Medical Billing ...??? !!!

The final frontier. Deciding when, if and how.
Ronn1708
Posts: 131
Joined: Mon Oct 14, 2013 2:33 pm

Medical Billing ...??? !!!

Postby Ronn1708 » Tue Nov 17, 2020 3:32 am

:o .Well the hospital bill came in the mail today 13 days post surgery. The insurance has been billed but of course the insurance company has not had time to respond. I almost went into shock. The bill was pennies shy of 75k. I am up at 2am with this on my mind. I told my wife if the insurance don’t come through we have lost the farm. I know the insurance company won’t end up paying that much in the end but wow. I had to have a CT scan Monday and my insurance would not approve it. The lady at the imagining clinic said they had placed the request for CT into pending and it might take 48-72 hours to get approved or it could be denied. They were to bill the insurance approximately $600 for the scan. I went the self pay route and cost me $300 cash. No wonder our healthcare cost are through the roof. I am not 65 yet so I’m still in the private insurance sector but you know Medicare is free to the Recepient. I said I wished my life away for my previous birthdays (15th get drivers license, 18th could buy beer, 21st could gamble) but older now and don’t want to wish my life away cause it goes by fastest enough on its own !! :(
But I do declare if 65 don’t sound good right now sitting here worrying at 2:20 in the morning.

Just wondered if anyone was shocked by the cost involved?
I got to have another surgery because of another issue in the next several days so I guess sleepless nights have just begun.
Thanks for any input.
Ron

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flguy621
Posts: 14
Joined: Sun May 03, 2020 7:29 am
Location: Clermont, FL

Re: Medical Billing ...??? !!!

Postby flguy621 » Tue Nov 17, 2020 5:56 am

I had my surgery 4 weeks ago and the bill was $125k. After negotiated discounts with the insurance, the hospital accepted $22k. I haven’t seen the doctor or anesthesia bills yet.

Waynetho
Posts: 1378
Joined: Wed Nov 27, 2019 11:22 pm
Location: Addison, TX

Re: Medical Billing ...??? !!!

Postby Waynetho » Tue Nov 17, 2020 6:14 am

Mine was only billed at about 66,000 total for all services and people involved. Insurance paid 37,000, give or take. I had met my out of pocket max for the year with my colonoscopy and UroLift procedures so I paid nothing.
59 yo, married 39 yrs. Urolift (x4) 8/12/19. AMS 700CX 15cm (no RTE) penoscrotal 10/28/19 Dr. Mark Allen, Frisco, TX. PD 1995/ED 2011. Cialis helped but hinged. (1995)L:6/G:5.5+, (2019)Pre-op L:5/G:4.5, (2/2020)L:6.0/G:5.0

FreddyFree
Posts: 445
Joined: Mon Nov 06, 2017 12:43 pm

Re: Medical Billing ...??? !!!

Postby FreddyFree » Tue Nov 17, 2020 6:38 am

Americans need universal health care!
AMS 700 CX 18cm. x 12mm. With 3cm. RTEs. 10/10/18

MK1965
Posts: 472
Joined: Thu May 24, 2018 5:32 pm

Re: Medical Billing ...??? !!!

Postby MK1965 » Tue Nov 17, 2020 7:30 am

Insurance companies are contracted with the hospitals and providers for pre set fees for any procedure. When you receive EOB ( explanation of benefits) you will see how much insurance will pay and what is your Remaining portion
Here is an example: Your Insurance and hospital agreed On 30K for IPP procedure which includes use of OR, pre-op and PACU , also all medications implant etc. Depending on your insurance, you might end with 20% coinsurance plus deductibles if you did not met it prior to surgery.
You will receive 2 more bills, from surgeon and anesthesiologists.
So, you can concentrate on healing and recovery.
To early to be sleepless at 2:20 am.
Wish you good luck .
MK
IPP 9/5/18; TITAN OTR 18 +1cm RTE,Prostate Ca at 51 y/o; RARP 11/2/16, ED Post RP, Cialis, Viagra, VED,TRIMIX painful, BIMIX ineffective,lost 2+ inches of length after RP. Revision 12/2/20 by Dr Clavell, AMS 700 CX, L 21 R 21+1.5 RTE.

