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Thu Jun 15, 2017, 10:21 AM

Health insurance question

I am very blessed to have great health insurance as I work for a school district. I am payroll and benefits manager but this is a personal concern.
6 weeks ago I took my husband to the ER with severe abdominal pain. He had a CT scan and later that afternoon had laparoscopic gall bladder surgery. He got 1 night in the hospital- semi-private room, regular floor not ICU.
We are self-insured with Aetna as administrator. Aetna was billed $65000 (!!!) by the hospital. That's just the hospital, not the surgeon or anesthesiologist. Those charges seemed reasonable. But $65000 for ONE NIGHT and an ER visit??? Of which my employer paid $27000! Since we're self-insured that's coming directly from my school and will certainly make our premium increase next year. What do they charge for a complicated illness with multiple days' stay??
I honestly think this is a mistake. Had an appendectomy 2 years ago (similar circumstances- ER visit, 1 night stay, same hospital - and I think Blue Cross (we had then) might have paid $5000.
Called Aetna and could not get a straight answer. Only "that's what they billed us, we paid our share and you owe $100." Like it wasn't my problem that my employer paid $27000.
Was this a mistake? Or is the list price for 1 night in the hospital really $65000??!

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Response to Freddie (Original post)

Thu Jun 15, 2017, 10:32 AM

1. Make sure your insurance was applied...usually there is an agreement with the hospital

I had a 25,000 bill but it went down to less than 1000 after all was said and done.

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Response to Demsrule86 (Reply #1)

Thu Jun 15, 2017, 10:37 AM

2. Aetna said it was

They already paid the $27000. The hospital is in-network. Just doesn't seem right for one night and an ER visit for a pretty routine thing.

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Response to Freddie (Reply #2)

Thu Jun 15, 2017, 10:43 AM

4. It seems high...and are you sure Aetna paid that amount?

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Response to Freddie (Reply #2)

Thu Jun 15, 2017, 10:45 AM

5. If you had an appendectomy that is not out of line...I missed that.

I spend five days in hospital in September for a blockage/no surgery...and the bill was $25,000 before the insurance company discount.

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Response to Freddie (Original post)

Thu Jun 15, 2017, 10:43 AM

3. I'll guarantee you BCBS paid a lot more than $5000 for that appendectomy.

And, depending on where you are, the bill that you're seeing from the hospital is probably their going rate. And based on that, the $27,000 payment is probably within Aetna's contractual agreement with the hospital. You could try asking the hospital for an itemized bill and see what, exactly, they're billing for.

Helps to understand why insurance is so expensive, doesn't it?

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Response to Freddie (Original post)

Thu Jun 15, 2017, 10:54 AM

6. I don't know if this is a state plan

or a school district plan. If the later, and your the benefits manager, call your rep at aetna (not the customer service line) and ask why aenta's prices are so far out of line with BC/BS. If they don't fix the problem, send out a bid and switch if needed.

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Response to Freddie (Original post)

Thu Jun 15, 2017, 11:02 AM

7. Some thoughts

 

The overall bill can be broken down into 3 parts, keep in mind sometimes a hospital bill will include the surgeon,anesthesiologist and any additional specialist fees:

1. The cost of the ER visit, which would include the ER doctor and any tests
2. The CT Scan, which may include a fee to interpret it
3. The room and board itself, which is probably at least $3000 a day

On top of all the above, high cost drugs and some other non-standard high priced items or tests may not be included in the room and board rate.

So if the surgeon & anesthesiologist fees were included in the hospital bill and because laparoscopic gall bladder surgery costs more then the more conventional gall bladder surgery, $27,000 for the entire bill, while high doesn't not seem outside the normal range.

A relative covered under Medicare went in for a very similar surgery, admitted through the ER & stayed for 5 day, the hospital billed $65,000 and the Medicare contracted rate was either $52,000 or $55,000.

If your health insurance company is ok with the bill, then the hospital probably did not bill anything unusual.

On edit: As an aside, in general hospitals located in major cities cost more.

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Response to Freddie (Original post)

Thu Jun 15, 2017, 11:02 AM

8. I checked into the hospital last August and the bill was $29,000 for 4 days and nights.

I ended up paying $4,000 (or $1,000 a day) out of pocket.. I was in such severe pain for so long I had to check myself in. They couldn't figure out what was wrong and they had to run a lot of tests on various organs. I could've gotten released 1 day earlier but the "specialists" didn't have the 20 min to see me. I found out I have a rare disease and no cure, only surgeries for the rest of my life to reduce the pain that will get worse until I die. No amount of meds can help the pain. 3/4 of my pancreas is scar tissue and can't be repaired. My meds are over $1,000 a month out of pocket with ACA. Unbelievable! As a teacher I didn't make much but I saved as much as I could (never got new clothes, never went "out", cooked at home, no entertainment, no vacations, cut my own hair, etc.) To think that 1 day cost $1,000 and how much I had sacrificed for years I was rightfully pissed off. I saved for emergencies but this was not what I had imagined I would end up spending it on nor the fact that it would be gone so quickly. The doctors have no concept of money and don't take your serious financial problems as a factor when they treat you. The whole system is a giant scam. The ACA has problems that can be easily fixed without being repealed. They should regulate hospital and drug costs as well as have single payer. I will lose my home to pay for future bills and I don't want my family burdened by my health costs.
Two years ago I heard of an exchange student from Norway (I think) and he was bitten by a poisonous snake. His bill was $250,000! He couldn't believe the rip off system we have here. Fortunately for him, he had bought extra travelers insurance and that saved him.
I don't know if this helps. My mother and a friend go through their hospital bills with a fine toothed comb and they often find errors like getting charged for the wrong stuff or being billed twice. It takes a lot of time and patience.
As a teacher I gave up their retiree medical insur since the ACA with subsidies was cheaper. I never would've guessed that the ACA would be in jeopardy. Now I can't get school insurance back so now I am screwed!
Good luck with your situation.

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Response to BigmanPigman (Reply #8)

Thu Jun 15, 2017, 11:20 AM

9. Stinks that you can't go back on COBRA

Since they're screwing with the ACA. So many retirees at my district did not take COBRA since they could get a good plan on the ACA. PA has Act 110 which allows retirees to buy insurance (at their expense) from their district til age 65 without the usual COBRA time limit.
Went into the Explanation of Benefits and found the complicating factor which makes this seem a bit more reasonable. DH had a small umbilical hernia repaired at the same time. He didn't know he had it and the surgeon said "why not fix it while I'm in there." The hospital bill was for 2 separate surgeries! Which I suppose was in their right to do.

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Response to Freddie (Original post)

Thu Jun 15, 2017, 12:12 PM

10. List prices are always high.

When I was uninsured the receptionist/bookkeeper at the doctor's office said they at best broke even on Medicaid patients. Debt retirement, improvements, subsidies for the Medicaid patients that didn't count as "at best" came from private insurance and the uninsured.

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