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Patients Pay Before Seeing Doctor as Deductibles Spread

Mycroft said:
Ah...no, Maggie.

What the article is saying is that when you go to your doctor's appointment, they will ask you for the co-pay and the cost for the blood test and any other treatment they expect to do until your deductible has been met...before the doctor will even see you.

You, on the other hand, came there expecting to pay only the co-pay, getting all the other stuff done and then getting a statement from your insurance company saying they were not going to pay for the treatment and stuff because your deductible had not been met and getting a bill from the doctor for the rest. By that time, payday has come and you have the cash on hand without having to dip into your savings to cover it.
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Please pick up the quote from the article that says that. How would your doctor know if you had or hadn't paid your deductible? In addition! Your insurance company has negotiated rates from healthcare providers. Blue Cross pays a different amount than Nationwide, IOW. Just because the doctor bills $100 for a blood test in no WAY means that your insurance company is allowing that amount.

The way you guys are figuring it, it's going to cost you $5,000 to go to the doctor. :rofl
 
MaggieD said:
This cannot be true. Period.

Think about it. You go to the doctor. The doctor visit is $125. You have a $5,000 deductible. The doctor is NOT going to collect $5,000 from you. Use your head. And, in this case, assume your mom has her facts absolutely 100% wrong. How on earth would your DOCTOR know whether or not you'd paid your deductible or not??

The doctor wants his co-pay.
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I'm no expert on Medicare so I only know what my mom tells me on this. She says all the docs want money up front before they will take her as a new patient. I don't know if there is a deductible or what formula they use all I know is they won't take her without money up front.
 
sawyerloggingon said:
I'm no expert on Medicare so I only know what my mom tells me on this. She says all the docs want money up front before they will take her as a new patient. I don't know if there is a deductible or what formula they use all I know is they won't take her without money up front.
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Your mom is on Medicare? Your mom's total deductible for the year is under $300. And how would the doctor know whether or not she'd paid that? There's something wrong with what she's telling you . . . or what you're understanding.

Medicare has nothing to do with Obamacare.
 
MaggieD said:
Your mom is on Medicare? Your mom's total deductible for the year is under $300. And how would the doctor know whether or not she'd paid that? There's something wrong with what she's telling you . . . or what you're understanding.

Medicare has nothing to do with Obamacare.
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She has been forced onto Medicare because of obamacare. I went into this in another thread about IBM retirees. Anyway what she is running into is doctors won't take new Medicare patients without money up front. I think I may have jumped into this thread with a different subject than you guys are specifically talking about though so I will bow out. I just have this on my brain because of talking about it with my parents lately.
 
MaggieD said:
Please pick up the quote from the article that says that. How would your doctor know if you had or hadn't paid your deductible? In addition! Your insurance company has negotiated rates from healthcare providers. Blue Cross pays a different amount than Nationwide, IOW. Just because the doctor bills $100 for a blood test in no WAY means that your insurance company is allowing that amount.

The way you guys are figuring it, it's going to cost you $5,000 to go to the doctor. :rofl
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When Barbara Retkowski went to a Cape Coral, Florida, health clinic in August to treat a blood condition, she figured the center would bill her insurance company. Instead, it demanded payment upfront.
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Earlier in the year, another clinic insisted she pay her entire remaining insurance deductible for the year -- more than $1,000 -- before the doctor would even see her.
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Who knows...maybe she has a history of not paying on time.

Doctors and hospitals at New York University Langone Medical Center collect co-insurance and deductibles upfront for inpatient and outpatient services, said Andrew Rubin, vice president for medical center clinical affairs and affiliates. The amount may be based on estimated cost of services. The practice helps clarify bills for patients and saves on administrative costs when it comes to collections, he said.
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Lee Memorial Health System in Fort Myers, Florida, collects co-payments and deductibles prior to elective services, Mary Briggs, a spokeswoman, said in an e-mail. If a doctor decides a procedure is urgent, they’ll work out payment plans, she said.
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And unless it’s an emergency situation, Presbyterian Healthcare Services, a nonprofit hospital system based in Albuquerque, New Mexico, requires patients with insurance to pay their deductible, copay and co-insurance at the time of service, and the uninsured pay in full.
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It seems to me that what is happening here is that more and more care providers are not willing to go through the common insurance billing procedures anymore.

