[MaximusB]

Move to Canada

[bbbbmw]

Originally Posted by MaximusB

Move to Canada

You'd still be waiting for that MRI....

[bbbbmw]

An MRI is almost always pre-approved - the provider calls your insurance and figures out:

- what the procedure will cost,
- what discount has been pre-negotiated by your insurance,
- what the net balance will be that you will owe.

That's the paper you got. Yes, it's an estimate, but it needs to be within a reasonable range. They collected it up front, so you should be off the hook.

For this to happen, the provider has likely billed it incorrectly to the insurance company. Consider:

1. Call your insurance company and ask them to review the claim. If it's a coding error, they can likely spot the error right off the bat, and give you some idea of the error. You then call the provider and tell them to re-bill it correctly. The provider has usually 60-90 days to do this.

2. If it's correct, then call the provider and tell them you paid according to a reasonable estimate that you were given. You can see a 10% variance, but not 250% - tell them you will pay another $69.00 max. Do this before it gets turned to collection.

3. Call the doc directly and explain what happened. You should also get a survey, which is very important to them. There's also rating on healthgrades.com.

4. Call your insurance company if they don't resolve this, and ask them to intervene. You can also file an appeal with your insurance, to have it formally reviewed.

This is what I'd do if I were you and I'm speaking on a personal level of what I solely would do and not giving any financial/legal advice.

[MaximusB]

Originally Posted by bbbbmw

You'd still be waiting for that MRI....

Good point... But many years ago I dislocated my shoulder for the 4th time playing hockey and my family doctor booked two separate appointments for me. One was for MRI and the other was to see a specialist/orthopaedic. Long story short, I had my shoulder surgery 4 months after my initial visit to my family doctor, before I even got my MRI date. But hey, I paid a total of $12 on a shoulder brace for post op recovery

[dreamingat30fps]

Originally Posted by bbbbmw

An MRI is almost always pre-approved - the provider calls your insurance and figures out:

- what the procedure will cost,
- what discount has been pre-negotiated by your insurance,
- what the net balance will be that you will owe.

That's the paper you got. Yes, it's an estimate, but it needs to be within a reasonable range. They collected it up front, so you should be off the hook.

For this to happen, the provider has likely billed it incorrectly to the insurance company. Consider:

1. Call your insurance company and ask them to review the claim. If it's a coding error, they can likely spot the error right off the bat, and give you some idea of the error. You then call the provider and tell them to re-bill it correctly. The provider has usually 60-90 days to do this.

2. If it's correct, then call the provider and tell them you paid according to a reasonable estimate that you were given. You can see a 10% variance, but not 250% - tell them you will pay another $69.00 max. Do this before it gets turned to collection.

3. Call the doc directly and explain what happened. You should also get a survey, which is very important to them. There's also rating on healthgrades.com.

4. Call your insurance company if they don't resolve this, and ask them to intervene. You can also file an appeal with your insurance, to have it formally reviewed.

This is what I'd do if I were you and I'm speaking on a personal level of what I solely would do and not giving any financial/legal advice.

What I found interesting is I noticed the paper only lists one thing although I had MRI and EKG. I signed no other paper. On the insurance side it shows both procedures, but MRI basically shows the plan discount to be the entire amount of the MRI so it shows I owe $0 for the MRI. Then on the EKG it says it was billed as $2,893.00 and the plan discount is $906.08 and I owe $1,986.92. Seems weird the MRI is basically not charged at all.

My old doctor use to do the EKG right in the office on some old machine he had. Never had any issues with it, never got some crazy bill from him for the EKG. Unfortunately he retired and new doctor doesn't have any of that stuff in the office.

I think I'm just going to pay the $150 and fight the $1200. I have never had this issue before even with my crappy individual health plan. Next time I will make damn sure I get an exact number before I let them do anything and I sure as shit will not be doing anything at that hospital again.

