5 ms·

It's also not a service people can easily "shop around" for in an emergency, or go without. Heck, the information asymmetry, alone, between the buyer of the se

by zzalpha 10y ago

It's also not a service people can easily "shop around" for in an emergency, or go without. Heck, the information asymmetry, alone, between the buyer of the service and the person offering it (that is, the information required to evaluate if they're getting the correct treatment at an appropriate cost) ensures the market will not be a fair one. Anyone who's gone to a mechanic that's performed unnecessary work knows what that's like... and that's just a car.

rgbrenner 10y ago
The current situation isn't like a mechanic at all. If a mechanic tells me I need some work done, I can call various mechanics and ask what they would charge to do that, and they'll tell me. If you try that with a hospital, they'll tell you no. Go ahead and try asking your doctor what something will cost. If I could ask for a price up front, then people who aren't in an emergency could shop around. That would force hospitals to actually compete, which would normally mean most providers would be within a range of the average market price. So when an emergency does occur and you were taken to a random hospital, chances are that hospital would have prices close to the market price.
- sjg007 10y ago
  Right now you shop at the copay level as a function of insurance. PPOs were a great scam to force coinsurance onto the masses.
- zzalpha 10y ago
  My comment about mechanics was specifically with regards to information asymmetry. That is, 99% of people do not know enough about cars to determine if they are being fleeced. Now imagine dealing with the human body. Information symmetry leads to market failures: https://en.m.wikipedia.org/wiki/Information_asymmetry https://en.m.wikipedia.org/wiki/Information_asymmetry
  - deleted 10y ago
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- deleted 10y ago
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- WalterBright 10y ago
  > If you try that with a hospital, they'll tell you no. Go ahead and try asking your doctor what something will cost. My experience is they will tell you, and you can ask for a better price, and I've always gotten one. The idea that one cannot negotiate with the hospital, the doctor, and the dentist is just incorrect. Try it next time.
  - sjg007 10y ago
    I've noticed that insurance pays at most 50% less, in many cases much less than that. And the medical provider accepts it.
  - pwinnski 10y ago
    Your experience is literally unbelievable to me. I don't doubt you, I just cannot believe there isn't more to the story. In another comment you seemed to indicate that you are perhaps uninsured and paying cash for everything? That would go a long way toward explaining why you have experiences that run dramatically counter to almost everyone else on this thread. It also seems like important information to be included, if so.
    - WalterBright 10y ago
      I am insured. You can opt to be billed by the provider, and submit the claim yourself. If you're unsure how this works, read the contract you have with your insurer, or call them on the phone. They may also be able to give you advice on negotiating for lower bills - after all, that lowers their cost as well. I have a high deductible, so usually wind up paying the entire bill out of pocket. There's no reason to go through the insurer for that.
- pimlottc 10y ago
  In general, doctors find the system as bewildering as you do. They might be able to give you a ballpark figure but you'll need someone in the billing department for a hard figure (if you can get one at all). Although they will still likely need an exact billing code for the procedure first.
stretchwithme 10y ago
Most health care is not delivered in an emergency. And even when it is an emergency, prices for everything could still be made available. Hospitals do decide how much they are going to charge for everything before you get the particular procedure. It's just not published.
- WalterBright 10y ago
  If they won't tell you, tell them you're going to their competitor hospital. That's all it takes to loosen things up.
jerkstate 10y ago
It's not even the same ballpark. At any reputable mechanic you can get a diagnosis done for free or low cost, and there exist books that estimate the time cost and replacement parts needed for pretty much every repair. There are some known unknowns going into it, like finding worn parts that need to be replaced, but I find that auto repair shops are pretty upfront about possible additional costs. I haven't had any similar experiences in healthcare; I don't think I've ever gotten an answer from a medical practitioner or office manager about the cost of a visit, procedure, lab work, or to what extent it would be covered by my insurance. Even for a vertically integrated HMO like Kaiser, simply no-one you can talk to knows.
- WalterBright 10y ago
  I have asked, and also asked for a discount if I paid on the spot. You can often get a third off the price that way - just by asking. It's the same with auto repairs. I'd take my car to the dealer for repairs, the service dept quotes me a price, I say that price sounds a little high, the price drops 30%. In any negotiation, you're going to get the sucker price if you don't ask what the price is, or make no attempt to negotiate. Nobody is obliged to give you their best price automatically.
  - jerkstate 10y ago
    If you don't mind me asking, what kind of medical office/procedure were you able to get a cash price and discount on, in what setting, and which employee did you ask? I've never heard of that happening in the US before the fact; I have heard about negotiating down your medical bill with hospitals after the services have been rendered, though that seems like a crapshoot to me.
    - mgkimsal 10y ago
      Can't reply for walter but... I've had a few experiences over the last decade with healthcare services. Had a consultation, some bloodwork and a other bits and bobs - nothing serious. Got a bill a month later for.. $430. This was done through insurance from my employer at the time, but my portion was still ~$430. I went to their office and said this was a little more than I'd be able to pay quickly (not a total lie - would have hurt at the time). Office manager there said "if you can pay cash we can call it $300 and be done with it". I paid the $300 cash and it was fine. This was a small private dr office in a professional office plaza place. Looking back... they could wait another few months for $430... and maybe have to take me to collections, or take $300 cash on the spot. Whatever averages they saw on collections, this was probably not a bad deal. Few years later, I have same insurance provider, but self-employed, so 'individual/family' plan. My wife got very sick, and we ended up in ER. X-rays, drips, sent home with medication, etc. Got a bill almost 3 months later for ~$3000. Called hospital and asked for some sort of discount. I got (same line from 3 different people on different tries) "this already is a discounted price, because you have insurance, these are the negotiated/discounted rates". Looking more closely at the paperwork, the 'retail' price was somewhere north of $5000, but the insurance company's 'negotiated' rate was ~$3000 ($2800 IIRC). It never hurts to ask, and maybe ask a lot, but it's not some magic "you'll always pay half price by just asking for a discount". And the point many others have made before - when you're having to go to ER, you don't have the luxury of shopping around, and generally the majority of folks you're seeing there are in no way cognizant of billing/pricing stuff (especially on a sunday when we went).
johng 10y ago
Imagine that you get charged for a $600 gown after the fact, but you can get that same exact gown from the manufacturer or any other company for $80 -- You should be able to reimburse the hospital to replace this item at that cost and a max of 20%... this would keep them from raping people on items of no importance.

