Silly accounting tricks

Now you see why the cash price for medical is so low! I see the same things on all my stuff, the actual price that flows down to the provider is a fraction of what was billed. I think a lot of it is just smoke and mirrors to make you feel like you really saved a lot of money.

I don't really know, but I'd guess there's actually a reason for the high "retail" prices. I do know that medical debt is a significant factor in many personal bankruptcies in the USA. I suspect the hospitals have a real reason for their inflated prices. Again, I don't know, but I suspect their non-insured "paying customers" are subsidizing their "nonpaying customers" (ie. those without insurance who never pay their bill). If you can charge the uninsured group of people 4 times what a reasonable price would be, then you'd only need 1 in 4 of your non-insured customers to pay their bill for the hospital to stay whole. I further suspect insurance companies simply refuse to subsidize non-insured non-paying customers, so they negotiate reasonable prices. This is all speculation on my part, but since so many hospitals seem to do it I do suspect there's a real reason behind it (although maybe not a reason we as customers would agree with). But who knows? Just my 2 cents.

Congratulations on your low out-of-pocket.

Recently I had a PSMA. I asked how much it would cost if I had no insurance. They said $7,000.

Then, my insurance "approved" the procedure, I had it done, then I got my bill: the cost was $21,000, and I had to pay $3,000 out of pocket.

I'm convinced it's twofold:
a) if the patient isn't in the know, and has the means, they'll happily take that profit
b)If the patient doesn't have insurance, or the means, that's the number they can claim as "unrecoverable" and deduct it from their taxes as a loss. (or at least against their actual profit)

"that's just my opinion, I could be wrong" - Dennis Miller

I was "lucky" I suppose in that I got prostate cancer in March of 2024 and finished my treatment in October of the same year so I only had to pay one deductible of $1,000 (plus $10 a month for Orgovyx). If I was diagnosed in October and the treatment crossed over into 2025 I'd have to pay the deductible again.

Seriously, though, I'm VERY lucky I have great insurance. It's one of the reasons I've stayed at my job for so long. I have friends who pay $400-$500 a month for coverage. My coverage costs my company $1,800 a month but my share of that is only $99.

@scottbeammeup More crazy math ... A HALF GLASS OF WATER . You could say A HALF FULL GLASS is equal to : A HALF EMPTY GLASS .
Therefore : A HALF EMPTY GLASS = A HALF FULL GLASS If you multiply both sides of an equation by the same amount -- You do not change it's value . Therefore - Let's multiply both sides by : X2 . The result "
ONE FULL GLASS = ONE EMPTY GLASS . Really ?
Enjoy your day .

That is exactly correct. I’ve attended a few insurance seminars and the providers are told to enter the “Usual Customary Fee” ($21000 here), then the “Accepted Fee”(what the insurance actually allows the dr for being part of their network). Then what they actually PAY the provider, snd lastly, what you owe as a copay.
It’s all done to make the insurance company look like some hero who forced the greedy MD to cut his fees. Kinda like professional wrestling but without the folding chair across the forehead…

Like a shell game with your health costs.

My kidney cancer cost around $130K just for the 5 days in the hospital and the surgery, the same surgery that took my prostate (same robot), and I've teased my doctor that after two surgeries he owes me a ride in his Lambo - he told me "I wish, I drive a VW Jetta but you can ride in it if you want". After the prostate surgery bills came in I can see that his post-insurance fee was $10K and since all surgeons are usually in a network of doctors, you have to figure he might get half that. A little humbling to me. I know he makes a very good living as a top notch surgeon but I think he's also a very humble man - my wife and I figure that he spends his money on something like his incredible toy train collection or glass figurines or something 😂.

Haha!! Now my surgeon is exactly the opposite! A strutting TV personality, surgeon to the stars, CEO’s and titans of industry. Lives in a mansion on Long Island and his office occupies an entire floor in a building on Madison Ave in NYC.
Operated on Roger Ailes, Curtis Sliwa….and me, a nobody who forked over $65K to be impotent and need salvage radiation.
I’ll take YOUR surgeon 6 days a week and twice on Sundays!!😂😂

I don't have all the bills in yet for my prostatectomy but I'm sure it'll end up being around that amount by the time everything is accounted for - that $10K was only the fee my actual surgeon charged for the procedure.

There was another urologist that I consulted with who was just like yours - he was such a pompous dill weed, so full of himself and had the Ferrari outside, upon further investigation he not only had 1/5th of the prostate surgeries under his belt but was rated as below average on outcome and way below national average on patient satisfaction. He was a hard no.

So, like you, I'll take my humble train collecting, figuring hoarding, VW driving surgeon every day of the week! He's kind of a weird dude but he's a good man and an excellent surgeon. But then again, who is to say that your surgeon isn't top notch and couldn't do more than what was done? You never know, I got dealt a good hand but so many others did not.