Med ins. prices vs. real cost question

[Anita in NC]

My son was sick today and I had to take him to the doctors. Long and short of it he has to have a nebulizer machine for his treatments every 4 hours.

The doctors packed me up with a brand new nebulizer machine and told me the company who supplies them would call me to work out the insurance/copay etc...

I spoke to the company and they said since I haven't met this years deductible for this child I would be responsible for the full cost of the nebulizer of $230.

Now since getting home and looking this particular brand of machine up I have found that new it usually goes for around $100.

So since I have found in the past that what a company bills an insurance company say in this case $230, if it were to bill, in reality it would only get say $100 from the insurance.

So since this is my first time dealing with medical insurance with a deductible. Am I going to have to pay the $230 or what the company would have been paid by the insurance?

Does my question make sense?

I know eventually I may have to meet a the deductible for the year for this child but this is the first time my son has been sick, he's now 3 and he may not get sick again this year.

Thanks for any advice.

[cc]

I'd talk to the medical supply company and tell them the problem and they may be willing to treat you as a self-pay and give it to you at the cheaper price. They may be willing to do this and give you a receipt that you can either use for next years income tax and/or if you have a medical savings account, get reimbursed from it.

[mzzlisa]

Why did the company call you? Did they already bill the insurance company and were told that you didn't meet the deductable? If thats the case, you will have to pay whatever the company bills you. But it will be credited towards your deductable as long as it went through the insurance company first.

[WildernesFamily]

Anita, if the company won't work with you, see if you can return the nebulizer and buy one from a place that has them cheaper... but if you ask to go selfpay and offer to pay in cash they should give you a break.

Also, with the meds, get them at Costco if you have one in your area, they're usually cheaper than anywhere else. You don't have to have a Costco membership to get prescription meds from them. My almost 3 year old also got sick this week and has to have the 4 hourly treatments.. hope your little guy gets better soon!

[mzzlisa]

Originally Posted by cc

I'd talk to the medical supply company and tell them the problem and they may be willing to treat you as a self-pay and give it to you at the cheaper price. They may be willing to do this and give you a receipt that you can either use for next years income tax and/or if you have a medical savings account, get reimbursed from it.

Thats a good idea! If you don't have to worry about meeting the deductable, I would try this first. If the company won't go for it, then just make sure you get credit from the insurance company for the purchase.

[SeptemberWolf]

Too bad the doc didn't explain this to you about the costs and options a little better before just giving you the machine. You might have been able to buy one at the going rate at a med supply store, if you are near one.

Insurance companies have different ways of handling these matters; you might be able to appeal. In my case, the insurance company pays the medical provider a set rate and I pay the difference, plus co-pay. So the provider sets the rate; insurance pays what they deem suitable; you pay the rest.

Make sure you read your insurance information as to what's covered and how much. But, I've always had to call my health insurer, because the coverage booklet is vague in too many places -- and even then, I've been given incorrect information. aggravating.

Good luck!

[Ohio dreamer]

Ask the company how much a 1 week rental is. That would give you enought time to call all your friends, everyone I know already has a nebulizer in the closet. BARROW ONE!

[WildernesFamily]

Originally Posted by Ohio dreamer

Ask the company how much a 1 week rental is. That would give you enought time to call all your friends, everyone I know already has a nebulizer in the closet. BARROW ONE!

Good point - in fact I see them on freecycle quite often.

[straight shot]

I'am self insured for dr appts and such, my clinic gives no discount to people that pay cash.

In the last yr DD got 3 stiches in the ugent care department cost $493.00

DD got strep , found out many kids had it at school , moms didn't have daycare so hence 53% of her classmates came down with it.
cost $139 no culture.

perscription $4 at wallgreens

DD needed imunizations ,3 of them this yr, cost $10 though the county nurse.

Still way cheeper than paying out of pocket for regular insurance for the yr.

If we have a major med claim I do have that with a $10,000 deduct so I will not forfit the farm. cost $ 221 per month.

