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MrJoeMoose44 karma

If you were The Emperor of Mankind, how would you fix medical billing?

My wife had surgery last year. Neither the surgeon nor the anesthesiologist had any idea what their services would cost. It turns out that the surgeon didn't cost us much at all. But it took almost a year for the insurance company and anesthesiologist to decide what we owed. Of course both sides sent propaganda to try and enlist us (and other patients) in their contract war. In the end we owed a few hundred bucks which seems preposterous given the prices we were quoted in excess of $20k.

I'm going through the same thing now with a psychologist. 6 months of visits and no bill while they argue with insurance. I don't know if I owe them $500 or $3500. They don't know either. Putting aside inflated costs that make healthcare unattainable for some, it seems like the system is too broken to even charge us efficiently. I need the Carmax no-haggle price.

On another note, how do you get enough rest? Our anesthesiologist was clearly exhausted by long hours. What does it take to stay healthy in your line of work?

Edit: Last one I promise. What's your favorite tabletop game? Do you like RPGs, board games, or war games?

MrJoeMoose17 karma

Your heart is in the right place on this one, but I would be wary of springing that sort "re-framing" on other people. Personally, the last thing I would want to hear at a time when I was already grieving is some trite shit like "angel day".

MrJoeMoose11 karma

In this particular case the debate was due to a contract spat between the insurer and the group of anesthesiologists. The surgeon and hospital were in network, but the anesthesiologist was not. It was not clear this was the case until well after the first meetings with all the different doctors and scheduling the surgery. We were even assured that the contract spat would be over shortly (I was a fool for believing that line).

We did have the option to delay the surgery and schedule it at a different hospital across town where the surgeon also operated. In that facility we would have had a different anesthesiologist that would have presumably been in network. We chose not to delay since the surgery was to correct a spine injury that was causing progressive nerve damage. She went from back pain to total leg numbness and loss of strength in just a few weeks. Days mattered.

After a year of debate, the insurance company and anesthesiologist group decided that we were not in network, but that the anesthesiologist would bill us at a lower imaginary price than the imaginary price for the uninsured. This was part of the agreement that re-established the in-network status for their group.

None of that really mattered because we had already almost reached our out of pocket maximum for any and all care (regardless of network). Wouldn't you know that the total we had to pay brought us within a few dollars of that exact out of pocket maximum? It's almost as if the letters, emails, and phone calls from both parties quoting figures in the tens of thousands of dollars were total bullshit to win us to their side in a fight over money! "Mrs. Moose, we urge you to contact Anesthesiologist Group. Due to their failure to meet our benefit requirements you may be responsible for bills of as much as $23,000!" "Mrs. Moose, this is Anesthesiology Group. If Insurance Company continues to deny your rightful coverage, you may be responsible for bills as high as $22,000!"

All malarkey. We gave them a few hundred bucks and a monthly phone call.

At no point, right up until the end, could anybody actually suggest a potential cost. Imagine if any other service worked that way! We asked both the surgeon and anesthesiologist what it might cost, and they both had the same answer. "I don't know". It's not that they couldn't tell us a ballpark. They couldn't tell us an order of magnitude.

With my current billing hassles I spent a few hours on the phone freaking about before I found the magic words. "Ma'am, what is the price if I'm uninsured?"

Turns out that the psychologist tries to bill the insurance provider $500 for my visit which should be reduced to the contracted price for my insurance provider. The insurer says their office is in-network, but the specific PA that did my appointments is not. They are still fighting about it. They quote the scary $500 a visit price tag.

The nice lady at the desk let me know that if my insurance decides it's covered I'll pay $80 - $90 a visit with my plan. The price if I am uninsured is $95. The $500 is just the starting point for their negotiations. Of course she can't just tell me that. I had to ask her about it specifically.

It's a broken system.