Health Insurance for me and the kids

[HouseofWool]

It depends.

The 11K is for the facility, and the technical portion of any labs/imaging, plus meds.

There will likely be separate charges for the docs who read the imaging, plus the ED doc.

Now, that could be a line item in the 11k, but without seeing the EOB, there is no way to know.

[Deebs]

Honestly, I don't exactly know. I called billing and explained our situation. We had been out of town with no access to a pediatrician for DD. We were in the process of changing insurance, everything was up in the air and a mess. Maybe the person I talked to just got tired of me explaining my story, but by the end of the call she told me to expect a revised bill showing a zero for amount due, and that's what happened. We did still have to pay a small professional fee to the physicians' group, but nothing to the hospital, which was the mother load of the bill.


Sent from my iPad using Tapatalk

[HouseofWool]

My guess is this was an in-net vs out of net issue, with urgent/emergent care covered at in net rates, but it was billed in a way that made it not look urgent.

[MDPhDWife]

My guess is this was an in-net vs out of net issue, with urgent/emergent care covered at in net rates, but it was billed in a way that made it not look urgent.

Wow that's clear as mud, lol. So basically because it didn't end up being her appendix, it was considered non urgent and billed at a higher rate than if it had been an emergency?

[HouseofWool]

No.

That was for Deb. To clarify further:

The problem arises with how urgent care bills. It can bill as an urgent care center (place of service code 20) or a clinic visit (place of service 11). Something like an ear infection can bill out exactly the same way in urgent care or a peds office. If you have limited out of network coverage, this might process automatically at the wrong rate even if you have coverage in place.

Usually a situation is considered urgent/emergent if the average person would be worried. In your case, lower abdominal pain of that severity would definitely fall under urgent/emergent.

[HouseofWool]

And, 11k for an ED visit seems high, but not astronomically so, depending on what tests were run.

[Deebs]

It was a level 4 visit (an allergy issue, but not anaphylaxis), so definitely billed at the ED level, I just think we got lucky.

Don't you think the $11,000 is because it was an obs visit, in addition to any testing? The visit didn't meet inpatient criteria, but was too long for an outpatient ED visit and isn't described as one.


Sent from my iPad using Tapatalk

[MDPhDWife]

Health Insurance for me and the kids

The thing is she didn't get a whole lot of tests IMO. Basically they set up an IV, took a little blood probably to run a CBC, took some urine, then had to do a foley to fill her bladder for the sonogram. That part kinda pissed me off because they could've done the sonogram while her bladder was full and then took the urine to test. Would've avoided her having the discomfort of a foley. Oh and they gave her a dose of morphine for pain. We had only been in the ER about 5 hours before they decided to admit and get a surg consult. I was surprised they admitted prior to getting the surg consult. In hindsight DH and I were wondering if we were to too quick to pull the ER trigger. We haven't gone to an ER in over 5 years, but I suppose hindsight is 20/20.

What sucks even more is the deductible and copays don't even apply towards our max out of pocket so we won't get much benefit out of having hit that unless something else major happens between now and the end of the year. Shit, I hope I'm not tempting fate.

[TulipsAndSunscreen]

That does seem like a lot of money for those tests. But look at the bill. There are sometimes errors and I've caught billing errors before that make things not covered that should have been covered, etc.

[spaz]

Yeah, I got genetic testing by my psychiatrist. $6,000 and not covered by insurance. ( Mental health isn't covered.) That said, although they billed our insurance, we have yet to get a bill and that was from back in April. I'm paying between 300 to 600 dollars a month in therapist or psychiatrist bills for me and 200 dollars a month in medicine. Oldest is now seeing people. We will see how much that costs us.

[MAPPLEBUM]

The thing is she didn't get a whole lot of tests IMO. Basically they set up an IV, took a little blood probably to run a CBC, took some urine, then had to do a foley to fill her bladder for the sonogram. That part kinda pissed me off because they could've done the sonogram while her bladder was full and then took the urine to test. Would've avoided her having the discomfort of a foley. Oh and they gave her a dose of morphine for pain. We had only been in the ER about 5 hours before they decided to admit and get a surg consult. I was surprised they admitted prior to getting the surg consult. In hindsight DH and I were wondering if we were to too quick to pull the ER trigger. We haven't gone to an ER in over 5 years, but I suppose hindsight is 20/20.

What sucks even more is the deductible and copays don't even apply towards our max out of pocket so we won't get much benefit out of having hit that unless something else major happens between now and the end of the year. Shit, I hope I'm not tempting fate.

I had an ovarian cyst in high school. The first time I woke up with pain I blacked (briefly) after crawling to my parents bedroom. It was the worst pain I'd ever felt. It still ranks top two at 29.

It's easy to say now you went too early but had it been something serious you would've been glad you did.

[Sheherezade]

My teen was transported to ER after passing out in a public place with no known cause. He was there for two hours, recovered immediately and was released AMA when they recommended he be admitted for more tests. While at the ER, he had bloodwork, an EKG and met with a doctor for evaluation. The bill we received was for $4000. Luckily, we were insured.

These charges are insane and make no sense. It's what pisses people off about healthcare.


Angie

[Thirteen]

I had an ovarian cyst in high school. The first time I woke up with pain I blacked (briefly) after crawling to my parents bedroom. It was the worst pain I'd ever felt. It still ranks top two at 29.

It's easy to say now you went too early but had it been something serious you would've been glad you did.

Yes! Awful stabbing, almost throwing up nasty pain. Glad your girl is okay, and sorry that it's so very expensive.


Sent from my iPhone using Tapatalk

[spaz]

The other thing I've realized is that most people don't have any idea what it costs.. When my psych said he wanted to do the test to know what kind of meds I needed, I said yes. It didn't even dawn on me to ask how much the test was, nor would I have dreamed it would have cost 6,000. I just thought I needed it so I should have it.

[alotofyarn]

Just agreeing with calling and asking. I've gotten 2 bills recently for lab work that should have been covered. They didn't pay it because they needed prior authorization, but apparently you can submit a request for a backdated prior authorization and get it covered after the fact. I suspect most people would have just paid it, but that was almost $500 that I saved by calling and asking about it, then having the nurse send in the required information.