FrankTalk.org

Tokyo_123 wrote:

Daytripper wrote:

TurnBackTime wrote:From $244k billed to settling for $18K. Is this practice legal?
Btw congrats on your out of pocket bill, looks like you hit the insurance lottery.

I paid cash around $18,000. Read on this forum that some with insurance are charged $150,000 and up. Can someone there please explain this, or is it just straight theft??

You got a deal it seems. On my initial video consultation with Dr. Clavell he seemed a bit uncertain to actual cost. “About $23,000” he said. Then when i began to firm things up (no pun intended) with the surgical coordinator she said “21,000”.

And that’s what i paid. $21,000.

Less than the price of a mid-range sedan, only i’m certain that the “new” will never wear off.

Covered by United Healthcare Advantage & Medicare.

So, far, just $340:

$100 hospital copay
$15 copay for 2 office visits (n/c for 1st one)
$225 for motel room.

A bargain IMO.

Tokyo_123 wrote:

Daytripper wrote:

TurnBackTime wrote:From $244k billed to settling for $18K. Is this practice legal?
Btw congrats on your out of pocket bill, looks like you hit the insurance lottery.

I paid cash around $18,000. Read on this forum that some with insurance are charged $150,000 and up. Can someone there please explain this, or is it just straight theft??

Did you pay the top advertised price for your airline ticket? I doubt that you did. What you're asking about is the insurance company gets big discounts off of the listed price. They have negotiated the discount a long time before the patient even shows up.
Members that pay cash for their implant normally get that same discount. Perfectly normal in lots of transactions. I don't understand why this concept isn't understood by people.

So I got this today. Still owe $2100 for anesthesia and already paid the Dr $740.

I worried needlessly about this…..I had flashbacks to when my twins were born prematurely and Champus (as Tricare was known back then) was exceedingly slow about the $600,000 NICU bill. Anyhow, I asked the doc how much this would cost if I had to pay out of pocket. He assured me my insurance was gonna pay. I pressed him for an answer, which was “a cash price of everything, as day surgery, for about $18k.”

I had it done. All the hospital, pathology, anesthesiology, facility, etc etc bills toralled $53k. The insurance allowed and paid $19K. We were agonizingly close to our catastrophic cap, wife had been hospitalized for a bad ass case of pneumonia. I ended up getting a bill for less than $5.

You’re damned right I paid it. I wasn’t gonna argue over $5.

What has it been worth? A helluva lot, for sure. If I had to suck it up and pay the whole $19k out of hide, would I? Probably. I’m past 3 years of totally trouble free operation and while nobody is going to mistake me for a porn star I’m well pleased.

That’s insurance company medicine math with the govt involved: 53 = 19.

sswinsfba wrote:Covered by United Healthcare Advantage & Medicare.

So, far, just $340:

$100 hospital copay
$15 copay for 2 office visits (n/c for 1st one)
$225 for motel room.

A bargain IMO.

OBTW, my doc chgs around $19k for self-pay.

Gt1956 wrote:

Tokyo_123 wrote:

Daytripper wrote:

I paid cash around $18,000. Read on this forum that some with insurance are charged $150,000 and up. Can someone there please explain this, or is it just straight theft??

Did you pay the top advertised price for your airline ticket? I doubt that you did. What you're asking about is the insurance company gets big discounts off of the listed price. They have negotiated the discount a long time before the patient even shows up.

Paid $200 in cash for my airline ticket. Used credit card points, and the extra $200 was for the upgraded seats on the way back to Tokyo.

Tokyo_123 wrote:

Gt1956 wrote:

Tokyo_123 wrote:I paid cash around $18,000. Read on this forum that some with insurance are charged $150,000 and up. Can someone there please explain this, or is it just straight theft??

Did you pay the top advertised price for your airline ticket? I doubt that you did. What you're asking about is the insurance company gets big discounts off of the listed price. They have negotiated the discount a long time before the patient even shows up.

Paid $200 in cash for my airline ticket. Used credit card points, and the extra $200 was for the upgraded seats on the way back to Tokyo.

I'm sure that the initial published price was alot higher than what you ended up paying. Do you consider the airlines pricing as theft?

Gt1956 wrote:I'm sure that the initial published price was alot higher than what you ended up paying. Do you consider the airlines pricing as theft?

Sorry, not a clue what you're saying. Actually, just bought a ticket to travel SE Asia, tomorrow. Used trip.com and costs were quite reasonable.

Daytripper wrote:Well my original implant was in 2012 and back then Aetna covered it without any hassles. Now in 2022-23 it seems like more and more insurance companies are listing it as an exclusion to keep their cost down and employers premiums down.

The lesson I learned for next enrollment period is to ask for each plans list of exclusions before making a choice, I see now that an exclusion in my case is more important than the deductable, copays or office visit cost because the exclusion has a serious drain on out of pocket cost. Also I'm researching if a supplmental plan be added in case another revision is required. GL.

Thanks for the reply. I had a consult with Dr. Clavell the other day. He is really straightforward in a good way, and I have no trouble recommending him. Unfortunately, their office no longer accepts Aetna (apparently they don’t like to pay out) but I may just say to hell with it and pay out of pocket. Not unless I find another dedicated implanter worth their salt near me.