He and his wife both got cataract surgery. His bill was 20 times higher than hers

[ck4829]

Last edited Tue Nov 22, 2022, 10:43 AM - Edit history (1)

Danilo Manimtim, who has a job evaluating disability claims for the state of California, knows the health care system and keeps tabs on his health benefits. He knew he already had met his health insurance deductible for the year, so he expected a manageable out-of-pocket expense for the surgery. He calculated his coinsurance would be about $750.

Then the bills came. ($4057)

Manimtim's big bill stems from a simple decision that turned out to be a pitfall in the nation's complicated health care system: He scheduled his surgery at a nearby hospital — a hospital that happened to charge about $7,000 more for the procedure than his insurer would pay.

Manimtim has proof that it could have been different right under his own roof: Four months later, his wife, Marilou Manimtim, 66, got the exact same procedure at an outpatient eye care surgical center in Fresno called EYE-Q. It is a half-mile from Saint Agnes Medical Center but is not affiliated with the hospital. (And she was billed $204)

https://www.wgbh.org/news/national-news/2022/06/27/he-and-his-wife-both-got-cataract-surgery-his-bill-was-20-times-higher-than-hers

[jimfields33]

1. Yeah definitely hospitals will charge more

Clinics were started to save time and money for patient and medical.

[RicROC]

2. I wonder if the wife had regular Medicare or Medicare Advantage?

My insurance broker keeps steering me away from regular Medicare and into Aetna Medicare Advantage. Although at this point, there has been no difference in my medical bills, I worry (and don't trust) about Aetna.

[Joinfortmill]

3. I have Aetna Advantage. Hospital bill 188k.

Yup, you read that right. I paid. 350 dollars. Procedure was for a brain aneurysm. Advantage plans are great. I think if you want some still experimental treatment you'll likely run into problems.

[SharonAnn]

5. Advantage plans can also take you to the cleaners, with no recourse.

You were lucky.

I would NEVER get an Advantage plan if I can have regular Medicare.

[Rebl2]

6. I know my

rheumatologist warned me not to get an advantage plan because they won’t pay for some of the medication I take. She said if I could stay on my husband’s federal insurance plan, that would be best for my situation.
My father in-law had Humana when he was alive. When he got cancer in his 70’s they limited his treatment. When it came to his macular degeneration they paid for everything. Saving his life-no. Treatment for eyesight-yes.

[Pinback]

4. Medigap (supplemental) plans vs. Medicare Advantage:

Consumer Reports has a helpful primer — https://www.consumerreports.org/medicare/pros-and-cons-of-medicare-advantage-a6834167849/