Author Topic: My $645 ingrown toe nail  (Read 11357 times)

frugalnacho

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My $645 ingrown toe nail
« on: November 07, 2014, 12:21:33 PM »
I went to a podiatrist in 2013 to have an ingrown toe nail cut out.  It was $30 for my copay, and insurance paid the rest.  According to my explanation of benefits they paid $125.

Then my insurance changed multiple times with the new legislation.  It seemed like they were changing it every few weeks and giving me a new insurance card and a new packet of documents.  It happened about 4 times, and was really frustrating.  I didn't read the entire thing over, it seemed pretty much the same.

I went back in 2014 for the same procedure and I assumed my insurance still covered it (I know, I already face punched myself for assuming this and not checking on it).  Turns out the podiatrist got reclassified as a "specialist" which is no longer fully covered.  Insurance will cover 80% of the bill after my $1,000 deductible is met - I was unaware of this at the time.  So I went in, told the dr I what I needed, specifically asked him not to cut the corner of the nail off to give me temporary relief (I had already done this at home - I still needed the surgery to permanently correct it or else I was going to have problems in the coming weeks) and he went ahead and did it anyway and scheduled the actual surgery for the following week.  I came back for the surgery, and later for 2 more follow up appointments.

Then I got the bills.  $112.36 for the initial visit, and each of the 2 follow ups, and $307.88 for the actual procedure.  I called to question them, but was not satisfied.  I explained that i'm aware I am responsible for the bills instead my insurance company because of the reclassification, and not having paid anything towards my deductible, but my issues were:

1. Why are my charges 500% more than what the insurance provider paid last time?
2. Why are follow up visits not included in the price of the procedure? (I have never encountered this for any procedure my family or I have gone in for - and in fact when I had the procedure done in 2013 my explanation of benefits listed only a single charge)
3. Why I was being charged so much for such minimal effort on the doctors part.  The procedure took less than 20 minutes of the doctors time (I did wait approximately 20 minutes for the toe to numb before he came back to do the actual procedure), and each follow up visit was less than 2 minutes of actual doctor time (not an exaggeration.  He came in, scraped at it with a metal instrument, put a band aid on, and said to schedule another follow up.  The next was the exact same except he said it was good - no follow up.  LITERALLY less than 2 minutes).  The initial visit was closer to 5 minutes of the doctors time.

I was told that the insurance company paid substantially more than $125 last time, and she rattled off several large charges totaling around $600.  I explained that I was looking at my explanation of benefits and it clearly listed a single payment of $125, and she said it was wrong she was looking at multiple payments totaling closer to $600.  If they received payments, why was it not listed on my explanation of benefits? Also, why would my explanation of benefits list a weird round number like $125 when none of the charges were even close to that value?  I am still confused by the whole situation.

I was not really given satisfactory answers for my other questions either, which I fully expected.  I was still cordial with the lady even though I was frustrated.  She explained that they always make sure to run someone's insurance card to ensure that they are covered before they do any procedures, so I had some follow up questions for her:

1. Are you able to see exactly what (and how much) is covered when you checked my insurance (ie what i'm personally going to be responsible for)?  If the procedure is less than $1000, and my deductible is $1000, then what does it even mean that I am "covered" by insurance? I always though running the insurance was a "cover your ass" policy for them, so they don't provide service to a dead beat without insurance.  But in my case it didn't cover their ass at all because I am liable for 100% of the charges.  She didn't have an answer, and i'm not sure if that question is better directed at my insurance provider than the doctors office.
2. I settled my bill (or so I thought, it was only for 3 of the 4 charges) several months ago during my last follow up.  Why am I just getting another bill several months later?  She said it was sent to insurance and just got kicked back to them this week.  I'm unsure why they would directly charge me for 3 of the bills on my last visit (presumably after the insurance instructed them to bill me because my deductible was not met and they were covering 0% of the cost), but then send the 4th to my insurance provider (knowing damn well insurance wasn't going to cover it since they were currently billing me for 3 of the visits).

