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Medical costs advice request (1 Viewer)

Jayrod

Jayrod

Footballguy
Dear friends of the FFA, I have a situation I would welcome any and all advice on.

My son is 17 and a handsome young lad. He's grown to 6'2" and is athletic. However, he has a large lump behind his right ear over the bone that sits there that protrudes. It is unsightly and though not as big as a ping pong ball, it is noticeable and he is embarrassed about it, choosing to let his hair grow out to cover it.

So we have told him we are going to have it removed. We go to his doctor who recommends an ENT specialist. We go to the doctor who looks at him for a grand total of like 3 minutes, says it is a lipoma and it is a simple surgery to remove it. The plan is to do general anesthesia and the whole process is supposed to take around 4-5 hours and was scheduled for this coming Monday.

Then today I get a call from the surgery center asking me how I would like to pay to cover our $9,000 bill. The total bill is over $28K and the insurance will cover over $19K leaving us with just over $9K. We do have a high deductible plan and I have an HSA, but it doesn't have that much in it...more like $1,500.

I said, uhhh.....we won't be paying that today and can I please get an itemized bill for that? She says she can provide that AFTER the surgery and that this is all just an estimate.

What in the heck should I do here? On the one hand I really want to do this for my son before his senior year. On the other hand, I don't even want to pay this bill or have it done just on the princpal of the matter. How in the world have we gotten here where it costs as much as a good used car to have a small outpatient surgery done? I can imagine I can work out the payment situation, but this is a big ole' gut punch I wasn't expecting. I was thinking we would have to shell out maybe $2-4K, but $9K just feels outrageous.

Any advice on ways to do this cheaper, better, negotiate, pull a John Q or whatever is welcome.
 
If you are thinking of not doing the surgery at all, I think this is one of those scenarios where if you told your son you would do this for him, you need to follow through with it.

As far as the money goes, a lot of places will work with you on payment plans. We've done this before on several really expensive hospital visits or what-not, and as long as you are paying something each month they can't send you to collections. That's without knowing your local places policy of course.
 
Does your son know it's going to be $9k? I'm wondering if he knew that whether or not he'd still go through with it at this time.
 
ChiefD said:
If you are thinking of not doing the surgery at all, I think this is one of those scenarios where if you told your son you would do this for him, you need to follow through with it.

As far as the money goes, a lot of places will work with you on payment plans. We've done this before on several really expensive hospital visits or what-not, and as long as you are paying something each month they can't send you to collections. That's without knowing your local places policy of course.
Click to expand...
I am going to talk to my wife about it. I am just hoping to brainstorm here on options. Yes, they discussed extended payment plans. Apparently there is a fairly common way to extend it over 5 years.
 
dgreen said:
Does your son know it's going to be $9k? I'm wondering if he knew that whether or not he'd still go through with it at this time.
Click to expand...
I just found out a few hours ago and didn't tell him yet. Only my wife and you guys.
 
I don’t know that I want the lowest cost guy cutting on my kids head, but maybe get a second opinion while checking with your insurance? Or is your network as devoid of competition like mine is?

That sounds large enough that I would hope it isn’t really considered “cosmetic” but you for sure want insurance preapproval.

Sometimes I’ve gotten a “discount” for paying in full on day of service. Other times I’ve done payment plans, both structured and “whatever I felt like paying that month”.

I think if it obviously bothers your kid and is hurting his self-esteem, you gotta do it, and it isn’t going to get any cheaper than it is now.
 
Granted it’s more than you thought and I’d make a call or two or three to insurance to try and get more of it covered. That said, I’d do it if it’s hurting his self esteem and cut back elsewhere. Think it’ll pay off in the long run several times over.
 
gianmarco said:
Even with high deductible plans, there's usually an annual max out of pocket amount. Do you know what yours is? Ours is $6K, and a quick search shows the average is about $5K.
Click to expand...
The max per person allowed by law is 8,050 this year.

OP should talk with his insurance carrier.

Also, with an HSA - dump money into it (for tax deduction), then pay whatever the cost ends up being from that.
 
Price and time sounds exorbitant but what do I know. Seriously, watch a couple episodes of Dr. Pimple Popper. She does much larger lipomas in her office with local anesthesia. I'd find someone like her. Based on the show, it seems that it is quite common for these things to keep growing. Best of luck however you decide to roll.
 
