agracer said:

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I just called the Urgent Care clinic.

Cash pay is $143.50 for an office visit, and $54 for covid/flu/something test.

Mad at myself b/c I know better than this. Always ask the cash price at these places. My family has saved $1,000's in insurance coverage over the last 10 years on the high deductible plan. I just didn't think $189 was unreasonable for the late night urgent care visit and didn't think a flu test would be $390!

Maybe they were just trying to milk the insurance. We will see what the actually bill me.

My son got his finger slammed in a locker about 10-years ago. Called his doctor, it was an office visit, then go to an image center, then radiologist to read the x-ray, then fee for splint...blah blah blah,...probably would have cost me $500+ for all that nonsense.

Called an Urgent care, aske for cash price for office visit, X-ray and splint. The lady on the phone said "$89 for office visit, $50 for X-ray and no cost for the splint". So went there, paid the $139 and walked out with a splint on his ring finger.

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Cash is the way to go. Doc offices like cash pay better because they do better with cash pay.

I have seen UC billing/collections. They prob avg $150/pp across the board from all insurances. For that $150 they have to pay a biller 5-7% of collections, they wait 2-6 months for payment. So they get back about $140.

Your cash pay is $200 which they get immediately without a wait.

So with your high deductible insurance, if the UC billed $1K then your insurance discounts it to say $500 then your are on the hook for $500 towards your deductble.

If you hit your deductible or have low/no deductible insurance then the UC bills $1k, your insurance discount may be $500 but what they pay may be $150. The UC can accept or can continue negotiation. Many times they will accept b/c going through further billing negotiations is time consuming and may garner an extra $50-100.

So you may think the UC made $500 off all insured visits but this is far from the case.

This **** needs to be ****ing fixed.
I just got off the phone as I need an MRI next week. If I self pay the price is $1,100. If I go with my insurance they are going to bill the insurance for $7k of which my part will be $2900.

But since it's the beginning of the year and I'm most likely going to need surgery it makes more sense for me to pay the $2900 becuase my out of pocket deductible is capped at $4500 for the year for the family. And the self pay wouldn't go towards any out of pocket costs for the insurance.

This **** is criminal.

https://capitol.texas.gov/tlodocs/88R/billtext/html/HB02002F.htm

Had 4 stents put in before Thanksgiving. $325k. My part $3600. Pretty cool being awake and watching the video of him doing his thing. Young cardiologist and his team had rock music blaring. They definitely had their work environment setup to their liking.

AGpops1923 said:

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Had 4 stents put in before Thanksgiving. $325k. My part $3600. Pretty cool being awake and watching the video of him doing his thing. Young cardiologist and his team had rock music blaring. They definitely had their work environment setup to their liking.

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Did this total require hospitalization? Seems high but that 325K has little resemblance to what the hospital/doc got paid.

Medaggie said:

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AGpops1923 said:

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Had 4 stents put in before Thanksgiving. $325k. My part $3600. Pretty cool being awake and watching the video of him doing his thing. Young cardiologist and his team had rock music blaring. They definitely had their work environment setup to their liking.

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Did this total require hospitalization? Seems high but that 325K has little resemblance to what the hospital/doc got paid.

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I spent one night in The hospital for observation.

redcrayon said:

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What is an ER specialty facility?

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Caprock (In CS for example). They shut down though.

hph6203 said:

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https://capitol.texas.gov/tlodocs/88R/billtext/html/HB02002F.htm

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So… I'd like to think I'm pretty smart unless it comes to health insurance. I read through your link and my understanding would be that if the amount I would pay directly to the Dr is less than the agreed rate with insurance that lesser amount paid straight to the Dr would count towards my OOP. But just got off the phone with BCBs and they say it wouldn't. Would it matter that this is BCBS Michigan and the law your referenced is a Texas statute. I live in Texas by the way and the procedure is in Texas.

So confused.

agracer said:

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I just called the Urgent Care clinic.

Cash pay is $143.50 for an office visit, and $54 for covid/flu/something test.

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Still dealing with this BS. They said $140 over the phone for the office visit, but billed $239 to my insurance, which wrote it down to $189.

