Doctors: if a patient made you aware that the diagnostic center you refer to is more than double others would you stop sending patients there?

Sorry to say but it sounds like the referral Dr is getting a percentage of what the CT scan is charging. We’re in NC, just a similar case where diagnostic center was set up by the referral group and charged more than the going rate.
Ask the diagnostic center to reduce it to the insurance “normally charged ” rate.

@Tropical_Willie Called them, fought with them. My fucking insurance is so fucking stupid, they are saying the negotiated discounted rate approved by the insurance is just $500 less then the amount these crooks want to charge, so I only pay based on the negotiated rate. I asked how much if I was self pay, and the hospital said if they find out I have insurance they will come after me for the rest I am supposed to owe. Huh? I told her I am not trying to hide anything, are you saying I can not pay outside of my insurance if I choose to pay out of my own pocket, and she just rambled off again how they will probably find in their records I have insurance and come after me. I am fucking not trying to hide anything. SO PISSED OFF! Does this never happen to republicans who want to protect the insurance comppnies? I just don’t get it. Theft, pure and simple. At minimum gouging.

Thank you for your answer by the way. None of my wrath is directed at you.

I feel your anger and understand your pain.

Can you turn them into the state insurance board?

@Tropical_Willie Probably they are not doing anything illegal, but I will do something I think. Matters if I can keep my anger up and spend the energy. If I write and contact people it will be armed with data.

I am going to contact the paient liaison and give them another chance to lower my bill, I paid a slightly lower price, but even if they wipe out what I owe altogether I will still write my insurance, because the insurance paid too much too, and that costs everyone. It is an integrity issue in my opinion.

Plus the billing supervisor I spoke to try to double talk me with bullshit. I really hate when someone talks to me like I am an idiot. She might actually believe what she is saying, she couls actually be an idiot, not a liar. Never know. I told her I paid a $360 for a regular CT in FL, no contrast, and I called another hospital here blah blah, and she launched into how a different state can be totally different. Then, she starts arguing their prices are recommended by the AMA. So wait a minute, the AMA, a national organization sets the price, she is arguing hospitals are supposed to follow those guidelines, and then she also wants me to accept that each state is different. How dumb does she think I am. Makes no sense. Forget about that prices vary in town anyway.

Sorry to ramble.

@JLeslie like @Tropical_Willie I share your pain and frustration.

I had surgery at the end of January followed by a 4 day hospital stay. I had my choice between two local hospitals at which my chosen surgeon has credentials to operate. I chose the one that has better outcomes and a better reputation – but found out they charged over $10K more for the procedure I had.

Here’s the interesting thing—my insurance covered it all, 100% either way. They didn’t care which hospital I chose…because they have negotiated rates with both hospitals that made the procedure the same cost either way.
The hospital I had the operation at billed me $29,000 for the room for 4 days. That’s a SEPARATE bill from the surgeon (he was only $3000) and the Internist ($1200) and the other care providers. Just the hospital alone for 4 days was nearly $30K. The insurance paid them only $17K – the negotiated amount – and that settled the bill in full. So, without insurance = $29,000, with insurance = $17,000. That just sucks, doesn’t it? If I were uninsured I’d sure want that discount the insurance company got.

Moreover, I wouldn’t have cared so much or noticed these details in the cost either..except the hospital made a billing mistake 2.5 full months AFTER they were paid by my insurance and subsequently sent me a bill for nearly $6,000.

After falling out of my chair in shock I called the hospital’s billing line.
I called and asked what could have possibly happened that the billing was altered in mid-April after the insurance paid the bill in full back in early February and was told (and I quote): “We’re going to take you to collections if you don’t pay it right now.”
(Mind you, at this point I’d had the bill in my hot little hands for less than 24 hours – and had never received a bill before this time. Collections?? Really?)

The hospital billing staff were not only rude (and threatening) they also misrepresented what had happened. The person I spoke to said: “Your insurance company took back the money.” (What?! Really? They can TAKE money out of your accounts that they paid over 2 months ago? That sounds odd to me…)

Getting no where and getting nothing but nastiness from talking to the hospital billing folks I called the insurance company.
They explained that although they paid the original bill at their negotiated rate with the hospital IN FULL on Feb. 8th (I was hospitalized until Feb. 4th, so the insurance paid the hospital just 4 days later!) the hospital charged them bogus “late fees”.
They (the insurance company) finally had received approval from the hospital accounting team to reverse those late fees on April 4th. The hospital refunded the insurance company $5,861.00.
On April 14th the hospital decided to “recover” those bogus late fees from ME. They issued the bill on April 14, I got it on April 15th and they did indeed attempt to put the bill in collections on April 15th – because I got nasty phone calls on April 18th and 19th from complete strangers (collections agencies?).

