No one can give you the cost of any procedure
One of the major problems with insurance is transparency
of costs. Until a year or so ago, no insurance company would tell you
what they consider Reasonable and Customary for any procedure. There is
no reason for that unless they do not want you to know the negotiations
involved with each provider. The hospitals and doctors are in a real
bind because they really don't know what to tell you when you ask how
much you will have to pay for what they order. I was not aware of the extent of the confusion until my journey to determine the cost of a relatively short surgical procedure. The prices given to me ahead of time varied from $1338.00 to $4600.00.
The process: I had a cyst on my vocal chord a little over a year ago. I spend much of my time on the phone and had problems with my voice. I decided to get costs prior to surgery at 2 of the approved providers in my area using the proper procedure code..
Original cost given from a Surgery Center $1,955.00.
Another provider with my policy - $3,019.00
The same provider without insurance - $4,600.00
After some cajoling to my insurance company, I was told that their Reasonable and Customary allowed was - $1,338.00. They said they did not have any information where I could get it done for that.
The end result: None of the above prices were correct. I had it done at the Surgery Center who wanted the $617.00 difference between the R&C (supplied to them by my insurance company) ahead of time and I paid part of that.
After all of the payments were made to the Surgery Center, I found out that I had a credit for the amount I paid prior to surgery because the insurance company paid almost all of the bill.
20 years ago, you would be able to call almost any hospital and get a very close idea of the cost of anything. Doctors and Hospitals did not create this problem. Naturally, I will attempt to eventually give you my thoughts on how we got here and why the system is broken.
Feel free to send me any posting if you would like to contribute and I will be happy to post it on the blog. It is unimaginable to me how estimated costs can vary more than $3,000.00 from being uninsured to the negotiated price for insurance coverage.
BTW...everything came out fine, but the process gives a lot of insight into Health Care problems.
TVP
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The process: I had a cyst on my vocal chord a little over a year ago. I spend much of my time on the phone and had problems with my voice. I decided to get costs prior to surgery at 2 of the approved providers in my area using the proper procedure code..
Original cost given from a Surgery Center $1,955.00.
Another provider with my policy - $3,019.00
The same provider without insurance - $4,600.00
After some cajoling to my insurance company, I was told that their Reasonable and Customary allowed was - $1,338.00. They said they did not have any information where I could get it done for that.
The end result: None of the above prices were correct. I had it done at the Surgery Center who wanted the $617.00 difference between the R&C (supplied to them by my insurance company) ahead of time and I paid part of that.
After all of the payments were made to the Surgery Center, I found out that I had a credit for the amount I paid prior to surgery because the insurance company paid almost all of the bill.
20 years ago, you would be able to call almost any hospital and get a very close idea of the cost of anything. Doctors and Hospitals did not create this problem. Naturally, I will attempt to eventually give you my thoughts on how we got here and why the system is broken.
Feel free to send me any posting if you would like to contribute and I will be happy to post it on the blog. It is unimaginable to me how estimated costs can vary more than $3,000.00 from being uninsured to the negotiated price for insurance coverage.
BTW...everything came out fine, but the process gives a lot of insight into Health Care problems.
TVP
Posted by The Virtual Patient at 2/24/2009 6:13 AM 
Categories: Reasonable and Customary,Costs,General,Pre-approval
Categories: Reasonable and Customary,Costs,General,Pre-approval
Hey--I am going to have this Vocal Cyst procedure done within the next few months. You wouldn;t happen to remember the procedure code for this would you?? I would like to contact my insurance compnay to get cost estimates.
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Sorry, don't have the procedure code, but your medical provider should be able to easily get that for you. Good Luck.
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great advice. thanks
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