Are you sitting down????

[gadgetman]

I got my first of what will be many bills for my AICD replacement. $98,052.15

As far as I can tell this does not include the charges by the Doctor.

I sure hope the insurance company looks closely at this bill, especially the following:

1 ICD, SC----$39,000
1 LEAD, ICD, DUAL----$12,000
1 AICD PULSE GEN INSERT----$43,946

From this bill, the insurance company was charged $82,946 for the unit, not counting the lead. From my memories of the first implant this appears to be over double the charges of my first implant. It should be interesting to see how this plays out. Some other ?interesting? charges:

1 OXYGEN/INITIAL----$131.00

Guess they charged for the ?room air? as I never had any oxygen via a tube of any sort.

1 TELEMENTRY MONITOR----$397.75

A steep ?rental charge? for 4 wires and a transmitter for less than 24 hours.

Over $30.00 for pills. They wouldn't allow me to take the ones I brought from home because they were not in the original containers.

Thank God (sorry Ross) for insurance.

May God Bless,

Danny

 

[Mary]

I got my first of what will be many bills for my AICD replacement. $98,052.15

As far as I can tell this does not include the charges by the Doctor.

I sure hope the insurance company looks closely at this bill, especially the following:

1 ICD, SC----$39,000
1 LEAD, ICD, DUAL----$12,000
1 AICD PULSE GEN INSERT----$43,946

From this bill, the insurance company was charged $82,946 for the unit, not counting the lead. From my memories of the first implant this appears to be over double the charges of my first implant. It should be interesting to see how this plays out. Some other ?interesting? charges:

1 OXYGEN/INITIAL----$131.00

Guess they charged for the ?room air? as I never had any oxygen via a tube of any sort.

1 TELEMENTRY MONITOR----$397.75

A steep ?rental charge? for 4 wires and a transmitter for less than 24 hours.

Over $30.00 for pills. They wouldn't allow me to take the ones I brought from home because they were not in the original containers.

Thank God (sorry Ross) for insurance.

May God Bless,

Danny

Glad you're home Bubba, but I'm not happy that you got whacked with such a bill. Tell them you did not get the O2. Most times they have a set-up charge that is automatically billed in anticipation of the patient utilizing it. If you didn't use it, then tell them about it!
I actually think the telemetry charge is reasonable . . . I'd charge more than $397+ to monitor you for 24 hours!

 

[Phyllis]

That's why insurance premiums are so high- especially for us that are self-insured! I have heard many stories of people (especially on medicare) who are charged for procedures that never occurred- I agree with Mary- call them on it!

 

[Adam 12-21-05]

Danny,

Do not freak out just yet. Just because a hospital bills an extraordinary amount for a particular service or medical product does not mean you or your insurance provider are obliged to pay all of it.

This is one of the more interestesting elements of the heart surgery experience. I could not believe the bills that piled up up on my desk. I remember one line item of the bills was for $187,000.

Take a guess at what the contracted rate of payment was for that bill?



Adam

 

[Nancy]

Joe's last hospital bill was $333.000.00, and he didn't have any major surgery, just some procedures, and a lot of so-so care. Thank God for insurance

 

[George]

I think it has become standard procedure for hospitals to bill outrageous fees, knowing that insurance companies will contest them. The bill for my PVR was over $90,000. I think they settled with my insurance for about a third of that.

 

[SumoRunner]

Glad some of you chimed in with bigger numbers. I was about to snark about how mine exceeded that amount 16 years ago. Yeah I was sitting down, but I didn't even flinch at seeing that number. This ain't a cheap game. You're playing against real pros.

Now watch out for all the ancillary bills for $50 bandaids and $100 Tylenols over the next few weeks. They don't list them as bandaids. They obfuscate the name with technical terminology, but it's really just plain old bandaids.

 

[Marty]

My understanding is commercial insurers, medicare, medicaid, etc. pay a fraction of these bills and the hospitals settle for it. Now, a person with no insurance is stuck for the total bill and has no bargining power. Last year we were told abut a young carpenter who had no insurance from North Carolina who went to Duke and was told his surgery would run about 250 K. He opted to go to India and I think his total expenses including air fare and a tour of the Taj Mahal came to about 10k.

