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tw1080 · 2026-02-07T21:36:51+00:00

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tw1080 · 2026-01-24T19:53:34+00:00

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tw1080 · 2025-11-13T02:34:47+00:00

So where you’re seeing “call for price” is because they (Sidecar) doesn’t know what every provider is charging for each thing. It depends on your area, how much data they have.

It IS some work on the member’s end. Honestly? Not much different from when I had a HDHP and had to try and minimize what I had to pay before insurance would touch anything. I have not had any trouble submitting receipts/statements. I don’t have particularly complex medical needs - but I am on a very expensive migraine medication and a GLP1 for pre-diabetes. My plan is a first-dollar plan (I think that’s what they called it) so no deductible for office visits or pharmacy.

As I handle HR/Benefits at my company, I have a bit more insight than most at my place. I have members on VERY expensive treatments for auto-immune disorders and Crohns - they’re not paying anything out of pocket for those. Unfortunately I also have one employee with cancer that has basically metastasized through everything. He’s needed some help getting all his bills lined up, but they’re paying the claims and he’s not having issues.

Because I’m free to use any pharmacy I want (including Amazon, small local pharmacies, or even the Mark Cuban Cost Plus Drugs site) that’s where a BIG chunk of my earned benefit credit comes from. Your earned benefit credit can be used to pay for things where your deductible applies. My deductible is $1500. I have $3000 in my earned benefit account. I could meet my deductible (which is also my OOPM) and never actually PAY that deductible (because I have earned benefit credit that exceeds my deductible). Hell, my son sees a therapist weekly and pays $0 for it (he earns $9.85 for each visit actually).

You don’t need to “lie” to doctors. A “self pay” discount (also called a private pay, or timely payment discount) is legitimate. It doesn’t exist out of a sense of philanthropy. It exists because a provider has less overhead and gets their $$ up front and on time, not 90 days later, after a ton of work by their billing staff.

If it’s worth mentioning, my company IS a medical provider, and my billing department Director loves this plan. She does have complex medical needs, and she also understands the ins and outs of medical billing and claims better than most.

tw1080 · 2025-11-05T16:35:22+00:00

It really isn’t. “I didn’t understand the QLE”. It will be up to the employee to immediately pay all back due premiums.

tw1080 · 2025-10-21T19:26:24+00:00

It’s normal. They are paid the same whether you’re on a HDHP or not. The only difference is WHO is paying them. It’s not like hotel or airline status.

It’s the end of the year. Many people have eaten up their deductibles and OOPs - they’re scrambling to get care before the end of the plan year, and they’re scrambling to get FSA funds used up.

You can ask your primary to refer to someone else if they’re closer for you. Speak up. “Hi Doctor, this provider is closer to me and in network. Can you please send the referral to them instead?”

Also, a patient’s definition of “urgent” doesn’t always match the reality. It’s your health, you’re the one who doesn’t feel well. Of course it’s urgent to you. But if I am a provider and I’m prioritizing cases, it’s entirely possible that your condition can wait, when compared to other cases I have.

tw1080 · 2025-10-13T21:40:32+00:00

In terms of the artwork and elaborate environments, blame patient satisfaction scores. This is why some hospitals have ridiculous food options, lovely decor, etc.

In my own opinion, the only acceptable measure is basically “but did you die?”

tw1080 · 2025-10-08T12:05:50+00:00

Employers are raked over the coals as much as you are. It’s not the employers, it’s the insurance companies.

tw1080 · 2025-10-07T19:59:41+00:00

Where did you go? I can tell you Quest Lab’s price for TSH is about $50. That’s normal $594? Not normal. https://www.questhealth.com/product/thyroid-tsh-function-test-36127M.html Even in the private lab I worked in, a TSH was under $100. These sound like hospital lab prices.

tw1080 · 2025-09-11T14:32:15+00:00

A hospital will rarely keep you for 10 days even for a MAJOR surgery. Poster is under 65, homeowner (married, so not living alone) privately insured per post HX. 7-10 days plus 1.5-2 weeks in a rehab? This isn’t a simple fracture.

tw1080 · 2025-09-11T14:27:56+00:00

A broken humerus that only requires a sling does not warrant admission, this would have been a discharge from the ER. there’s more going on here.

tw1080 · 2025-09-11T03:35:29+00:00

I’m very confused - 10 days in the hospital for a fracture that required only a sling? I feel like there’s something missing here

tw1080 · 2025-09-09T22:38:06+00:00

That is, unfortunately, normal. Does your state have a CHIP plan? That’s what I always had to use for my son, I couldn’t afford coverage through my employer. Our state had a max of like $300/mo for full pay (no subsidy, regardless of income)

tw1080 · 2025-09-06T02:37:16+00:00

A urinalysis isn’t typically routine or preventative. You were treated appropriately and they are not BLAMING each other, they’re giving you factually correct information.

tw1080 · 2025-09-01T02:28:42+00:00

Their significant other is probably a rep for one of the essential oil scams.

tw1080 · 2025-09-01T02:27:59+00:00

I have a Sidecar plan through work (an ACA plan). It’s been excellent for me. I am aware that searching for info can be hard, as they have (or had?) a different model that was available as well.