[Benedict1957]

Originally Posted by MaximusB

Good point... But many years ago I dislocated my shoulder for the 4th time playing hockey and my family doctor booked two separate appointments for me. One was for MRI and the other was to see a specialist/orthopaedic. Long story short, I had my shoulder surgery 4 months after my initial visit to my family doctor, before I even got my MRI date. But hey, I paid a total of $12 on a shoulder brace for post op recovery

That's true, but your tax burden is much higher.

I live in the U.S. Last year I paid a little under $200,000 in federal income tax. I'm fortunate enough to live in a state with no state income tax. In Vancouver my total tax burden would be more like $306,000 (rough estimate).

[bbbbmw]

Originally Posted by MaximusB

Good point... But many years ago I dislocated my shoulder for the 4th time playing hockey and my family doctor booked two separate appointments for me. One was for MRI and the other was to see a specialist/orthopaedic. Long story short, I had my shoulder surgery 4 months after my initial visit to my family doctor, before I even got my MRI date. But hey, I paid a total of $12 on a shoulder brace for post op recovery

You had surgery before there was an MRI? A US insurer wouldn't pay that claim, and you could sue the doctor, etc. Very glad it worked out well for you (I'm assuming), as things could have gone sideways if there was something else unexpected (like a tumor, fracture, etc.) while you were under the knife...

[bbbbmw]

Originally Posted by dreamingat30fps

What I found interesting is I noticed the paper only lists one thing although I had MRI and EKG. I signed no other paper. On the insurance side it shows both procedures, but MRI basically shows the plan discount to be the entire amount of the MRI so it shows I owe $0 for the MRI. Then on the EKG it says it was billed as $2,893.00 and the plan discount is $906.08 and I owe $1,986.92. Seems weird the MRI is basically not charged at all.

My old doctor use to do the EKG right in the office on some old machine he had. Never had any issues with it, never got some crazy bill from him for the EKG. Unfortunately he retired and new doctor doesn't have any of that stuff in the office.

I think I'm just going to pay the $150 and fight the $1200. I have never had this issue before even with my crappy individual health plan. Next time I will make damn sure I get an exact number before I let them do anything and I sure as shit will not be doing anything at that hospital again.

Very good point - which further makes it sound like they billed it incorrectly. Either you didn't get the EKG, or the EKG was part of the MRI procedure for some reason, and should be coded along with the MRI (not separately), or it was a separate procedure that they didn't pre-authorize, and therefore they shouldn't try to collect from you.

How much is your deductible?

[dreamingat30fps]

Originally Posted by bbbbmw

Very good point - which further makes it sound like they billed it incorrectly. Either you didn't get the EKG, or the EKG was part of the MRI procedure for some reason, and should be coded along with the MRI (not separately), or it was a separate procedure that they didn't pre-authorize, and therefore they shouldn't try to collect from you.

How much is your deductible?

Deductible $3,550.00 max OOP $7,150.00. I have different insurance now though even higher deductible.

[bbbbmw]

Originally Posted by dreamingat30fps

Deductible $3,550.00 max OOP $7,150.00. I have different insurance now though even higher deductible.

So they may have coded it incorrectly, or the EKG wasn't pre-certified, and maybe not medically necessary. Your medical record would also document why they did an ekg - you could get a copy of it pretty easily, and/or ask the doc why he did one.

This is all a hassle, of course, but you did save money in premiums by buying a cheaper high-deductible plan.

This is the kind of situation that Obamacare created; high deductible plans mean you're having to manage healthcare payment, instead of your insurance company, who used to handle these things...

[bbbbmw]

Btw - medical debt will definitely screw up your credit, so don't ignore it. The hospital can pull your account back from the collection agency, and refile the insurance claim, or whatever.

You might also want to contact your credit card companies and get an increase on your credit maximum - that would likely help your credit score

[dreamingat30fps]

Originally Posted by bbbbmw

This is all a hassle, of course, but you did save money in premiums by buying a cheaper high-deductible plan.

