Gastro-Intestinal Help

hyo silver · Jun 28, 2006

I had no idea these tests and procedures were so expensive. If I'd had to pay for everything I've had done, I'd be dead from overwork. Health coverage of $100 a month for a family of four looks pretty cheap.

heliotropehead · Jun 28, 2006

<div class='quotetop'>QUOTE(hyo silver @ Jun 28 2006, 12:28 PM) [snapback]278113[/snapback]</div>

I had no idea these tests and procedures were so expensive. If I'd had to pay for everything I've had done, I'd be dead from overwork. Health coverage of $100 a month for a family of four looks pretty cheap.
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$100/month for a family of four?! What we were offered is 4 times that! I had coverage in Louisiana, but lost it with my job after the hurricane. My employer paid for both of us. At our current jobs, it's offered but we would have to pay $400 for just the 2 of us. Right now that's just not an option. Needless to say, I've recently started job hunting again.

I now have another appt. scheduled with a FP doctor. According to the nurse, the office visit will run me between $150-$600 depending on what the doctor has to do. :blink:

Marlin · Jun 28, 2006

<div class='quotetop'>QUOTE(hyo silver @ Jun 28 2006, 01:28 PM) [snapback]278113[/snapback]</div>

I had no idea these tests and procedures were so expensive. [/b]
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But they really aren't that expensive, they just charge a lot.

Case in point... I just recently got a statement from insurance company that lists the benefits they paid out last month. Included in that were a bunch of tests, mainly chorestorol and such. The statement lists for each test what the doctor charged and what the insurance company allows for each test. In order to particpate in the network, the doctors have to agree to the insurance company's prices. So even if the doctor charges more than the insurance company's allowance for a test or procedure, they must take as full payment the insurance company's allowance.

That recent statement showed that the doctor charged nearly $600, and the insurance company paid him $84, and that the $84 was to be considered full payment and that I was not responsible for the difference.

So, either the doctor is losing money every time I walk in the door, or he is charging a 700% markup.

efusco · Jun 28, 2006

<div class='quotetop'>QUOTE(Marlin @ Jun 28 2006, 12:59 PM) [snapback]278129[/snapback]</div>

But they really aren't that expensive, they just charge a lot.

Case in point... I just recently got a statement from insurance company that lists the benefits they paid out last month. Included in that were a bunch of tests, mainly chorestorol and such. The statement lists for each test what the doctor charged and what the insurance company allows for each test. In order to particpate in the network, the doctors have to agree to the insurance company's prices. So even if the doctor charges more than the insurance company's allowance for a test or procedure, they must take as full payment the insurance company's allowance.

That recent statement showed that the doctor charged nearly $600, and the insurance company paid him $84, and that the $84 was to be considered full payment and that I was not responsible for the difference.

So, either the doctor is losing money every time I walk in the door, or he is charging a 700% markup. [/b]
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At $84/visit the doctor is indeed, in all likelyhood, losing money. They lose money with Medicaid in most states as well. Overhead alone would likely not be covered by that $84. But, of course, the profits are going to be made up elsewhere. Other payers, profits in lab tests and procedures, etc. And, of course, in mark-ups paid by self-pay patients and those with higher paying insurance. More than likely the contract price paid to your doctor was negotiated by the insurance company and he gains some other benefit that balances the difference.

But yea, medical stuff is expensive. And, to be honest, $400/mo for major medical coverage, if it's decent coverage, is pretty cheap. I'm not privy to your financial situation, but it's an expense that can be well worth it. If you do have gall bladder disease and need lab work, an ultrasound, a surgury referal, then surgery--even if it's an out patient procedure, by the time you pay all the doctors (FP, surgeon, radiologist, anesthesiologist), OR fees, lab fees, pathology fees, medications (which shouldn't be much), and figure in time lost from work even with an out patient laproscopic procedure and no hospital bill you're talking about $7-10K+...that makes that $5000/year seem pretty small. Also, one bad slip and fall with a broken bone can leave you in a heck of a lurch.