Had I been fully aware of the charges it would have influenced my decision and I would have gone to a regular physician.  My own fault for being ignorant of exactly what my insurance covered, but I am still outraged at the prices and the way it went down.  Oh well, live and learn.


Gone Fishing

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Re: My $645 ingrown toe nail
« Reply #1 on: November 07, 2014, 12:43:07 PM »
Sorry to hear about the $ damage.  This kind of stuff is all to common.  I feel like I am just handing over my wallet saying take what you need to a teenager everytime I go to the doctor.  Sorry about the toe as well.  I have one that I have been fighting for about 7 years due to an injury but I hear a lot of folks have genetic causes.  I watched a few youtube videos on trimming the nail and have been getting along okay until my friends 4 year old kicked it and turned it black about a month ago. 

With your fertility procedures going on, are you set to hit the deductible anyway?

frugalnacho

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Re: My $645 ingrown toe nail
« Reply #2 on: November 07, 2014, 01:06:20 PM »
Sorry to hear about the $ damage.  This kind of stuff is all to common.  I feel like I am just handing over my wallet saying take what you need to a teenager everytime I go to the doctor.  Sorry about the toe as well.  I have one that I have been fighting for about 7 years due to an injury but I hear a lot of folks have genetic causes.  I watched a few youtube videos on trimming the nail and have been getting along okay until my friends 4 year old kicked it and turned it black about a month ago. 

With your fertility procedures going on, are you set to hit the deductible anyway?

Both procedures were on the same toe (right big toe).   I recently had the big toe on my left do the same thing.  After the huge bills I had to pay I decided I would just buy a nice ingrown toe nail kit for $15.  I sterilized it in alcohol, cut down the side, and ripped it out by roots.  It was painful, but no where near $645 worth of painful! (not to mention leaving work 4 separate times and driving all the way out to an office).  I suppose I could have gone to a regular physician, but that is a pain in the ass too.  It's been a couple weeks since I did the self surgery and i've had no issues.  If/when I do have issues with it growing back (I can't destroy the matrix like the dr can, so i'm assuming it will regrow back at some point - hopefully not back into my flesh though) I will go to my primary dr.

The only fertility cost i've incurred has been for semen analysis, which is not covered by insurance at all.  The rest of the drugs/procedures fall to my wife.  The stuff that is covered is already covered (no requirement to meet deductible), and the stuff that isn't covered isn't covered at all regardless of the deductible. 

They have all been unexpected expenses (I do have some money set aside, but wasn't planning to use it).  I am really kicking myself for not fully funding our IRAs before I dumped money into a taxable account (I thought we would be able to slowly max our 401k/IRAs before the deadline in addition to the taxable account).  Now I may have to sell some shares out of the taxable account to fully fund my wife's IRA.  I am holding off on that because I may still be able to hit the max by the april deadline.

Bob W

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Re: My $645 ingrown toe nail
« Reply #3 on: November 07, 2014, 01:28:35 PM »
Rant Warning!!!!

Welcome to the sickness care industry in America!   In Japan you would have had better care and paid like $20 total including insurance.  No appointment would have been needed. 

I had an experience a few years ago.  Chest pain -- doctor calls nurse who wheels in portable EKG machine.   I ask "wait,  what does that cost?"  They look at each other blank --- "ummm?  we have no idea."   Me --- thanks,  I think I'll skip it.   

The fact that their business model includes no one knowing what a service costs is unbelievable.  Then you add that a CAT scan can cost $800 one place and $4000 down the street and it gets crazy. 

By the way,  in Japan a CAT scan costs about $75.  You can actually fly to Tokyo spend the week partying and still pay less than $4,000!

Why is that?  Why is medical care 7% of their GNP,  no appointments required for any doctor's office,  use it twice as much,  live longer,  more sophisticated equipment and better outcomes?  And the Japanese doctors get paid better while every person has private health insurance.  While ours sickness care industry will soon be 25% of our GNP.   Around twice as much as any other country. And now we are mandated to pay for it, even if we never use it.

