First let me say the treatment I received was outstanding, everyone was super nice. The wheel chair pusher man sang me a song on the way to my destination and he really could sing wonderful. My surgeon was top notch quality human who treated me with superb care and consideration. My rant is this... apparently they (Rex) have a new billing policy whereby they 'estimate' what you will owe them after filing insurance, and when you register for outpatient surgery they basically tell you to pay their 'estimate' upfront. It has been a while since I needed care, I thought you paid a hospital copay, they file, insurance company figures out cost-deductible and then you either pay lump sum or payments to Rex for the balance. Boy was I shocked when the lady told me I needed to give her a check or a credit card for $3500 dollars. Yall I just about had a heart attack, thank God I was in the hospital. My surgery was not elective so I panicked and thought maybe I could not even get the surgery. I told her there was no way I could do that, I cried and she put a $900 payment on my MC as I tearfully said I had no idea how I would pay that (we do not carry a balance on our CC). My deductible is $3500 so I knew in the near future I would start making payments on that, but was not aware of having to pay it upfront. So just know this may happen to you if you need care, they should send out an fyi with their pre registration packets.
This is certainly good to know, especially since the husband is in the process of scheduling an appointment with a gastroenterologist to have a colonoscopy. We know we will have to pay something out-of-pocket and, like you, expected to be billed the difference after Aetna pays the insurance payment. We want to go the preventive route with this test - husband is now 52 and not getting any younger - but don't have that kind of money to spend, without hoping to arrange payments. I find it interesting that the yearly mammogram I have costs us nothing... Update: I did read through his plan and the way I am interpreting what it says in the booklet, a colonoscopy should by covered 100%, and we would be responsible for the $20 copay when he goes in for the dr. appointment. Hopefully, there will be no surprises - cost-wise, or healthwise. Getting old is costing a lot, it seems, much like the maintenance on a car that is showing its age!
Oh my goodness, what is this world coming too. If we walked around with that kind of money we probably could pay an higher deductable, etc. It is sad that you can't even get medical care with out having to pay up front. I had some outpatient test done at Wake back in Feb. glad they didn't ask for the money up front. I would have had to leave.
It's called Consumer Driven Health Care. And it's the employers that asked for this, not the insurance companies. Most don't realize that it's not the insurance company that pays your medical bills but your employer. They hire the insurance company to administer the health insurance plan they want for you. They pay an admin fee for their data sources, customer service, use of their contracted provider network (taking advantage of much much lower negotiated rates than the normal charge), claims processing (writing the check for them) and precertification. They also are paying for the wellness programs the insurance company offers. Employer groups realized that medical costs were skyrocketing and in order to continue offering their employees insurance had to find a way to lower costs. So, the high deductible, coinsurance plans were developed. The premiums are lower (or at least not as much an increase as if they stay with the traditional HMO and PPO plans). Preventitive care is covered at 100% but you just have to determine what YOUR employer defines as part of preventitive care. So mammograms and colonoscopies could actually be covered at 100% and not subject to the deductible. Many doctors and hospitals started out not asking for the deductible or estimated coinsurance up front but got burned on the back end by non paying patients. So now many do estimate your expense and ask for a downpayment. You can try to fight it since many contracts only allow them to collect copays up front and not deductibles and coinsurance. Some have resorted to giving prompt pay discounts (like WakeMed) if you pay your bill within so many days of receipt in order to try and get their money after the fact. WakeMed did not make us pay anything up front and offered a 15% discount if we paid our bill within 10 days of receipt. That saved us a lot of money! These new plans can actually end up less expensive for many people with the traditional plans when you look at the difference in premiums and useage. It also makes people stop and think about the cost of healthcare and will hopefully make wiser decisions. That is why there is so much emphasis on preventitive care; to help keep the healthy people healthy and minimize health problems for those with chronic conditions. All said, yes, this is a big change for most and expensive but it will also force people to think more about their healthcare and also "shop around" for the best prices. If I can see a doctor and use a hospital that will cost ME less I will do that. There are also HRA's and HSA's with these plans to help you with the cost. Many employers actually give you part of the deductible money in an account to help with your deductible costs. I'm sure I'll get flamed for all of this, and I'm not saying I support it 100% since the people who will suffer and not get the care they need are the ones who need it most, but I just wanted to dispel the misconception that this was driven by the insurance companies. My key message is make sure you understand your benefit plan and shop around for your healthcare and prescriptions!