Not trying to scare you, but sometimes that $400 seems like a lot, but one $5 Latte a day is $150/mo, a couple nights out at a restraunt can easily add up to a couple hundred bucks, and your health is not only an immediate expense, but a dent in your ability to make a living should you be out of work due to extended illness or injury. Please, I don't mean to lecture, but sometimes putting numbers on paper gives a different perspective to the situation.

Marlin · Jun 28, 2006

<div class='quotetop'>QUOTE(efusco @ Jun 28 2006, 02:37 PM) [snapback]278146[/snapback]</div>

At $84/visit the doctor is indeed, in all likelyhood, losing money. They lose money with Medicaid in most states as well. Overhead alone would likely not be covered by that $84. But, of course, the profits are going to be made up elsewhere. Other payers, profits in lab tests and procedures, etc. And, of course, in mark-ups paid by self-pay patients and those with higher paying insurance. More than likely the contract price paid to your doctor was negotiated by the insurance company and he gains some other benefit that balances the difference.[/b]
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Yeah, but this was for the lab tests, which this doctor's office handles themselves. They might send the actual blood samples out to a lab, but they draw the blood and handle the collection of payment themselves. This is unlike my previous doctor, who would send me to an external lab to have the tests done.

So, if they were losing money on these tests, then surely they would look at my chart, see what my insurance is, and send me to an external lab for the tests, instead of sending me 15 feet across their office to the room where their nurse draws my blood.

DaveinOlyWA · Jun 28, 2006

i had my blood work done and it cost $545 for the lab. then $125 for the doctors visit. generally lab bills can take up to 3 months to bill. you may be getting something else in the mail in a few months.

Oxo · Jun 28, 2006

<div class='quotetop'>QUOTE(heliotropehead @ Jun 26 2006, 02:13 PM) [snapback]276940[/snapback]</div>

I've been suffering with this for a while now,... I'm at wit's end so any thoughts, suggestions are much appreciated.
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When I first saw this post I thought it was misguided and would not have many replies but it's all turned out to be interesting to me as a foreigner. I've been trying to work out what some of the abbreviations mean, and their equivalent here. I assume that FP means family practitioner - or what we would call a GP here, general practitioner. Gut 'GI' puzzles me. I take this to mean what we would call a specialist or a consultant. Here few would think of going to a specialist before they had consulted their GP. And anyone born here in the last 60 years or so would be registered with a GP (or a group of GPs) from birth, although you are not obliged to stick with the same GP if you find you have no confidence in him/her, or rapport.

Finally I send my best wishes to heliotropehead. I hope he'll feel more settled and in better spirits when he's been given advice by an expert.

hyo silver · Jun 28, 2006

Not to hijack Heliotropehead's thread, but these costs and coverage issues are new to me. What would be the percentage of Americans with no medical insurance? What would happen to someone without coverage in an emergency?

DaveinOlyWA · Jun 28, 2006

i have supplemental insurance, no primary. i had a colonscopy last year and my cost was about half @ $900.

about a third of americans have no or insufficient coverage. i fall in the latter

Salsawonder · Jun 28, 2006

In this instance it is best to be poor enough to get Medicaid/MediCal and even then it can be difficult to find an MD who will take new cases.

I am so thankful for an employer that aggressively searches for the best insurance deals and coverage. I pay $35 a month for coverage that has $20 co-pay for office visits, $20 generic and $40 non-generic. We even struggle to adjust shifts so the line staff can get benefits if they work 32h/wk. Benefits are a huge determining factor in job searches for many these days and difficult for most employers to offer.

efusco · Jun 28, 2006

GI=GastroIntestinal--an old abreviation for what we now call Gastroenterologists.

FP=Family Practician/physician. These are specialists in Family medicine who've completed a 3 year residency and are consider more qualified. They are boarded in their specialty--you may see FAAFP after their "MD" to indicated their board certification.

GP=General Practitioner--no post medical graduate training is required to call oneself a GP. Some are good, but you have no guarantees of their skill/training.

