On Sat, 3 May 2008 13:06:51 -0500, "Anny Middon"
<AnnyMiddon@[EMAIL PROTECTED]
> wrote:
>Earlier this year I had a bout of kidney stones. Luckily I'm insured.
BCBS
>sends out these Explanation of Benefits ("This is not a bill") sheets
which
>show what the what the billing entity charged, what we will owe that
entity,
>what BCBS will pay, and what just goes away -- BCBS like I guess just
about
>every insurer has agreements with the providers in the PPO which limit
what
>will actually be paid for services.
>
>I thought it might be intersting to see what people here would guess the
>charges were, how much will actually be paid, and how much goes away.
>
>Here are the services I received (I think this is everything):
>
>5 visits to the doctors' (both my primary care doc and the urologist)
>offices (includes procedure to remove the stent)
>1 ER visit (includes pain meds (4) and IV)
>2 days in the hospital (including various meds -- IVs, antibiotics, pain
>meds)
>4 visits from the docs (2 by each doc) while I was hospitalized
>1 surgery as an inpatient to insert a stent
>Urologist and anesthesiologist (they twilighted me for this one) charges
for
>the above surgery
>1 surgery as an outpatient to remove stent, laser the remaining stones
and
>insert a new stent
>Urologist and anesthesiologist (general anesthetic) charges for the above
>surgery
>1 CT scan (with immediate reading/interpretation -- I'm pretty sure there
>was an extra charge for this)
>4 x-rays (1 chest x-ray, 3 KUB [2 exposures])
>1 stress test
>4 blood tests
>4 urinalysis tests
>1 analysis of stool specimen
>Professional charges to interpret the above tests
>Various charges from Walgreen's for meds -- I'm not going to count up the
>meds I purchased, so since prices can vary greatly, I'll tell you that
total
>charges here were $210.00.
>
>We will end up paying for both our deductible and co-pays exactly
$2,000.00
>for all of the above.
>
>So what's your guess on what the totals billed are?
>
>Total amount paid by BCBS?
>
>Total amount that disappears because of arrangements between BCBS and the
>providers?
>
>Obviously this last amount is the difference between what was billed and
the
>total that will be paid, including the $2000 we'll pay.
If it's anything like Eddie's back surgery in 1995, you pay the
$2000.00 co-pay, the total amount billed is over $150,000...BCBS paid
$27,000.00 and the rest went into the ether. So the total paid was
$29,000 on charges of $150,000.
But those are 1995 dollars and I don't know how it would translate to
2008 dollars. I just know it's a better magic act than watching David
Copperfield.
Lisa Ann
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