 

[Ross]

$98,052.15 x 65% = 63,733.90 or less that insurance will pay them.

 

[rgmcguire]

Holy cow!!! How much for mitral valve repair or replacement? How do you ever pay it all?

 

[Lynlw]

My understanding is commercial insurers, medicare, medicaid, etc. pay a fraction of these bills and the hospitals settle for it. Now, a person with no insurance is stuck for the total bill and has no bargining power. Last year we were told abut a young carpenter who had no insurance from North Carolina who went to Duke and was told his surgery would run about 250 K. He opted to go to India and I think his total expenses including air fare and a tour of the Taj Mahal came to about 10k.

Another thing that really stinks, is if you go "out of network" We have been lucky so far in that, I've been able to get insurance to cover things that were "out of network" as In network w/ lots of phones calls ect, but it CAN make a huge difference, depending on what kind of insurance plan you have and I believe state laws.
Most plans for out of network are 80/20 which you would THINK means they negotiate w/ the doctors, hospitals ect and pay their 80% of that fee and you pay the 20% BUT from what i've learned (and we were just talking about about this on one of my CHD groups) you the patient, don't really pay 20%most likely you will also have to make up the difference, of all the money owed from the entire amount billed, minus the amount the insurance pays, I think it may be called "balance billing" here is an example one of the Moms gave
"Say for Procedure A, maybe an x-ray, echo, consult, etc., the doctor charges
$300. For this same Procedure A, the insurance company has agreed to pay
80% of what is "reasonable and customary." The insurance company then
decides that $50 is reasonable and customary for this procedure (no matter
what the doctor charges) and pays 80% of $50 (or $40). The other $260
doesn't just disappear, unfortunately, but is billed to the parent. "

(me again)
So IF you are planning on going out of network, you have to be sure to ask alot of questions and get everything in writing. If you know a surgery at one hospital cost about 100,000 and your insurance is 80/20 you would think you will owe about 20,000, BUt IF insurance thinks 50,000 is reasonable, they will pay 80% of that 50,000 and you could owe closer to 70,000
(This a SC laws, but there is a good chart 1/2 way down the page explaining it https://www.doi.sc.gov/Eng/Public/Consumer/healthinfoSCconsumer.aspx )

 

[Granbonny]

Last week..I got my bill from my annual checkup..from PCP..Looked and there was an echo?An echo? for just a yearly 5 minute checkup..(labs done before he came into room...I had to call for several days..You know the thing..hold, ect. but I decided..enough..and called at 8 a.m. when they opened..and got thru to billing lady..and told her. I have my echos from Cardio..not my PCP for an annual checkup.....If I had not called..maybe medicare would have paid it to PCP..but enough wasted tax-payers money... ..It is not just human doctors..watch the Vets, too. Before my last dog passed..they had billed me for a female..neutering..saying She..needed it done....at age 12..at UGA vet school. the best..However , my dog was a MALE. Cheaper than a female..Still had to mortage my home to get him out. He did live 1 more year. worth it....He was only there 2 days. tooks me months to pay it off. No insurance for dogs. Bonnie

 

[hensylee]

Most of us don't realize that there is a contract between ins companies and doctors and a contract between ins companies and hospitals, etc. It changes as time goes by but is signed by each for a period of maybe 5 yrs (it might have changed since I was working with it). The greed upon amount is what the insurance company pays a percentage of, usually 80% unless you have major medical. The patient or his/her supplemental insurance, if you have it, pays a percentage or all of the balance, depending upon your plan. We are all shocked by the bill, but it is unreal. Scares us, doesn't it? Even if we see the actual bill, that would scare us, too.

I generally ask for an itemized bill so that I will know what they have charged me for. Those $10.00 aspirin are really a joke aren't they?

 

[Nancy]

"The greed upon amount is what the insurance company pays"

Hensylee-- HaHaHa--I know this was a typo, but such an appropriate one!

 

[Lynlw]

"The greed upon amount is what the insurance company pays"

Hensylee-- HaHaHa--I know this was a typo, but such an appropriate one!

I chuckeld at that one too

 

[hensylee]

that's so funny - so appropo