I was without insurance for about 8 years and had learned insurance was the only way to get treatment - doctors would not take me as a patient. After finally getting onto an insurance plan, I decided to have basal joint arthroplasty - a procedure that replaces diseased thumb joints and if untreated leaves one unable to hold a pen, open a jar or perform basic daily living skills. the insurance plan has a deductible and there is a share of total costs that are the financial obligation of the patient, however, the total plan coverage is overall very comprehensive. Prior to my surgery, I received a call from the outpatient surgery center to confirm my appointment. the scheduler also said my share of the surgery center bill would be $1,700. I was surprised at this, and it made me wonder what my share would be of the surgeon, anesthesiologist, and others so I started making calls. When I called the doctor, I was told to call the billing office. The billing office told me to call the insurance company. The insurance company said to call the doctor. In several of the calls, the person on the other end gave a tiny bit of information ("You will have to give me the codes for your procedure before I can release that information.") I was told the doctor and their billing company did not know what the insurance would pay because it was different every time. The insurance company said the doctor would know the rate of reimbursement for my particular procedure because it would be art of the doctor's contract with the insurance company. The billing company said the insurance company pays different rates on each of the codes that apply to my procedure in some (mysterious) order of priority and they had no way of knowing in what order the charges would be applied. After five hours on the phone and multiple calls to insurance, doctor and billing, I was never able to find out what my share would be. I even told the doctor's office I would not pay the remainder of the bill if I could not be told what my share would be in advance. They told me to call the insurance company. I have not yet received the bills. I'm afraid I won't be able to cover the costs and the results will be financially disastrous, yet to be able to continue to work and make a living I had no choice but to undergo this surgery. ... separately, in preparation for this same surgery, I had to obtain a routine EKG and blood work. I have done these before and paid cash of about $125 for both. In this case, because the surgeon was associated with a local hospital group, I had to go to the hospital for these tests. I received a bill for over $500 with only $100 of it being picked up by insurance. I was incredulous and called the doctor's surgery representative, to seek that office's assistance in determining whether the charges on the bill were correct. After two calls, I have yet to hear back from the doctor's office. I will end up paying the bill because one thing hospitals always do quickly is turn people over to collection! I just wanted to chime in that the situations described in this story happen everywhere. The mystery and complete absence of transparency or even simple information is frustrating and maddening. We need a "truth in medical costs" act to work like the truth in lending requirements work. Thank you.
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