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Finding out the price is only half the battle - finding out every doctor who might be involved in a procedure so you can make sure they're in network is the oth

Finding out the price is only half the battle - finding out every doctor who might be involved in a procedure so you can make sure they're in network is the other half. Getting healthcare - even with insurance - can be terrifying.

badwolf 8y ago
Gah. This is such a shitty thing. "Sorry, the anesthesiologist was out of network, though everyone else in the hospital is in network"
- sumoboy 8y ago
  If you're in an in-network hospital it's not your job to interview every doctor that sees you and determine if they're in or out of network. Take it up with the hospital billing when you get the bill is what I was told by hospital admin people and tell them it's not my problem.
  - telchar 8y ago
    They'll tell you the exact opposite once you get your bill and they're trying to collect. I just had that conversation with a provider myself, after I got the bill.
- tfigment 8y ago
  This did literally happened to my dad. I guess the fact that he is so poor helped negotiate the quoted price down later after much harassment. You have flesh eating bacteria eating away your leg and you need to make sure that everyone is in the same network and its not like you have other concerns or even really the ability to figure this out easily. After that I went to Kaiser because I'm not sure its possible to go out of network at least like that.
  - pmiller2 8y ago
    That's part of why I have Kaiser, too. I don't need to worry about providers of any sort being out of network (nurses, assistants, docs, labs, etc.)
  - Balgair 8y ago
    Happens to my SO constantly. We went in for a urology visit, scheduled for months beforehand by the urologist, get a test done, yadda yaddda yadda. Now, up to 3 years later, we still get bills for that particular visit (in addition to other follow-ups) on a monthly basis. It's ~4/8 hours per week of extra work nearly every week in dealing with this nonsense. It's as if they don't even bother with sending us a bill anymore, they just go straight to collections companies. At this point, I know better than to think it's ever going to be fixed. The insurance and Hospital billing phone numbers are literally on speed dial. On particular phone call stands out. We got our insurance on a 3-way call with my SO and the hospital billing. For a urology test they charged us ~$800 for the test strip (just a single one!), which the hospital tried to claim was not covered (nothing, it seems, is ever 'covered'). Even the insurance person on the phone was aghast at the hospital: "Wait, so you are telling us that even urological tests, like a basic pH strip, at the specific office for urology, is $3000? What is our client even paying for, like, what is it exactly, that a urologist does? How much does a smile cost?" US Medical billing makes Kafka blush.
sjg007 8y ago
This is not really a thing.
- ceejayoz 8y ago
  It definitely is. https://www.tdi.texas.gov/news/2018/tdi10082018.html https://www.tdi.texas.gov/news/2018/tdi10082018.html > The problem meant consumers couldn’t get in-network anesthesia services at more than 20 hospitals and surgical centers in three of the state’s largest metro areas. https://www.vox.com/2018/5/23/17353284/emergency-room-doctor-out-of-network https://www.vox.com/2018/5/23/17353284/emergency-room-doctor... > Except he wasn’t: While the emergency room where Kohan was seen was in his insurance network, the oral surgeon who worked in that ER was not. That’s how Kohan ended up with a $7,924 bill from the oral surgeon that his health plan declined. > Separate data from the Center for Public Policy Priorities, an Austin-based think tank, finds that a staggering number of Texas emergency rooms have zero in-network emergency physicians — meaning that patients are guaranteed to see a doctor who does not accept their health insurance.
  - sjg007 8y ago
    And it is still not a thing because the State prohibited said action.
    - desdiv 8y ago
      Yes, just like how the federal government prohibited marijuana and therefore no one in the United States of America consumes marijuana. Someone up thread made a claim and the burden of proof was on them. Now multiple reliable sources have been provided to satisfy that proof. You claim an unspecified law prohibit this and that this prohibition actually works. So now the burden of proof falls on you to actually cite the law and provide reliable sources of this law actually working.
    - ceejayoz 8y ago
      By that logic, murder's not a thing. Texas got mad here because there were no in-network anesthesia services. Having some out-of-network providers is depressingly common, and hard to guard against: https://www.modernhealthcare.com/article/20180917/NEWS/180919898 https://www.modernhealthcare.com/article/20180917/NEWS/18091... > About 25% of patient visits to hospitals in their insurance network result in balance billing from care by out-of-network physicians. Also, from the Vox article: > The problem with that law, Pogue argues, is that it requires patients to contact the state — and patients often aren’t aware of the option. Kohan, for example, didn’t know he had these rights until I told him. Pogue’s research suggests this is really common: Only 3,824 Texas patients have used the law to resolve their surprise bills since 2009. CPPP estimates that this is a tiny fraction of the 250,000 surprise medical bills sent out in the same time frame. This is just Texas, too. Plenty of states don't have their 2009 state law to work with.

