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from the there-should-be-an-app-for-that dept.
Fountain Valley resident Jennifer Moore makes a really good point.
"When you take your car to the mechanic, they give you a written estimate before they touch it," she told me.
"So why is it that when you go to the hospital, you have no idea how much something will cost until the bill arrives?"
Moreover, why are prices so completely different from one healthcare provider to another?
And why is it that when patients try to find out in advance how much something will cost, they're treated like unwelcome guests rather than equal partners in their own treatment?
[...] The near-total lack of transparency in healthcare pricing is a key reason we have the highest costs in the world — roughly twice what people in other developed countries pay.
Simply put, drugmakers, hospitals, labs and other medical providers face no accountability for their frequently obscene charges because it's often impossible for patients to know how badly they're being ripped off.
[...] Moore's insurer, Cigna, was charged $2,758 by the medical center for the two ultrasounds. However, Cigna gets a contractual discount of just over $1,000 because it's, well, Cigna. All insurers cut such sweetheart deals with medical providers.
That lowered the bill to $1,739. Cigna paid $500. That left a balance of $1,239, for which Mika was entirely responsible because she hadn't met her $1,250 deductible for the year.
Moore quickly ascertained online that the average cost for a pair of ultrasounds is about $500 — meaning the medical center's original $2,758 charge represented a more than 400% markup.
Cigna's lower contractual charge of $1,739 still meant the bill had been marked up more than 200%.
And the $1,239 Mika had to pay was more than twice the national average.
Wait, it gets even worse.
Moore said that after working her way through various levels of customer service in the medical center's billing department, she learned that the cash price for the two ultrasounds was $521.
https://www.latimes.com/business/story/2019-07-29/column-could-our-healthcare-system-be-any-dumber
(Score: 5, Informative) by legont on Saturday August 03 2019, @02:27AM (27 children)
Usually cash price is higher than what insurance negotiated.
Regardless, it is ridiculous. Just last week my wife had x-ray in a certain eastern European country and it was 200 times less than I paid using a rather good insurance. Yes, walk in price was 200 times less than insured one in the US.
Even $521 quoted here still would be 10-20 times too expensive.
"Wealth is the relentless enemy of understanding" - John Kenneth Galbraith.
(Score: 3, Funny) by krishnoid on Saturday August 03 2019, @02:37AM (1 child)
They tend to use a lot more consonants there, so basic supply and demand probably pushed the price of x-rays down a lot.
(Score: 3, Touché) by c0lo on Saturday August 03 2019, @03:03AM
Well, fuck! If that's the reason, then you, the Americans, should stop using so many dissonants then.
https://www.youtube.com/watch?v=aoFiw2jMy-0 https://soylentnews.org/~MichaelDavidCrawford
(Score: 4, Interesting) by Spamalope on Saturday August 03 2019, @02:42AM (8 children)
My fav in cancer treatments - they run your credit to see what assets you have - can't know what the prices is until they know what your life savings is...
(Score: 2) by krishnoid on Saturday August 03 2019, @02:45AM (2 children)
Which reminds me for all you old people -- get your colonoscopy done. A lot of times you can opt-out of the "amnes"-thesia and it's quicker.
(Score: 0) by Anonymous Coward on Sunday August 04 2019, @12:12AM (1 child)
TBH, I wonder what the point of the amnesia medication is. I had an endoscopy a number of years ago with nothing of any sort other than a mild numbing agent applied to the tongue and it was perfectly fine. Is it really that much worse having a similarly sized set up stuck in the other end?
Mind you, they ran that endoscope all the way through the stomach to the duodenum. And took a couple biopsies on the way. It wasn't like they just stopped in the throat or even stomach.
(Score: 1, Interesting) by Anonymous Coward on Sunday August 04 2019, @05:24AM
The reason for the sedation is four-fold. First is that with the prep, they don't want the actual experience to be bad because that just breeds noncompliance. Therefore they like to give something to wipe your memory of the actual procedure, which also can affect your memory of how bad the actual prep was. Second is that, unlike an endoscopy that takes less than 15 minutes, colonoscopies can take up to an hour per procedure (not counting recovery time), and asking someone to remain still and comfortable that long can be difficult. Third is that the intubation isn't well tolerated in about 20% of patients, even under twilight sedation, so that just breeds the idea of just deep sedating everyone because you don't know which category each patient falls into in advance. Fourth is that the actual results can be affected by the sedation level of the patient due to their mental state affecting the intestinal motility, shape, and other factors.