Sorry Marlin, you're right in that the cost of tests is a far different thing that the billed rate. More than likely the physician did make a small profit on the tests alone. I didn't realize that that was all you were refering to.

galaxee · Jun 28, 2006

<div class='quotetop'>QUOTE(efusco @ Jun 28 2006, 02:37 PM) [snapback]278146[/snapback]</div>

...your health is not only an immediate expense, but a dent in your ability to make a living should you be out of work due to extended illness or injury.
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that is the strongest argument you can find for health insurance...

and i can speak from experience, this alone makes insurance worth having. like i said, we have experienced a loss of income due to illness recently, and simultaneoulsy had to come up with lots of insurance copays/stuff to meet the deductible, etc. however, looking back, without the insurance i think the bills would be near $10k now after everything. losing out on ability to work and getting stuck with that kind of medical bill is a real double whammy that would send most spiraling into serious debt. our $1700ish out of pocket doesn't seem like much in comparison to that.

i agree that seeing the FP is the best way to start out. i've had my dealings with the medical community years ago and what i learned is to see what the broad-spectrum-of-experience doctor thinks before going to someone with more narrow vision, so to speak. (no offense to you specialists out there)

best wishes

Jeannie · Jun 28, 2006

<div class='quotetop'>QUOTE(galaxee @ Jun 28 2006, 05:58 PM) [snapback]278255[/snapback]</div>

that is the strongest argument you can find for health insurance...

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I noticed you were the last poster in this thread, Galaxee, and just imagined you asking the DH to check the service bulletins <g>

I agree with you. I've been without ANY insurance since getting laid off 3 years ago, working now as a 'temp' and hoping it turns into employment with BENEFITS. My 2005 medical expenses on my 1040 were higher than my income!

Starbug · Jun 28, 2006

Unfortunately, I fall into the catagory of being without insurance. My family can't afford it. My mother hasn't worked in years (was a stay-at-home-mom, now nurses my dieing father), I don't make enough to have it (i can bearly afford my car payments & gas), and my father can nolonger work because of the cancer. We USED to have insurence many years ago, but my father dropped it because it was so expensive (I don't honestly know how much it was, but he's always been extremely cheap, so it may not have actually been much). So now in our current predicament, we are screwed. His cancer bills will cost us $200,000+ by the end of the year, his funeral will cost a lot (I think I once heard they cost around $10k?), and we still have to find a way to pay our car/water & electric/house mortgage/& food bills on top of his climbing medical bills.

So yeah, anyone who can get insurence should; because you never know when life will smack you upside the head with some emergency.

hdrygas · Jun 28, 2006

<div class='quotetop'>QUOTE(efusco @ Jun 28 2006, 06:43 AM) [snapback]278005[/snapback]</div>

I'm going to reiterate my suggestion to NOT cut out the "middle man". An FP takes a much broader and open minded view of your symptoms and is less likely to start with expensive and invasive testing that may or may not lead to a diagnosis and cure. Right now your differential diagnosis--the variety of possible causes of your symptoms--is very broad. Although it seems to you that this is a purely GI problem, and in all likelyhood you're right, without someone taking a thorough history, doing a good exam and recommending appropriate treatment and referals it is very easy to end up going down an entirely wrong and expensive path.

I can assure you that the GI will, in all likelyhood, recommend an EGD (endoscopy of the upper GI tract). Minimum cost for the procedure including physician fees, equipment, drugs, lab testing, and pathology will far exceed $1000. If that doesn't fix the problem further testing will be incured. In my mind a GI is more likely to prescribe an expensive Proton pump inhibitor for GERD symptoms, many FPs will also, but your chances of them prescribing an inexpensive H2 blocker that will likely work just as well is much higher.

I think you will ultimately save money, have a better chance at an accurate diagnosis, and will have an established relationship with an primary care physician with whom you can see for life's other minor illnesses as they crop up. Getting in to see a PCP is generally much easier and faster than with a specialist once you're established and will definately save you money over coming to the ER--your only other realistic alternative when you're down-and-out with a stomach flu or sinus infection or something like that.