544kenmatt
Posts: 208
Joined: Sun Nov 17, 2019 10:17 am
Location: ROCHESTER , NY

Re: Medical Billing ...??? !!!

Postby 544kenmatt » Tue Nov 17, 2020 10:11 am

Most providers will overbill the insurance to make sure they aren't underbilling for the procedure. The insurance will cut back the amount to whatever the contracted price is for the procedure.
AMS 700 LGX 10/31/2019. age 63

Lost Sheep
Posts: 3973
Joined: Mon Jul 04, 2016 11:16 pm

Re: Medical Billing ...??? !!!

Postby Lost Sheep » Tue Nov 17, 2020 12:10 pm

Ronn1708 wrote:I am not 65 yet so I’m still in the private insurance sector but you know Medicare is free to the Recepient.

Medicare is not free. There are premiums involved. And co-pays, too. Not sure about deductibles. Coverage for drugs is available and not free, either. Medicare part "A" is free, I think. But the rest....
.
Lost Sheep
AMS LGX 18+3 Nov 6, 2017 Dr Shaw.
READ OLD THREADS to ask better questions and better understand answers.
Make yourself part of your medical team.
Document your current penile size: photos and written records.
Pre-op V.E.D. therapy helps.

Lost Sheep
Posts: 3973
Joined: Mon Jul 04, 2016 11:16 pm

Re: Medical Billing ...??? !!!

Postby Lost Sheep » Tue Nov 17, 2020 12:13 pm

FreddyFree wrote:Americans need universal health care!

To a great extent, Americans have willinly chosen the health care system we have. This is through our votes and instructions to our legislators -or the abdication of those responsibilities.

In a Democracy (of whatever form), a population gets the government it deserves.
Last edited by Lost Sheep on Tue Nov 17, 2020 2:56 pm, edited 1 time in total.
Lost Sheep
AMS LGX 18+3 Nov 6, 2017 Dr Shaw.
READ OLD THREADS to ask better questions and better understand answers.
Make yourself part of your medical team.
Document your current penile size: photos and written records.
Pre-op V.E.D. therapy helps.

SW0110
Posts: 503
Joined: Sun Sep 02, 2018 6:15 pm
Location: Central Kentucky

Re: Medical Billing ...??? !!!

Postby SW0110 » Tue Nov 17, 2020 2:51 pm

My revision billed in over 175000. I ended up out about 800 bucks after all the disallowances and caps along with approved payment to hospital.
18 cm plus 1 rte titan installed March 2019. Revision March 2020 by Dr. Andrew Todd, Richmond KY. He replaced the titan with an AMS 700 LGX 18 cm cylinder plus 2 rte for 20 cm total length.

Gt1956
Posts: 969
Joined: Fri Apr 05, 2019 2:47 pm

Re: Medical Billing ...??? !!!

Postby Gt1956 » Tue Nov 17, 2020 2:55 pm

Lost Sheep wrote:
FreddyFree wrote:Americans need universal health care!

To a great extent, Americans have chosen (through their votes and instructions to their legislators -or the abdication of those responsibilities) the health care system we have.

Reform of our system is a constant topic. BUT I've yet to hear of a system that would reduce the costs. At least by very much. Somewhere someone in the system would need to be eliminated or their income reduced. I just don't see that happening in at least my lifetime.
Best that I can suggest is for us to try to control from the consumer side. I take 8 different pills a day. Only 1 is a proprietary drug. Generics are fine to me as long as they produce the desired effect. Being a type 2 diabetic. I use insulin. Not at this time but I have used Walmart's house brand insulin with excellent results. A vial of it lasts me about 5-6 weeks. Fast acting is about $28 a vial. Long acting is about $23 & lasts me 6 weeks. It does not come in a fancy self injecting pen so I buy syringes. They are very cheap & some states don't require a prescription to purchase insulin.
Also, my insurance offers refills by mail. Generics are $7 for 3 months supply. But if you have a Walmart near you. Some of mine are available from them for $10 per 3 month supply. So perhaps you can save some $$ by shopping common generics from Walmart rather than a neighborhood pharmacy.
Just a few ideas to help keep costs down.
65 HBP at 40 high triglycerides at 45. Phimosis at 57. Type 2 at 60


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