Upcoming Surgery - advice on bill/cost scrutinizing needed

[Rollin]

I get checkups every year (including skin care at the dermatologist since with are outside a lot in FLA), but it has been 35 years since I've needed any extra/expensive medical attention.  I'm planning some surgery in December and want to approach it in the most cost effective way possible.  I do not want to be surprised (or shocked) when I get the bill.  So, is there such a thing as a medical bill consultant, like you can hire for car insurance/accident claims?

I'm already planning on having the surgery in 2015, which will help because me and the DW have already had a couple of items added onto or deductible.  I get a $1,200 HSA payment each year and can pay some of the bill when it comes in 2016 with the $1,200 from 2015 and some from the $1,200 for 2016.

Also, I'm planning this surgery pre-FIRE (lower deductible) since I'll be on ACA with a high deductible next year.

[Thegoblinchief]

Many/most hospitals should be able to give you a treatment proposal with dollar amounts. You can then call your insurance and find out what your net cost will be, at least approximately.

Other than that, you'd need to doctor shop to see if other hospital systems (or international) are cheaper.

[Gone Fishing]

Not sure of the procedure but if you will need crutches/walker afterwards, bring your own.  Also see if local anesthesia is an option vs general.  Once you get the final (post insurance) bill, call the hospital and see if you can negotiate them down by paying all at once, or get an interest free payment plan.  Good luck!   

[2ndTimer]

If the surgery requires you to stay over night take your own personal care stuff, slippers etc.  Every bit of that stuff gets charged to your account.  So avoid a $15 toothbrush by bringing your own.

[Retired To Win]

I get checkups every year (including skin care at the dermatologist since with are outside a lot in FLA), but it has been 35 years since I've needed any extra/expensive medical attention.  I'm planning some surgery in December and want to approach it in the most cost effective way possible.  I do not want to be surprised (or shocked) when I get the bill.  So, is there such a thing as a medical bill consultant, like you can hire for car insurance/accident claims?

I'm already planning on having the surgery in 2015, which will help because me and the DW have already had a couple of items added onto or deductible.  I get a $1,200 HSA payment each year and can pay some of the bill when it comes in 2016 with the $1,200 from 2015 and some from the $1,200 for 2016.

Also, I'm planning this surgery pre-FIRE (lower deductible) since I'll be on ACA with a high deductible next year.

Make absolutely sure in advance that your insurance does cover your procedure, in your situation.  If it does not, still make sure that you list your insurance in your pre-procedure paperwork, and that the bill is submitted to the insurance company... even if you know if will not be covered.

And here's why.

The bill the hospital submits to the insurance company will be at negotiated insurance company rates.  But, if and when the insurance company spits back the claim, there's a good chance -- a very good chance -- that the hospital will then rebill you at retail rates.  Not good.  So you'll need to have the insurance company paperwork that shows what the hospital billed it in order to be able to defend yourself against the superinflated bill you would get in these circumstances.

(Yes, I'm talking from personal experience.  Thank goodness I had the hospital bill processed through the insurance company, even if my procedure was not covered under the policy's terms.)

[Rollin]

Thank you all for the replies.  I have already done some estimating on my insurance company's website and will open up a conversation with the doctor too.  I have a relative that broke many bones falling off a roof and the bill was $70,000 (no insurance) and he negotiated payments at no interest and also got the bill down to $40,000.

Mine is for laproscopic hernia repair if that makes any difference.  My insurance provider gives the rates of various doctors in the area for the overall cost (very much the same), but I feel as though there are a lot of extra high costs that go into that and I'd like to avoid (like $15 tooth brushes!).

[ShaneD]

As part of the precautionary prep:

Keep a small notebook and pen with you while in the hospital, and note down as best as you can everyone you interact with at the hospital. If you're feeling too drugged to write, ask the person -- or whatever nurse or assistant might be with them -- to write their name and position down for you. You want to be able to keep track of who actually operated on or touched you or reviewed something for you so later you can check the bill to make sure no one extra appears. In my own case, hospital tried to charge me an extra $10,000ish for an anesthesiologist that never showed up and another few thousand for a doctor who never came to see me. It helped my case that I had notes (including in some hospital staff's writing) to show both were bunk.

Do the same (as best you can) with what meds you take during your stay. Along the $15 toothpaste lines, I was charged $45 for ONE aspirin that I never was prescribed, received, or took.

If you're heavily drugged, the above isn't easy, but do the best you can. If you have someone who can stay with you for periods and do the note-taking, that's also helpful.

[forummm]

Also make sure that only people in your insurance network will be involved in your care. Those that are out of network can bill you personally for insane thousands of dollars and it's not covered by your insurance out of pocket maximum. Even if the hospital is in network the doctors at the hospital could be out of network.

[Thegoblinchief]

Also make sure that only people in your insurance network will be involved in your care. Those that are out of network can bill you personally for insane thousands of dollars and it's not covered by your insurance out of pocket maximum. Even if the hospital is in network the doctors at the hospital could be out of network.

I'll +1 that. I've read a few horror stories involving just that (in network hospital, out of network doctor) around here.

[Rollin]

The doctor is in-network for sure, but the others I do not know yet and will surely find out.  I plan on having a talk (appointment) with the doctor's staff about all this and let them know that I am looking to make this as efficient as possible.  In other swords I do not plan on just letting things fall where they might and let the insurance take care of it.  At a $2,800 deductible and 80%/20% after that it can still add up to quite a lot.  Also, I'm real close to FIRE (4/16/16) so I am watching things very closely.