How to Avoid Getting Screwed -Healthcare Costs, Mole Removal

[mtcham]

Check to see if your dermatologist can do the biopsies, it can save some money. Smart not to mess around with irregular moles, I had one that turned out to be a melanoma. For skin tags I've used a blowtorch and hot nail.

[butterscotch]

Get a second opinion.

Raised moles, irregular boundaries, irregular colors are certainly suspicious, but it doesn't mean you have to cut them all off. Assessment via dermascope or hand-held confocal microscope (e.g. Lucid VivaScope), possibly followed by biopsy on a couple of the worst looking ones is preferable to cutting them all off at once. This is coming from someone who is high risk for skin cancer and has a shit ton of moles.

[fomofo]

OK, this has nothing to do with mole removal, but it does pertain to the first two items in the thread title, so rather than start a new thread thought I'd just post here. It's an interesting case story, and shows how even with insurance and following Doctor recommendations you can get screwed badly.

The patient: Amari Vaca, now 1, who was covered by a Cigna policy sponsored by his father's employer at the time.

Medical services: An 86-mile air-ambulance flight from Salinas to San Francisco.

Service Providers: Reach Medical Holdings, which is part of Global Medical Response, an industry giant backed by private equity investors. Global Medical Response operates in all 50 states and has said it has a total of 498 helicopters and airplanes.

Total bill: $97,599. Cigna declined to cover any part of the bill.

What gives: Legal safeguards are in place to protect patients from big bills for some out-of-network care, including air-ambulance rides.

You can listen to or read the full story here...

https://www.npr.org/sections/health-...ally-necessary

P.S.

[old goat]

"Patricia Kelmar, a health policy expert and senior director with the U.S. Public Interest Research Groups, noted, however, that hospitals could familiarize themselves with local health plans, for example, and establish protocol, so that before they call an air ambulance, they know if there are in-network alternatives and, if not, what items the plan needs to justify the claim and provide payment.

'The hospitals who live and breathe and work in our communities should be considering the individuals who come to them every day," Kelmar said. "I understand in emergency situations, you generally have a limited amount of time, but, in most situations, you should be familiar with the plans so you can work within the confines of the patient's health insurance.' "

What bullshit. In an emergency doctors have better things to do than figure out what documentation the patient's insurer might need. That's not what the medical record is for. It is also bullshit that the first hospital refused to support the appeal. Hopefully UCSF wrote in support. I could see telling the ER doc--look, you can support the appeal or we can subpoena you when we sue Cigna and you can spend a day in court testifying to the same thing.

The air ambulance bill was bullshit too. Mine from Reno to Sacramento was 27,000. (And it wasn't medically necessary but ambulance wasn't an option due to a blizzard and I was transferred because Renoun in Reno was charging Kaiser more per day than the flight.) In the olden days of health insurance, when every insurer paid every provider, the insurers and providers established acceptable fees for medical services including ambulances and air ambulances. Now the insurers only control costs for their network of providers, leaving out of network providers free to charge whatever they feel like with no control. Renoun billed Kaiser 400,000+ for my care. Kaiser paid a quarter of that and Renoun was glad to get it. (Under the new law the out of network provider has take the network rate but of course that only applies if the insurer doesn't deny coverage.)

[Core Shot]

Just whac them

[Trackhead]

seborrheic keratosis? Usually removal is elective.

[Trackhead]

The air ambulance bill was bullshit too. Mine from Reno to Sacramento was 27,000. (And it wasn't medically necessary but ambulance wasn't an option due to a blizzard and I was transferred because Renoun in Reno was charging Kaiser more per day than the flight.)

To play devil's advocate, I spent a long time in the aeromed industry, our profit margins were slim/non-existent. It costs a lot of $$ to pay nurses, pilots, mechanics to be on call 24hrs a day and keep aircraft flying. Also really fucking rare to go by air "due to blizzard". Almost always the other way around, especially if it was a rotor transport. Helicopters like to fly into the side of mountains in blizzards.

And something stinks, you can not, per EMTALA, transfer a patient to another facility based on insurance reimbursement. It has to be higher level of care requirement or some other patient care concern, but not a financial decision.

Curious to know the details of this. Was this prior to 1985 (EMTALA)?

[AdironRider]

The past three years the AR fam has had quite a ride health wise, including a life flight, NICU stay and a cancer treatment. All in total billings came out to over 400k. All is now well.

I have never been more happy to pay just pay the out of pocket max each year. Even after 20 years of paying into the health insurance system I'm way ahead financially and its not close. I used to really think health care was a fucked system but I will tell you, I was really really happy to have the best healthcare in the world available at a moments notice when I needed it. In some ways I get why its expensive, you get what you pay for in a lot of ways. That isn't to say in some ways they are milking you as well, but that exists in literally every industry. I just paid a plumber 700 to fix what ended up being a sock my kid stuffed in a drain. Said plumber was in the house for all of 25 minutes. You can't tell me that isn't an egregious bill also.

The life flight was a total bitch to deal with but they eventually caved and took the insurance approved amount. That took two years of stress and countless hours on the phone working the system to get done but it got done. So definitely feel for that side, but at the same time, what are you going to do, say no?