Why the hell is that?

Yeah, yeah,  I know Bob,  "why don't you move to Japan then?"    Well apparently when I retire the working stiffs will pay for all my ACA premiums. 

forestbound

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Re: My $645 ingrown toe nail
« Reply #4 on: November 07, 2014, 01:50:23 PM »
Yikes! I understand your frustration. I wanted to have tubal ligation and wanted to know how much it cost before hand. No one COULD or WOULD tell me. I found this ridiculous. There was a great, must read TIME article by Steven Brill a few years ago. It was so enlightening, and maddening. I think it is must read for everyone who wants to comment on the American healthcare system.

http://time.com/198/bitter-pill-why-medical-bills-are-killing-us/

Hope your DIY toe surgery works. I wouldn't have the guts to do that to myself.

DoubleDown

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Re: My $645 ingrown toe nail
« Reply #5 on: November 07, 2014, 02:25:41 PM »
For the future: Tear off a tiny piece from a cotton ball, roll it into a little ball, and place it under the nail to gently lift it out from the painful/infected area. Once it's lifted out, your body can heal itself, and you can cut the nail yourself once the swelling and pain have gone down. Works wonders, heals completely on its own with no surgery, no drugs, no discomfort, and no $$$.

surfhb

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Re: My $645 ingrown toe nail
« Reply #6 on: November 07, 2014, 05:08:26 PM »
Pics?

scottish

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Re: My $645 ingrown toe nail
« Reply #7 on: November 07, 2014, 07:30:11 PM »
NNNNNOOOOOOOO!   Not the ingrown toenail pics!

Ingrown toenail treatment is free in Canada as well.    Our health care is just as good as Japan!  :-)

Hotstreak

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Re: My $645 ingrown toe nail
« Reply #8 on: November 07, 2014, 07:41:00 PM »
I'm sitting here laughing my ass off right now, Frugalnacho, because you're upset about your insurance, which has 1/3 the deductible and pays 10% more than the most premium plan my employer offers.  I would love to have a plan like yours!




I had physical therapy a few years ago, at about $90/appt.  They had some issues working with insurance.. and I called every month to see if the bill was due yet.  8 months later, yep, there it was in the mail.

jawisco

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Re: My $645 ingrown toe nail
« Reply #9 on: November 07, 2014, 08:30:14 PM »
For the future: Tear off a tiny piece from a cotton ball, roll it into a little ball, and place it under the nail to gently lift it out from the painful/infected area. Once it's lifted out, your body can heal itself, and you can cut the nail yourself once the swelling and pain have gone down. Works wonders, heals completely on its own with no surgery, no drugs, no discomfort, and no $$$.

+1.  I did this recently at it worked well.  I couldn't believe how easy it was (although it is a bit painful to put it under the nail the first time, but not even $25 painful).  You can find instructions online how to do this.

socaso

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Re: My $645 ingrown toe nail
« Reply #10 on: November 08, 2014, 05:54:03 PM »
I've noticed this change in pricing since Obamacare, too. I have to have yearly MRI's for a couple of years to monitor a condition. The first year was pre-Obamacare and I paid about $200 and insurance covered the rest. The next year, post Obamacare, I paid $500 and then received a further bill in the mail for about $200. I called them up. What's this for? I paid when the MRI was done. They told me that was the fee from the guy who has to read the MRI. I asked why didn't they just charge the whole charge all at once? They said that's not how they do it. I asked if there was ever a circumstance in which an MRI was taken that did not need to be examined. Nope. Then for god's sake, I implored, just charge the whole thing at once. Got nowhere with that, of course. My policy hasn't changed at all. I had open market insurance before and after Obamacare and made no changes to my policy.

