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

[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.

[Anonymous]

I went to a specialist appointment in another state planning to pay 100% out of pocket. It was worth it to me to see this guy who is tops in his field.

They still wanted my insurance info so i shrugged and gave it to them. Lo and behold I only had to pay $125. because they gave me the BCBS rate even though my policy expressly limits me to one particular medical group in one particular state.

[Anonymous]

There was one time when I needed to get an MRI quickly before going back to the doctor to discuss the results. If I used insurance I was going to have to wait as they went back and forth with the radiology provider, so I said f it I'll just pay for the MRI out of pocket. No surprise, the radiology provider was able to get me in that same day for the scan. When looking at the paperwork I discovered that they charged me for the MRI roughly 25% of what they would have billed the insurance company had I used insurance. If you pay cash for medical services you can often get a very good cash price. Your time and avoiding the hassle of dealing with insurance are worth something too.