[MagnificentUnicorn]

Usually you can request to enroll in the air ambulance service until they load you up. Our nurses in the ER will ask patients or their family if they want to enroll in the air ambulance insurance if a flight will be needed.


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[Trackhead]

Usually you can request to enroll in the air ambulance service until they load you up. Our nurses in the ER will ask patients or their family if they want to enroll in the air ambulance insurance if a flight will be needed.

The aeromedical insurance system is such a racket. You’re no doubt dealing with Airlift (I used to fly for them) and Life Flight Network. It used to be done to capture flights (call Airlift I have their insurance)…the bedside sign up was a phenomenon that started in about 2017 after Uber competitive for-profit programs started doing it, which then forced Airlift to do it as well. Then flight insurance rates plummeted.

FWIW I don’t think aeromed can balance bill Medicare/Medicaid so flight insurance is pointless. It’s only for third party insurance where you end up with the copay balance. That is all the insurance covers. Most flight companies also don’t let uninsured by flight insurance because again, it only covers the copay.

[Peruvian]

The past three years the AR fam has had quite a ride health wise, including a life flight, NICU stay and a cancer treatment. All in total billings came out to over 400k. All is now well.

I have never been more happy to pay just pay the out of pocket max each year. Even after 20 years of paying into the health insurance system I'm way ahead financially and its not close. I used to really think health care was a fucked system but I will tell you, I was really really happy to have the best healthcare in the world available at a moments notice when I needed it. In some ways I get why its expensive, you get what you pay for in a lot of ways. That isn't to say in some ways they are milking you as well, but that exists in literally every industry. I just paid a plumber 700 to fix what ended up being a sock my kid stuffed in a drain. Said plumber was in the house for all of 25 minutes. You can't tell me that isn't an egregious bill also.

The life flight was a total bitch to deal with but they eventually caved and took the insurance approved amount. That took two years of stress and countless hours on the phone working the system to get done but it got done. So definitely feel for that side, but at the same time, what are you going to do, say no?

Insurance is a collective (can you say “socialism”?) process. I remember when my mother in law who had MS for 40 years also was diagnosed with Leukemia. She ended up in the hospital for well over a month and due to the skilled nursing and other extensive treatment her prior condition required she rang up in excess of $1mil. Luckily my FIL was on a health insurance plan from a golden parachute buy out in the 90s so between that and Medicare they had very little out of pocket expenses. The many of us pay for years into the system to help offset those costs. Well, and the execs need their ski homes too, right?

It sounds like your family had excellent health care but don’t confuse that with the “best health care in the world” trope. Singapore, Norway, the Netherlands, and another few dozen other counties have objectively better care than the good ol USA. For what we pay, we should have such a better system.

[AdironRider]

The system worked for me and I am happy to have had the access I did. Would I have liked it to be cheaper? Sure, everyone would. I also recognize the profit motive has led to the US leading the world in medical advancement and development over the past 100 years that those other developed countries take distinct advantage of. If the development costs were more evenly distributed globally that would certainly help the US system cost wise.

[Bunion 2020]

I also recognize the profit motive has led to the US leading the world in medical advancement and development over the past 100 years that those other developed countries take distinct advantage of.

Maybe we did, currently I don't think we do.

One thing I have already learned after dealing with Medicare deductibles is, never pay out of pocket for anything.

Wait until you are absolutely 100% certain you owe what is claimed.

[MagnificentUnicorn]

The aeromedical insurance system is such a racket. You’re no doubt dealing with Airlift (I used to fly for them) and Life Flight Network. It used to be done to capture flights (call Airlift I have their insurance)…the bedside sign up was a phenomenon that started in about 2017 after Uber competitive for-profit programs started doing it, which then forced Airlift to do it as well. Then flight insurance rates plummeted.

FWIW I don’t think aeromed can balance bill Medicare/Medicaid so flight insurance is pointless. It’s only for third party insurance where you end up with the copay balance. That is all the insurance covers. Most flight companies also don’t let uninsured by flight insurance because again, it only covers the copay.

We have Airlift NW(UW) and LifeFlight. Airlift isn’t too bad because it’s funded by UW Medicine/State.


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[XXX-er]

If the local pro's can't figure it out they medivac and they do it all the time

The system worked for me and I am happy to have had the access I did. Would I have liked it to be cheaper? Sure, everyone would. I also recognize the profit motive has led to the US leading the world in medical advancement and development over the past 100 years that those other developed countries take distinct advantage of. If the development costs were more evenly distributed globally that would certainly help the US system cost wise.

then why is the USA 47th in life expectancy according to world-o-meter?

[Trackhead]

then why is the USA 47th in life expectancy according to world-o-meter?

US is #10 in the world for obesity, lead only by Polynesian /Samoan. 10 year old kids in this country have documented fatty liver disease, hypertension, and hyperlipidemia. Little kids with diseases of obesity that historically only affected adults. That's at least a part of it. Self responsibility is hard to accept these days.

