Ever tried to get an estimate on a medical procedure?

[Beeman]

I have actually been trying to get an out of pocket estimate for a colonoscopy. I have insurance and it seems neither the doctor's office, the hospital, or my insurance company can tell me what it will cost out of pocket. i've even spoken to a financial counselor at the hospital chain, I never knew they had such a thing. Everyone seems to agree that a person should know what a procedure should cost them out of pocket, but none can tell you. They can tell me the percentages but not the dollar or the discounted dollar amount, they do all offer payment plans.

[travlnusa]

We have had the same problems. We are on a HSA plan and shop for services. It can be next to impossible.

What has helped is when we just make up a number. We wil then call clinic #1 and tell them that we have a quote, can they beat it? ( we do not share the fact the quote is from my wife).

This will at least get a conversation started.

I also ask what Medicaid will pay, and use that as a guide.

[Misty]

Call and say, " My Dr wants me to have a colonsocopy, I am a cash paying patient. How much will it cost total if there are no complications? They have a CPT code with a price attached. You should be able to call your insurance and find out what the contracted amount is. The total, minus the allowed amount, minus your portions is what it will cost. There will be a write off for the doctor. There always is. When you make a visit to your doctor for a follow up on cholesterol or something, they circle an E&M code. Or CPT code. There is a low complexity, mid and high. Say you were the mid....an established patient mid level would be the code 99213. Say it is a $76.00 charge for that. Your insurance and doctor have a agreed on a set amount price for that code. Say, $46.00. Your copay is $15.00, The office will get a check for $46, you will pay the $15 and they will right off $15.00. So they have to know the prices they are going to charge for the procedure. Your insurance has the contracted amount they will pay, and you will know your percent you must pay. It will give you a general idea anyway.
There are several CPT codes for colonoscopies depending on the technique your provider chooses to use. Plus be aware there will be separate charges for the facility, anesthesia, the reading of the biopsy sample, etc etc...it is not all inclusive now days.
Does that help or did you already know that??

[snoozy]

That's what I like about the dentist I go to: They do an exam (and have a set fee for that) and tell you what needs doing, and then they pull out a menu and tell you EXACTLY how much it will cost.

When I was in emergency many years ago with a possible appendicitis, at every stage I asked, "How much will it cost?" Since it was a teaching hospital, I got examined by waves of residents:

The first year residents said , "Oh, we don't know."
The second year residents said, "Oh we don't know."
The third year residents said, "Oh, we don't know."
The fourth year residents said, "Oh, we don't know."

To all of the above, I said, "Well, you don't know actually for sure that it is my apppendix, and I don't have insurance, and I don't eat at restaurants with no prices on the menu."

The fifth year resident said, "It's Sunday, so accounting is closed, but I'll see what I can find out." She made a few calls to who knows whom, and came back and told me it would cost about $4,000. This was in 20 years ago. So finally, I had a number to get my head and my paining abdomen around. She pointed out that if it was my appendix, and it burst, I'd be spending at least 2 weeks in the hospital dealing with peritonitis, and THAT would really cost me. So at this point I opted to go ahead with the surgery, and that resident was the surgeon. I believe it ended up costing $3,200, which I paid off in chunks as quick as I could.

This whole business of "sign here to swear to pay whatever we say" or do without medical care is just a travesty.

[agmantoo]

I can tell you this regarding the procedure. In one hospital, my 20% exceeded the 100 % that a friend (no insurance) of mine paid in another hospital. The hospitals were 17 miles apart. After gripping, the hospital I went to dropped 30% off my copay if I would pay them there and then! I paid but made a commitment to myself never to return to that place.

[james dilley]

Any time I have had to have Surgery the doctors office has gotten the costs for me.

[Beeman]

Originally Posted by Wind in Her Hair

I can tell you I routinely submitted a Predetermination of Benefits for our Oral Surgery office. I had to include in it the projected cost of every surgcal procedure, surgeon's fees and assistance's fees along with CDT codes for each procedure. Then we received back from the insurance company an approval or disapproval or request for additonal information.

This report did NOT tell what out of pocket fees or copayments might amount to. Thats because each medical facility is "in network" or a "participating provider" for only certain insurance companies and those facilities agree to accept "the assignment of benefits" for the percentage that is covered by the insurance contract based on Usual, Customary and Reasonable charges for those procedures. Therefore, out of pocket responsibilities will vary depending on the insurance company AND the provider and where in the United States the procedures are performed.

See?

Seriously, its frustrating for EVERYONE that no clear answer is given to what appears to be a simple question. My suggestion? Find someone who has your your same insurance who has had the same procedure and see what they had to pay.