Called when I got the $390 bill 3 weeks ago. Said I was given an "multi viral panel with antigen test".

I explained on the phone that I asked for only a flue test and the PA said "it's all the same test" which implies to me that it's the same $54 test they told me over the phone.

Oh, no, that's a much different test. Ok, then how come when I call and ask the clinic for that cost over the phone, its $195? Why are you billing me $390 for a test that you say should be $195? "That's only an estimate, we can't tell exactly what the provider is going to recommend."

OK, "I ASKED FOR A FLU TEST, WAS TOLD "IT'S ALL ONE TEST". Why would I agree to pay $390 for something I didn't want?

So they were going to escalate it to review coding.

Get another bill today for the same $390. Call and they say the same as above. I asked what happened with my coding review from last month and no one seems to know the answer. I'm supposed to get a call back. I should have told the billing agent when she calls me back to have her supervisor on the phone if they're going to decline everything b/c I'm not paying $390 for the flue test I asked for.

I'll offer to go on a $5/month payment plan and ask they send me a bill in the mail every month to pay. Then, after 6-months I'll call and offer to settle for $50.

I just think of how absolutely massive the insurance industry even is. How much money is needed to keep that thing afloat, before we even start talking about profit and then expenditures like lobbying and whatnot?

How many people even truly know how it works in and out? Where do you guys learn this stuff? Trial and error? Second hand? My parents taught me exactly zero things about life and it gets really ****ing old smashing my face into every barrier possible because of ignorance. I'm old enough now to at least question a lot of things but man, it was the pits when I was younger and didn't even know I was supposed to ask questions.

Health care needs major reform. I don't know anyone that doesn't have a hand in the pot that doesn't agree with that sentiment.

This stuff is going on because we're about half way to a universal payer system. Whether its true or not, I don't know, but there'e been a lot written that Government payment rates (medicare/medicaid) are below the cost of service, so doctors and hospitals make it up by really screwing over private insurance. The "I don't have insurance" price is probably in the middle and closer to true cost.

I do know (daughter is a physician) that hospitals that have a majority of medicare/medicaid patients are really struggling because there just aren't enough private payers to make up the difference. It was a major decision on where the daughter decided to practice when she finished up fellowship.

javajaws said:

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MouthBQ98 said:

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The removal of up front published pricing and cash payments or financing for sertvice in favor of various third party payers has wildly skewed the costs and pricing mechanism for medical services. The billed price is an order of magnitude different than the cash value for the service.

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In other industries we would call that fraud. But in the healthcare industry it's called business as usual.

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Not to defend the healthcare/health insurance industries but this is directly the result of governmental interference and laws promulgated by the government.

redcrayon said:

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What is an ER specialty facility?

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Corporate facility

This is the cost of A. Government Bureaucracy diddling in health care and B. The hospital treating 9/10 patients without insurance.

My prostate cancer came back after 4 years and besides having to get radiation treatment, I'm taking a new drug called Nubeqa. A month supply out of pocket was $350. They billed the insurance company $21,000. You may have seen it advertised on TV. Happy I could help pay for their advertising.

https://www.msn.com/en-us/health/other/russian-run-texas-medical-supplier-at-center-of-massive-medicare-billing-scheme-feds-say/ar-AA1WWv5W?ocid=msedgntp&pc=U531&cvid=699db136cc1541f9a31534109edacce3&ei=52

Quote:

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Centurion began submitting large batches of claims in late September 2025, shortly after Machutadze became the company's managing member, investigators said. In a little more than a month, the company submitted claims for 78,663 items mostly intermittent urinary catheters billing roughly $134 million, with $90 million initially processed as "paid."

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Quote:

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The affidavit also describes a second medical supply company, this one based in Florida, that investigators say is linked to Machutadze. That company submitted claims for 1.64 million medical items totaling $3.34 billion. Medicare suspended payments on Dec. 26, 2024. Investigators say at least $4.35 million from the company's accounts was wired to Hong Kong and China.

