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I need a biopsy and have an appointment later this week. They called me for intake questions today and hit me with the cost - over $4000.
Now that I'm home, I did the estimate cost for the exact procedure, at facilities within 10 miles of me.
First, I don't think the facility I'm going to is on there, which almost makes me think it is out of network. Yet she knew my in-network deductible. She told me it was the contracted price between them and my insurance.
The price range of all the facilities in 10 miles is $1500 - $6000+
First I need to make sure where I'm going is actually in network. The place I am scheduled to go has a good reputation but I'm pretty sure most of the lower priced ones do as well. I've been going there awhile and am comfortable there, but cannot believe I could save so much money just picking a different place.
I don't even know that I'm asking a question here, kind of blown away at the whole thing! Anyone have advice or experience?
The price difference is really not that surprising. At some facilities, even getting a rough estimate is like cracking the code to Ft. Knox. Does your insurance company have a cost estimator tool online and that's where those prices are coming from or are you actually able to get direct quotes?
Just be aware that depending on the physician or where you have it done, there may be other phantom costs that show up later, such as separate facility fees, imaging fees, etc. Best wishes on your procedure.
I need a biopsy and have an appointment later this week. They called me for intake questions today and hit me with the cost - over $4000.
Now that I'm home, I did the estimate cost for the exact procedure, at facilities within 10 miles of me.
First, I don't think the facility I'm going to is on there, which almost makes me think it is out of network. Yet she knew my in-network deductible. She told me it was the contracted price between them and my insurance.
The price range of all the facilities in 10 miles is $1500 - $6000+
First I need to make sure where I'm going is actually in network. The place I am scheduled to go has a good reputation but I'm pretty sure most of the lower priced ones do as well. I've been going there awhile and am comfortable there, but cannot believe I could save so much money just picking a different place.
I don't even know that I'm asking a question here, kind of blown away at the whole thing! Anyone have advice or experience?
Maybe it would help to ask your insurance carrier what they cover for that procedure...regardless where you end up getting it unless a provider is really out of network. They may have different contract allowances for different providers. What YOU end up being responsible to pay may not end up being that much different.
The price difference is really not that surprising. At some facilities, even getting a rough estimate is like cracking the code to Ft. Knox. Does your insurance company have a cost estimator tool online and that's where those prices are coming from or are you actually able to get direct quotes?
Just be aware that depending on the physician or where you have it done, there may be other phantom costs that show up later, such as separate facility fees, imaging fees, etc. Best wishes on your procedure.
The $4000+ figure came from the facility themselves. They said it was the contracted rate.
The other figures I got from the insurance companies cost estimator tool online. I went to an ENT last year and can use it to see if the comparisons are close, but it's a different year.
The tool had all the fees broken down, procedure, xrays/imaging, anesthesia and facility. I temped in a medical place 30 years ago and remember all those mysterious fees!
And I know what you mean about Ft. Knox! A few years back I had my first colonoscopy and finally gave up getting info. They wouldn't commit to *anything* (it was free except for the prep)
Quote:
Originally Posted by GreggT
All I can say is: keep in mind we have the best health care system in the world!
The other thing I might add is this is very typical all over.
Sentence 1 was sarcasm right? And Sentence 2 is depressing
Quote:
Originally Posted by Parnassia
Maybe it would help to ask your insurance carrier what they cover for that procedure...regardless where you end up getting it unless a provider is really out of network. They may have different contract allowances for different providers. What YOU end up being responsible to pay may not end up being that much different.
I'm calling the first thing tomorrow. I would be an idiot to throw away 2K if those numbers are true.
And no one should have to go through this crap while already stressing over a procedure.
First, I don't think the facility I'm going to is on there, which almost makes me think it is out of network. Yet she knew my in-network deductible. She told me it was the contracted price between them and my insurance.
...
First I need to make sure where I'm going is actually in network.
You need to call your insurance company and specifically ask.
Quote:
Originally Posted by yesitis456
The $4000+ figure came from the facility themselves. They said it was the contracted rate.
The other figures I got from the insurance companies cost estimator tool online. I went to an ENT last year and can use it to see if the comparisons are close, but it's a different year.
The tool had all the fees broken down, procedure, xrays/imaging, anesthesia and facility. I temped in a medical place 30 years ago and remember all those mysterious fees!
And I know what you mean about Ft. Knox! A few years back I had my first colonoscopy and finally gave up getting info. They wouldn't commit to *anything* (it was free except for the prep)
Sentence 1 was sarcasm right? And Sentence 2 is depressing
I'm calling the first thing tomorrow. I would be an idiot to throw away 2K if those numbers are true.
And no one should have to go through this crap while already stressing over a procedure.
Did you run the calculator on your insurance company's site for the place you actually talked with? Does it match? Why not call the other places and ask them directly? Otherwise you could be comparing apples and oranges. I wouldn't use one of those calculators except for a rough estimate of what to expect a procedure to cost.
You need to call your insurance company and specifically ask.
Did you run the calculator on your insurance company's site for the place you actually talked with? Does it match? Why not call the other places and ask them directly? Otherwise you could be comparing apples and oranges. I wouldn't use one of those calculators except for a rough estimate of what to expect a procedure to cost.
The place I have an appointment with does not show up. A place with a very similar name at the same address does, and at a cheaper price ($2500 vs $4100). But there are a lot of medical places in that building so I'm not sure if it's my place or another one.
So I have to call the insurance company in the morning. My experiences with calling Anthem in the past were horrible, so I hope this works out better.
Whatever facility you select, ask them about a discount for payment on the day of treatment. Many will knock off an additional 20% if you pay in full before you leave. This is welcome if you have a large deductible.
Whatever facility you select, ask them about a discount for payment on the day of treatment. Many will knock off an additional 20% if you pay in full before you leave. This is welcome if you have a large deductible.
Thanks! I've found they'll do that even when working up payment plans.
I have had experience working for the insurance company as well as for a provider in billing. I would def suggest contacting your insurance carrier and confirming the network status of the facility you are going to. If the facility is different from your reg office which it sounds like it is, also be prepared to receive a separate physician bill. Cost estimator tools are wonderful! but can be misleading sometimes.
You can request the "Allowed" amount of charges from your insurance carrier as well, you can even have them look up the specific procedure code. You did some awesome work! and Kudos to you for questioning this! Maybe not in your case but too many times are patients pushed into procedures and end up paying more than necessary. Exactly why I moved into patient advocacy. Someone has to stand up for the patients!!
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Anyone have advice or experience?
