LegendKiller

So, I go and get my knee fixed. 10k for the surgery, not bad. But I needed a new brace. So I went to the doc this morning and he asked me if I wanted more drugs, he gave me 60 percocet last time and I have only used 10 in 2 weeks, he was going to write 60 more...heh.

Then I have to go get this new brace, custom fitted. I walk into the office in a hurry since I was already 2 hours late for work. I asked them to just charge it to my CC and I'd get reimbursed from insurance since I didn't want to screw around with finding my claim rep.


"Ok, that'll be $1,100"....WHAT!?!?!?! For a piece of plastic, foam, and velcro?

I asked them to just put it on my insurance. Their eyes lit up like it was christmas 2 months early. So they called State Farm, finally found my rep and told her....


"Ok, that'll be $2,000".....!?!?!?!?!?!?!? NINE HUNDRED MORE FOR THE SAME THING?

I asked them what was up and they said "We give a break to people who pay cash since they usually don't have insurance, its a nice thing we do". Bull F'in crap, you do that because you can milk insurance companies.

I am calling them tomorrow and telling them that SF rejected the claim so I need to pay by CC, I'm not letting the crooks have $900 more.

People bitch that its medical malpractice suits that cause skyrocketing insurance premiums. Its not that, its over prescription of drugs and moronic charges against insurance. I am tired of crooks that think that just because they can take advantage of the system they should.


/rant

ialsohaveadream

Damn right. Hospitals are a business, too, and there's plenty of greedy ones out there.

ShawnLee

I'm glad you're doing that. It's sad that people will just let it go when it's somebody else's money...

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kimchicowboy

speak yo mind brotha

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ray

Actually, what she said is actually semi true. The doctor's offices I have been to have often given discounts to people who didn't have insurance for simple things like X-Rays or Physical Examinations. Doctor's are people with feelings and they do understand the hardships of securing insurance at a reasonable price these days. Cut them a break once in a while.

Houdini

I agree with most of the above. Medical supplies and things like leg braces are extremely expensive. I'm not sure exactly why, except for the custom made items or extremely limited-run items. And companies sometimes give away some items and even medications to people without insurance or means to pay (I often give out vouchers given to me by drug reps for supplies of meds). Gouging the insurance company isn't the right way to make up the cost, though.

Anyway, the med malpractice issue can spiral out of control. Higher malpractice insurance --> higher charges and unnecessary tests ordered for defensive medicine--> higher cost to the consumer/insurance company --> higher cost of medical insurance premiums. Blah.

Merlin

You should talk to Kevster. He has quite a few stories about leg braces and insurance companies. Just make sure there are no fragile objects around when he gets going on them.

And yes, medical costs for such things are way out of control. But it could be worse. You could be in the hospital getting $15 asprin.

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nickel

i am not 100% sure but i believe it is illegal to increase the fee due to the patient having insurance.

if you were to tell your insurance company that they were charging you $1,100 for the service, but it would be $2,000 if you claimed it on your insurance, the insurance company might cry fraud.

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welfareloser

well, i understand the anger, but it's slightly mis-directed here. two things to keep in mind:

a leg brace is expensive. it's not like a gameboy, where the factory makes millions of them. the factory makes thousands of them. overhead costs are high, especially since technology is constantly updated and you don't want two-year-old technology when it comes to your body parts... you want the best leg brace man can devise.

and, more importantly...

the durable med supply company is simply playing the game by the rules that are set up. they're no more greedy than your insurance company, which, trust me, will screw you and the companies billing you any time they can get away with it.

point being, they really couldn't sell a leg brace for $1100 to everyone and remain in business. now, it's not exactly something selfless and "nice" that they do to charge the uninsured less, since they are passing that cost on to the insured... if they charged everyone the same just enough to stay afloat, i'm betting it would be a $1950 brace... $1100 for the uninsured, $2000 for the insured.