The best part? When I called the insurance company to ask about this the insurance representative did a “party line” and called the Hospital billing office and resolved the issue with a supervisor in the billing department while I was on the line listening. So I got to overhear the hospital say I had a zero balance, didn’t owe anything and the bill had been erroneous. (Totally different story than what I was told when I called!)

So when the collectors called I just ignored them and hung up. This week on Monday afternoon I called just to make SURE and the hospital billing department said I have a zero balance. The $5861.00 bill has gone away.

All I have learned from this is that as much as I hate insurance companies (because mine tries very hard not to pay claims that are definitely part of the plan benefits) ...I think I hate this hospital’s billing department far more. It’s a sad sad day when you feel safer dealing with your HMO than the hospital.

The kicker to all this – two days after discharge, when I was still unable to stay upright for more than an hour or two at a time and was essentially bedridden the phone rang and the caller ID had the hospital’s number on it. I had been sleeping..but when I saw the number, thinking it was one of my doctors calling from the hospital to check on me, (my wonderful surgeon did call me several times to follow up on how I was recovering) I answered..only to find that it was a telemarketing service fishing for “donations in gratitude of my recent stay”—wouldn’t I like to donate in the amount of $5,000 or $10,000 to the hospital! I would have laughed if it wouldn’t have caused me pain—but instead I just hung up.

@geeky_mama Thanks for sharing your story. It just proves again that the system sucks. I actually philosophically don’t care if my insurance pays the whole thing, I care that people, including myself are getting ripped off. In the end the more the insurance pays out, the higher everyones deductible is, so it affects us all. Right now I have insurance with a very high deductable, its supposed to make the patient more aware of fees and shop for service better, but to be honest it is almost impossible to get prices from the docors, hospitals or insurance, they make it incredibly difficult. Of course in your situation your decision to go to the hospital with better results would be the most pressing reason to go, and I understand why you did, but this particular situation I speak of is a CT scan that anyone can do pretty much, there is not much left to technique or infection risk, etc.

My husbands company sort of seems to just negotiate a percentage off of charges billed as their negotiated price, and is not looking closely at what is being charged, and so doctors and hospitals can totally screw the company until it somehow gets red flagged, which may not happen so fast. So, it is not like the insurance company is going through eavh thing with a fine tooth comb saying what they are willing to pay for a procedure.

It makes me sick that billing is basically done by what the market will bear, and not as a reasonable fee for services or supplies incurred/used. Some states have caps, like MD, that a hospital cannot charge more than 21% or 21 times I cannot remember right now over cost as the billed price. Other states don’t have these ceilings and sometimes it is as high as 400% more for the patient.

And, the thing is, the people having to deal with this crap are sick. Bad enough they are sick, but they have to fight for the coverage they deserve, the coverage they pay for in premiums.

@JLeslie I agree – the system is terribly broken. I lived in Japan – which has excellent medical care at fair prices thanks to socialized medicine – and am incredulous when people say we have the best medical system in the world here in the US.
No, we have very good, very high-tech medical care that not all Americans have equal access to – and medical care that bankrupts families, that makes sick people beg insurers to cover vitally necessary procedures and that forces doctors to bill at outrageous amounts to actually recoup a fair price for their services.
And don’t get me started about the insanity that is Malpractice Insurance – I know of very talented OB/GYNs who have literally stopped practicing or switched specialties because their sky-rocketing insurance costs made it impossible to pay the bills.

I think Insurance companies and For-Profit medical corporations are absolutely to blame. Insurers are making HUGE profits and any medical group or hospital that is for-profit seems completely counter-intuitive to me…

My dad is a doctor and we’ve had some pretty heated discussions about this stuff—but he also has NO IDEA what medical care costs because doctors perform services for their colleagues pro bono. He’s never paid a medical bill in his life and doesn’t realize that some under-insured or uninsured guy who sees him in the ER may be saddled with a $5,000 bill that takes him 6 years to pay off.
BUT at the same time—if a guy comes into the ER complaining of back pain and my dad doesn’t order a CT scan and it turns out 2 months later that it was tumor pressing on his spine that my dad didn’t find in the 15 minutes he examined the guy—then the guy will sue.
So, because they have to rule out EVERY possible condition when you come into the ER (even if those tests are terribly expensive and probably not necessary to diagnose you with a pulled back muscle from raking leaves) ..you’ll leave having paid a HUGE co-pay (or worse if you’re uninsured) just because the doctor is pushed into a corner to run every available test to rule out every possible other cause for your back pain.

I don’t see a way to fix it. We as a society are too litigious and too profit focused.

I guess I need to think about emigrating to Canada. I have a lot of friends there very content with their medical care.