True, but having to get an individual plan my options are limited. I use to have a half decent plan which cost me about $400 a month, then it went to $500 then $600 and then $900 last year which is when I dropped it. Now I don't even think they offer it at all. Unless you spend $1k+ per month they are all high deductible pretty shit plans.

Originally Posted by bbbbmw

Btw - medical debt will definitely screw up your credit, so don't ignore it. The hospital can pull your account back from the collection agency, and refile the insurance claim, or whatever.

I'll call them both on Monday and see. Hopefully they are more helpful than last time I talked to them.

Originally Posted by bbbbmw

You might also want to contact your credit card companies and get an increase on your credit maximum - that would likely help your credit score

I've tried lol!! The exact business card that's causing the issue wont raise the credit limit because of my credit, kind of ironic. We just got setup with 60 day terms with our supplier so that should alleviate some of the issues I think.

[MaximusB]

Originally Posted by bbbbmw

You had surgery before there was an MRI? A US insurer wouldn't pay that claim, and you could sue the doctor, etc. Very glad it worked out well for you (I'm assuming), as things could have gone sideways if there was something else unexpected (like a tumor, fracture, etc.) while you were under the knife...

Well.... a dislocated shoulder is relatively easy to diagnose and to repair. For one, the shoulder socket won’t sit where it is suppose to and one arm will be visibility lower than the other. You can also move the socket around with your other hand and feel the slack. The orthopedic surgeon did a few simple test in my shoulder and said my labrum is either torn or stretched from repeated dislocations. A MRI scan in my case would only show whether my labrum was torn or stretched, but the actual repair procedure is the same for both. So surgery was my only option to a permanent fix if I wanted to continue playing hockey or any physical sports. And yes everything worked out for me, I was back playing 6 months after surgery.

Sorry for

[AIRHEIR]

Originally Posted by 3rdcoast228i

I'm not experienced with these things but... If you can't get out if paying totally, I've been told by others, alot of times you can call the doc and "negotiate" the price down quite a bit.

This....they are usually willing to negotiatie quite a bit.

[Ali Shiralian]

Originally Posted by RABAUKE

Fuck. Never left a hospital with a bill except for the TV in my room. You guys pay way less in taxes then we do north of the boarder but hospital bills can add up. Hopefully they don't find anything serious, because that's where the big money could start. Peace, hope you're all good.

I don't wanna start a healthcare discussion between Canada and the US here but as you said if it's a serious condition then it can get expensive real fast in the US. About ten years ago my wife was diagnosed with brain aneurysm. She passed out at work, they called the ambulance and then called me. Within one hour we were in the helicopter to Toronto. They did the operation same night and basically saved her life using a new operation procedure. They kept her in the hospital for two weeks and made a room for me and our family (private). After they released her, because I couldn't have my car, they hired a private patient carrier and drove both of us home. The cost of operation 150,000, my cost zero. I rather pay the high taxes and not worry about what if.

Have a great night.

[Ali Shiralian]

Originally Posted by bbbbmw

You'd still be waiting for that MRI....

That's what you think. Read my story above.

[Benedict1957]

Originally Posted by Ali Shiralian

I don't wanna start a healthcare discussion between Canada and the US here but as you said if it's a serious condition then it can get expensive real fast in the US. About ten years ago my wife was diagnosed with brain aneurysm. She passed out at work, they called the ambulance and then called me. Within one hour we were in the helicopter to Toronto. They did the operation same night and basically saved her life using a new operation procedure. They kept her in the hospital for two weeks and made a room for me and our family (private). After they released her, because I couldn't have my car, they hired a private patient carrier and drove both of us home. The cost of operation 150,000, my cost zero. I rather pay the high taxes and not worry about what if.

Have a great night.

It'll vary from person to person. Generally speaking in the U.S. for the highest tier of health insurance (private PPO with a low deductible) you're looking at roughly $5000 per person per year, so for a family of four top tier health insurance should cost around $20,000 per year.

Whether or not one benefits from living in Canada depends on whether or not one expects to pay more than $20,000 per year extra in taxes compared to the U.S.