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Quote:

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As part of that crackdown, 19 defendants were indicted in what prosecutors described as a Russian-based transnational scheme that used shell buyers to acquire U.S. medical supply companies. The group then submitted $10.6 billion in fraudulent claims for urinary catheters and other durable medical equipment an operation known as Operation Gold Rush.

One of the companies that prosecutors said was used in the scheme, Konaniah Medical Supplies, listed an address in Grand Prairie. A 2024 I-Team investigation found the Texas company billed Medicare nearly $3 billion for urinary catheters in the alleged scheme.

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Lots of fraud related to Russian groups operating in the US.

infinity ag said:

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Investigate insurance companies.

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The issue is hospitals and their billing…which probably ties back to employee compensation.

K2-HMFIC said:

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infinity ag said:

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Investigate insurance companies.

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The issue is hospitals and their billing…which probably ties back to employee compensation.

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Everything ties back to a CEO somewhere who wants to unethically (but not illegally) inflate his bonus.
Check it out. You will find that I am right but no one wants to admit it.

infinity ag said:

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K2-HMFIC said:

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infinity ag said:

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Investigate insurance companies.

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The issue is hospitals and their billing…which probably ties back to employee compensation.

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Everything ties back to a CEO somewhere who wants to unethically (but not illegally) inflate his bonus.
Check it out. You will find that I am right but no one wants to admit it.

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You're almost there.

It goes back to the government interfering in things and creating policies with unintended consequences which results in people far smarter than the politicians and bureaucrats finding ways to profit while remaining in legal compliance.

Same thing happened with sub-prime mortgages and all that which created the financial meltdown in 2007.

$4 tube of super glue, a band-aid and be done with it

When my two kids were born, we had someone come into the room and test their ears. White lab coat and an id badge. Just said I am hear to check their hearing. They checked and then left. We didn't sign anything or really interact with them.

About a month later, we get a bill for $300 for each kids hearing test. I explain to them that we have maxed out of deductible and I don't pay anything without a EOB from my insurance company. They explain that this isn't covered by insurance and I would have to pay it out of pocket. I told them I wouldn't be paying the bill then.

A month goes by and they try to turn me over to collections. I called the hospital and they said they aren't affiliated with the hearing test and I would have to deal with them directly.

The conversation went something like this:

I paused for a second and then very calmly said wait you aren't affiliated with them?

Yes sir, we don't have anything to do with them. They are a 3rd party provider.

So, you allow a non-affiliated person to wander through the delivery wing running tests on newborns.

Well, we do know who they are but they aren't part of the hospital.

How did they get my information including my social security number and the health information on my children?

Long pause. I am not sure how they got that information.

Did you all share this information with them without my approval?

There is language in the admissions forms that allows us to do that for the purposes of care.

Care by affiliated providers.

They aren't affiliated. You will need to take it up with them.

I am giving you two options. You contact them and have them cancel the bill or I am going to the internet and the press explaining that you all are allowing medical tests on newborns by random people without their parents consent.

Sir we will contact them and make it go away.

Ol_Ag_02 said:

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This **** needs to be ****ing fixed.
I just got off the phone as I need an MRI next week. If I self pay the price is $1,100. If I go with my insurance they are going to bill the insurance for $7k of which my part will be $2900.

But since it's the beginning of the year and I'm most likely going to need surgery it makes more sense for me to pay the $2900 becuase my out of pocket deductible is capped at $4500 for the year for the family. And the self pay wouldn't go towards any out of pocket costs for the insurance.

This **** is criminal.

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This is what drives me absolutely crazy about our system. The "negotiated rate" between the insurance and provider is more often than not higher than the cash rate. Makes zero sense.

I can only imagine any law to "fix" this issue would just cause providers to increase their cash rate to the insurance rate screwing over consumers.

infinity ag said:

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K2-HMFIC said:

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infinity ag said:

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Investigate insurance companies.

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The issue is hospitals and their billing…which probably ties back to employee compensation.

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Everything ties back to a CEO somewhere who wants to unethically (but not illegally) inflate his bonus.
Check it out. You will find that I am right but no one wants to admit it.

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Please don't pollute this thread with your insanity. Please also seek help.