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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: 1, Informative) by Anonymous Coward on Saturday August 03 2019, @07:17PM (1 child)
Most procedures are fixed cost beforehand. There is a LARGE set of documented procedures on it. They are all pre-priced pre-coded. Walk in X dollars. Cotton swab y dollars. Check for persistent cough z dollars. Test for a b and c, Q dollars. So on and so on. They have at least a ball park of what something costs. It is in their computers. Source: I designed systems like it in a past job.
They *know* what the 'real cost' is and what each insurance companies negotiated cost is. They already know. Surprises sometimes happen when you open someone up even that is fairly rare because of tests beforehand. Non surprises are here to get the shot so you do not get the mumps. That is fixed and up front. Not all things are an emergency. Even many surgeries are that way. I hear from friends and co-workers all the time 'I am going in next week to get ABC taken care of'. The costs are already pretty nailed down. There is not going to be much 'gotcha' there. You have an ulcer. It will be known within a small margin of error what the cost will be up front. Just like a car mechanic. You can call one up and say "i want to switch out the alternator on my 2003 Chevy Malibu what is the hours and cost on that'. They will say 'about XYZ' depending if there is something else. Mechanics have the added benefit they can stop in the middle of a procedure while you may not have that option in an operation. But lets say I break my arm I go into the doctor. He fixes and sets the arm. Puts the cast on it prescribes some pills for the pain. He MAY notice hey there is a spot on my arm that may be cancer you may want to check that out. He is not going to stop and start chemo right then and there. Same thing with a mechanic. They do the procedure and see something else...
(Score: 0) by Anonymous Coward on Monday August 05 2019, @10:16PM
Uh, no. You don't know how billing for healthcare works, no matter how similar you think it is to your prior work, sorry. My source: I work in the industry, directly.
Where you are right: There is a set list of procedures, copyrighted by the American Medical Association, which is called Current Procedural Terminology (CPT). It runs from code 1000[2]? through code 99999 (unspecified and unknown procedure). It is not 89999 numbers because there are blank files. CPT is broken down into 5 primary areas: Surgical (or other invasive) procedure (codes 10000-69999). Radiology (diagnostic and interventional, 70000-79999). Lab diagnostics (80000-89999) "Nonsurgical management" (we don't have to cut you, but it's not a straight up office visit, 90000-95000), and Evaluation and Management (office visits, hospital consults, etc., 96000-99999 but really just 99xxx.) There are thousands and thousands of codes. Your physician knows a bunch of common ones. Your physician does not know them all. Guaranteed. Not even coders stay current with everything. But there are books to look stuff up.
Where you begin to be wrong: You have an ulcer. What kind? Gastric? Esophageal? Duodenal? OH, you don't know the type! Silly person. So, you're going to come in and the physician will look you over. The physician confirms you have a gastritis, but you have no vital sign issues or other pathology that indicates that this is a crisis or needs any kind of aggressive management. The physician *doesn't care* which type you might have so long as he can be reasonably sure you're not going to bleed out or develop an immediate complication which might put you in jeopardy. (Actually, esophageal ulcers might well get some additional treatment then and there because esophageal bleeds are generally medical emergencies) - HEY, you just got sent to the Emergency Room! But here's what he will tell you to do: Go home. Get rest. Take some OTC meds. And if it is still bothering you in two weeks come back in and they'll go to the next step.
Now, should the physician's advice here be free to you? Oh. How much is fair for his opinion that a) you aren't dying, b) most people recover from gastritis without further complications with care available at home, c) first time ulcer symptoms may well resolve themselves although process on this is changing, d) if it is actually an ulcer then here's what to look out for and do next.
But wait! You have been going for six weeks this way before you walked in the door, and you have tenderness that may indicate this isn't an ulcer but a herniation.... all righty then. The physician feels around, and thinks you *might* have a herniation, but he can't tell for sure. Off you go for your X-Ray! Now, is that going to be 2 views, or 3 views, or is he worried about bleeding so he wants a CT instead? (Or, you're sweating too and your heart is beating fast and your BP is skyrocketing. Nope! Not ulcer! Chronic angina that may have already progressed to heart attack!)
Fast forward, and a surgeon is going to cut into you to repair your hernia. Is the surgeon going to use the posterior approach, anterior approach, laparoscopic? Is he cutting the upper stomach or the lower stomach? Now, I'll admit I haven't looking into all the possible herniation and ulcer codes. Not my field. I've got the book for it. But I can tell you that a single procedure may have any one of 10 codes, each with their own costs, for the basics of the procedure. ANY of those codes are modifiable by what are appropriately called "modifiers" for things like 'we only did one side,' or, 'we needed a second physician here,' or, 'we had to stop the procedure [because the patient was going south fast]'. NO insurer publishes a full list of how they slice and dice modifiers.
The physician might only have a clue about how long your procedure will take. Maybe they start with one approach and have to back out and try a different one (oh, but that different approach didn't get precerted! sorry!!!)
All this is a way of saying no, your physician's office has no real clue of what taking care of your ulcer may ultimately cost. And any physician stupid enough to quote you a price is likely one you don't want to go to. Could there be a basic idea of what it *might* run if there are no complications? Yep - they might have clues about what each level of care ballparks at. But the second a provider says, "well, uncomplicated it will be $XXXXX" then the patient WILL scream bloody murder if it is $1 over that even if the patient didn't follow physician instructions and introduced a riverload of complications by their own fault. And then you get another article about how physicians don't live up to their "billing promises."
Sorry about the length. The next thing that happens is your physician dictates (or otherwise records) the exact procedure done and all steps in it. Then a professional coder reviews that dictation, consults those books and comes up with all the charges that are applicable. (No, each cotton ball is not accounted to you by the physician. Hospital biling, different animal entirely, BTW. Those are managed by Diagnosis Related Groups, where your ICD-10 medical diagnoses specify how much the hospital will get even though they account for things like surgical and wound management trays and each pill you get.)
Anyway, the coder submits it to your insurance. The insurer (let's say Mingmong Insurance) runs those CPTs, crafted exactly for what you went through, through their systems and they find out that you have a contract with Gorpdork insurance to pay 10% less than what Mingmong would pay. And Mingmong and Gorpdork have a contract! So NO, the provider gets paid what they would have been if you had Gorpdork instead! Yay!
My basic point is still, no, healthcare is much more complex as I said earlier. Your mechanic knows every single step that replacing that alternator will take and there is only one way to do the job. That isn't healthcare, and be glad it isn't.