Owned Posted August 30, 2011 Report Share Posted August 30, 2011 My understanding is that the price they charge is usually whatever insurance pays out at, even if that's more than they would require. The price can change if you are paying out of pocket. That's correct. The problem is that every insurance company has a different rate for each service and that rate is different depending on the practice. They may pay $200 to one office and $250 to another, for the same procedure, while another insurance company pays $275 and $300. The simple solution providers use to ensure they bill for the maximum allowable contracted rate is to bill far above the average contracted rate for each service. If the average amount for a procedure is $300, they will likely bill $600 or $700 every time, to everyone so that they will always get the full contracted rate. What that means for people without coverage or people who unwittingly go out of network is that they get shafted with this ridiculously inflated figure. The thing that has not yet been discussed is that if you go to a doctor, that practice will be questioned by your impending insurance on whether or not you had this issue prior to coverage. They will say yes and all related claims will be denied for pre-existing condition. Similarly, they will question YOU about the date when this issue first happened. If you lie, it's insurance fraud. If the insurance wants to push it, they can have a doctor examine you and try to determine how old the injury is. If they can find any evidence, outside of scheduling surgery for the day the plan goes active (which is a dead give-away), they will try to deny your claims. That being the case, just pretend to be an illegal and go to the ER with no identification. :arob: Link to comment Share on other sites More sharing options...
Jack8745 Posted August 30, 2011 Author Report Share Posted August 30, 2011 I called my "future" insurance company and because i have ppo according to them i will be covered. that said a good friend of mine had to go to the er for his hernia few years ago, he has insurance at his company for 6 months. long story short they denied him and said it was a prior injury and he should have taken care of it. they threw a 30k bill at him, went to court and the insurance won. he had to pay for it all. then about a year later the final bill came out to be "only" 10k Link to comment Share on other sites More sharing options...
TRACStar Posted August 31, 2011 Report Share Posted August 31, 2011 I had an appendectomy in Oct with no insurance. Total bill came to just under 50K, all said and done I ended up paying less than 400. Most hospitals do have things in place like charities and shit that if you qualify for cover most of the bill. Link to comment Share on other sites More sharing options...
Stormtrooper1 Posted August 31, 2011 Report Share Posted August 31, 2011 That's a good point, I bet it would involve removing half of your stomach, and of course a liver delete. With ROBOTS! Link to comment Share on other sites More sharing options...
rmorse Posted September 1, 2011 Report Share Posted September 1, 2011 Guess what day it isssssssss! Link to comment Share on other sites More sharing options...
Jack8745 Posted September 1, 2011 Author Report Share Posted September 1, 2011 :blush: you remembered today at 3:30pm a doctor will tell me again i need surgery Link to comment Share on other sites More sharing options...
rmorse Posted September 1, 2011 Report Share Posted September 1, 2011 I'm an elephant.... Hope it goes ok! Link to comment Share on other sites More sharing options...
Jack8745 Posted September 17, 2011 Author Report Share Posted September 17, 2011 i got surgery 2 days ago. hurts like hell now i have to pay 1300.00 and insurance take care of the rest thanks for a the good thoughts people Link to comment Share on other sites More sharing options...
fastwagonhawaii Posted September 17, 2011 Report Share Posted September 17, 2011 get well dude, I watched my father go through the hernia thing it was crazy. take your time and heal, my dad didn't and he regretted it big time. Link to comment Share on other sites More sharing options...
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