It has taken a bit for my medical insurance provider to assimilate and process the claims for my recent colonoscopy. I thought I would share the results with you. At least, the results as they exist right now. I have no doubt that there will be even more fiddling and massaging of the expenses by involved parties.
- Doctor’s fees for “surgery” and consultation: $1,320
- Facility fees for the procedure: $3,300
- Pathology fees for tissue exam: $1,107
- Pharmacy fees for “cleansing” product: $59.99
- Total for the whole she-bang: $5,786.98
But how did those costs get broken out? What did insurance cover? What did it bounce, what did it discount and what got “written off”?
- The doctor was not a “preferred” provider. The translation of that is that the doctor has not agreed to “accept” the plan allowance offered by my insurance company. In this case, the plan allowance was a total of $402.21. Since he was out of network, my deductible of $300 kicked in, so the insurance company paid him a grand total of $71.56, leaving me owing my doctor $1,248.44.
- The facility is a preferred provider. My plan allowed for $645.38. As a preferred provider, they eat $2,654.62. My co-pay was $96.80, and the facility got a check from my insurance for $548.80.
- The pathology was also in the preferred provider group. My plan allowed for $226.08, resulting in a $880.92 write off. My co-pay was $33.91 and the pathology folks got a check for from my insurance for $192.17.
- I’m not sure what Walgreens ate on my prescription, but I had to pay $13.21 on the $59.99 bill.
So, out of the original, $5,786.98… There are at least $3,535.54 in write offs that just vanish. I’m out of pocket $1,392.36 and my insurance paid out approximately $893.22. If you are not completely confused yet, there’s more to the story. I have a limited flexible spending account that can be used to pay for out of pocket expenses not covered by insurance. Money is pulled out of each of my wife’s paychecks and deposited into the flexible spending account as pre-tax dollars. We get to use our own money to pay for these expenses, but it is pre-tax money as opposed to net money, which results in about a 25-30% savings. So my true out of pocket is really like a bit over $1,000 when all is said and done.
Is there a bright side to this? Well, yes. There was some light in there when the doctor was doing his thing. And he found out that there’s really nothing wrong with my plumbing and peace of mind does have value. Of course, a $1,000 would have made for a helluva night on the town with wifey and then some fun at a swanky hotel… Don’t just assume that your insurance is going to cover it all. Be an educated consumer!