a car accident. This is what we get for allowing health insurance to be publicly traded and a for profit industry.

[///M///]

Originally Posted by BeastieBombRacing

In Switzerland, for example, they pay roughly twice as much income tax. So you pay for it, one way or the other.

Am aware of that but it's not twice. This what people don't get here in this country that they are effectively paying closer to the same tax others pay in countries like Germany, Netherlands, Switzerland, etc where healthcare is covered when you add in the premium and deductible you are paying for insurance every year. Let's say my effective federal Tax rate is 30%. Now add in the monthly premium I am paying towards insurance every year to cover my family and that's another 8-10% easy. And if I am using the insurance that year add another 2-3% that goes towards meeting the deductible. Where does that get me? Well into the 40% plus of my salary.

I would rather pay 40% in taxes every year knowing that my health is covered no matter what than have to worry about plans every year, deductibles, coinsurance and all that crap.

The problem here is that everyone does not want to contribute to the system. It's all me, me, me. The young say I don't need to see a doc so why should I pay towards medical, others feel they are healthy so why pay? But guess what, everyone starts to get old and needs medical help at some point.

[243Racing]

Originally Posted by ///M///

Am aware of that but it's not twice. This what people don't get here in this country that they are effectively paying closer to the same tax others pay in countries like Germany, Netherlands, Switzerland, etc where healthcare is covered when you add in the premium and deductible you are paying for insurance every year. Let's say my effective federal Tax rate is 30%. Now add in the monthly premium I am paying towards insurance every year to cover my family and that's another 8-10% easy. And if I am using the insurance that year add another 2-3% that goes towards meeting the deductible. Where does that get me? Well into the 40% plus of my salary.

I would rather pay 40% in taxes every year knowing that my health is covered no matter what than have to worry about plans every year, deductibles, coinsurance and all that crap.

The problem here is that everyone does not want to contribute to the system. It's all me, me, me. The young say I don't need to see a doc so why should I pay towards medical, others feel they are healthy so why pay? But guess what, everyone starts to get old and needs medical help at some point.

To pay an effective federal tax rate of 30% in the US, you'd have to be making well over $400k as an individual. So, super happy for you

However, I don't buy that you're paying $40k a year towards premiums and deductibles.

[243Racing]

Originally Posted by NickyC

$100, yep. Not a new plan either, had it for years.

That's pretty strange. Usually that copay covers most of the services you receive in the ER.

For example, I went in with a concussion a few years ago, and the CT scan was included in my ER copay (which was $100-$150)

It's so dependent on so many things - and I agree that's the core problem of our healthcare. Private insurance could work if the way you were charged for care wasn't such a crapshoot.

I like the car example, there's pretty acceptable baseline prices for labor (mechanical, paint, etc) and I believe they're adjusted for market. So the estimate you get from Body Shops A and B likely won't be markedly different.

[CTinline-six]

The issue is our healthcare system is run by the insurance companies. A family friend is a surgeon in Miami, and he has insurance companies basically telling him what he should do when patients come in with X injury/ailment. He has argued before with what he describes as some insurance rep reading out of a book. Everything has a process where you must first jump through a series of hoops that aren't needed (which of course the insurance companies make money off of) before you are allowed to do the actual treatment that will heal the patient.

It's like bringing your car to the repair shop with an engine noise but they tell you to get it washed and change the brakes first because that's what they do for all cars before diagnosing them.

[Salty Dog]

Originally Posted by BeastieBombRacing

To pay an effective federal tax rate of 30% in the US, you'd have to be making well over $400k as an individual. So, super happy for you

However, I don't buy that you're paying $40k a year towards premiums and deductibles.

So in Canada, if you make $400K the tax rate is 45%....at $100K you're going to pay about 25%, however that's just the federal income tax. Then there is the sales tax HST which is 13% on every single purchase, then theirs the user fees (tax) government "revenue tools" (tax), health care supplement (tax), property tax, carbon tax and then the tax we pay on gas, tobacco and alcohol.

At the end of the day, my wife and I make good livings salary wise, by the time we pay all of our tax more than half of our income is taken in tax.

[243Racing]

Originally Posted by Salty Dog

So in Canada, if you make $400K the tax rate is 45%....at $100K you're going to pay about 25%, however that's just the federal tax. Then there is the sales tax HST which is 13% on every single purchase, then theirs the user fees (tax) government "revenue tools" (tax), health care supplement (tax), property tax, carbon tax and then the tax we pay on gas, tobacco and alcohol.