badwolf 8y ago

Gah. This is such a shitty thing. "Sorry, the anesthesiologist was out of network, though everyone else in the hospital is in network"

sumoboy 8y ago
If you're in an in-network hospital it's not your job to interview every doctor that sees you and determine if they're in or out of network. Take it up with the hospital billing when you get the bill is what I was told by hospital admin people and tell them it's not my problem.
- telchar 8y ago
  They'll tell you the exact opposite once you get your bill and they're trying to collect. I just had that conversation with a provider myself, after I got the bill.
tfigment 8y ago
This did literally happened to my dad. I guess the fact that he is so poor helped negotiate the quoted price down later after much harassment. You have flesh eating bacteria eating away your leg and you need to make sure that everyone is in the same network and its not like you have other concerns or even really the ability to figure this out easily. After that I went to Kaiser because I'm not sure its possible to go out of network at least like that.
- pmiller2 8y ago
  That's part of why I have Kaiser, too. I don't need to worry about providers of any sort being out of network (nurses, assistants, docs, labs, etc.)
- Balgair 8y ago
  Happens to my SO constantly. We went in for a urology visit, scheduled for months beforehand by the urologist, get a test done, yadda yaddda yadda. Now, up to 3 years later, we still get bills for that particular visit (in addition to other follow-ups) on a monthly basis. It's ~4/8 hours per week of extra work nearly every week in dealing with this nonsense. It's as if they don't even bother with sending us a bill anymore, they just go straight to collections companies. At this point, I know better than to think it's ever going to be fixed. The insurance and Hospital billing phone numbers are literally on speed dial. On particular phone call stands out. We got our insurance on a 3-way call with my SO and the hospital billing. For a urology test they charged us ~$800 for the test strip (just a single one!), which the hospital tried to claim was not covered (nothing, it seems, is ever 'covered'). Even the insurance person on the phone was aghast at the hospital: "Wait, so you are telling us that even urological tests, like a basic pH strip, at the specific office for urology, is $3000? What is our client even paying for, like, what is it exactly, that a urologist does? How much does a smile cost?" US Medical billing makes Kafka blush.

sjg007 8y ago

This is not really a thing.

ceejayoz 8y ago
It definitely is. https://www.tdi.texas.gov/news/2018/tdi10082018.html https://www.tdi.texas.gov/news/2018/tdi10082018.html > The problem meant consumers couldn’t get in-network anesthesia services at more than 20 hospitals and surgical centers in three of the state’s largest metro areas. https://www.vox.com/2018/5/23/17353284/emergency-room-doctor-out-of-network https://www.vox.com/2018/5/23/17353284/emergency-room-doctor... > Except he wasn’t: While the emergency room where Kohan was seen was in his insurance network, the oral surgeon who worked in that ER was not. That’s how Kohan ended up with a $7,924 bill from the oral surgeon that his health plan declined. > Separate data from the Center for Public Policy Priorities, an Austin-based think tank, finds that a staggering number of Texas emergency rooms have zero in-network emergency physicians — meaning that patients are guaranteed to see a doctor who does not accept their health insurance.
- sjg007 8y ago
  And it is still not a thing because the State prohibited said action.
  - desdiv 8y ago
    Yes, just like how the federal government prohibited marijuana and therefore no one in the United States of America consumes marijuana. Someone up thread made a claim and the burden of proof was on them. Now multiple reliable sources have been provided to satisfy that proof. You claim an unspecified law prohibit this and that this prohibition actually works. So now the burden of proof falls on you to actually cite the law and provide reliable sources of this law actually working.
  - ceejayoz 8y ago
    By that logic, murder's not a thing. Texas got mad here because there were no in-network anesthesia services. Having some out-of-network providers is depressingly common, and hard to guard against: https://www.modernhealthcare.com/article/20180917/NEWS/180919898 https://www.modernhealthcare.com/article/20180917/NEWS/18091... > About 25% of patient visits to hospitals in their insurance network result in balance billing from care by out-of-network physicians. Also, from the Vox article: > The problem with that law, Pogue argues, is that it requires patients to contact the state — and patients often aren’t aware of the option. Kohan, for example, didn’t know he had these rights until I told him. Pogue’s research suggests this is really common: Only 3,824 Texas patients have used the law to resolve their surprise bills since 2009. CPPP estimates that this is a tiny fraction of the 250,000 surprise medical bills sent out in the same time frame. This is just Texas, too. Plenty of states don't have their 2009 state law to work with.