By the way, your doctor knows what insurance coverage you have...including what deductibles you must meet. They get statements from your insurance company, too.
 
Mycroft said:
Who knows...maybe she has a history of not paying on time.

It seems to me that what is happening here is that more and more care providers are not willing to go through the common insurance billing procedures anymore.

By the way, your doctor knows what insurance coverage you have...including what deductibles you must meet. They get statements from your insurance company, too.
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Re your last paragraph above, yes, they do get statements. After the fact. I can see, with an elective surgery, as an example, that the hospital would check with the insurance company before your scheduled surgery to see what they're paying and what you have to pay...and want that money up front. But the idea that one is going to have to pony up a $5,000 deductible for a doctor visit is ludicrous.

In general, doctors want their co-pays up front. This has been going on for some time now. People wait to be billed and then don't pay their co-pay. Or take months to pay their co-pay. I don't blame doctors one iota for that. Invoicing over and over again over months and months in order to get a patient to pay a $30 bill is inefficient and means that doctors are turning over these unpaid co-pays to collection agencies. This is nothing new.

If you'll notice in the first quote you picked up, the up-front amounts are based on an estimated cost of service. Not that one will have to pay their entire deductible up front.

This is another one of those half-truths being bandied about to scare the livin' bejesus out of people.
 
sawyerloggingon said:
She has been forced onto Medicare because of obamacare. I went into this in another thread about IBM retirees. Anyway what she is running into is doctors won't take new Medicare patients without money up front. I think I may have jumped into this thread with a different subject than you guys are specifically talking about though so I will bow out. I just have this on my brain because of talking about it with my parents lately.
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Well, I'd love to know how your mom's IBM retirement kept her out of Medicare. IBM would have to be stupid IDIOTS to pay some kind of regular insurance for anyone eligible for Medicare. Medicare is $139 a month, for God's sake. There is so much misinformation out there from people like you who have half the story that NO ONE understands what the **** is going on.

No insurance on EARTH will pick up the tab for separate coverage for someone eligible for Medicare. Not one. They will provide a supplement for Medicare, but they are in no WAY picking up Medicare-eligible expenses. It would appear that even your MOM doesn't understand what kind of coverage she has/had.
 
MaggieD said:
Well, I'd love to know how your mom's IBM retirement kept her out of Medicare. IBM would have to be stupid IDIOTS to pay some kind of regular insurance for anyone eligible for Medicare. Medicare is $139 a month, for God's sake. There is so much misinformation out there from people like you who have half the story that NO ONE understands what the **** is going on.

No insurance on EARTH will pick up the tab for separate coverage for someone eligible for Medicare. Not one. They will provide a supplement for Medicare, but they are in no WAY picking up Medicare-eligible expenses. It would appear that even your MOM doesn't understand what kind of coverage she has/had.
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IBM had insurance with Kaiser that was supplemental to Medicare is the way I understand it and that is now gone. Their old doctors won't take them now without that separate IBM insurance so they have to look for new doctors. So much for " If you like your doctor keep him". This has been discussed in another thread though, I don't want to derail this one.
 
MaggieD said:
Re your last paragraph above, yes, they do get statements. After the fact. I can see, with an elective surgery, as an example, that the hospital would check with the insurance company before your scheduled surgery to see what they're paying and what you have to pay...and want that money up front. But the idea that one is going to have to pony up a $5,000 deductible for a doctor visit is ludicrous.

In general, doctors want their co-pays up front. This has been going on for some time now. People wait to be billed and then don't pay their co-pay. Or take months to pay their co-pay. I don't blame doctors one iota for that. Invoicing over and over again over months and months in order to get a patient to pay a $30 bill is inefficient and means that doctors are turning over these unpaid co-pays to collection agencies. This is nothing new.

If you'll notice in the first quote you picked up, the up-front amounts are based on an estimated cost of service. Not that one will have to pay their entire deductible up front.

This is another one of those half-truths being bandied about to scare the livin' bejesus out of people.
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In the case of that first lady mentioned in the article, my guess is that she requires ongoing treatment. The first provider, the doctor's office, probably doesn't want to continue dealing with her insurance...especially if she has a history of non-payment or slow payment. The second provider knows that their services will, at some point, go beyond the lady's deductible. So, they have demanded that she pay that deductible, in full, before they continue with their course of treatment. So, yes...she has to pay her entire deductible to them if she wants them to treat her.