There is SOMEONE in the medical billing office who HAS that information -good luck getting it.

PS (Cabin Fever says if the cost appears to be too much, take a trip to Minnesota. He has an underwater camera he uses for fishing and he can attach it to his sewer snake and he will do your colonoscopy for free. All you have to do is supply the Vaseline. A gallon should do.)

I've had a lot of strange offers like this including air hoses and different lubricants, I think I'll save my pennies and pay a Dr.
I like your explanation, it's as clear as mud just like the explanations I've been getting. but at least most I've talked to are very nice and all agree but still can't help.

[diamondtim]

I did this once when I was scheduled to have a surgery and didn't want any surprises. It took a couple of days.

I had chased down the hospital, doctor, gas-man, pathologist, etc and got them to accept the customary and usual price for the procedure. The whole thing ended up costing near what was estimated (IIRC ). You start with your doctor and ask who else will be involved. Then you call each involved party and ask what it will cost and will they settle for the "customary and usual" charge for the procedure. If not, ask your doc who else is allowed to do the deed, at that hospital (or another hospital he does surgery in). This is usually not done and you'll be suprised at how cooperative they are when their pricing is questioned.

The surprises come when the the doc (and others ) charge whatever they want. The insurance says they will only pay its percentage of the "customary and usual". The patient then gets billed for their percentage of the "customary and usual" and the rest of what the doc (and others ) charged that the insurance said was "over the top". Its a real nice scam !

Believe me, it is worth the phone calls and leg work.

[LMonty]

as an ER nurse- clinical folks in the hospital are basically not allowed to know what things cost! we arent even supposed to know if the pt has any insurance, private pay, govt payment, etc. Why?

Because if we knew any of that, we would be accused of either not treating or under or over treating based on the patients financial status! Which is a major violation of ethics and a few other rules....

So, ( at least in most hospitals I know of) we are totally insulated from any of that info, that way we have plausible deniability for any accusations abou tus treating a patient based on their financial status. we get plenty of those accusations....constantly. It seems these days like every 7th or 8th patient or so comes in with a chip on their shoulder, gunning for anything they can find, being aggressive and difficult to deal with, sometimes even making complaints and accusations before they even get to the room .... and thats just one less exposure for us, in an enviorment where we're constantly be accused of something.


I remember the days when we could help people, and take their financial status into account. Ask them things like "do you want this prescription that is cheap, but you need to take four times a day; or the newer medicine that you only take once a day but it costs three times as much". or offer them the chance to do tests as outpatients the next day which could concievably save them hundreds of dollars, or similar types of things.

Another example- theres lots of folks that come in just to get a tetanus shot for a minor puncture wound...in reality, youve got 72 hrs after the injury to get one and its still effective. I used to be able to tell them it would cost them about 200-300 dollars for the ED visist fee, doctors fee and the shot itself, and their insurance wouldnt cosnider it an emergrency and therefore wouldnt pay the bill. But they could go to their doctors office tomorrow and pay 10 or 15 bucks for the same thing-

Now, if I so much as told them that, and they did leave and go to the doctor- they could call and complain, and i could personally end up fined 25,000$ USD and the hospital fined the same $$$ for a violation of EMTALA law for trying to discourage or refusing evaluation/treatment to provide a "medical screening exam". According to what we've been taught- this has happened.

I understand your frustration- but considering the circumstances- I'll be darned if I'll put my livelyhood at risk anymore because of the disaster that EMTALA and HIPAA and other such regualtions have caused. All good ideas, but IMO they've morphed into monsters that actually create more problems than they were created to solve, and make it harder for us to really be patient advocates.

Honestly? Dont blame your healthcare providers, most are just trying to do what we do and still stay afloat. Thank Congress, and the litigation attorneys, and the subset thats always looking for a handout or to rape anything they can from what they think are deep pockets. The pockets it all eventually comes out of is yours and mine- lets face it, we end up paying for all this nonsense.

Theres a heckuva lot of people that are trying to give good patient care, to make a difference, to help folks- and in the 30 yrs Ivre been doing this, Ive watched one roadblock after another be created that are supposedly in the patients best interest.

I used to love my job, and felt it mattered. Now, I cant wait to get out of it. I'm looking for another type of nursing where I can work with patients as a partner with them; where I can have a good relationship, and not constantly be verbally, physically and mentally abused. Ive seen way to many good docs and nurses leave the ED the hospital and or the profession because of the same feelings-guess Ive finally reached my limits!

Its a real shame- and it just makes the situation worse, when the people who want to be there to help their community and neighbors get so burned out from the constant conflict they give up. Sadly, I just dont see how its going to get better anytime soon.