Leading cause of death
1. Heart disease (typically correlated with obesity)
2. Cancer (some cancers correlated with obesity, but we also live in a polluted world)
3. Covid (again, related to obesity)
4. Accidents (unrelated)
5. Stroke (often times related to obesity, see heart disease)
6. Diabetes (obesity)
7. Alzheimers (yay, you lived long enough to get it)
8. Chronic liver disease (leading cause is fatty liver disease - obesity)
9. Renal syndome (typically related to diabetes/hypertension - obesity)

[skaredshtles]

The system worked for me and I am happy to have had the access I did.

Aye. That right there is the rub in the U.S.

If *every* U.S. citizen had the access you did, we probably wouldn't have this thread.

[XXX-er]

Because we are a nation of fat pigs. Looking in a mirror (rhetorical) is often the answer.

US is #10 in the world for obesity, lead only by Polynesian /Samoan. 10 year old kids in this country have documented fatty liver disease, hypertension, and hyperlipidemia. Little kids with diseases of obesity that historically only affected adults.

iPads, video games, sedentary

That's at least a part of it. Self responsibility is hard to accept these days.

Is USA al that different from Canada which comes in at 19th ?

[adrenalated]

Is USA al that different from Canada which comes in at 19th ?

10 seconds of Google indicates that the adult obesity rate in the US is ~40% vs ~30% in Canuckistan, so yes.

[Kevo]

Interesting to see this thread get resurrected a decade later.

The aeromedical insurance system is such a racket. You’re no doubt dealing with Airlift (I used to fly for them) and Life Flight Network. It used to be done to capture flights (call Airlift I have their insurance)…the bedside sign up was a phenomenon that started in about 2017 after Uber competitive for-profit programs started doing it, which then forced Airlift to do it as well. Then flight insurance rates plummeted.

FWIW I don’t think aeromed can balance bill Medicare/Medicaid so flight insurance is pointless. It’s only for third party insurance where you end up with the copay balance. That is all the insurance covers. Most flight companies also don’t let uninsured by flight insurance because again, it only covers the copay.

I recently learned that air ambulance balance billing is illegal in Idaho. Regular ambulance balance billing is legal though. If you have health insurance and you are ever presented with the option of air ambulance or regular ambulance, always take the air ambulance (at least in Idaho). The law is called the "No Surprise Act".

Balance billing as a practice should be illegal in every state for every medical service. Medical bankruptcy for people with insurance is unconscionable.

I currently have a very good healthcare plan- $1,600 deductible, 2k out of pocket max for in network and HSA eligible.

For now, the healthcare system is working for me but I know that I am lucky by way of working underneath a very large employer.

I have dealt with so much nonsense with other plans- preauthorization bullshit, preexisting condition nonsense (pre-ACA), out of network billing for certain providers outside my control at in network facilities, balance billing from in network providers where I had to find people at my insurance company to threaten the provider, etc, etc.

For those lucky enough to have the best plans in the US (PPO plans with deductibles that are reasonable in proportion to income, etc, etc), the US system is among the best in the world. I've been able to get elective MRIs covered 100% on a day's notice. My understanding is that getting next day elective MRIs is all but impossible in Canada or the UK.

For those that the system doesn't work for, the US system is a national embarrassment and a travesty.

I've experienced both sides in different times of my life. We should be able to do better.

[AdironRider]

Aye. That right there is the rub in the U.S.

If *every* U.S. citizen had the access you did, we probably wouldn't have this thread.

On several occasions I have taken less pay for a better benefits package and that turned out to be the right choice on my end.

[Trackhead]

Yup, US system is great, until it isn't, then it's fucking horrifying and unethical.

I navigated as a chemo patient last year, it was like a full time job for my wife (I didn't give a fuck about anything but trying to stay alive).

Mostly my issue was long/short term disability, not insurance. But if my employer dropped me, I'd be medically bankrupt.

[TNKen]

Six years ago, my helicopter ride for my fx femur for an hour and five minute flight from Western NC to Columbia, SC was $67k. Service was PHI Air. Despite the fact that it was branded and under contract with my wife's employer, they refused to pay saying the services could have been done locally. I had specialty hip implants that only 10 surgeons in the US were doing.

Filed suit on the non-coverage. Worked out a suitable arrangement with the provider and PHI Air. The next day after the settlement agreement, PHI's autobot sent me a letter offering to settle in full for $10,000 less than the litigation agreement. Used that to parlay $7,500 into my pocket.

Working on a case now where a 10 minute ride was $87,000.

Look into Airmedcarenetwork.com Supposedly is now a universal insurance for med-flights that covers most providers. Pretty cheap and covers everyone in the household.

[skaredshtles]

On several occasions I have taken less pay for a better benefits package and that turned out to be the right choice on my end.

Again - if everyone had such options, this thread wouldn't exist.

The healthcare "system" is a fucking embarrassment in this country.

[AdironRider]

I get it you want universal healthcare. That said, you can walk onto basically any local DPW crew right now with a pulse and a GED and have some of the best healthcare in the country (in a general sense - govt employees get good benefits). Options exist.

The nordic countries mentioned here collect on average, 42.6% of GDP in taxes vs the US which collects 26.6%. A large portion of that goes to universal healthcare. A different system comes with a different economic reality.