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @06:24AM
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @09:16AM (3 children)
Is this legal?
US only, I assume.
Running a credit check in Australia would show up on the record.
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @10:41AM (1 child)
Yes, it's legal (health care in the US is a for-profit industry, and treating the customers/patients is a secondary concern to maximizing profits). The credit check will show up on credit reports, but the customer/patient has to approve the credit check or they simply won't be seen by a doctor (let alone receive treatment).
(Score: 0) by Anonymous Coward on Sunday August 04 2019, @12:28AM
The thing about the people who complain about this type of "progressive" pricing is they also demand progressive taxation. You can't have it both ways.
USA is the most progressive country on the fucking planet, and all businesses operate that way. Sure you think the guy paying 10k is getting the same kind of treatment as the guy paying 100k? No he is not, it's the difference between a new car with no options and the one that costs 3x as much. The business will operate to ensure as many people as can own cars, hell two if possible, but the way they go about delivering cars to people is quite different depending on what they can afford. Now some people will claim"oh you shouldn't do that! everyone should have same level of care regardless of wealth!" Well that is a nice ideal, but it is not how the world works, and it will never work that way. Even in countries where everyone is "equal" by being equally poor, the elites still get better treatment by going outside the country.
(Score: 0) by Anonymous Coward on Sunday August 04 2019, @12:14AM
In Australia there would be no point in running a credit check as they send the bill to the same place regardless of patient. The only real concern is that the medical records are kept up to date and the appropriate procedures are billed to the correct insurer. At no point would they be looking at a patient leaving them tens of thousands of dollars out of hospital pocket.
(Score: 5, Informative) by AthanasiusKircher on Saturday August 03 2019, @03:06AM (4 children)
I used to think that, but there are increasingly a lot of situations where that is absolutely not true. About a decade ago, I was diagnosed with high blood pressure. (All four of my grandparents and both of my parents take high blood pressure medication, so it seemed pretty inevitable that I would have to deal with this at some point.) For the first four years or so, I got my medication directly from a pharmacy located right next to my health-care provider who worked easily with my insurance and who was recommended by my doctor. I paid $10/month "copay," I think. Eventually it went up to $12/month, and then maybe even $15/month.
Then I moved to another state. I had to find another pharmacy. I was nervous about the cost of medication, as I had switched to a high deductible plan where I had to pay a few thousand dollars out of pocket each year before I'd get payments toward most drugs. So I went to a local pharmacy with some "pharmacy discount card" I found online, hoping to beg for mercy. Turns out if I got this store's grocery discount card, I could now get my drug for $12 for a 90-day supply (or $5 for a 30-day), less than 1/3 of what I was paying WITH INSURANCE before. And no, I wasn't getting some brand-name drug before. They were both generic.
Sure enough, when I looked at the grocery receipt, it listed the retail price as something like $130 for my 90-day supply, but it was "discounted" when I paid cash with no insurance to $15. I'm sure this store and others charged a lot of random people lots of money because insurance didn't get as good of a deal.
Since then, of course, I've realized these common "generic drug" discounts exist at a lot of retailers and pharmacies. I always ask about them, and since then I've switched pharmacies three times, at two of which I paid $0 for my medication. I don't live near a chain that does that anymore, but at my current pharmacy, my drug is on a list that I can get a 90-day supply for about 50 cents more (with no insurance) than if I filed with insurance, but my insurance will only give me 30-day supplies. So, to me it's worth it to pay $2/year to not have to go to the pharmacy every month. That's how little insurance gets me.