No, some of the very large companies may be self-insured, but not the majority of them. The majority of the companies buy insurance the very same way the rest of us do, they buy what they can afford from the insurance company, whether they pay the entire amount of just a portion of the premium. The only way to reduce the cost is to increase the deductible and copay amounts and even then the increases every year are double digit percentages.
True Wayne, I just wanted people to understand the requests for this type of plan was initiated by employer groups trying to control their costs and premiums. And at least it allows some employers to offer health insurance that otherwise could not. I've been in a situation before without insurance, and I'd much rather pay a deductible based on a contracted rate between the hospital and insurance company than the full price. You'd be amazed at how much they reduce the bill for the insurance company. Many years ago there were no HMO's or PPO's and it was indemnity based insurance with a deductible and usually 80/20 coinsurance. But the medical charges weren't so inflated so it was manageable. Can you imagine how much more we would pay now if there were no negotiated rates in place? For example, my daughter's recent trip to a local ER was billed as $1400.00 but the amount they based our coinsurance on was the contracted rate with the insurance company and that was only $550.00! With a 20% coinsurance, that means paying only $110.00 vs. $280.00.
I had surgery back in Dec. 2008, they did not do this. Good thing as I would not have had the money to pay either.
Seems to me they should have at least told you this before the day you showed up for surgery. I'm sure most people would not have been able to come up with even $900 on the spot like that! :?
wow..I was at Rex in December of 07, and no one even bothered me with insurance forms or anything...of course I was there for a different reason... I think I would have knocked out anyone who dared ask me about how I was going to pay them... I find it sad that some seem to care more about what insurance you have then helping someone who needs medical assistance. I know emergencies are different, but still...when does it become a little more than what insurance do you have...I just wish that was not their first question...
It isn't just Rex. My sister had to have two kidney surgeries at Duke earlier this year and they wanted something upfront too. She didn't have it and they did the surgery anyway as she has above average insurance...................but there you go. I guess there are so many who can't pay they have to get what they can.
medical costs I get that companies need plans with higher deductibles, I get that hospitals want to be paid and that they probably have a devil of a time collecting high premiums. I thank God everyday hubby has a job with insurance, even with a high deductible. I knew going in we would have to payback $3500 in the future. There was never a question in our mind that Rex would eventually get their money, even if we needed to put down some and make payments on the rest. My beef was with the last minute policy suprise. Especially since hubby told me not to use credit card if at all possible. We are frugal folks and I work as a substitute teacher, so obviously I am not making any money right now. I was thinking I would pay off my bill in the fall/spring when I was working again. If I had known before hand they expected a large sum, it would have made the situation less stressful. The policy was so new that the registrar had to go through her process manual page by page to check me in. If this had been elected surgery, I may have just cancelled. Then I would have messed up the Dr.'s schedule and I would be walking around thinking I was dying of breast cancer. So sad that we have come to this, it is always about the money, isn't it. But no matter what it was worth every tear and dollar...I do not have cancer!!!
I'm so glad it turned out ok for you! Scary stuff..........and then you add the money on top of it and it can throw you for a loop! DH's father had to have emergency open heart surgery about 10 years ago. He had just started a new job and had ZERO insurance of any kind. When they told him at the end of his 4 day hospital stay, with emergency heart cath and emergency open heart surgery was going to be in excess of $45,000.............I thought he was going to have another heart attack right then and there. It was truly horrendous. Luckily, there was some sort of fund the hospital had access too supplied by donors to cover situations like that. At the end of the day, they covered his entire bill. We felt like there were two miracles then, a miracle he survived (he had no blood pressure and no pulse when the ambulance brought him in, clinically dead) and another one that he didn't have to pay that bill. I thank the good Lord that he was in the right place at the right time. I know owing that money would have killed him in the end.
I definitely think that physian offices and facilities need to state their policies up front and think Rex did an awful job by surprising you after services had been rendered.
