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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: 4, Interesting) by AthanasiusKircher on Saturday August 03 2019, @04:25AM (8 children)
Indeed. A few years back I went for a physical. My insurance covered a free physical with basic lab tests, etc. once per year as preventative care. My doctor's office filed the claim wrong, and I was billed for a couple hundred dollars. I called them up and they filed again. This time it came back with different errors. I called the insurance company and they said they filed the wrong codes -- the correct procedure code but some secondary code for the reasoning was wrong. By this time six months had passed, so I was due for another doctor's visit, at which point I explained my last billing stuff was still wrong. They filed a third time. Again, a different but still incorrect bill arrived.
I called the insurance company again, and once again my doctor's office could not figure out how to file the right codes... So I begged the insurance person to just tell me what codes they needed so I could tell the doctor, but she couldn't tell.me that -- that would apparently be like facilitating fraud by telling me how to file my own procedures to save money.
Eventually, after speaking to a manager, I convinced them to call my doctor's office directly and discuss how the codes work. Apparently they could talk to a provider about the codes, but telling them to me (even though they had to do with MY healthcare) could be seen as some sort of fraudulent influence.
All of this to file the correct codes for a routine physical.
Finally, nearly a year after the physical, my latest billing statement arrived. They actually refunded me about $11, because they had actually misfiled the insurance claim a fourth time. But in the process they had accidentally double-credited me for something else, so I ended up $11 ahead of where I was supposed to be if they filed things correctly. So I gave up and just took the $11. I guess "close enough" is the best you can hope for in medical billing. (Note also that this was not some obscure weird insurance -- at the time I was in a standard state health plan for all government employees in the state that had only two options.)
Since then, if I am going to a physician for something routine, I bring a copy of the relevant part of my insurance benefits book that covers my visit and sit down with the billing person before I leave to try to make sure they understand how to file my claims. I've had only one error since then, and not a big one.
Medical billing is insane in the U.S. I dread the day when I'll need to have aakor procedure, as I can't imagine the mess that could happen.
(Score: 2) by AthanasiusKircher on Saturday August 03 2019, @04:28AM (2 children)
I have no idea what autocorrect did to my final sentence, but I meant "a major procedure."
(Score: 1, Funny) by Anonymous Coward on Saturday August 03 2019, @01:03PM
The dreaded, yet inevitable, Aakor procedure.
(Score: 3, Funny) by Runaway1956 on Saturday August 03 2019, @02:29PM
Don't sweat it. English is evolving, after all. Kovfefe!
(Score: 4, Funny) by aristarchus on Saturday August 03 2019, @07:44AM (2 children)
This is why we cannot have nice things, like single payer health insurance!
Exactly, saving money under a capitalist insurance regime is fraud! Athanasius! Give us a pound of your flesh, closest to your heart! Or pay the out-of-network fee. Same diff.
(Score: 3, Interesting) by AthanasiusKircher on Saturday August 03 2019, @03:35PM (1 child)
Yeah, that was one of the crazier things I encountered in this process. It was a really weird reaction from the person on the phone when I just asked (innocently) for the codes. She kind of made some noises and then said, "Of course I can't do THAT..." And I said, "Why not? I just need my doctor to get this right, and clearly they can't figure it out." And the reply was, "Well... I mean, you can see that we can't be telling patients how to code their procedures! That would be fraud!"
Although the person on the phone was generally nice and helpful, I was treated as if I were suggesting criminal activity just because I recommended an efficient solution to an obviously stupid process. Also, it should be noted that the insurance person on the phone by that point could see from the history of the claim what the doctor's office was TRYING to do. The way it was coded didn't MAKE SENSE. So, it would obviously not be "fraud," since it was pretty clear from the list of stuff that I had just had a physical, not some random set of specialized tests to treat an abdomenal problem or whatever it was coded for at that point.
It's all absurd.
(Score: 0) by Anonymous Coward on Monday August 05 2019, @01:21PM
In Australia they are required by law to provide you with the information required to find out what is required and how much it will cost. Actually getting the correct codes is a serious PITA. Then you find that they won't quote until you book an appointment or operation or they just can't do it because they don't know which health care professional will do each part and since they all charge differently I'm sorry we can't quote you.
I found a way around it. First, nail down the parts you can get a hold of. The codes for the doctor and the parts of the procedures they do know. Then research approximately what they will cost. Then book a doctor, but don't go to the appointment. Before the appointment get them to book the actual procedure in the future. Get them to provide you with an invoice. A while later cancel it. Wash rinse and repeat until you have the numbers.
Given the range of cost can be in the thousands to tens of thousands it might be worth doing. Most people won't bother. The public hospital system is so much easier. Go to a doctor, get a referral to a specialist or surgeon or whatever, go to the appointments. Go to the hospital. Deny them access to your private health insurance details. Get it done. Get on with life.
(Score: 0) by Anonymous Coward on Saturday August 03 2019, @01:27PM (1 child)
And how much were you compensated for all that time and attention you had to spend on it? Don't shrug and say it was no big deal. Imagine if you had to do that every time for every product or service you buy. I went to a store with one of those self check-outs the other day. I couldn't figure out how to weigh the bananas. The attendant helpfully tried to train me how to use their "automated" system. There were four steps involved. Funny thing. I don't want to be trained as a grocery checker. I don't want to be trained as a medical billing expert. Imagine if I expected my clients to be trained as database administrators so I could shirk responsibility and sluff-off my mistakes as "no big deal, you deal with it...
(Score: 2) by AthanasiusKircher on Saturday August 03 2019, @03:43PM
I would NEVER shrug such a thing off. I was positively incensed the entire time. I seriously considered sending the doctor's office a bill for "account research," but I thought it was too unlikely that they would pay it. So, I just quit going to that doctor, after having a conversation with the billing person and my doctor about precisely why I was leaving. Most billing people aren't quite so incompetent, but the underlying problem is of course the overcomplicated system.
One surprising thing about this was that no one at any point said, "No big deal, you deal with it..." to me. At no point did the doctor's office object to refiling the claim several times. They were always polite to me, always promptly removed late charges from my bill when I requested a refiling (even though they ultimately didn't get their money until almost a year after the visit), and honestly I think the first incorrect filing started because they didn't look at my insurance in detail first and tried to code things in a way to SAVE me money. And the insurance people were polite and nice most of the time too.
It didn't make me any less angry about the whole thing, but actually -- with the exception of when I was refused billing codes -- everyone I interacted with was actually TRYING to help me resolve the issue. The problem was that the system was so insane that they couldn't communicate correctly to get it to work the right way.