if you don't like the fact that people with different insurances get charged different amounts for the same stuff, bitch to the government about the stupid regulations that allow it, not to the companies that play by the rules. i, for example, don't like the fact that there are specialists in my area that my kids need to see, but the doctors won't see them because we have the wrong insurance

and, a final point...

you shoulda bought one on ebay. heck, i've got one to sell right now... if you're about a men's size M, return the other one, because i've got a very expensive flexion-limiting knee brace that prm used after his knee surgery a few years ago that i'm about to list and expect to sell for about $100.


see, but it IS legal to DECREASE the price for those without insurance... semantics, but the law allows it.

and trust me, you don't want to sic your insurance company on the brace company - neither one gives a sh** about you, and YOU are the one who will get screwed. listen to me on this one... unfortunately, i'm pretty durned sure i have more experience in this area than anyone else here. fighting with med billing and health insurance companies has been my full-time job for the last two years...

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molecularfire

Every hospital that I've worked for charges those with insurance more, it's the only way to make up some of the cost of treating a population where 30-50% don't have any form of medical insurance whatsoever.

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Disclaimer - The above opinion should not be taken as medical advise. My only advise is to talk to your doctor. If you are stupid enough to take anything I say seriously, you have nobody to blame for your cranio-anal inversion but your stupid self.

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ufcrusher

You are looking at it completely the wrong way. Most Doctors offices have agreements with the insurance companies that they will be only a certain amount of the claim and that the doctor has to write off the remainder. The insurance companies determine the allowable amount by utilizing several doctors of their own and asking how much they would charge for it. Thus, if 9 out of 10 doctors would charge $1000 for a procedure yet the insurance company lackeys say that it would only cost them $600, the insurance company will only agree to pay $600 nevermind that the real cost is $1000. This leaves a $400 amount for the doctor to right off. The doctors agree to do this because its better to collect a definite $600 from the insurance then trying to get $1000 from someone who in actuality can not pay it. The time/effort/cost of getting the money actually ends up making it cheaper to go with the insurance allowed amount.

Thus, if a patient has no insurance the situation is that they would end up paying more then the insurance company would, since there is no agreement to pay only the allowable amount. This is inherently unfair to the patient and thus the doctors office will often have a special rate for patients without insurance which in truth is probably close the allowed amount from the insurance company.

If you ever check your EOB's from your insurance company you will see the allowable amounts at work in the situations where they pay 100% of the bill.

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Burzhui

yea man you shouldn't get angry, A lot of times insurance companies have higher prices then medical offices charge anyway, so for example an insurance company pays 2000 for one procedure but office X charges 1000 for the same procedure, so why not charge 2000 if it's allowed

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Kevster

I have two custom knee braces. One is for hazardous sports like Rugby and football. This one is a custom-fitted fiberglass/steel brace that was very popular in the NFL until the newer carbon-composite braces became cheaper. I have one of those too. It fits underneath my clothing and is form-fitted to my leg so it is very handy for other sports I do like skiing and judo.

Trying to get my second brace took quite a bit of wrangling. It was after my second surgery and my insurance company said would pay 50% of the cost of the brace and then proceeded to pay only 35%. I started getting bills from the knee brace company to pay up and ultimately had to sue my insurance company in small claims to get them to pay. After they paid up, I left the company I was working for and promptly dropped them (though I did pay well over the cost of my brace in insurance premiums). I fully understand the medical business and how it is played on both sides. My mother was a nurse, then a hospital administrator for a small regional 110-bed hospital so I really have heard both sides. It just pisses me off when my insurance company says they will pay it in writing then decide after I get the brace that they have "revised my case" and will only pay 35%. Thats when I call the lawyers.

See? I was able to say all that without getting excited or breaking anything!



*slam! kkkrrrash!* Oops... I spoke too soon...

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ApltnHkyMutt

I work for Walgreens pharmacies as a CPHT (certified pharmacy tech) .. When we bill insurances we end up getting less than what a cash paying customer would pay. Insurance companies get the better end of the deal always... its how they stay in business.