The problem is the prices billed are based on the maximum "discount" given so those without that discount suffer. It is like the jelwerly stores a few years back who were taken to task by the AGs for running the 50% off "sales" all of the time. They mark up the product with the intention of giving that discount. I had a woman who came to work for me after she had lost her job and insurance coverage. She had gone to the pharmacy to try to get a better price for her prescriptions. They charged her less for some of them than her copay had been under her insurance plan. Thus, she had been paying more for years just because she had insurance. The same for the hospitals. My wife was kept overnoght recently and the bill was $6K, but $2.5K was given as a discount for the insurance company. This means they were almost doubling their prices in order to give that discount because they will not discount below their costs.
I went to REX last year because I was having stomach pain. They made me wait 10 hours and did a few tests. The bill for the treatment was $6700 and they told me it must have been a stomach virus and I should drink plenty of water. Between my self and Insurance I assumed it was paid for, somehow there was $40 left owing and they turned me over to a collection agency for it. I wasn't very impressed by there treament as far as the bill goes,now I have a bad mark on my credit report.
I am not saying I know exactly why it happened, however, my husband was extreme pain earlier in the year and we went to see our family physician. He suspected a kidney stone and requested a scan for accuracy. Prior to the scan we had to pay the deductible up front for the procedure. It was several hundred dollars due immediately prior to the scan being performed. Just prior to the new year, we (self employed) made an adjustment in our medical insurance to increase the deductible to lower the premiums. I believe since the deductible had increased to a dollar amount which might make some medical facilities worry about receiving the amount, they request the amount up front for surety purposes. Up until we increased the deductible, we were never requested to pay the deductible up front.
Uh oh. I think maybe a call to Aetna customer care will be in order, to find out exactly how much we should expect to pay as our share. Sometimes wording in these booklets are rather vague and open to interpretation. Husband does have a follow-up visit with his PCP, who recommended a Dr. Sachdeva for this colonoscopy. So far, this other doctor has not returned our phone call about scheduling an appointment. But it will give him time to ask the main dr for more information about it, it is the specialist this dr went to for his own procedure. Sometimes the terminology in the insurance explanations are confusing as well; somehow there is a charge for his last visit to his PCP for $40, which Aetna will not pay, and stated that it was put toward his deductible. This charge is above and beyond the $20 copay that we understood would be the ONLY charge for the visit (annual checkup). Something about not covering training and education. His doctor is an "in network" guy, so we would like to know what the heck this extra charge is. We are waiting to see if the doc has the nerve to actually send us a bill for it. Then there will have to be some explaining to do by his office, as no one received any kind of "training". Believe me, heads will roll. Sometimes if a patient questions a charge, it will be "reconsidered" and subsequently be removed. My thinking is that they'll try to charge you for anything they can get away with, and most people won't question it, and just pay. We were billed for the difference between a medical bill for surgery resulting from an on the job injury, and what the workman's compensation insurance paid. We discovered this was illegal, and made sure they knew about it! Needless to say, the charges were removed. So be very aware when receiving any kind of bill, question what is not clear. Do not pay until you are confident it is a legitimate charge. And do your homework before agreeing to any kind of medical procedure, so your eyes are open before going in. And make a HUGE stink if they pull unexpected s*** on you. You are the paying customer. Do not lose sight of that. Enough rambling; I feel better now...:lol:
Part of it might be due to the rising Bankruptcies and their fear of getting stuck with the bill. A few years ago I was in bad shape and had to consult a bankruptcy lawyer, I told them up front I wanted to do everything possible to avoid bankruptcy. But was given hell anyways for paying my JC Memorial hospital bill. Fortunately I was able to work my way out of it and never had to deal with them again.
HAHAHA ok I am laughing bc I use to work there and that so called "estimate" isnt a true estimate, they are just trying to collect some money upfront from all the patients so the bills dont go into collections! So for future refrence when they ask you for a payment upfront you just need to tell them that you can not pay them at this time but would be glad to have a payment plan set up. I am glad that you had a good experience with them overall And... before you pay any bill for a hospital ALWAYS ask for an itimized statement! They tried to charge me for meds that I didnt even take and I was an employee there!!