And this is not the only place I've heard of this happening in medicine. If you think about it, actual CASH prices (not prices for billed costs to customers, but actual payment on the spot in cash or something equivalent) SHOULD be cheaper, as it cuts out huge amounts of costs for the middleman, time for filing and arguing with insurance companies that providers do, etc. The only reason costs are more expensive for individuals who are billed is because of a high delinquency rate on medical payments. If you walk in and offer to pay for your ultrasounds in cash, if the provider was acting rationally, they should definitely give you a better deal than what they would be billing your insurer for. Just like walking into a used car dealership with cash in hand. You can usually get a much deeper discount by avoiding all the details of payment, checking credit, setting up loans, etc.
Of course, we do not live in anything resembling a rational system when it comes to health care billing in the U.S., so most cash customers do pay more. And it's often next-to-impossible to find out what the exact cost of your procedure may be in advance, even for basic stuff. The insurance stuff completely mucks up everything. The easiest way to make health care costs drop overnight would be to require all costs for procedures costing less than a few thousand dollars (or whatever) to be posted clearly, perhaps along with a reasonable "cushion" in the case of emergency complications for more complex things.
If I can go to an auto mechanic and get an "estimate" before they do anything to my car, I should be able to get the same thing from a doctor or a hospital. It's the only honest way to do business. The only difference, as I already mentioned, is the potential for emergency complications in the case of more complex procedures, where they may not be able to get your consent in the middle for an increase in cost (unlike a mechanic who encounters a complication). In the case of everything but major procedures like major surgeries, they should be able to provide a list of potential complications, the relative risk of such complications happening, and an estimated cost for dealing with them in the midst of a procedure.
Short of going to single payer (the only rational choice in a civilized society, in my opinion, but I accept there are those who disagree), that's about the only efficient way to fix our system quickly. If providers offer discounts for someone with insurance, it should be very clear and straightforward and listed on the estimate -- and ALL such deals should be open and public and listed for all types of insurance, so everyone sees what discounts can be had and from whom.
The fundamental problem is a sequence of middlemen that have no interest in serving the consumer, coupled with complete lack of transparency. The only way to combat that is to shed a light directly on the costs.
(Score: 2) by SemperOSS on Saturday August 03 2019, @08:47AM
I think the in-procedure crises could be handled by adding a small surcharge to the price of the procedure (an "insurance" of sorts). The surcharge would be calculated by averaging the known risks of the procedure meaning that the many that do not experience any crisis would pay for the few that do ... except the hospitals would like to insure the insurance too and add many times the actual risk cost instead of just enough — just in case. Also, many people would probably consider this "socialist treason" and anti-libertarian dogma.
Sigh!
I don't need a signature to draw attention to myself.
Maybe I should add a sarcasm warning now and again?
(Score: 5, Interesting) by DavePolaschek on Saturday August 03 2019, @11:16AM
I was self-insured from 1998-2006. Cash price was always cheaper than insurance at the doctors I went to. I didn’t do a lot of shopping around, and frequently went to the then-new urgent care facilities. But I also went to the People’s Clinic [peoples-center.org] for routine stuff, as payment was based on your (self-reported) income, and the care was always good. They always seemed surprised to see a non-indigent nerd showing up, and they told me that I was paying more than I had to by reporting my actual income, but it was affordable enough.
I had more than one talk with the billing person and she said that one of the things that kept their costs low was that they didn’t do insurance paperwork unless absolutely necessary. They just got what they could from the patient and used med-students from the nearby university and doctors donating time to keep costs down. I think that’s changed somewhere along the way, but they’re still in business, so they’re doing something right.
(Score: 3, Informative) by bobthecimmerian on Saturday August 03 2019, @01:42PM
Sure. In 2007 through a paperwork screwup my family was uninsured and my wife needed an emergency MRI. We were billed $7,000 and I negotiated the payment down to $4,300. I paid it with a credit card. A few months later I called the same hospital and asked to get an MRI, and asked what the price was if I paid cash up front. Answer: $250.
