Do you have a high health insurance deductible?

Has your doctor ordered diagnostic tests to rule out cancer or some other life-threatening condition? Are you an “insider” — already aware of strategies that can greatly reduce the amount you’ll owe? Or are you more like me, so shocked by the mention of cancer that you don’t ask enough questions or talk to the right people? Then this letter is for you. I hope you can learn from my very expensive experience.

I suffered from a painful recurring condition for 10 months before I insisted on seeing a specialist. He immediately ordered two diagnostic tests to rule out cancer. I told him I had a high deductible and asked if it could wait until after the first of the year. He said no, the symptoms had gone on too long. When I talked to the scheduler in his office about whether I should pay cash or use my insurance, she said, “The CT scan will be about $2,000, and what if you need surgery?” So I decided I could afford $2,000 towards my deductible and ran it through my insurance.

Fortunately, the tests were negative for cancer. However, I was stunned when I received the EOB (Explanation Of Benefits) from my insurance company the day after Christmas to learn they were charged $7,854 for my CT scan. To meet my deductible, my portion is $4,423. And I am stuck with it. I’ve called the billing office several times, my insurance company, and everyone else I can think of. There is no relief for me at this point.

This is what I should have done, and what I hope you will do if you are in this situation:

1. Get the CPT code from your doctor. Call the Summit billing office at (928) 537-6911 and ask how much your insurance will be billed. Don’t take anyone else’s word for it. Call the billing office. (That’s their advice to me.)

2. Google “MDSave Summit” and search your procedure to learn the cash price. The MDSave price for my CT scan would have been $730, at the same facility. This would have saved me almost $3,700 had I known about it in advance.

3. Shop around. Call facilities in the valley. See if they have an MDSave option.

4. Look for tests at a free-standing facility if possible, NOT one connected with a hospital. Even though you’re having an outpatient test, hospitals bill insurance companies for “hospital overhead.” This advice was from my insurance company.

Maybe you know these things, and all I’ve done is publicly declared my stupidity. But I'm hoping someone can learn from my experience. To your health.

Muriel Metcalf,

Lakeside

(3) comments

pxllr

Just think, if we had the same healthcare that most developed countries have, there would be no deductible, no co-pay, no out of pocket costs. Overall costs would be less than we pay now and our infant mortality rate and overall life expectancy would increase to match those other countries. We would no longer have to ask if this or that procedure can be put off till next year to satisfy the deductible. We would no longer have to worry if that procedure will bankrupt us or cause us to lose our home. GoFund Me is one of the 3 largest healthcare funding sources in this country. Other countries they don't need it cause it's all covered. Preexisting conditions do not result in higher cost in other countries the way they do here. When will the USA become a developed nation?

ronzim

pxllr: Absolutely. If we had Medicare for all such draconian charges would be a thing of the past.

2rusty

Nothing stupid here, Muriel. Lots of good advice, thanks for taking the time to write.

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