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posted by martyb on Saturday August 03 2019, @01:44AM   Printer-friendly
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


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  • (Score: 4, Funny) by aristarchus on Saturday August 03 2019, @07:44AM (2 children)

    by aristarchus (2645) on Saturday August 03 2019, @07:44AM (#875031) Journal

    This is why we cannot have nice things, like single payer health insurance!

    o 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.

    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.

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  • (Score: 3, Interesting) by AthanasiusKircher on Saturday August 03 2019, @03:35PM (1 child)

    by AthanasiusKircher (5291) on Saturday August 03 2019, @03:35PM (#875163) Journal

    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

      by Anonymous Coward on Monday August 05 2019, @01:21PM (#875922)

      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.