When to use insurance and when not to and pay out of pocket?

[Anonymous]

I can't even get doctors to call me back and making any appointment takes 3-4 months.
Nobody has any idea what the insurance pays or doesn't. The automatic insurance payment also simply stopped in December.
I can go on and on when it comes to dealing with it all.
I have heard that paying cash is cheaper, but have no idea how to find out.

[Anonymous]

I know it used to be in a healthcare provider's contract with each insurance company that if a patient wanted to self pay and go around the insurance that this was not allowed. It is different that being "uninsured". I worked in a PT office where a patient was discharged due to lack of medical necessity, but wanted to keep coming for one modality that he was willing to pay for indefinitely, and the office admin said that it went against their contract with his insurance.

[Anonymous]

Anonymous wrote:I can't even get doctors to call me back and making any appointment takes 3-4 months.
Nobody has any idea what the insurance pays or doesn't. The automatic insurance payment also simply stopped in December.
I can go on and on when it comes to dealing with it all.
I have heard that paying cash is cheaper, but have no idea how to find out.

This is exactly how they like it. And we keep paying outrageous premiums.

[Anonymous]

We never pay. We wait for the bills to almost go into collections and then negotiate a very low payment.

[Anonymous]

Anonymous wrote:I can't even get doctors to call me back and making any appointment takes 3-4 months.
Nobody has any idea what the insurance pays or doesn't. The automatic insurance payment also simply stopped in December.
I can go on and on when it comes to dealing with it all.
I have heard that paying cash is cheaper, but have no idea how to find out.

What we do is wait for the bills to send out the final notices, then we call and negotiate a very low cash payment. We are talking bills of say 7k getting settled for $500. Be patient.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I can't even get doctors to call me back and making any appointment takes 3-4 months.
Nobody has any idea what the insurance pays or doesn't. The automatic insurance payment also simply stopped in December.
I can go on and on when it comes to dealing with it all.
I have heard that paying cash is cheaper, but have no idea how to find out.

What we do is wait for the bills to send out the final notices, then we call and negotiate a very low cash payment. We are talking bills of say 7k getting settled for $500. Be patient.

Then after this they will drop you and not give you services right?

[Anonymous]

The years I had expensive tests (multiple MRIs, biopsies, etc.) I used insurance because I knew that I would meet my deductible of $6000, which I did by Spring. It would have ultimately been much more via self pay. Testing went on through December and then I also squeezed other visits I normally would have put off so that I wouldn't have to pay the normal OOP costs, got 90-day prescriptions filled, etc.

It's a crapshoot, really. IME, I haven't been able predict what I'll use in a single year beyond the one year of serious illness.

[Anonymous]

Anonymous wrote:What radiology company is it? If its one local to here I think i know what's happening. If you have insurance that test likely isn't $3800. I would go for insurance and get my money back or have them verify your coverage up front.

Johns Hopkins Radiology.

Mychart shows me the estimated cash price versus insurance payment. I had an MRI earlier this year and I actually had to pay the $3800. I called to negotiate but they wouldn't do anything and I have health issues so I paid up. This was the negotiated amount supposedly. They billed around $8000 and negotiated amount is the $3800

[Anonymous]

Anonymous wrote:The years I had expensive tests (multiple MRIs, biopsies, etc.) I used insurance because I knew that I would meet my deductible of $6000, which I did by Spring. It would have ultimately been much more via self pay. Testing went on through December and then I also squeezed other visits I normally would have put off so that I wouldn't have to pay the normal OOP costs, got 90-day prescriptions filled, etc.

It's a crapshoot, really. IME, I haven't been able predict what I'll use in a single year beyond the one year of serious illness.

I'm just short of my family deductible and currently pay 35 percent coinsurance.

I have 3 MRI and 1 CT scan coming up but unable to get an appointment for all of them in December. I got 2 appointments for Dec but the other 2 are pushed out to January. Those would have been free if I did them in Dec but no appointments available. Not sure whether to move them all to Jan but I am scared that if it's cancer I am losing time.

[Anonymous]

Anonymous wrote:Strategy when to use insurance and when not to?? Do you all do some tests with and some without insurance?

MRI with insurance - $3800
MRI without insurance costs - $1100

What do you all do when it comes to expensive tests like these?

When I look at the estimates for no insurance, if I had not used insurance for all my tests this year I would have saved 2K.