Thegoblinchief

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Re: My $645 ingrown toe nail
« Reply #11 on: November 09, 2014, 06:01:36 AM »
I've started asking the "cash" price for things. In a lot of cases, it's well below the inflated price they bill to insurance, and cheaper than what gets back to me via deductible/copay.

This is particularly true in edge case fields where people often don't have insurance coverage. When I saw a chiropractor for something a while back, the cash price was $40 but they billed insurance something like $120.

frugalnacho

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Re: My $645 ingrown toe nail
« Reply #12 on: November 10, 2014, 07:43:21 AM »
For the future: Tear off a tiny piece from a cotton ball, roll it into a little ball, and place it under the nail to gently lift it out from the painful/infected area. Once it's lifted out, your body can heal itself, and you can cut the nail yourself once the swelling and pain have gone down. Works wonders, heals completely on its own with no surgery, no drugs, no discomfort, and no $$$.

I've tried those tricks, they don't always work 100%. 

I try to avoid surgery if at all possible, but an ingrown toe nail is painful, especially if the above tricks end up not working and it grows into my skin anyway.

Christiana

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Re: My $645 ingrown toe nail
« Reply #13 on: November 10, 2014, 08:39:52 AM »
Sometimes insurance companies don't send EOBs for care that they are paying 100% for.  Maybe that is what happened your first time around.

frugalnacho

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Re: My $645 ingrown toe nail
« Reply #14 on: November 10, 2014, 08:48:50 AM »
Sometimes insurance companies don't send EOBs for care that they are paying 100% for.  Maybe that is what happened your first time around.

Possibly.  Still doesn't explain why they paid exactly $125, but the office has no record of exactly that sized payment, which seems weird to me.

I've thought about it, and maybe she was reading what they charged and not actually what they received as payment?  I asked though, and she was clear that they did in fact receive those payments. 

Somehow it still doesn't add up to me.

Fodder

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Re: My $645 ingrown toe nail
« Reply #15 on: November 10, 2014, 08:54:38 AM »
It just boggles my mind how much time, money, effort/energy is spent on healthcare billing the US.

OP - I'm so sorry for all the drama you are going through.  The more people's accounts I read of the healthcare system in the US, the more confused I am.  It just seems so complicated.

Hope you get it all figured out.

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Re: My $645 ingrown toe nail
« Reply #16 on: November 10, 2014, 09:28:58 PM »
Yikes! I understand your frustration. I wanted to have tubal ligation and wanted to know how much it cost before hand. No one COULD or WOULD tell me. I found this ridiculous.
I'm in Australia, but about to have a salpingectomy for sterilisation purposes. No-one would see me for sterilisation publicly (I have no kids), hubby couldn't get a vasectomy (he has medical issues preventing it) so cue my private health insurance. As for finding out what I have to pay other than that, no success thus far. We know there's a $500 excess, we know there's a bit of gap to pay with the anesthetist and no gap with my surgeon or hospital. Can they put it down on paper as a quote? Good luck with that.

We're going ahead regardless (Thursday actually), because even if cost $5000 (which it won't), it would be less than the projected cost of alternative contraception (let alone the cost of a child!).



 

franklin w. dixon

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Re: My $645 ingrown toe nail
« Reply #17 on: November 10, 2014, 09:40:47 PM »
Welcome to America. Here's your hamburger, your Harley Davidson, and your medical bankruptcy.

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Re: My $645 ingrown toe nail
« Reply #18 on: November 11, 2014, 07:48:01 AM »
I've noticed this change in pricing since Obamacare, too. I have to have yearly MRI's for a couple of years to monitor a condition. The first year was pre-Obamacare and I paid about $200 and insurance covered the rest. The next year, post Obamacare, I paid $500 and then received a further bill in the mail for about $200. I called them up. What's this for? I paid when the MRI was done. They told me that was the fee from the guy who has to read the MRI. I asked why didn't they just charge the whole charge all at once? They said that's not how they do it. I asked if there was ever a circumstance in which an MRI was taken that did not need to be examined. Nope. Then for god's sake, I implored, just charge the whole thing at once. Got nowhere with that, of course. My policy hasn't changed at all. I had open market insurance before and after Obamacare and made no changes to my policy.

