When I go get my car fix and I would go around to get an estimate for multiple body shop even if it is under insurance. But when it come to health care, you ask them for a cash price, they said they don’t know.
This is so astonishing cause you would assume they have NEGOTIATED the rate given its in network so there is little variability in what can be charged by the doctor and what can be thrust upon the customer. ex. if you charge $100K more than other in-network doctors, good luck, cause the insurance company is only paying the doctor $5,000 no matter what and the customer will be on the hook for X% of that (outside of deductible and other math required to quote a price)...
I'm not saying it's a good way to do things.
Opening a price list, it looks like one hospital charges ~$5000 for a knee replacement without major complications, and then the matching price for one with complications is $30000.
So how do they quote that when the complications can be unpredictable?
Which of course just says that maybe people shouldn't be put in the situation of trying to figure it out for themselves.
Then they should be ones buying “price insurance” to compensate them potentially exceeding the quoted costs. That also has the pleasant effect of aligning incentives so they can keep their costs accurate.
Quote a menu then. Something like:
If everything goes well, we'll do X, Y, and Z; which will cost $5million, plus an extra $200,000 for the Oxford comma.
Some potential complications are this and that and they cost even more, etc. All surgeries are risky, and you could require life saving interventions which will cost a stagering amount, and we won't be able to ask for consent.
The patient could say; well wait, I don't actually want an Oxford comma, please leave that out; and they could put that on the chart, and if it's added, it doesn't get billed.
And also because providers have genuinely zero idea what insurance will pay for and insurance has zero idea what a provider is going to bill for. You can get basically exact costs for specific codes but good luck assuming they’ll bill it that way.
I used to do consulting and fixed price estimates were common. Even when requirements were unclear. The way I mitigated this was with multiple clients.
Hospitals have lots of customers. They don’t have to perfectly estimate everything, they just have to be good on average.
Here’s a podcast from Econtalk with Dr Kieth Smith from Surgery Center of Oklahoma [0] where he explains how his hospital does it. Basically he estimate the cost for an average procedure and charge that, they are good at estimating and adjust each year. Sometimes extra stuff happens, sometimes less stuff happens. If the shit hits the fan during the procedure they have that rare event factored in.
It’s such an odd argument because they certainly could if they had to. But they don’t, so they don’t.
[0] http://www.econtalk.org/keith-smith-on-free-market-health-ca...
Not sure why describing what they do is being treated as a defense of it.
They said it was fine though because insurance would actually cover it.
But they were wrong on that account too.
In comparison, the actual fertility clinic we went to was upfront and told us the price of everything ahead of time.
Everytime I've had to deal with a hospital the billing experience has been a nightmare. Fuck hospitals.
Even a car mechanic gives you a detailed quote of what he EXPECTS and then you sign off knowing there is a caveat that more work could be needed.
From the article:
> As of Jan. 1, hospitals must publicly reveal the negotiated rates reached with insurers for services, a landmark shift in the sector notoriously opaque when it comes to pricing. The data offer a peek behind the curtain, exposing prices long kept a secret.
The catch is that they can't guarantee what services you'll receive. If you have complications after your inpatient surgery, the price is going to be higher than the estimate due to additional services.
[1] https://www.commonwealthfund.org/blog/2014/affordable-care-a...
I am just a little afraid that they will find other ways to obscure things quickly.
1/ Got the procedure codes from the doctor
2/ Got the doctor's estimated billing for those codes
3/ Reviewed my insurance information and in/out network status and then called up the insurance company to confirm the amount they would reimburse for those codes
They REFUSED to give me a clean $ number on how much they would pay of the bill that the doctor would give me. The bill from the doctor was high so naturally I wanted to know the true cost that I might be stuck with and the insurance company just wouldn't give a straight answer.
Naturally if there are complications and you have to have new procedures then it makes sense to me the price could go up, but for a straight procedure code to price transparency there doesn't seem to be any change in my personal experience
Note that mechanics don't particularly know what they're going to have to do to any given car before they really get into working on it. Yet the market functions perfectly fine with estimates, agreements on hourly rates, phone calls for decisions on surprise situations, etc.
The reason I'm curious is because using your car analogy, if I was a barely competent mechanic then management would probably be fine letting me perform oil changes, but when a classic Rolls Royce comes in with all original parts, management isn't going to let me touch that, right? They'll need to call in the big guns, whose rates are definitely higher than my "oil change" rate. I know that doesn't directly map with how medical procedures play out. I guess my real question is when and how does that balance out?
In the car analogy, there are natural differentiators between levels of service, namely completely different shops that Rolls Royce owners go to. Even so, the same shop could have a price list specifically for Rolls Royces, using Rolls Royce certified mechanics.
And the residual where a shop is willing to pay for damage caused by barely competent mechanics on less expensive cars, but only becomes concerned when that liability grows? It seems like that should fall on the business.
As with everything, "it depends".
You often can get an idea from your insurance company, who will often provide you with what's called the "usual and customary" rates for a given procedure (in-network). Depending on the procedure, though, it may be hard to pin down. The procedure you want may actually consist of 3 things, and you need to look at all 3 up.
Also, if you call some private practices, and if it's a standard procedure (ultrasound, etc), you will often get a quote if you tell them you'll pay cash without involving insurance (some people ask for the "uninsured rate"). Often that will be less than the insurance negotiated rate. The down side is that whatever you pay will not count towards your deductible.
My experience getting a COVID vaccination was eye opening. I walked into a large facility, provided ID, was asked screening questions, consulted with a provider about a medical issue and got the shot.
I work for an employer with a legacy PPO. I suffered a back injury, had a major surgery and 8 weeks of physical rehab. My out of pocket was a few hundred bucks. I didn’t lose a days pay because of sick leave at half pay and short term disability insurance. The people I was in rehab with were losing jobs, selling cars, facing complete ruin.
The lack of ethical standards and focus on profit over the general welfare of the people is gross.