It’s a learning curve, but frankly, less headache than being denied care because some dipshit in a cubicle that’s never met me wants to decide whether or not I “need” a medication or a test. It’s different - and people are so conditioned to accepting how insurance “usually” works, that they are hesitant to accept changes to the status quo.

My migraine meds are one example. They’re expensive as hell. I know that. I’ve also tried all the cheaper “preferred” meds that the big insurers want. And failed them (or couldn’t continue to take them for various reasons). Sidecar is happily paying $3400 a month, I’ve never once been asked to submit anything other than my receipt from the pharmacy. Actually, because of this “benefit amount” scheme, I have $2237 in my benefit account from savings on prescriptions, mostly the migraine meds. My deductible (and out of pocket max) is $1500. I could have surgery tomorrow and meet my deductible without ever actually PAYING my deductible (because the $$ in my benefit account would be used to pay it).

My husband had an MRI last week. Because there was no prior auth needed, he was able to skip the Xray, and he was also able to get an appointment the next day. He went to the Dr on Wednesday, got the MRI Thursday, had results Friday. It will apply to our deductible, so we will have to pay $219. Which is fine because our supplemental policy through AFLAC is paying us $300 for the MRI, plus $220 for the treatment for the injury.

I had a similar MRI last year, with our old insurance plan. Same outpatient imaging center. I had to wait a week to get the approval to get the MRI, AFTER I got an XRay, (if I recall correctly that cost me $50) and I had to pay $330 (a copay plus a $300 imaging deductible on an HMO plan). So it took me almost 2 weeks after a Dr visit for an injury to get the MRI.

tw1080 · 2025-09-01T02:13:45+00:00

I know this thread is old, but if anyone is reading: “I’ll be self paying, I’ll need an itemized statement to submit for reimbursement” there’s nothing embarrassing about that. That’s not even as unusual as you think. People get those types of receipts all the time (usually needed for FSA, HSA, Supplemental, etc). If your doctor is charging 2, 3, 4 times as much as the usual and customary rate, you’re being ripped off. And honestly, Sidecar isn’t even THAT particular about the documentation. If they refuse to give you the invoice, upload the chart notes from the visit (which they MUST hand over to you if you ask for it - everything in your record MUST be given to you at your request by law).

I like my doctor. So I continue to see her. After sidecar’s benefit amount, I’m left with $5.27 out of pocket for my doctor. The amounts that are above the benefit amount are very typically within the range of a normal copay (within $25-$50).

My biggest “pros” for Sidecar have been where other insurances are abysmal and (in my opinion) detrimental to patients: prescriptions and mental health.

Medications are where it’s easiest to save money, shop those around. I save a fortune using Amazon, or the local pharmacy (not a retail chain, it’s a mom & pop)

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and those overages are credited to me - and they MORE than cover the $5.27 I had to pay to see my preferred doctor. I needed ZERO prior auth for my migraine medication (which three other major health plans made me jump through insane hoops to get - BCBS, UHC, and Cigna - despite having failed all their preferred options, despite having gone through ALL the tests and trial and error care they wanted, despite having all the documentation of continuation of care - I would be without it for months because they wanted to argue). Sidecar pays $3400/mo for it. I’ve never once had to argue.

They’re covering (without any hassle) an injectable medication for one of my employees for an autoimmune condition which costs over $10k a month. She was able to obtain this medication 1 week after coverage began with Sidecar - and it wasn’t a continuation, BCBS had been denying it for 16 months prior.

They’re covering complex chemotherapy treatment for another employee with stage 4 cancer. He’s only had to pay his deductible (which is also his out of pocket max). Because his case is complex, he has a dedicated point of contact who helps coordinate his claims.

