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> Similar surgeries in the States have cost my insurance north of twenty grand. I'm assuming you're referring to the amount your insurance company had to pay,
by chimeracoder 11y ago
> Similar surgeries in the States have cost my insurance north of twenty grand.
I'm assuming you're referring to the amount your insurance company had to pay, not the amount that you had to pay. If so, keep in mind that the prices insurance companies pay for procedures are not designed to make sense on an individual level[0].
I've explained this in more detail on previous comments, but basically, hospitals lose money on publicly-insured patients (Medicare/Medicaid), and so they have to make up the difference by overcharging private insurers. This is why the sticker price for procedures is so heavily inflated - they're intended to be the starting point for negotiation, and the insurers then negotiate standard rates (still inflated, but less so) for in-network providers.
In other words, the amount that your insurer had to pay for your ECG includes an amortization of the amount of excess cost that your insurer bears in order to (effectively) subsidize the patients on public insurance.
In theory, this should not affect your out-of-pocket costs (though of course, in the end, it all does come out of patients fixed monthly premiums, so you still are paying for it in some way).
Yes, this is unnecessarily complicated, but that's the way billing works.
[0] That is not to say that the amount that the insured patients pay for procedures shouldn't make sense on an individual level - just the amount that the insurer pays on top.
- douche 11y agoI still had to pay my $2500 deductible on the $2600 ECG, so the insurance company didn't worry about haggling them too much. If you're young, relatively healthy, non-clumsy, male, and childless, chances are you might not go to the doctor once in a year, so it'd be a gamble, but you might very well statistically be better off pocketing the insurance premiums. Better yet, put on a furry suit, bark convincingly, and go to a vet if you need some common medications or procedures that are mind-bogglingly expensive when prescribed for humans.
- jakobegger 11y ago$2600 for an ECG is a ridiculous sum. Out of curiosity, I checked how much my insurance pays a doctor for an ECG (I live in Austria). My insurance (SVAGW) pays 36€ for an ECG. Of course, the total bill would be a bit more since the doctor would likely also charge for consultation (33€), draw blood, order lab diagnostics (6€) etc. The total would probably be well under 200€.
- hospes 11y agoYou are lucky that you are in Austria and can check prices somewhere. In US It is really hard to get prices for any medical services (including serious and expensive surgeries) before they are scheduled or you already received them. My friend had a C-section during the delivery, hospital billed insurance 40K. She paid her deductible. C-section just like many other procedures are not planned and doctors are making decision on-fly during the delivery and obviously you do not have enough time to discuss pricing or negotiate them. So normally in this kind of cases you see the price 1st time in the bill, when you get it in your mail in couple weeks after the fact.