A rough estimate using online calculators shows that the break even point is around $200,000/year in annual income.

If one makes less than $200,000/year, one would benefit from living in Canada. If one makes more, the U.S. ends up being cheaper in the long run if we're looking at only the highest tier health insurance. I used British Columbia and Texas to compute (rough) tax burdens.

[Ali Shiralian]

Originally Posted by Benedict1957

It'll vary from person to person. Generally speaking in the U.S. for the highest tier of health insurance (private PPO with a low deductible) you're looking at roughly $5000 per person per year, so for a family of four top tier health insurance should cost around $20,000 per year.

Whether or not one benefits from living in Canada depends on whether or not one expects to pay more than $20,000 per year extra in taxes compared to the U.S.

A rough estimate using online calculators shows that the break even point is around $200,000/year in annual income.

If one makes less than $200,000/year, one would benefit from living in Canada. If one makes more, the U.S. ends up being cheaper in the long run if we're looking at only the highest tier health insurance. I used British Columbia and Texas to compute (rough) tax burdens.

Higher income in Canada pays more taxes that's very true although I need to mention like everywhere else in the world, our top .1% do store most of their resources offshore. As most people in here make less than the 200k, majority of the population benefits from the universal healthcare. Do we wish we paid lower taxes? Absolutely, do we want to scrap the universal healthcare so we can pay less taxes? Absolutely not. This sentiment is shared by almost all Canadians.

Have a great day

[bbbbmw]

Originally Posted by Ali Shiralian

I don't wanna start a healthcare discussion between Canada and the US here but as you said if it's a serious condition then it can get expensive real fast in the US. About ten years ago my wife was diagnosed with brain aneurysm. She passed out at work, they called the ambulance and then called me. Within one hour we were in the helicopter to Toronto. They did the operation same night and basically saved her life using a new operation procedure. They kept her in the hospital for two weeks and made a room for me and our family (private). After they released her, because I couldn't have my car, they hired a private patient carrier and drove both of us home. The cost of operation 150,000, my cost zero. I rather pay the high taxes and not worry about what if.

Have a great night.

That's really great - seriously glad you had a good outcome. But for non-emergencies, refer to the previous post about waiting over 4 months for an MRI.

[bbbbmw]

Originally Posted by dreamingat30fps

True, but having to get an individual plan my options are limited. I use to have a half decent plan which cost me about $400 a month, then it went to $500 then $600 and then $900 last year which is when I dropped it. Now I don't even think they offer it at all. Unless you spend $1k+ per month they are all high deductible pretty shit plans.

I'll call them both on Monday and see. Hopefully they are more helpful than last time I talked to them.

I've tried lol!! The exact business card that's causing the issue wont raise the credit limit because of my credit, kind of ironic. We just got setup with 60 day terms with our supplier so that should alleviate some of the issues I think.

Didn't realize you had individual coverage, but the increases/options are still the same issue.

Maybe get a new credit card?

[Ali Shiralian]

Originally Posted by bbbbmw

That's really great - seriously glad you had a good outcome. But for non-emergencies, refer to the previous post about waiting over 4 months for an MRI.

If it's non emergency then why would you want an MRI immediately?

[Mr Carrots]

Originally Posted by Ali Shiralian

If it's non emergency then why would you want an MRI immediately?

Why on earth not? Many soft tissue injuries can only be repaired in a limited time.

Tear a bicep, tricep, quad or pec tendon and you have a couple of weeks window to fix it before it becomes permanently disfigured. And no, OHIP does not view those as essential. My father in law has required a shoulder repair in his rotator cuff for a year now and waited 4 months for a hernia repair that just got posponed again for no good reason. I tried to get him to pay cash and come here but hes got Stockholm syndrome for the system that hes paid into his whole life will eventually come through for him

The province also let my mother in law almost die and become crippled because they wanted to save a few hundred dollars on a CT scan for an elderly woman whod just had a stroke.

Still not as bad as the horrors my UK family has experienced on the NHS but close