I am not sure I understand why you wouldnt use insurance since it applies to your deductible. You basically met your 4k deductible and now pay coinsurance. The only way to figure out if it was a poor choice or not would be to get through the entire year using insurance and then change this one MRI to self pay- and see if you would pay less?

If youre getting multiple expensive tests you were going to meet your deductible anyways, you just would have paid 1100 cash that doesnt apply to your deductible thus any charges after the MRI would have then applied to the deductible using your insurance but you would have needed to pay 4k to get to the coinsurance portion. It seems like you would be delaying the inevitable.

The question isnt always self pay or bill to insurance its self pay with no insurance vs using insurance. Dental works out that way for us since I can get us seen for 325x2 and 375x2 which is less than the premium offered by my employer. The dental insurance still requires copays and coinsurance for services so I end up paying less for regular q6mo dental care for 4 people (xrays, 2 cleanings, treatments) than I would paying the premiums plus copays for those services. The caveat is, of course, costs beyond regular dental care but the dental insurance doesnt really cover much and that's why both my husband and I have HSAs funded.

[Anonymous]

Anonymous wrote:

Anonymous wrote:The years I had expensive tests (multiple MRIs, biopsies, etc.) I used insurance because I knew that I would meet my deductible of $6000, which I did by Spring. It would have ultimately been much more via self pay. Testing went on through December and then I also squeezed other visits I normally would have put off so that I wouldn't have to pay the normal OOP costs, got 90-day prescriptions filled, etc.

It's a crapshoot, really. IME, I haven't been able predict what I'll use in a single year beyond the one year of serious illness.

I'm just short of my family deductible and currently pay 35 percent coinsurance.

I have 3 MRI and 1 CT scan coming up but unable to get an appointment for all of them in December. I got 2 appointments for Dec but the other 2 are pushed out to January. Those would have been free if I did them in Dec but no appointments available. Not sure whether to move them all to Jan but I am scared that if it's cancer I am losing time.

Did you sign up for cancellation lists? Or call every day to see if there is an opening. Its worth your time if you can get them performed after you meet your OOP Max and therefore wouldnt be responsible for cost sharing.

[Anonymous]

For medical i would always use the insurance. Call the insurance company to negotiate if their price is so much higher than self pay.

For dental or vision self pay is often better.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:The years I had expensive tests (multiple MRIs, biopsies, etc.) I used insurance because I knew that I would meet my deductible of $6000, which I did by Spring. It would have ultimately been much more via self pay. Testing went on through December and then I also squeezed other visits I normally would have put off so that I wouldn't have to pay the normal OOP costs, got 90-day prescriptions filled, etc.

It's a crapshoot, really. IME, I haven't been able predict what I'll use in a single year beyond the one year of serious illness.

I'm just short of my family deductible and currently pay 35 percent coinsurance.

I have 3 MRI and 1 CT scan coming up but unable to get an appointment for all of them in December. I got 2 appointments for Dec but the other 2 are pushed out to January. Those would have been free if I did them in Dec but no appointments available. Not sure whether to move them all to Jan but I am scared that if it's cancer I am losing time.

Did you sign up for cancellation lists? Or call every day to see if there is an opening. Its worth your time if you can get them performed after you meet your OOP Max and therefore wouldnt be responsible for cost sharing.

Yes, on the wait list but these tests are 1 hour each and so it's hard to get immediately. One of them is more than 30 days away.

I'm calling every day no luck.

[Anonymous]

Anonymous wrote:For medical i would always use the insurance. Call the insurance company to negotiate if their price is so much higher than self pay.

For dental or vision self pay is often better.

Insurance company negotiated amount was $3800 for the MRI. They submitted an $8000 claim. Can the insurance negotiate even further if a patient asks? I've never done this before.

[Anonymous]

Anonymous wrote:

Anonymous wrote:For medical i would always use the insurance. Call the insurance company to negotiate if their price is so much higher than self pay.

For dental or vision self pay is often better.

Insurance company negotiated amount was $3800 for the MRI. They submitted an $8000 claim. Can the insurance negotiate even further if a patient asks? I've never done this before.

That negotiated rate is between the insurance and the practice. You can only get something different if YOU negotiate with the practice.
But it sounds like from other answers on here, if the practice knows you have insurance, they want that $3800.