It's not cheep and they seem to run patients though all test , unless it's out of pocket cost for the patient. I think national health would be bad but, national major med is on the order.

[chicken]

We run all our doctor bills through our insurance co. They usually have a set limit on what they pay. If our deductible isn't met we are only responsible for the set limit not the actual charge. (Does that make sense?) That alone saves us money. We have a HSA with a high deductible through Golden Rule. DH is self employed so we buy our own insurance. Not cheap, that's for sure.

[FiddleKat]

Insurance companies ALWAYS overcharge to begin with.
DD is on Medicade because of her severe disability and classified as medical needy. She infact, has two nebs. herself. The second one was her grandma's and when she got it, the equipment company claimed that those units could only be rented out. Which she knew was a croc, considering DD nebulizer we own and insurance paid for it.
She called Medicare on it, and found out that they actually paid for it, yet the company tried telling my parents they had to "rent" it. So if they went by the companies saying, they would have been renting a machine that was paid for by the insurance companies.
My mom ended up passing away several months later, and my dad gave us the nebulizer to use as a back up.

[travlnusa]

We have a high deductable insurance plan. We know that we will have to pay, but we have the health provider send bill to BCBS.

BCBS will then tell the health care provider what they will "pay", and provider ends up adjusting bill to match. It is that bill we pay.

We are also very very blessed with Dr and Clinic that understands self paying ins, and offers us many choices based on costs.

[straight shot]

Dr's need to Dr's again and know what they think before adding a million bucks worth of testing to be done before they can make a finale decision.

But so many sue and Dr's have no choice but order tests and tests and give nebulizers out , hospitals have no choice to charge such silly amounts, they need to CYA.

[MorrisonCorner]

Anita, call your insurance company and get the scoop straight from them. I know when I get a bill the insurance company takes what is charged (say $100) and then reduces it to what they'll pay ($80), then pays a percentage of that ($60) and I am responsible for the remainder ($20). I am not responsible for the $20 they reduced the original bill by.

It is likely your insurance company allows $100 for this machine and you're not responsible for the rest, BUT if you can be tricked into paying for the rest you won't get your money back.

When I was in the hospital for a month last winter one doctor sent "double bills" out. One to the insurance company and one to us. The one to us looked like we owed the money right away and if we paid it right away we'd get a discount. There were thousands of dollars worth of bills pouring in every day so we really couldn't pay right away.. and it went on the pile. Then a week later we got a more strident bill. And the week after that one threatening to go to collection.

It takes, on average, 6-8 weeks for an insurance company to pay a provider... so this office basically had 6-8 weeks to trick us into paying the bill before the insurance company coughed up and we realized we weren't liable for the bill.

Anyhow, about bill #3 and surgery #2, when it looked like I might not make it, the DH was so stressed someone in his HR department said "bring the bills to us and we'll sort it out." So he did and they found the double billing. Apparently they made a horrific stink about it because they did some research and discovered a lot of their employees had been ripped off this way. Which got the insurance company involved, and they weren't happy...

But this "double billing" is quite common. That's the bill which says "you owe" but has somewhere in tiny print on the bill "insurance pending." If you pay the bill, and so does the insurance company, good luck getting a refund unless the service is scrupulously honest.

[stirfamily]

My hubby uses a CPAP machine and we ran into the same thing. Much cheaper on the internet than from where the doc sent the prescription--a place here in town. I called the place, told them what company on the internet had it cheaper and for how much and what do you know....they gave it to us at that price!
BTW, now when we need anything for his machine, I always buy off the internet.
Karen in Indiana

[Cheryl in SD]

I found a machine used at a medical supply store locally last week for $50. I have gone to paying cash for office visits, and they still mess up my account. Both of our doctor's offices in the last few years have not recorded payments, sent in insurance wrong, not recorded insurance paynments & it took months to straighten things out. One place our bill never went down. The billing company kept telling it tht it was our insurance & that it would all work out. Finally our doctor fired them & "forgave" our bill. My records showed we had paid it, at least as close as either the doctor or I could figure out. The billing company still showed us at owing $400.00!

Call your insurance.