Doctor Was Out-of-network ...

[somarco]

Most health insurance plan designs encouraged over-utilization. The copay is the worst thing that ever happened to health insurance. Eliminate all copay's and require a minimum $2500 deductible before the carrier pays anything.

Tyler, health insurance is extremely complex. Asking for transparency on anything beyond routine care is foolish.

But it is not the routine care that drives up claims (in spite of what the public and DC believes). The biggest overall contributor to claims is a public that refuses to live a healthy lifestyle. Roughly 70% of claims are for chronic illness and 80% of those could be prevented or cured with changes in diet and lifestyle.

You can blame carriers and providers all you want, but doctor waiting rooms are filled with overweight people that get little or no exercise and think the idea of eating light is a 1200 calorie salad.

 

[txpcsbent1]

Surgery has many cost components and can be very confusing as to what you are responsible for. Several years ago I had a surgery. I received a bill for the anesthesiologist for $7000. I called them directly and explained that I did not realize they were out of network and that I was not able to pay the full amount. I asked if she could help me out. I was very nice, very polite. After talking and going back and forth I got her to agree to $2000. I paid it in 3 installments. Dr.'s typically have a cash price and an insurance price. Their fees are typically negotiable and they have wiggle room to work with you.

Recently I had surgery and this time I talked to the insurance company, the two surgeons offices, the hospital, the anesthesiologist, and confirmed that everyone was in network. However, some diagnostic work at the hospital was not in the network and I was not notified that it was not in the network. My cost was nearly $2000. I will be calling them to discuss reducing that bill to what is customary for such charges, typically around $300 to $400.

My take is don't be afraid to negotiate on out of network charges. Don't be afraid to complain if you feel they are unreasonable to the local BBB, state medical board, etc. Medical care must be more transparent and consumers should not be taken advantage of by exorbitant charges and fees.