We just got the EOB for cataract surgery in one eye. The replacement lens was a basic single vision replacement so basically the "standard" option and the procedure went well with no complications nor other issues.. The patient is on a Medicare Advantage program through their Government Retiree/pension plan. The surgery was performed in a hospital outpatient clinic by a Ophthalmologist that has their own practice. All were in-network for the Medicare Advantage plan.
The total gross billings including hospital and physicians was $32,000! The amount approved by the insurer was roughly $3,200 (but not exactly 10%) with the patient's portion being the plan's standard 20% co-pay of roughly $640.
I've seen large insurance discounts before but never anything that reduces to by 90% for such a large billing. With the possible exception of some medical tests originally billed at several hundred dollars.
So my question is why to providers bill such high amounts when they know they'll be reduced so dramatically. Especially in this case where $32,000 for basic cataract surgery is outrageous. A quick google search shows the average cost is $3,500. Since $3,500 is average, I can't see any individual nor insurance paying anything remotely close to the $32,000 gross billing.
So basically last year I was feeling a bit low. I really didn’t know how to become better since I had never faced this before. I used to not get proper sleep and woke up after having dreams due to my anxiety. So I just started noting what activities I did and whom I did it with in a google doc. Slowly I also started rating how I felt about the interaction. Soon I started to notice a pattern that I felt better when I hung out with some people and when I did certain activities. This way I was able to feel much better than before and I gained confidence that I can control my own mental health. I stopped dreaming as frequently since then. I even built an app for this so that other people can do the same .
The app is called Happyer which was made based on the above experience and provides insights into impact of a given activity or friend.
https://play.google.com/store/apps/details?id=com.happyer4life for android https://apps.apple.com/ca/app/happyer/id1537711110 for iOS.
I have created a subreddit https://www.reddit.com/r/Happyer/ to help easily address issues/bugs & to allow users to share their happy experiences :)
Also here is our website https://happyer4life.com if you would like to provide feedback, donate(to handle maintenance costs) or just know more about the app!
I’m starting a new job on Monday. Current insurance will last through the end of the month and new insurance will kick in June 1st. My wife has a transfusion to keep her psoriasis under control June 2 otherwise things will get very bad. In the past it has taken upwards of 30 days to get things “approved” for the medication. We’ve asked to move the transfusion date up into May and was told no.
What are the best options to make sure that we don’t miss that June 2 transfusion? Can I start the “approval” process with the new insurance early and hope for the best? Should I pay for a month of COBRA with the old insurance? Would that conflict with my new company insurance? Maybe I can do COBRA and push back my new company insurance for a month?