RE: medical bills -
Having had a very recent (still ongoing) issue with medical billing I'll relate my situation.
I had shoulder surgery (again)on 10/23. This go around was a "Superior Capsular Reconstruction with Allograft". That was what was discussed with the surgeon in his office when the surgery was scheduled.
In late November I Received a bill for $12,429.25, my insurance denied payment for the allograft because it was "not scientifically proven" for the condition. They kindly informed me that if I couldn't pay all at once I could make 12 easy payments of $1,035.77.
I went back and forth with the billing folks and was constantly told that they were "working with the nurses" to get this taken care of.
The insurance payout on the original $12,429.25 would have been probably about 50%-60% of the billed amount.I'm fairly certain that there would have still been a profit at that payout.
A week ago I contacted them again and was informed that they were going to grant me a 70% self pay discount. $3,728.77. I'm going to go out on a limb and bet that there is still profit in that figure.
During my review of records I pulled up the insurance company approval letter showing approval for "29806 Arthroscopy, shoulder, surgical; capsulorrhaphy". I had never encountered the term capsulorrhaphy prior to seeing it in the insurance document and the term was not used in the two previous shoulder surgeries I've had this year. I had to look it up. I also reviewed all the documents from the surgeon and nowhere is that term to be found. It is my suspicion that a coding error occurred and they either haven't figured that out or are unwilling to accept that they screwed up.
I suspect that my situation is not particularly rare and I doubt that I will resolve this in my favor and I will be stuck with the $3728.77 bill.
The total lack of transparency and a total lack of available information regarding pricing and costs of medical treatment is at best immoral. No other field demands customers agree to paying for a service up front with no idea of what the service will cost till after it is done. Of course I understand that there are situations where the unexpected is found mid-procedure but I doubt that is the overwhelming norm. That kind of crap is why we are going to end up with government run socialist style health care.