How much money might one expect to spend on diagnostic urology tests (US)?

theupandup

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I suspect this might vary quite a bit from case-to-case depending on insurance and individual circumstances, but if any US people here have finished all of their diagnostic tests, how much did it end up costing you out of pocket? Even if it's not a perfect estimate for the avg person, having some ballpark of what one could expect would be helpful. I'm allowed to stay on my mother's insurance for the next year or two, which is not terrible but also not great (BCBS). Also, are there any tests which aren't worth the time/money, or ones which should be prioritized over others?
 
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daylight

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It was/is covered by insurance, you have to pay your visit fee and any deductibles. hard to say, as your coverage is your coverage. Ask your doctor or call your provider.
 

theupandup

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It was/is covered by insurance, you have to pay your visit fee and any deductibles. hard to say, as your coverage is your coverage. Ask your doctor or call your provider.
Wut, you had no copay? I normally have to pay hundreds of dollars after tests or imaging. But I also don't know how deductibles work.

Maybe in retrospect this isn't a very useful question, if peoples insurance varies so much. Just would be nice to have *some* idea of what I might be looking at. Normally when you go to the doc they just ask you to do various tests and if you ask about costs they just handwave about "you'll have to ask insurance" and you don't find out how much you need to pay until you foot the bill. Frustrating.
 

daylight

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Wut, you had no copay? I normally have to pay hundreds of dollars after tests or imaging. But I also don't know how deductibles work.

My bad, a visit fee == copay

A deductible is what you pay out of pocket before the insurance covers the cost. Some insurances just use a percent coverage or a fixed reimbursement amount. The result, the patient pays the balance.
 

ltaluv

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Here's how my insurance works (BCBS, high deductible health plan through my employer): My deductible is $4k, my copay is 20%, and my out-of-pocket cap is $6800. So the first $4k of medical and prescription costs that I invite, I have to pay in full. They get filed with insurance, but I'm on the hook for the costs. The next $14k of expenses, I have to pay 20%, which at the point that my bills have hit $18k ($4k + $14k) means I've paid $6800 out of pocket. At that point, insurance pays 100% until the end of the year, when everything resets.

So, in January go visit my urologist. She bills $700 for the visit, but the insurance's negotiated rate is $200, so I pay $200 out of pocket. She writes off the other $500.

In March I have surgery. The hospital bills $11,000, the surgeon bills $2100, and the anesthesiologist bills $37,000 (I'm not making that last one up - that was the anesthesiologist bill from my surgery in May!!) The insurance knocks it down to $12k altogether through its negotiated rate (and the anesthesiologist has to settle for $2600 because of my insurance - poor guy has to do more work to make the payment on his Lamborghini.) I pay the first $3800 (since I already paid $200 toward my $4k deductible), then 20% of the remaining $8200, which is $1640. I've now paid $5640 out of pocket, and my insurance has paid $6560 (80% of $8200).

This continues until I've paid $6800, at which point the insurance pays everything. My medical bills usually run $50-100k a year (and sometimes as high as $250k), so I get to that point every year - last year it was in June, this year it was in April.

Confusing? Sure. And that's with made-up, round numbers. Throw in dozens of prescriptions, healthcare for a family of five, multiple doctor visits and procedures, lands here and there, and it starts getting complicated. That's the wonder of our US healthcare system, that it takes a lot of work and effort to keep track of all of this and all that labor does nothing to treat my medical issues. I've spent at least six hours on the phone in the last month (mostly on my employer's dime) trying to fix an issue where the insurance is still reporting that I haven't met my copay, so I've spent an extra thousand dollars or so just to get my most critical medications, and I've had to quit taking all my non-critical ones. I don't expect them to ever reimburse me for the extra money, which isn't in the $16k I budget every year for healthcare expenses. They've been promising for over a month that it's fixed, but it's not done yet.

Obviously I'm not the most typical case, but I'm far from the only one having to deal with this kind of complexity. It's remarkable that they can keep this accounting juggernaut working; when it breaks, I end up being the one paying for the failure, since I'm the one without lawyers on staff. But mostly it works, as long as I pump in the same amount of money every year as my mortgage costs.

So how much do these procedures cost? Nobody except the insurance company accountants knows.
 

daylight

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And don't forget deductibles are annual - They reset at the first of the year. Also, there are sometimes lifetime caps that kick in for amount the patient pays as well as the insurance companies.