You may think this article is just some half-truth scare tactic, but that lady had to tap her savings to get treatment. Sounds to me like that lady got hit hard with truthful reality.
 
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Mycroft said:
In the case of that first lady mentioned in the article, my guess is that she requires ongoing treatment. The providers know that their services will, at some point, go beyond the lady's deductible. So, they have demanded that she pay that deductible, in full, before they continue with their course of treatment. So, yes...she has to pay her entire deductible to them if she wants them to treat her.

You may think this article is just some half-truth scare tactic, but that lady had to tap her savings to get treatment. Sounds to me like that lady got hit hard with truthful reality.
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It is some half-truth scare tactic. There will always be "horror stories." Not every hospital requires anything CLOSE to that. And you don't know "the rest of the story." Like whether or not she left unpaid bills from LAST YEAR'S treatment with the hospital. IOW, that she didn't pay her deductible from LAST year.
 
sawyerloggingon said:
IBM had insurance with Kaiser that was supplemental to Medicare is the way I understand it and that is now gone. Their old doctors won't take them now without that separate IBM insurance so they have to look for new doctors. So much for " If you like your doctor keep him". This has been discussed in another thread though, I don't want to derail this one.
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That has more to do with IBM deciding it's not going to include Supplemental Insurance for its retirees than anything else. This has nothing to do with Medicare -- and nothing to do with Obamacare. You have just given us "the rest of the story" -- IBM has decided to discontinue its Medicare Supplement Policies for its retirees. You're absolutely right. This has zero to do with this thread.

Very few doctors are going to want to treat a patient who doesn't have a supplemental policy. It's always been that way and there's little chance of that changing in the future.
 
MaggieD said:
It is some half-truth scare tactic. There will always be "horror stories." Not every hospital requires anything CLOSE to that. And you don't know "the rest of the story." Like whether or not she left unpaid bills from LAST YEAR'S treatment with the hospital. IOW, that she didn't pay her deductible from LAST year.
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shrug...

I don't think the article is a scare tactic or a half-truth. It's just stating that this is happening. Nowhere in the article does it say that every hospital is doing it...but they do say that, with more people buying insurance plans with high deductibles, it could become more of a problem.
 
MaggieD said:
That has more to do with IBM deciding it's not going to include Supplemental Insurance for its retirees than anything else. This has nothing to do with Medicare -- and nothing to do with Obamacare. You have just given us "the rest of the story" -- IBM has decided to discontinue its Medicare Supplement Policies for its retirees. You're absolutely right. This has zero to do with this thread.

Very few doctors are going to want to treat a patient who doesn't have a supplemental policy. It's always been that way and there's little chance of that changing in the future.
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Obamacare is what enabled IBM and all these other big corps to do this and that is exactly what the so called crazy right wingers said would happen if obamacare passed. Dems call this an unintended consequence but if they knew it would happen was it really unintended?
 
sawyerloggingon said:
IBM had insurance with Kaiser that was supplemental to Medicare is the way I understand it and that is now gone. Their old doctors won't take them now without that separate IBM insurance so they have to look for new doctors. So much for " If you like your doctor keep him". This has been discussed in another thread though, I don't want to derail this one.
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I'm on Medicare and have Kaiser without any help from IBM or anyone else. Of course it's not free, but it is affordable. So much for not being able to keep Kaiser.
 
sawyerloggingon said:
Obamacare is what enabled IBM and all these other big corps to do this and that is exactly what the so called crazy right wingers said would happen if obamacare passed. Dems call this an unintended consequence but if they knew it would happen was it really unintended?
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Sawyer, give it up. IBM was always free to drop that supplemental policy for their employers. It was (apparently) not part of their guarantee, but a very nice perk they were willing, up until now, to provide. Regardless, Obamacare had zero to do with IBM "being allowed" to drop that coverage.
 
MaggieD said:
Sawyer, give it up. IBM was always free to drop that supplemental policy for their employers. It was (apparently) not part of their guarantee, but a very nice perk they were willing, up until now, to provide. Regardless, Obamacare had zero to do with IBM "being allowed" to drop that coverage.
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"Let’s give credit where credit is due. Obamacare has undoubtedly accelerated interest in private exchanges by spurring investment and discussion of the public insurance exchanges mandated under the law. That’s the carrot, so to speak, attracting companies towards private exchanges.