Three years ago I had a family member in the hospital from December 30 to January 10. During that time my health insurance switched on January 1 from one insurer to another. The hospital accepted payment from both insurers. But when the billing was processed, the two insurers played football with the bill, arguing with each other and the hospital over who was responsible for what. The hospital billing department appealed their decisions a few times but missed one of the deadlines to appeal and extend the billing consideration period. Because of that, all future billing requests were denied because they hadn't been processed within 180 days of discharge plus the extensions to the billing period added by previous appeals. Now, according to the papers I signed during the admission process, if my insurers screw up I am responsible for the balance. So the hospital could have sent me an $18,000 bill. But to their credit, they told me they wouldn't punish me because the insurers figured out how to screw them. They got nothing.
(Score: 0) by Anonymous Coward on Sunday August 04 2019, @12:36AM
That's not surprising, the first blood pressure medications that they generally prescribe are diuretics that have been around for ages. There are other medications that are more expensive, but usually they won't go to those until after the cheaper ones.
And yeah, those are often times less expensive if you don't involve insurance. It seems like I was paying like $6 or so a month for my supply back when I was taking it.
(Score: 2) by JoeMerchant on Saturday August 03 2019, @03:32AM
That's not even a very big spread, I've seen 10x and more difference on items, and then there's the amount the insurance "allows" which could be $80 in a case like this.
🌻🌻 [google.com]
(Score: 5, Informative) by driverless on Saturday August 03 2019, @03:40AM (1 child)
Holy fsck! The price for an ultrasound here is around USD70 walk-in, and this is a generic first-world country where things aren't that cheap in general. An X-ray costs about the same, and the tech was apologetic to me about how high the cost was. Just to clarify that, that's not government-subsidised, that's what the medlabs charge you. So compared to $1,739 for two that's under one-tenth the price of the US.
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @04:46AM
butbut muh R&D
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @06:19AM
(Score: 1, Interesting) by Anonymous Coward on Saturday August 03 2019, @10:36AM (1 child)
Not in my experience. I recently had an MRI done on my knee (pro tip: don't rupture tendons or tear your meniscus). Insurance price was $2,550, self pay was $475 (if paid up front). I told them I didn't have insurance because I'm well below my $5k deductible.
The administrative costs for dealing with insurance companies are ridiculous and the medical practices pass that cost (plus markup) on to the patients. Plus, the time it takes to get payments from insurance companies slowly increases. It is not unusual for Medicare payments to take 12-14 months. Floating that much accounts receivable is hard when staff, leasing companies, insurance carriers, etc expect to get paid on a timely basis.
(Score: 0) by Anonymous Coward on Monday August 05 2019, @10:23PM
No, the charge cost was $2,550. Your self pay was $475. The price insurance would have paid would have been about $350 and the proivder would have been ordered to write off the other $2,100.
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @12:27PM (1 child)
No usually it is cheaper, the only people who think cash price is higher are those who tell them they have insurance before asking. Once they know you have insurance they need to tell you the cash price in their contract, not the real price.
Admitting you have insurance is like writing sucker on your forehead. The only other people who have it are using it as a tax avoidance scheme.
(Score: 0) by Anonymous Coward on Monday August 05 2019, @10:25PM
If the insurance company finds out the provider is discounting a self-pay less than the insurance (and they will sooner or later), then that provider is told that they either keep their self-pay prices about the insurance price or they kiss their contract goodbye. The whole point of the insurance contract is that the insurer delivers volume in exchange for getting a discount less than what the ordinary person pays. That does not have to be the chargemaster rate of the procedure, just higher than what the insurance rate is.
(Score: 3, Funny) by Runaway1956 on Saturday August 03 2019, @02:15PM (2 children)
Eastern Europe? That wasn't exactly an X-ray, was it? They have an old Soviet nuclear warhead hidden behind the curtains. You walk in front of it, and the radiologist reads you, live.
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @03:36PM (1 child)
you should learn how nuclear weapons work before making stupid comments that attempt to be funny
(Score: 2) by Runaway1956 on Saturday August 03 2019, @03:54PM
And, you should pull that three foot long stick out of your ass before you presume that I don't know how nukes work. I worked, slept, showered, shit and shaved within the confines of a floating nuke silo for 2 1/2 years. My shipmates and I joked about this shit all the time, thank you very much.