Few people ask what the price will be in advance. I do know people that do, and they can and do shop around. You can get quite a bit better prices that way.
Few procedures are an emergency.
Few procedures are an emergency.
Unfortunately, there's no benefit to them to tell you (2). And without verifying your exact insurance coverage (i.e. submitting a claim) they have no idea how (1) relates to your eventual out-of-pocket costs (and they're disincentivized from telling you the billed rate in case you're actually another insurer trying to negotiate lower rates).
1) unless this is the first time they've done it, they'll at least have a range and an explanation for the difference.
2) They're motivated to not tell you. By staying quiet, they prevent you from shopping around. They maintain the ability to decide charges rather than having to negotiate. Telling you only once you owe them is something other businesses would love.
Is there a doc in the house who can give us their perspective? What's up with this pricing?
As an aside, in addition to other confounding factors, cost accounting would likely affect physician compensation since it would shine a light on their actual effort. Expect that to Just Not Happen in an organization with more than one provider. They enjoy their compensation, and they will fight to keep it.
Edit: perhaps the physician compensation scheme I am familiar with is wildly atypical. Hence the N=1 disclaimer.
It's usually pegged at multiples of what Medicare reimburses (ie, "300% of Medicare rates")
> Expect that to Just Not Happen in an organization with more than one provider. They enjoy their compensation, and they will fight to keep it.
It has nothing to do with physician compensation, because most are salaried now anyway, and they make a lot less than people think. The problem is that they literally do not know what the reimbursement rates are.
Even if you have insurance, they may be able to bill you for the difference between the cash and negotiated prices. It depends on relevant law and terms negotiated with your insurance provider. It's prudent to ask. Also, providers will sometimes "accidentally" bill you for that difference, even if they're not permitted to.
It's been my observation that hospital billing departments do many things "accidentally". Strangely, these never involve under-billing. A lot of bad things would have to happen to them (and insurance) before I'd start to feel even a little bad about it.
In other words, just because the errors are accidental, it doesn't mean they happen at random.
(This argument applies to any shady business practice that "looks" like an accident, for example dark patterns on websites, or having great customer service for taking your money but terrible customer service for refunding it.)
The doctor had an x-ray machine on premise, but he admitted to me that his costs for it were high and that I could get a better price at the imaging place across the street.
Once there, when I explained my lack of insurance, I was told that not paying up front adds $75 because billing is a PITA.
Even though an insurer might be able to negotiate a good rate, they can't beat cash on the barrel head because cash pay doesn't require nearly as much work.
Even uninsured can end up negotiating the bill, albeit after the fact.
Sometimes, insurance might negotiate lower prices than what a certain procedure/treatment costs, i believe that's not uncommon. They make up for it from other procedures in general.
1. The lack of health care cost transparency reduces price competition. 2. people not asking for price in advance, or not caring because the are already past their 1. deductible 2. out of pocket maximum makes healthcare expensive[a]. Similar to reference pricing, high-deductible health plans (with added HSA benefit) makes people think twice before going to doctors. I also felt a lot of people are not price conscious about healthcare - just yesterday a friend mentioned "i picked the most expensive plan so i don't have to think about it". Completely reasonable, but one reason why prices get higher each year.
[a: reference pricing] http://www.nytimes.com/2016/08/09/upshot/how-common-procedur...
Yes. One could say something like "I know that you're billing me three times what you get from insurance companies, and I know that you'd pay at least 50% to a collection agency, so will you accept 40% now?"
> Sometimes, insurance might negotiate lower prices than what a certain procedure/treatment costs, i believe that's not uncommon. They make up for it from other procedures in general.
True. Also from payers with less negotiating strength.
Unfortunately, this misses another pertinent point, that the provider/facility will be able to charge off and deduct as a loss either that 50% of the original amount they're going to charge you, as well as getting 50% from collections, or 100% if they're... 'creative'. This can often reduce incentive to negotiate.
There's nothing which prevents the sharing of this information, is there?
I'd like to see at least the protocol used in automobile repairs. You get an estimate and approve it. If the estimate turns out to be incorrect, you have the option of deciding on another course of treatment. This scenario can't work in many situations, such as surgery, but knowing some costs up front would help everyone make better decisions.