FYI, our system has been broken since way before the ACA. Maybe this shit wasn't happening to you, but it was definitely happening. Solid effort blaming Obama, though.

But yeah, to echo everyone else, I absolutely despise the opacity of healthcare pricing. Maybe the growing popularity of HDHPs will help fix it... I can only hope. And the thing where they take forever to bill you is weird, too. A few years ago I was in Houston for work for a couple months, and it happened to overlap with my yearly gyn appointment, so I went to some doctor I had never been to before. Literally a year and a half later I got a bill in the mail for my copay. At first I was suspicious because why wouldn't I have just paid the copay at the time of service? But I looked in Mint and I didn't see any record that I had paid it, so I figured they were probably right and just mailed a check (it wasn't that much, like $25). But a year and a half? Why the fuck?

chasesfish

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Re: My $645 ingrown toe nail
« Reply #19 on: November 12, 2014, 01:11:32 AM »
I have had a Dr cut those out twice, it really f-ing hurt between taking shots in the big toe and the bandages sticking to the raw cut out,  I bought this tool off amazon and it'll get under there and file the corner of the toenail and keep it from in growing:

http://www.amazon.com/Tweezerman-5200-r-Ingrown-Toenail-File/dp/B000WI1YC8

Much better than taking those damn shots in the toe!!  (And cheaper than a copay)

FiguringItOut

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Re: My $645 ingrown toe nail
« Reply #20 on: November 13, 2014, 09:18:46 AM »
I just had a mole on my face removed for $150.  Total time spend on the procedure 1.5 minutes, included an numbing injection, doc cutting the thing off with scalpel, and cauterizing the site.  This was on top of the $50 copay just to get into the office.

And taking two children to an ophthalmologist to get their eyes checked and get their prescriptions for glasses was another $200: $50 each copay plus $50 each was charge for actual Rx.  This doc office does not include Rx for glasses as part of their vision test visit.  Do not ask and do not comment on this.  This was stupid and I’m changing doctors for next time I need my kids checked.  As I have perfect vision I had no idea to ask for this and was shocked to find this out after the fact.  Live and learn.

eyePod

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Re: My $645 ingrown toe nail
« Reply #21 on: November 13, 2014, 09:57:18 AM »
Oh, want to hear my F-up? I "suffer" from migraines. I average about 2 a year, I'm out of commission for about 2 days, and then back to normal. During the migraine, I'm fine as long as I don't move much. Can sit there and play videogames instead of staying at work. No big deal, right?

Well, a few years back, i had one where I also had stroke like symptoms - couldn't find my words, over an hour of the aura, numbness in my fingers/arm. Well, I didn't do anything and i was fine in a few days just like normal. Now, about 2 months ago, I got two migraines within a week. This has never happened. #1 had some numbness (so this has happened twice ever now), and # 2 was really minor, only missed one day of work. On a separate note, my mom had a stroke at the age of 29, and I just turned 29. Hers was probably a complication of migraines+pregnancy.

Well, all of this bugged my wife and my mom, and they forced (not really) me to go to a specialist. They talked to me, said that changes do occur, but what the hell, get an MRI. I figured it was worth it since I could finally say to my wife/mom that I had no damage.

Got the MRI, perfectly fine, and I have a couple of doses of meds that should help if I get another migraine.

Bill comes in the mail for $400+.... WTF? Turns out that the MRI place that I got referred to was out of network.

For background info, I will go to the doctor once per year max, get to say no to all the scary questions and yes to all the good ones. I'm pretty healthy, active, and I dont' have any chronic issues. I HAVE NO IDEA HOW THIS MEDICAL WORLD WORKS.

Long story short, this was a good $400 lesson for me. What a dumbass.