The “stick” is Obamacare’s “Cadillac Tax”, which will hammer companies with a 40 percent excise tax beginning in 2018 if their plans cost more than a fixed amount – an amount that is set to grow more slowly than medical inflation traditionally has. Combined, these forces are driving companies toward a “defined contribution” strategy where they will offer employees a set amount with which to shop for insurance through an online marketplace – an exchange. (The other alternative would be to just move your employees en masse into high deductible plans, perhaps while kicking in some money for an HSA.)

Obamacare Is Killing Traditional Employer-Sponsored Health Insurance - Forbes
 
sawyerloggingon said:
"Let’s give credit where credit is due. Obamacare has undoubtedly accelerated interest in private exchanges by spurring investment and discussion of the public insurance exchanges mandated under the law. That’s the carrot, so to speak, attracting companies towards private exchanges.

The “stick” is Obamacare’s “Cadillac Tax”, which will hammer companies with a 40 percent excise tax beginning in 2018 if their plans cost more than a fixed amount – an amount that is set to grow more slowly than medical inflation traditionally has. Combined, these forces are driving companies toward a “defined contribution” strategy where they will offer employees a set amount with which to shop for insurance through an online marketplace – an exchange. (The other alternative would be to just move your employees en masse into high deductible plans, perhaps while kicking in some money for an HSA.)

Obamacare Is Killing Traditional Employer-Sponsored Health Insurance - Forbes
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Raising deductibles (Cadillac Plans always have low deductibles) is a way of controlling healthcare costs. If a consumer is paying the bill? The consumer will be more cost-efficient. If my deductible is $250? I'm going to hit the ER any time I choose. If the deductible is $1500? Notsomuch.
 
sawyerloggingon said:
"Let’s give credit where credit is due. Obamacare has undoubtedly accelerated interest in private exchanges by spurring investment and discussion of the public insurance exchanges mandated under the law. That’s the carrot, so to speak, attracting companies towards private exchanges.

The “stick” is Obamacare’s “Cadillac Tax”, which will hammer companies with a 40 percent excise tax beginning in 2018 if their plans cost more than a fixed amount – an amount that is set to grow more slowly than medical inflation traditionally has. Combined, these forces are driving companies toward a “defined contribution” strategy where they will offer employees a set amount with which to shop for insurance through an online marketplace – an exchange. (The other alternative would be to just move your employees en masse into high deductible plans, perhaps while kicking in some money for an HSA.)

Obamacare Is Killing Traditional Employer-Sponsored Health Insurance - Forbes
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Wasn't retiree health insurance one of the perks that drove GM to near bankruptcy back in '08?
And wasn't that retiree health insurance one of the examples that the anti union voices gave to show how unions were to blame for the economic woes of the auto industry?

so, let's make sure that IBM doesn't have to take government bail outs.
 
MaggieD said:
Raising deductibles (Cadillac Plans always have low deductibles) is a way of controlling healthcare costs. If a consumer is paying the bill? The consumer will be more cost-efficient. If my deductible is $250? I'm going to hit the ER any time I choose. If the deductible is $1500? Notsomuch.
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You are tone deaf on this issue and reacting purely out of emotion because you want the plan to work so badly. I on the other hand hope it works because it is here but am looking at it logically and seeing a train wreck heading our way.
 
Dittohead not! said:
Wasn't retiree health insurance one of the perks that drove GM to near bankruptcy back in '08?
And wasn't that retiree health insurance one of the examples that the anti union voices gave to show how unions were to blame for the economic woes of the auto industry?

so, let's make sure that IBM doesn't have to take government bail outs.
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GM had a crappy product that could not compete and union benefits that dwarfed IBM. My mom worked there 20 years and gets $400.00 a month. Compare that to GM union retirement.
 
Dittohead not! said:
I pay $30 at the HMO, and have for a couple of years now.
That doesn't inspire me to go the the ER instead, no way.

Health care is not free, never was, and never can be.
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The other problem with modern HMOs is that it can take months to get an appointment with your doctor and if you can't wait, they will specifically direct you to the ER. If I call my doctor today, I will not see him before 2014, I guarantee it.
 
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