If adherence to estimates can't be made to work, I'd like to see limits on how long after a procedure you can be billed. At present, it's not at all unusual to get a bill months after a procedure from a completely unexpected source. There's usually no way to determine whether the amount billed is correct.
In the absence of that, it's just not so easy to shop around for medical care.
As most of the people in this thread have experienced its a maddening process. I've tried several times for routine procedures and its a huge headache that takes lots of time and lots of waiting on hold.
If the bill is potentially one of those crippling high ones, I'd suggest it's worthwhile to invest the time doing this, despite it being maddening.
But I suppose it could work better. I'm skeptical though. Finding the appropriate "accounting" folks in person would be a nightmare. A lot of the hospitals and providers I've dealt with use "third party" billing so your in person strategy with these types of parties would basically be impossible.
I recently served jury duty on a civil case where the heart of it was about determining medical costs, and listened to people whose expertise was to determine what was reasonable and customary pricing for a given service tell me price ranges that spanned orders of magnitude sized differences in price. They needed access to multiple private databases (whose costs were prohibitive for a single use case) to determine these prices... but even with those databases they had to temper what they found with their own expertise as the data could be incorrect or incorrectly encoded. They also explained that prior to providing a service, you might anticipate only one item to be charged, the end result might actually be an order of magnitude more items charged, some of which were literally additional instances of the anticipated services.
A few years ago, when it was rolled out, I was trying to help my mother-in-law shop around for Medicare Part D plans. This should have been the easiest thing to price out: I had a list of prescription items, I knew exactly what doses and medicines she needed, and how often. I got a list of eligible providers, and proceeded to determine their their pricing and coverage rules. I figured it should be as simple as building a spreadsheet and doing basic linear optimization. First, it turned out to be very hard to get pricing, particularly in an easy to digest fashion. Beyond that, I was told the pricing could be missing some entries, could be incorrect, or could be out of date and/or could change in the near future. I also found that coverage policy invariably had subjective elements that made outcomes nondeterministic. Nobody was willing to stand behind a fixed price.
Most of the time it is a #@$@#%ing crap shoot.
This seems like the absolute worst way to chose a doctor. I know some people in England chose hospitals based on car park charges, and I guess that's worse, but still.
What would your reaction be if you went to a dealer to buy a new car and he claimed to be unable to come up with a price?
As you can probably see from this thread, most of us would have the same reaction: impotent frustration. I can go to another dealer if I don't get straight answers. I can walk away at any point up until the final signature. This is simply not an analogous situation, as evidenced by the repeated testimony of everyone here.
And this guy: https://www.youtube.com/watch?v=Tct38KwROdw
"Shopping around" for healthcare in the US is impossible.
Staff are not allowed to tell you negotiated prices. They don't even know. On top of that, medical billing will jack up the prices by adding extra billing codes.
Healthcare in the US is a scam. Without transparent prices it will stay this way.
That's certainly not true. Try it. I've negotiated with a lot of outfits who claimed their prices were not negotiable. That's just a crock.
A good friend of mine is a successful businessman, and certainly does not need to negotiate. But he negotiates everything - it's entertainment for him. I'm constantly surprised at the amazing deals he gets on supposedly "non-negotiable" items, including medical bills.
Your suggestion is laughable. We asked three different hospitals what the cost for our daughter's birth was going to be; none of them could provide us with the answer until after the claim was submitted to our insurance. The out of pocket from the hospital we picked was $12k.
Now negotiating a bill down after the fact? Sure, if you can't afford to pay and document it, it can be done. But if you can afford to pay? Be prepared to be raked over the coals.
US healthcare sucks, and your anecdotal evidence is weak at best.
And I can have the exact same test done twice and get different bills.
None of this information was available in the computer systems of the providers who file the claims, nor have I been able to get it from my insurance in advance.
Recent anectode: 10minute chat to doctor about general health costed my wife 200$. She didn't get any blood work done, it was the price of the "visit/consultation". It was supposed to be preventive care, but not coded as such.
I think the hugest problem in the US thats not been looked at is regulating the providers - I don't think competition alone will help in emergency situations, but at least with doctors visits knowing how much something would cost would be incredibly helpful.
It was one of the most traumatic experiences of my life.
It's one of the many things broken about the US healthcare system. In no other market would a seller be able to get away with not providing a contractual quote before the service is provided.