Getting a simple price quote for medical procedure...NOT EASY!

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This place became famous in the last 10 years for doing surgeries for a cash price. No insurance involved.

Depending on how high your deductible is, you could save money by going here instead.

Travel costs would obviously need to be accounted for.


https://surgerycenterok.com/
 
Originally Posted by Blaze
The only place they gave me was the hospital here in Colville, Wa. Its right next door to the orthopedic surgeon.

Surprise, surprise. They're probably related (part of the same hospital network). Problem is, it doesn't mean the doctor is in-network. I'm curious how ignorant they would act if you asked for the names of multiple offices and/or doctors that can perform this.

Years ago, we had a medical plan that required our family doctor to refer us to any specialists. No problem there... He referred me to a specialist (they all have their "buddies", who has a good reputation, etc, etc) and I asked "is he an in-network doctor?". His response was, "I don't know. Let me find out." and he did and he was, so all was good.
 
The fact that you live in Colville adds a lot to this conversation.

Colville is a small town pretty far from any large metro. It's a beautiful place.

Having said that, it does restrict you in your medical choices. I'm wondering if you can get it done cheaper in Spokane?
 
The doctor part should be easy. Ask him straight up what he's going to charge, same as you would with a mechanic or a house painter. It's the facility that's going to have all the ups and extras.
 
Originally Posted by JHZR2
...
How posted prices isn't a thing is beyond me. How stabilized billing rates isn't a thing is also beyond me.

It is a thing.
Starting January 1 2019 all hospitals must make their pricing available per the Affordable Care Act.

Problem is, this list is a confusing list of codes and gobbly gook for most, and is not an all inclusive list. As mentioned above, there is a charge for the procedure, but there is a charge for the physician, the nurse, the IV, the fluids, the medications, and a bunch of other stuff.

Google "hospitals required to post prices" and you will see all the complaints about this new law not helping anything at all.

Here is the page for a large hospital system (Methodist) in Houston, towards the bottom is a .csv file with costs. Figure out what having an appendectomy would cost you.
Do you know what all is involved in the procedure? Do you know what blood work will be done? How about radiology? Anesthesia? Recovery? Actual surgery? Surgeon cost? Ancillary staff cost?
 
While it is important to stay healthy, I hope the OP has a procedure and can afford it if it is necessary. Got anything you no longer need you can sell to pay?
 
Originally Posted by MrMoody
The medical industry has gotten away with secret & selective pricing for far too long. We all know where this is headed.

Your insurance company will probably be more help because the prices are determined by the hospital's contract with them, unless the hospital dings you for uncovered charges, which they are not supposed to do.

Yeah,like a 500 dollar tylenol.
 
My insurance gives me a health cost estimator tool. Otherwise our local hospital, if you schedule in advance, will call and tell you exactly how much it'll cost you. Learned that when they said it'd be $248 after our "insurance discount" for a friggin thyroid ultrasound. Another place did it for $80.
 
Originally Posted by Old Mustang Guy
Won't you end up paying your deductible anyway on the second procedure?


Yes, but I have to put the surgery off until late August because of work (self employed). I was just curios how much $$ of my bank account was going to get chewed up before Summer. I didn't think it would be a big deal just to call about a simple price check like an auto part etc, WRONG! Still no answer from them but its a weekend.
 
Contrast all of this with the dental practice I use.

They handle insurance with deductibles, copays and contracted prices, too.

BUT, anything they advise you to do, they give you a quote, net after insurance, in advance, in writing, on the spot, even multiple quotes for different options.
 
Originally Posted by JHZR2
Originally Posted by Alfred_B
Originally Posted by Propflux01
Originally Posted by Blaze
They first asked me if this is cash or insurance and then go on to say this will take several days to work up an estimate and we can e-mail that to you, grrrrr.


Cash pays more.


They have to give a discount for cash patients that is equal to the going discount the insurance companies have negotiated.


Says what law? Per my post above, genuinely interested.


IRS code 501(r)
 
Originally Posted by MrMoody
Contrast all of this with the dental practice I use.

They handle insurance with deductibles, copays and contracted prices, too.

BUT, anything they advise you to do, they give you a quote, net after insurance, in advance, in writing, on the spot, even multiple quotes for different options.

It's a much simpler industry.
 
I went through the same thing last summer. I'm not 50, and I have family history of colon cancer (dad), so insurance won't cover a colonoscopy without reaching a deductible (family history makes the colonoscopy go from one code to another.... )

I spent FOUR DAYS calling the hospital, the doctor's office, the anesthesiologist, the this, the that, the who. They would tell me someone else was involved, I'd call their office.

I was told so much different information as far as costs, etc., that I think every entity involved was so confused and really didn't know WHAT TO DO with how they were going to bill ME....

I paid about $435 in lab fees (they pulled 3 pollups) and some other fee ( surgeon? ), never saw a bill or EOB from any other entity. Unreal. All I was trying to do for those 4 days was figure out how much it was going to cost me, since all of it was going to be out of pocket. I did get figures from some entities, but it was a complete cluster and it took 4 days?
 
@thooks, the cost varies depending whether they find polyps or not. If the hospital and the doctor don't obtain the correct pre-authorization then the insurance company will deny payment and the patient may end up paying the full bill. For example, if they predict that they will find polyps and pre-authorize that and don't find any, the insurance will deny for performing the incorrect procedure. Or the opposite is true as well.

The reason you didn't get an eob is probably they pre-authorized regular colonoscopy, the insurance denied payment and the hospital ate the cost and wrote it off.

That's why no one could give you an answer because getting paid is a crapshoot.
 
Got the price estimate today.

$560.00 with a 30% discount for paying cash or $392 my cost. Appointment set-up for the 23rd to get it done.

I really thought it would be a lot more than that. One epidural cortisone injection in my back was $3400.00 about 5 yrs ago so I was thinking it would easily be over $1,000.00 for the shoulder.
 
Ask for a determination of benefit [or whatever it is called], they will run it just like they are billing for it, then your insurance will come back with a dear john letter and let you know how bad it will be.
 
Thanks stockrex for that. They did mention I could possibly qualify for financial assistance regarding my deductible when it comes to surgery time. Its going to be 6 weeks in a sling and another 4 to 5 months after that until I have full use. Right now its almost impossible to reach forward and shift my truck. I don't know how I'm going to get through this hay season. That is our only income right now and why I'm waiting to get this done. This summer will be 26 yrs since we started the hay business and never missed a yr.
 
Healthcare is a tough thing and should be considered as compensation packages and negotiations or in self employment business plans.

My wife makes decent money at hospital however her real pay comes from Zero deductible health insurance for family of 5 for not a terrible rate.
 
Originally Posted by madRiver
Healthcare is a tough thing and should be considered as compensation packages and negotiations or in self employment business plans.

My wife makes decent money at hospital however her real pay comes from Zero deductible health insurance for family of 5 for not a terrible rate.


Agreed, my wife has the same deal she is a hospital employee. I'm lucky to be on her insurance.

I work at a competing hospital, as an IT contractor and we have terrible insurance.
 
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