At the end of the day, my wife and I make good livings salary wise, by the time we pay all of our tax more than half of our income is taken in tax.

One of the reasons I decided not to move up there a few years ago. Last year, doing some rough math, my total tax burden (including federal, state, fica, insurance premiums, etc ) was about 27% - which as you said would just cover my federal tax bill somewhere like Canada

I'm sure, however, that's a lot easier to accept for Canadians who grew up with that being the way it always was.

In America, we don't have a majority of people who are OK paying higher taxes in order to subsidize everyone's health care. A plurality - sure. By and large, we want taxes to be lowered.

[AntF32]

I needed some blood tests, visited my local Hospital and was in and done within 15 minutes. Got the results back the following week and what was I charged i hear you ask.........

£0.00 - You have to love the NHS

[243Racing]

Originally Posted by AntF32

I needed some blood tests, visited my local Hospital and was in and done within 15 minutes. Got the results back the following week and what was I charged i hear you ask.........

£0.00 - You have to love the NHS

Kinda like prepaid maintenance on your BMW. You go through service and don't get charged anything, and it feels good as long as you don't think about that $5k you were charged up front

Now imagine if our bodies came with a warranty

[Salty Dog]

Originally Posted by BeastieBombRacing

One of the reasons I decided not to move up there a few years ago. Last year, doing some rough math, my total tax burden (including federal, state, fica, insurance premiums, etc ) was about 27% - which as you said would just cover my federal tax bill somewhere like Canada

I'm sure, however, that's a lot easier to accept for Canadians who grew up with that being the way it always was.

In America, we don't have a majority of people who are OK paying higher taxes in order to subsidize everyone's health care. A plurality - sure. By and large, we want taxes to be lowered.

So I do love my country but the fact is we are being taxed to death, and it's getting worse. Our healthcare isn't as great as everyone tells you. Our wait times are terrible, and unless you live in a large city or close to one you don't have a lot of services available to you so you're going to have to travel to get some services. Having said that if you have an emergency you will get excellent care. Because our system is government run, it is burdened down with bureaucracy, studies have shown that our healthcare system is more heavily administered than most others globally. I will say this though, about a decade ago I spent several months in the hospital, 3 major surgeries, multitudes of tests about a dozen CT scans and then the follow up care. The only bill I saw was for the TV I had in my room.

[AntF32]

Originally Posted by BeastieBombRacing

Kinda like prepaid maintenance on your BMW. You go through service and don't get charged anything, and it feels good as long as you don't think about that $5k you were charged up front

Now imagine if our bodies came with a warranty

I'm happy to pay my N.I contributions, it gives me comfort that should i need emergency healthcare I'm not going to be hit with ridicules costs afterwards or having to prove i can afford treatment.

My wife has had been undergoing treatment for Stage 3 cancer for coming up to two years now, all covered under our healthcare.

[zx10guy]

Originally Posted by Salty Dog

So I do love my country but the fact is we are being taxed to death, and it's getting worse. Our healthcare isn't as great as everyone tells you. Our wait times are terrible, and unless you live in a large city or close to one you don't have a lot of services available to you so you're going to have to travel to get some services. Having said that if you have an emergency you will get excellent care. Because our system is government run, it is burdened down with bureaucracy, studies have shown that our healthcare system is more heavily administered than most others globally. I will say this though, about a decade ago I spent several months in the hospital, 3 major surgeries, multitudes of tests about a dozen CT scans and then the follow up care. The only bill I saw was for the TV I had in my room.

I don't know anything first hand about the Canadian healthcare system. But because of my medical situation, I have been active on the various cancer support forums. There are some people that fall into the situation you've mentioned that are in Canada. They live in a rural area and have to drive hours in to the nearest cancer treatment centers. With various things that is just life, they've had challenges with the whole logistics whether it be scans to actual treatment.

One thing I'm stunned about is the limit on access to your own information under the Canadian system. What I mean by this are lab results and scans. When you deal with cancer, you learn about this thing called scanxiety. It's the anxiety one feels just before going in for scans and the painful wait after for the results. From what I've seen, Canadians have to wait till they see their doctor before they know the results. Sometimes this is only a few days but can be as bad as a couple of weeks based on what I've seen on the forums. This would drive me nuts. For me, I have been able to get my scan images right after I finish the scan procedure and have been able to get the official radiology report later that day.

[243Racing]

Originally Posted by zx10guy

From what I've seen, Canadians have to wait till they see their doctor before they know the results. Sometimes this is only a few days but can be as bad as a couple of weeks based on what I've seen on the forums.

I would lose my fucking shit every time.