Could you switch out of the HSA for next year into a different/better plan? Granted he'd have to wait until January but if it's a big cost savings could be an option, only 8 months away at this point
 
gianmarco said:
Even with high deductible plans, there's usually an annual max out of pocket amount. Do you know what yours is? Ours is $6K, and a quick search shows the average is about $5K.
Click to expand...
Was coming to post this. You need a doc to call it necessary and then you shouldn’t have to pay more than max out of pocket limit. My company’s MOOP for the HSA qualified plan is 7100.
 
matttyl said:
gianmarco said:
Even with high deductible plans, there's usually an annual max out of pocket amount. Do you know what yours is? Ours is $6K, and a quick search shows the average is about $5K.
Click to expand...
The max per person allowed by law is 8,050 this year.

OP should talk with his insurance carrier.

Also, with an HSA - dump money into it (for tax deduction), then pay whatever the cost ends up being from that.
Click to expand...
Never mind. Posted bad info since he has an HSA
 
matttyl said:
gianmarco said:
Even with high deductible plans, there's usually an annual max out of pocket amount. Do you know what yours is? Ours is $6K, and a quick search shows the average is about $5K.
Click to expand...
The max per person allowed by law is 8,050 this year.

OP should talk with his insurance carrier.

Also, with an HSA - dump money into it (for tax deduction), then pay whatever the cost ends up being from that.
Click to expand...
How is BlueCrossNC charging this....

Individual Out-of-Pocket Limit$9,450 in-network / Not covered out-of-network
 
The Dreaded Marco said:
I’m a pediatrician, not a surgeon, but $28K and a five hour surgery under general anesthesia for a lipoma excision does not sound right to me.

I’d definitely get a 2nd opinion.
Click to expand...

Partner was in ICU for 3 days and then the hospital for another week. No surgery, but the entire bill was just over $11k.
 
Mitchie said:
Could you switch out of the HSA for next year into a different/better plan? Granted he'd have to wait until January but if it's a big cost savings could be an option, only 8 months away at this point
Click to expand...

This was my thought. We did this last year - switched my wife’s family plan to a “Cadillac” level coverage but timed it to cover a few big ticket items we scheduled to take place in that year.
 
Second opinion and possibly push it 8 months to get a better insurance plan.

Tell your kid that you'll give him half the delta between the cost in 8 months and the $9k or you'll put $4k in his college savings account.
 
The Dreaded Marco said:
I’m a pediatrician, not a surgeon, but $28K and a five hour surgery under general anesthesia for a lipoma excision does not sound right to me.

I’d definitely get a 2nd opinion.
Click to expand...
It is not a 5 hour surgery. I literally made up an estimated time from check in until we leave. No one has told me how long it will be. Please forget the time.

But the cost is exorbitant.
 
gianmarco said:
Without knowing the exact size and location, many lipoma excisions can be done in the office setting with local anesthesia.

If it's much more complicated, then it should be easier to have it coded as non-cosmetic, I would think.
Click to expand...
It is definitely more complicated. I've had some removed from my arms in an office before. His is quite large (almost looks like half of a ping pong ball) and is right behind his ear so we were told it required an Ear, Nose and Throat specialist.
 
Jayrod said:
gianmarco said:
Without knowing the exact size and location, many lipoma excisions can be done in the office setting with local anesthesia.

If it's much more complicated, then it should be easier to have it coded as non-cosmetic, I would think.
Click to expand...
It is definitely more complicated. I've had some removed from my arms in an office before. His is quite large (almost looks like half of a ping pong ball) and is right behind his ear so we were told it required an Ear, Nose and Throat specialist.
Click to expand...
If that's the case, if the lipoma is causing discomfort, it's not cosmetic.
 
BassNBrew said:
matttyl said:
gianmarco said:
Even with high deductible plans, there's usually an annual max out of pocket amount. Do you know what yours is? Ours is $6K, and a quick search shows the average is about $5K.
Click to expand...
The max per person allowed by law is 8,050 this year.

OP should talk with his insurance carrier.

Also, with an HSA - dump money into it (for tax deduction), then pay whatever the cost ends up being from that.
Click to expand...
How is BlueCrossNC charging this....

Individual Out-of-Pocket Limit$9,450 in-network / Not covered out-of-network
Click to expand...
i think mine is 12500
 
BassNBrew said:
matttyl said:
gianmarco said:
Even with high deductible plans, there's usually an annual max out of pocket amount. Do you know what yours is? Ours is $6K, and a quick search shows the average is about $5K.
Click to expand...
The max per person allowed by law is 8,050 this year.