Thanks to the ACA, pre-existing conditions cannot be excluded. Otherwise, switch jobs or the company switches providers, and you may not have coverage for care. Like COVID related health issues, incontinence, cancer, spinal injuries, dot dot dot. Had to throw that in for reflection.
 

ltaluv

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And don't forget deductibles are annual - They reset at the first of the year. Also, there are sometimes lifetime caps that kick in for amount the patient pays as well as the insurance companies.

Thanks to the ACA, pre-existing conditions cannot be excluded. Otherwise, switch jobs or the company switches providers, and you may not have coverage for care. Like COVID related health issues, incontinence, cancer, spinal injuries, dot dot dot. Had to throw that in for reflection.
I used to run into the pre-existing condition thing. For the first three years after college, I couldn't afford care for my uncertain colitis because it was considered a pre-existing condition. I put up with the pain and the bloody diarrhea without getting treated long enough that it finally got grandfathered in, but that's some of the damage that's been done that I expect is going to require removal of my colon later this year or next.

I think one of the features of the ACA was that lifetime benefit caps are no longer allowed. Previously, my insurance capped my lifetime benefit at $1M, which sounds like a lot until you realize that I'm already likely over that after 40 years of IBD and 20 years of autoimmune liver disease. When I need a transplant (probably less than five years now - I've had a good run, better than most with the illnesses I have) it'll be at least $750k just for that year, more if I get the urinary diversion I'm talking about with my doctor to treat my interstitial cystitis.

There are two major insurance companies active in New Mexico, and I've never had a job here where I wasn't insured through one of them. Without the ACA, I'd have to change jobs to juggle benefits between the companies, and post-transplant I'd be maxed out on lifetime benefit with both of them and I'd have to move somewhere else to get insurance that would still cover me. If the ACA gets thrown out, we'll be back to the situation where the insurance companies will be able to decide that I'm not worth all that money, and I can either move or die.

Over the course of my life, I've probably cost the insurance companies about 50% more than I've paid in premiums. At least with the current laws, they're not allowed to deny me care so that I'll die and quit hurting their profit margins.
 

theupandup

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Man. I'm so sorry you had to deal with this. As if the medical stress isn't enough, you get straight up stolen from by these companies.

I kinda feel lame for being so dramatic. My finances are not in a good position right now, but I'm nowhere near my life being endangered by the accessibility of medical service. It's unethical that people are put in precarious situations like that while insurance companies make so much money.

So how much do these procedures cost? Nobody except the insurance company accountants knows.
Damn, I figured :\ I guess it just has to be viewed as a leap of faith, and you have to do the best you can to make room in the budget for some mystery large number. thank you for the info, I'm still on my mom's insurance (additional benefit of ACA) so I think my only bills are just copay and whatever that bill is that they send you a bit later, but that was still actually helpful.

Since my symptoms are so mild and not impeding on my ability to function I might just wait a bit to see how things progress before investing in specialized healthcare. I need to secure a new job in the next month or two or I'm hosed.
 

ltaluv

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Man. I'm so sorry you had to deal with this. As if the medical stress isn't enough, you get straight up stolen from by these companies.
It is what it is. Some of it is a current battle, so I end up angry and venting on other people's threads. :(

Since you're on insurance, your doctor should be able to give you a pretty good cost estimate for the tests. They call your insurance company, who tells them where you are in your deductible and can give them an exact amount that they'll pay for the procedure, and how much your copay is. If you haven't seen a urologist yet, you'll probably have to at least go in for an initial office visit before they'll decide if you need the tests. That should be pretty cut and dried as to what it'll cost under your insurance.
 

theupandup

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It is what it is. Some of it is a current battle, so I end up angry and venting on other people's threads. :(

Since you're on insurance, your doctor should be able to give you a pretty good cost estimate for the tests. They call your insurance company, who tells them where you are in your deductible and can give them an exact amount that they'll pay for the procedure, and how much your copay is. If you haven't seen a urologist yet, you'll probably have to at least go in for an initial office visit before they'll decide if you need the tests. That should be pretty cut and dried as to what it'll cost under your insurance.
In my experience they've been pretty unhelpful beforehand about how much various procedures cost. They just say something like "that's something you'll have to figure out with your insurance" or that I have to ask someone else or something. The initial copay normally isn't too bad, but usually I get a larger bill some time later and I have no idea how to figure that value out. But maybe it has to do with the deductible. I might just call the insurance provider directly. Thanks again for the help. And wishing you the best <3
 
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