7 ms·

This. Exactly This. I am sick of hearing "oh you just pay $20 co-pay". No we don't. The real cost is much more and these pharmas and insurance companies know it

This. Exactly This. I am sick of hearing "oh you just pay $20 co-pay". No we don't. The real cost is much more and these pharmas and insurance companies know it. I know because I paid it for a family of 4. It costs $1500/Month for a decent plan that does not have high "out of pocket" costs (Read capped at $5000). So you pay $1500 per month and in worst case scenario, you can still pay $5000 out of pocket for a year IF the insurance company does not deny a claim. I usually don't make political comments but one thing that was disappointing with Obamacare was the fact that it did not address this root cause and instead touted that now anyone can get insurance. Sure, someone with pre-existing condition is now probably a little better off but overall, obamacare did not address the main issue: getting rid of middlemen (insurance companies) and let doctors/hospitals work on fair and transparent pricing. Isn't that what America is all about ? Free Market, eh. If I may steal the legendary MLK's words, I have a dream. A dream where I can call any doctor/hospital and ask what will it exactly cost to get a simple X-Ray done without saying "Oh no, I ain't got no insurance". Just a dream.

gizmodo59 10y ago
Adding to this, if you have insurance most of the hospitals will jack up the prices. One of my friend did not have the insurance card, so the hospital billed X$ and told him that if he later gives the insurance id they will charge them. He later called the hospital and gave the insurance details and he is charged (X+Y)$. Being the first time he got sick this year, he had to pay his entire deductible meaning he paid more because he HAD insurance.
- phkahler 10y ago
  IMHO providers should be required to charge the same price to all patients. That's not to say hospital X should pay the same as hospital Y, just that X needs to charge the same to all it's patients for a given service/procedure and Y needs to charge their own price for the same to all their patients. If you have insurance, then they need to be charged the same too. This would go a long way to promoting competition and price transparency.
  - kmonsen 10y ago
    and maybe make those prices public?
  - riahi 10y ago
    We are legally required to charge the same price to all patients. Specifically, we cannot charge less than we charge Medicare/Medicaid. Insurance companies are charged the same amount too; except, they negotiate a set reimbursement for a given service. Medicare/Medicaid does the same. Individuals are totally able to call up the financial services department of $LocalHospital and negotiate. In fact, if we accept insurance/Medicare/Medicaid and OFFER a cash discount to an uninsured patient, we are one whistleblower away from a Medicare Fraud investigation.
    - srini 10y ago
      Allowing differing reimbursement amounts seems pretty similar to charging different prices to different patients. Why not remove negotiation entirely and say price is X for all patients and you must reimburse 100%?
      - riahi 10y ago
        Is your hourly rate set to a certain price by a central body? Why should mine be?
        subhobroto 10y ago
        TLDR: Stop capitalizing on suffering. The reason why people on this thread are complaining is not because they have a natural disposition against doctors: it's because they have been taken advantage of! Long post: Good point, except that get to see I see the invoice AFTER a service has been provided to me, sometimes MONTHS after the encounter EVEN AFTER SPECIFICALLY asking for an estimate upfront. If you know a provider who works otherwise, feel free to answer this question: https://www.quora.com/How-do-I-find-a-general-physician-in-San-Diego-who-is-known-for-helping-people https://www.quora.com/How-do-I-find-a-general-physician-in-S... No providers office I know of are willing to provide estimates to patients for procedures the same office requires the patients to be financially responsible for! The reality is that the provider is like a programmer who builds what I discussed with her to build only that I get a $10k bill AFTER THE FACT without having a say in whether I am OK with it or not and she just went ahead and did the project for me without even asking me if I wanted her to do it. If I don't pay, my credit will be trashed with a collection entry. This is unacceptable. I am not sure if you agree. Case in point: I went to a specialist to figure out the ringing in my ears. I made it clear to both the administrative staff and the doctor that I should be told of any charges outside the office visit fee before such a charge would be incurred. The specialist looked into my ears and said my ears looked fine and the ringing could be due to stress. A month later I got a $1500 bill for "in office surgery". Apparently, if a specialist inserts anything into my body, it's a surgery and billed in addition to an office visit fee. I do NOT believe this is proper. The provider took full advantage of my inconvenience. I am lucky it was a $1500 bill and not a $15000 bill. It could very well have been and I would have NO recourse. I am happy to pay your negotiated rate as long as you tell me what that rate is and how many hours you estimate it will cost me. What I am NOT happy to do is be forced to pay an amount that I had no say in the first place. Providers ARE exploiting their patients and getting away with it by placing the blame on the faceless insurance companies. Patients are not walking blank checkbooks. They are suffering and under pain and looking to you for a remedy. Providers have a right to make money. Providers DO NOT have a right to exploit.
rayiner 10y ago
Transparent medical pricing is not possible so long as hospitals have an obligation to treat sick people whether or not they can pay. Hospitals heavily cross subsidize between insured, uninsured, and Medicare/Medicaid patients. As long as we put expectations on doctors and hospitals that compel them to do that, they cannot provide transparent pricing.
- codegeek 10y ago
  It is not possible in the current setup, yes. But if there was no insurance company to deal with for little things like X-Ray, that's the question. Why is transparent pricing so difficult for a hospital management to come up with if they don't have to answer to an insurance company OR even the Govt. for that matter ? Private Hospitals are mostly run like a business anyway so why not this part ? The status quo is not good enough and that is the point I am making.
  - rayiner 10y ago
    Are we going to allow doctors and hospitals to turn away anyone who can't pay the advertised rates? Like we allow every other business to do? And will we require Medicare and Medicaid to pay those advertised rates, without the discounts they currently get? Jose are the things that force cross-subsidization.
    - bradleyjg 10y ago
      The hospitals that are covered by EMTALA (duty to treat) are those that "receive federal assistance, maintain charitable nonprofit tax status, or participate in Medicare". A hospital is free to get off the federal government gravy train if it thinks it can make more money that way.
      - rayiner 10y ago
        You can't have the government distorting the market by bringing half of all potential customers under a single taxpayer-funded system then pretend that hospitals have a real choice in whether to participate in those programs.

