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Thu Dec 26, 2019, 01:40 PM

For Her Head Cold, Insurer Coughed Up $25,865




Alexa Kasdan had a cold and a sore throat.

The 40-year-old public policy consultant from Brooklyn, N.Y., didn't want her upcoming vacation trip ruined by strep throat. So after it had lingered for more than a week, she decided to get it checked out. Kasdan visited her primary care physician, Roya Fathollahi, at Manhattan Specialty Care, just off Park Avenue South and not far from tony Gramercy Park.

The visit was quick. Kasdan got her throat swabbed, gave a tube of blood and was sent out the door with a prescription for antibiotics. She soon felt better, and the trip went off without a hitch. Then the bill came.

... When Kasdan got back from the overseas trip, she says there were "several messages on my phone, and I have an email from the billing department at Dr. Fathollahi's office." The news was that her insurance company was mailing her family a check for more than $25,000 to cover some out-of-network lab tests. The actual bill was $28,395.50, but the doctor's office said it would waive her portion of the bill: $2,530.26.

...The third reason for the high bill may be the connection between the lab and Kasdan's doctor. Kasdan's bill shows that the lab service was provided by Manhattan Gastroenterology, which has the same phone number and locations as her doctor's office.

...New York state has a law to protect patients from surprise bills. The law requires doctors' offices to warn patients in advance that they are using an out-of-network provider and that patients may be responsible for excess charges. If a patient doesn't consent to the involvement of an out-of-network doctor, then the patient must be held financially harmless from the bill. But it doesn't prevent an out-of-network provider from sending a bill or collecting from an insurer. Kasdan says she was not told that the throat swab was being sent out of network at the time of her appointment, though it's possible one of the many papers she signed included a broad caveat that some services might not be in network...

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Reply For Her Head Cold, Insurer Coughed Up $25,865 (Original post)
BeyondGeography Dec 2019 OP
sandensea Dec 2019 #1
shanti Dec 2019 #2
sandensea Dec 2019 #3
Quemado Dec 2019 #6
sandensea Dec 2019 #7
Hekate Dec 2019 #4
Hermit-The-Prog Dec 2019 #8
ck4829 Dec 2019 #10
Recursion Dec 2019 #5
area51 Dec 2019 #9
Recursion Dec 2019 #11

Response to BeyondGeography (Original post)

Thu Dec 26, 2019, 01:48 PM

1. Health care in this country has become a racket

Like so many other things.

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Response to sandensea (Reply #1)

Thu Dec 26, 2019, 01:52 PM

2. And the doctors own a large chunk of it

so they'll never give it up willingly.

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Response to shanti (Reply #2)

Thu Dec 26, 2019, 01:59 PM

3. Someone's got to pay for their wives plastic surgery and their kids' drug rehab

Those are taken care of by other doctors, so they don't come cheap.

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Response to sandensea (Reply #1)

Thu Dec 26, 2019, 03:49 PM

6. Bingo!

I audited the health care industry for 15 years. You are correct - the industry is a racket. Money and profit have a higher priority than patient care.

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Response to Quemado (Reply #6)

Thu Dec 26, 2019, 04:11 PM

7. Here's hoping that changes someday

And soon!

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Response to BeyondGeography (Original post)

Thu Dec 26, 2019, 02:11 PM

4. I will say it again: if health insurance companies gave a damn about how they disburse their money

...they would be in collective revolt against overcharging by labs, suppliers, and hospitals. They have the clout -- we do not.

I've been using a CPAP for 15 years. In the first few years, I received invoices along with the supplies, paperwork that showed the amount being charged to Blue Cross. It was stunning. I wish I'd saved some, because while there was no cost to us at that time, someone somewhere thought a length of plastic hose was worth $60+ dollars, and a bit of foam filter 1/2 inch by 1 inch was worth $15.

Behind the scenes, Blue Cross might have been negotiating a more reasonable price, or maybe it was just a case of one hand washing the other. But what if we'd had no insurance?

It's beyond disgusting.

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Response to Hekate (Reply #4)

Thu Dec 26, 2019, 06:23 PM

8. somebody has to pay for all the pretty buildings ...

Last edited Thu Dec 26, 2019, 08:41 PM - Edit history (1)

Here's just one


Try counting the number of insurance company skyscrapers. Add in executive mansions, summer retreats, winter retreats, jets to get from one to the other, and little perks.

The cost of health care is not much. It's all the overhead we buy.

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Response to Hekate (Reply #4)

Fri Dec 27, 2019, 03:56 AM

10. Oh we have clout

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Response to BeyondGeography (Original post)

Thu Dec 26, 2019, 02:15 PM

5. The problem in US health care is price discovery

We don't have it, and we need it.

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Response to BeyondGeography (Original post)

Thu Dec 26, 2019, 10:18 PM

9. The only reason we have this in/out of network BS is the insurance cos.,

which started this BS to "negotiate better prices". Yeah, we all see how well they "negotiate".

We need comprehensive Medicare for All/Single-payer now.



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Response to area51 (Reply #9)

Fri Dec 27, 2019, 04:28 AM

11. Are you going to require doctors to accept that Medicare?

They aren't required to now. Many don't. If it's not legally required -- for that matter if it's not legally forbidden to surplus charge or insure privately -- you're still going to have in and out of network problems.

The political problem with this is that when you talk about outlawing private insurance, public support drops to about 25%.

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