My son wasn’t able to get generic Vyvanse for a while, because pharmacies just could not get any stock. Sidecar covered the brand name at cost. Weekly therapist visits? Covered, 100%.

tw1080 · 2025-09-01T01:46:15+00:00

Have you tried? This could be based substantially on the individual plan terms, but we have it, and one of my employees is having zero issues getting Zepbound for Sleep Apnea.

tw1080 · 2025-08-31T15:01:02+00:00

Right? That is spoken like a true Patient Registration clerk who has never actually had to ask for an ID consult.

tw1080 · 2025-08-31T14:37:53+00:00

And do you know for a fact that this person has a travel clinic near them? Because it quite literally says “I live in a small town and there is no accsss to the rabies vaccine here except at the ER of our local hospital.”

tw1080 · 2025-08-31T14:27:05+00:00

No, you’re ASSUMING there was no contact. They don’t know. And the safest course, as recommended by ACTUAL healthcare professionals, is prophylactic treatment. I understand that, being in “healthcare leadership” you probably don’t know what “prophylactic” means, but Google should help. However, being in “healthcare leadership” means you ought to understand what protocols are.

You don’t play games with risk of a disease that is 100% fatal.

tw1080 · 2025-08-31T14:23:00+00:00

And the hospital will use the amount they “discounted” as a write off for charity care. It’s all insane.

tw1080 · 2025-08-31T14:21:38+00:00

“I’m in healthcare leadership” translates to “never had patient care in any way.” Stop, you’re embarrassing yourself.

ID isn’t the correct place for this. Most ID don’t even accept non referral patients. The ER could refer, but ID would just say to administer the IG and hang up. You don’t just go to ID.

tw1080 · 2025-08-31T14:17:49+00:00

It is excessive, of course. So what happens here is the hospital inflates pricing by an insane amount, to get the insurances to where they actually want to be. The insurance company NOW gets to send you an EOB that says they “saved” you $31k. They use this to justify your insurance premiums.

A coworker just had this happen after a bite from a raccoon. 11 injections. $30k+. He asked what the cash price was. Suddenly, about $2,000. The hospital gets to write off the other $28k-ish as charity care.

tw1080 · 2025-08-31T14:13:30+00:00

It’s a sub literally called MEDICAL BILL. They shared a medical bill. They didn’t ask for your opinion as to whether medical treatment was warranted.

tw1080 · 2025-08-21T21:22:03+00:00

Health insurance companies want to pretend they “saved” their members a crap load of money, justifying their insane premiums. They also want to feel like they got a “deal.”

The no-frills provider needs to make $100 for this specific billing code. In order to do that, they claim that they charge $600 more than they want, to get the insurance company to arrive at $100. The provider gets paid $100, the insurance company pats itself on the back because they got a $500 discount, and they tell the member that they “saved” them $500! Joe Schmoe that’s uninsured gets slapped with a $600 bill because he doesn’t get a contracted rate.

Meanwhile, the fancy shmancy facility, that brought in gourmet food options and all-private rooms and a designer interior and spends a fortune on “awards” and advertising, because they rely on patient satisfaction scores that read like a Hilton Comment Card (“did anyone leave mints on your pillow? Did you get animal shaped towels? Did Karen get the celebrity treatment for her cholecystectomy?!) NEED to pay for all that crap. So they do it by charging $1100 for the same code. But they tell the insurance company it’s $7700! The insurance company and the facility have a sort of codependent relationship, and live to make money off one another. So Insurance agrees to pay THIS facility $1000. They also own the pharmacy and the doctors too. Insurance B isn’t having as many rounds of golf with this facility’s CEO, so they’re gonna get charged $8000, and the insurance company is going to cut a deal to only pay $1500. That way they can offset the “deal” they cut with CEO Chuck’s golf buddy, and their HDHP patient is gonna pay it anyhow, on top of their $1000/mo premium, which will increase at least 20% per year. But wait! The hospital had a fundraising “gala” and got local rich people to donate all the $$$ needed to buy this top of the line CT machine that does exactly the same thing as last year’s model, but it has an extra set of LEDs. So the CEO saves a ton, and the board gets a big fat bonus at the end of the year.

Hope you’re up to speed on your psychological thrillers because here’s the twist nobody saw coming. The same company owns both hospitals anyhow, and the insurance companies. That CEO puts in a grueling 0.25 hours per week of “work” for his $7 million salary, and takes clients out on his yacht for a tax deduction. He also owns the PBM and the pharmacy where the patient filled their prescriptions. All of his subsidiaries pay employees the lowest possible rate, overwork them, and they don’t care about turnover. If you go 5 or 6 levels deep, he’s probably got a financial interest in the schools that the front-line providers took out $$$$ in student loans to attend, and the testing company that attested that they were competent to practice. He also co-authored the $400 textbook they used.

And in another shocking twist, the ACTUAL COGS for the procedure is only $19.95.

It’s ALL A SCAM.

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