OP should talk with his insurance carrier.

Also, with an HSA - dump money into it (for tax deduction), then pay whatever the cost ends up being from that.
Click to expand...
How is BlueCrossNC charging this....

Individual Out-of-Pocket Limit$9,450 in-network / Not covered out-of-network
Click to expand...
That’s not an HDHP (a plan eligible for an HSA like the OP mentioned).
 
gianmarco said:
Jayrod said:
gianmarco said:
Without knowing the exact size and location, many lipoma excisions can be done in the office setting with local anesthesia.

If it's much more complicated, then it should be easier to have it coded as non-cosmetic, I would think.
Click to expand...
It is definitely more complicated. I've had some removed from my arms in an office before. His is quite large (almost looks like half of a ping pong ball) and is right behind his ear so we were told it required an Ear, Nose and Throat specialist.
Click to expand...
If that's the case, if the lipoma is causing discomfort, it's not cosmetic.
Click to expand...

Seems like the insurance is already coding it as non-cosmetic, right? Otherwise they wouldn't be paying the $19k.
 
Any chance you could hold off until the new year, then sign up for the medical "gold plan" in 2025 which would decrease your deductible then allow you to pay increased insurance via payroll deductions. Additionally you could max out your HSA to get some minor tax benefit.
 
I had a rather large lipoma removed from my back. Had it removed by a dermatologist in office under local anesthesia, I think I just paid my deductible.
ENT is head and neck but may check out a regular dermatologist for a second opinion and see what they think.
 
I've had a couple of these in my life, one on my shoulder and one on my back. It was back in the 80's and I had an old school doc who did pretty much everything he could in his office before he would refer you someplace else. Local anesthetic to numb it up, slice down the middle, pop it out, couple stitches, GTFO. I don't recall the cost but it's irrelevant to try to compare to what you were quoted. Because it's on his head I'm guessing they are being a little more cautious but it really shouldn't be a big deal and $9k sure sounds like a lot more than the procedure I just described. Especially with it being a general anesthetic.
 
Yeah, some good advice here.

1) Double check your max OOP.
2) Consider changing insurance plan for next year and do it then. This isn't emergent.
3) Definitely get a 2nd (and even 3rd) opinion. If general anesthesia can be avoided, then that would be ideal, both health as well as cost wise. Plus, your current charges may be much less.
4) Make sure it's not being billed as cosmetic.
 
@Jayrod


another thought is to throw yourself on the mercy of where it's being done. a while back when we had crap insurance, my wife needed a lumpectomy. and i had just found out that i only had one kidney. :oldunsure: LAM!! at the suggestion of the woman in the billing department, we applied to the hospital's charity program. there were some hoops to jump through but they took care of 85% after insurance. if you have :moneybag: :boatloads: :moneybag: this won't work.
 
Something else to keep in mind, if you go through with it this year - as discussed above, you’ll likely hit your max OOP for him for this one procedure alone. If so, everything else for him this year is “free”. Make sure all his checkups for it, and his annual checkup, and anything else he may need/want is done before the deductible/OOP resets.
 
gianmarco said:
Yeah, some good advice here.

1) Double check your max OOP.
2) Consider changing insurance plan for next year and do it then. This isn't emergent.
3) Definitely get a 2nd (and even 3rd) opinion. If general anesthesia can be avoided, then that would be ideal, both health as well as cost wise. Plus, your current charges may be much less.
4) Make sure it's not being billed as cosmetic.
Click to expand...
Agree with the above. I’d also be willing to bet the surgical center is intentionally billing the higher cost code, and the use of (high cost) general anesthesia is unnecessary.

I’d request a dermatology referral, and in the likely long delay before the appointment, figure out a better insurance plan. If that yields unsatisfactory results, I’d definitely consider medical tourism, to a place like Canada or Costa Rica, rather than Mexico.

All that said, this perfectly illustrates many of the reasons medical care in this country is a train wreck.
 
I had a benign tumor in my cheek in my 20's, I was living on my own and did not have the money to have it removed, it eventually wrecked my self confidence and I went close to 5 years between dates. I eventually got it removed, but by the time i could afford it the nerves were so wrapped around the tumor it turned what would have been an easy surgery into one that took 10 hours of the surgeon carefully unwrapping the nerves from the tumor.

I wish my parents would have helped me pay for the removal when it was first discovered.
 
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