gizmodo59 10y ago

Adding to this, if you have insurance most of the hospitals will jack up the prices. One of my friend did not have the insurance card, so the hospital billed X$ and told him that if he later gives the insurance id they will charge them. He later called the hospital and gave the insurance details and he is charged (X+Y)$. Being the first time he got sick this year, he had to pay his entire deductible meaning he paid more because he HAD insurance.

phkahler 10y ago
IMHO providers should be required to charge the same price to all patients. That's not to say hospital X should pay the same as hospital Y, just that X needs to charge the same to all it's patients for a given service/procedure and Y needs to charge their own price for the same to all their patients. If you have insurance, then they need to be charged the same too. This would go a long way to promoting competition and price transparency.
- kmonsen 10y ago
  and maybe make those prices public?
- riahi 10y ago
  We are legally required to charge the same price to all patients. Specifically, we cannot charge less than we charge Medicare/Medicaid. Insurance companies are charged the same amount too; except, they negotiate a set reimbursement for a given service. Medicare/Medicaid does the same. Individuals are totally able to call up the financial services department of $LocalHospital and negotiate. In fact, if we accept insurance/Medicare/Medicaid and OFFER a cash discount to an uninsured patient, we are one whistleblower away from a Medicare Fraud investigation.
  - srini 10y ago
    Allowing differing reimbursement amounts seems pretty similar to charging different prices to different patients. Why not remove negotiation entirely and say price is X for all patients and you must reimburse 100%?
    - riahi 10y ago
      Is your hourly rate set to a certain price by a central body? Why should mine be?
      - subhobroto 10y ago
        TLDR: Stop capitalizing on suffering. The reason why people on this thread are complaining is not because they have a natural disposition against doctors: it's because they have been taken advantage of! Long post: Good point, except that get to see I see the invoice AFTER a service has been provided to me, sometimes MONTHS after the encounter EVEN AFTER SPECIFICALLY asking for an estimate upfront. If you know a provider who works otherwise, feel free to answer this question: https://www.quora.com/How-do-I-find-a-general-physician-in-San-Diego-who-is-known-for-helping-people https://www.quora.com/How-do-I-find-a-general-physician-in-S... No providers office I know of are willing to provide estimates to patients for procedures the same office requires the patients to be financially responsible for! The reality is that the provider is like a programmer who builds what I discussed with her to build only that I get a $10k bill AFTER THE FACT without having a say in whether I am OK with it or not and she just went ahead and did the project for me without even asking me if I wanted her to do it. If I don't pay, my credit will be trashed with a collection entry. This is unacceptable. I am not sure if you agree. Case in point: I went to a specialist to figure out the ringing in my ears. I made it clear to both the administrative staff and the doctor that I should be told of any charges outside the office visit fee before such a charge would be incurred. The specialist looked into my ears and said my ears looked fine and the ringing could be due to stress. A month later I got a $1500 bill for "in office surgery". Apparently, if a specialist inserts anything into my body, it's a surgery and billed in addition to an office visit fee. I do NOT believe this is proper. The provider took full advantage of my inconvenience. I am lucky it was a $1500 bill and not a $15000 bill. It could very well have been and I would have NO recourse. I am happy to pay your negotiated rate as long as you tell me what that rate is and how many hours you estimate it will cost me. What I am NOT happy to do is be forced to pay an amount that I had no say in the first place. Providers ARE exploiting their patients and getting away with it by placing the blame on the faceless insurance companies. Patients are not walking blank checkbooks. They are suffering and under pain and looking to you for a remedy. Providers have a right to make money. Providers DO NOT have a right to exploit.

rayiner 10y ago

Transparent medical pricing is not possible so long as hospitals have an obligation to treat sick people whether or not they can pay. Hospitals heavily cross subsidize between insured, uninsured, and Medicare/Medicaid patients. As long as we put expectations on doctors and hospitals that compel them to do that, they cannot provide transparent pricing.

codegeek 10y ago
It is not possible in the current setup, yes. But if there was no insurance company to deal with for little things like X-Ray, that's the question. Why is transparent pricing so difficult for a hospital management to come up with if they don't have to answer to an insurance company OR even the Govt. for that matter ? Private Hospitals are mostly run like a business anyway so why not this part ? The status quo is not good enough and that is the point I am making.
- rayiner 10y ago
  Are we going to allow doctors and hospitals to turn away anyone who can't pay the advertised rates? Like we allow every other business to do? And will we require Medicare and Medicaid to pay those advertised rates, without the discounts they currently get? Jose are the things that force cross-subsidization.
  - bradleyjg 10y ago
    The hospitals that are covered by EMTALA (duty to treat) are those that "receive federal assistance, maintain charitable nonprofit tax status, or participate in Medicare". A hospital is free to get off the federal government gravy train if it thinks it can make more money that way.
    - rayiner 10y ago
      You can't have the government distorting the market by bringing half of all potential customers under a single taxpayer-funded system then pretend that hospitals have a real choice in whether to participate in those programs.