In any case, I'm glad you're persuing a diagnosis and hopefully the GI doc you're seeing is a good internist as well and won't over study/over treat you or be too narrow in his focus for a diagnosis.
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OK I was a bit flip with my previous reply but Efusco makes sense. Also you need to have a Family Doctor, PCP (primary care provider), general practitioner, general internists, what ever, to coordinate, collate and keep track of all of us specialists. All of us have tunnel vision. Unless you are in a group model HMO your "chart" i.e. medical record is spread all over hells half acre. No one has all of it. In this day and age I would request, assertively, and with respect, a copy of every encounter you have. Yes that means everywhere, and keep it with you. A good medical history and information is invaluable. Until such time as we have a universal medical record this is a critical thing that you can do to protect yourself.

daniel · Jun 29, 2006

I think Evan is right: Start with a GP. A specialist thinks within his speciality, and is accostomed to seeing people who have been refered to him after possible diagnoses outside his specialty have been ruled out. A GP is more likely to start you off on the right track.

Mystery Squid · Jun 29, 2006

<div class='quotetop'>QUOTE(Salsawonder @ Jun 28 2006, 04:18 PM) [snapback]278191[/snapback]</div>

In this instance it is best to be poor enough to get Medicaid/MediCal and even then it can be difficult to find an MD who will take new cases.

I am so thankful for an employer that aggressively searches for the best insurance deals and coverage. I pay $35 a month for coverage that has $20 co-pay for office visits, $20 generic and $40 non-generic. We even struggle to adjust shifts so the line staff can get benefits if they work 32h/wk. Benefits are a huge determining factor in job searches for many these days and difficult for most employers to offer.
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that's right...

'cause the governing body of the AMA in conjunction with other forces from the acadamia regime, have intentionally manipulated the MD market over the years, so to speak...

...actually, it's almost an exact reflection of the oil industry come to think of it... 9 billion dollar quarterly profit has got to be generated somewhere, just like Dr. salaries in the US.... h34r: of course frivolous lawsuits don't help, but that's another tirade, and more smoke in mirrors... pay no attention to the man behind the curtain indeed...

<div class='quotetop'>QUOTE(hyo silver @ Jun 28 2006, 03:16 PM) [snapback]278166[/snapback]</div>

Not to hijack Heliotropehead's thread, but these costs and coverage issues are new to me. What would be the percentage of Americans with no medical insurance? What would happen to someone without coverage in an emergency?
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the two best things to do:

1. don't get sick.

2. if you do prepare in advance, shield, or get rid of all your assets at least 5 years prior to a major illness.

of course, if you don't prepare, give everyone the finger and pull a chapt. 7..., at least, that's what I'd do...

<div class='quotetop'>QUOTE(hyo silver @ Jun 28 2006, 01:28 PM) [snapback]278113[/snapback]</div>

I had no idea these tests and procedures were so expensive.
[/b]
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yeah, and you'll never see actual "prices", rather "codes" the average layperson cannot reasonably decipher... smoke in mirrors... hell the OIL INDUSTRY is more transparent than the healthcare system in this country... :lol:

SteveS · Jun 30, 2006

<div class='quotetop'>QUOTE(Mystery Squid @ Jun 29 2006, 11:47 PM) [snapback]278943[/snapback]</div>

that's right...

'cause the governing body of the AMA in conjunction with other forces from the acadamia regime, have intentionally manipulated the MD market over the years, so to speak...

...actually, it's almost an exact reflection of the oil industry come to think of it... 9 billion dollar quarterly profit has got to be generated somewhere, just like Dr. salaries in the US.... h34r: of course frivolous lawsuits don't help, but that's another tirade, and more smoke in mirrors... pay no attention to the man behind the curtain indeed...
the two best things to do:

1. don't get sick.

2. if you do prepare in advance, shield, or get rid of all your assets at least 5 years prior to a major illness.
of course, if you don't prepare, give everyone the finger and pull a chapt. 7..., at least, that's what I'd do...
yeah, and you'll never see actual "prices", rather "codes" the average layperson cannot reasonably decipher... smoke in mirrors... hell the OIL INDUSTRY is more transparent than the healthcare system in this country... :lol:
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still nothing compared to the insurance industry...

by the way... i have ulcerative colitis... so I can sympathize with the OP's predicament...

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