by zzalpha 10y ago

rgbrenner 10y ago

The current situation isn't like a mechanic at all. If a mechanic tells me I need some work done, I can call various mechanics and ask what they would charge to do that, and they'll tell me. If you try that with a hospital, they'll tell you no. Go ahead and try asking your doctor what something will cost. If I could ask for a price up front, then people who aren't in an emergency could shop around. That would force hospitals to actually compete, which would normally mean most providers would be within a range of the average market price. So when an emergency does occur and you were taken to a random hospital, chances are that hospital would have prices close to the market price.

sjg007 10y ago
Right now you shop at the copay level as a function of insurance. PPOs were a great scam to force coinsurance onto the masses.
zzalpha 10y ago
My comment about mechanics was specifically with regards to information asymmetry. That is, 99% of people do not know enough about cars to determine if they are being fleeced. Now imagine dealing with the human body. Information symmetry leads to market failures: https://en.m.wikipedia.org/wiki/Information_asymmetry https://en.m.wikipedia.org/wiki/Information_asymmetry
- deleted 10y ago
  [deleted]
deleted 10y ago
[deleted]
WalterBright 10y ago
> If you try that with a hospital, they'll tell you no. Go ahead and try asking your doctor what something will cost. My experience is they will tell you, and you can ask for a better price, and I've always gotten one. The idea that one cannot negotiate with the hospital, the doctor, and the dentist is just incorrect. Try it next time.
- sjg007 10y ago
  I've noticed that insurance pays at most 50% less, in many cases much less than that. And the medical provider accepts it.
- pwinnski 10y ago
  Your experience is literally unbelievable to me. I don't doubt you, I just cannot believe there isn't more to the story. In another comment you seemed to indicate that you are perhaps uninsured and paying cash for everything? That would go a long way toward explaining why you have experiences that run dramatically counter to almost everyone else on this thread. It also seems like important information to be included, if so.
  - WalterBright 10y ago
    I am insured. You can opt to be billed by the provider, and submit the claim yourself. If you're unsure how this works, read the contract you have with your insurer, or call them on the phone. They may also be able to give you advice on negotiating for lower bills - after all, that lowers their cost as well. I have a high deductible, so usually wind up paying the entire bill out of pocket. There's no reason to go through the insurer for that.
pimlottc 10y ago
In general, doctors find the system as bewildering as you do. They might be able to give you a ballpark figure but you'll need someone in the billing department for a hard figure (if you can get one at all). Although they will still likely need an exact billing code for the procedure first.

stretchwithme 10y ago

Most health care is not delivered in an emergency. And even when it is an emergency, prices for everything could still be made available. Hospitals do decide how much they are going to charge for everything before you get the particular procedure. It's just not published.

WalterBright 10y ago
If they won't tell you, tell them you're going to their competitor hospital. That's all it takes to loosen things up.

jerkstate 10y ago

It's not even the same ballpark. At any reputable mechanic you can get a diagnosis done for free or low cost, and there exist books that estimate the time cost and replacement parts needed for pretty much every repair. There are some known unknowns going into it, like finding worn parts that need to be replaced, but I find that auto repair shops are pretty upfront about possible additional costs. I haven't had any similar experiences in healthcare; I don't think I've ever gotten an answer from a medical practitioner or office manager about the cost of a visit, procedure, lab work, or to what extent it would be covered by my insurance. Even for a vertically integrated HMO like Kaiser, simply no-one you can talk to knows.

WalterBright 10y ago
I have asked, and also asked for a discount if I paid on the spot. You can often get a third off the price that way - just by asking. It's the same with auto repairs. I'd take my car to the dealer for repairs, the service dept quotes me a price, I say that price sounds a little high, the price drops 30%. In any negotiation, you're going to get the sucker price if you don't ask what the price is, or make no attempt to negotiate. Nobody is obliged to give you their best price automatically.
- jerkstate 10y ago
  If you don't mind me asking, what kind of medical office/procedure were you able to get a cash price and discount on, in what setting, and which employee did you ask? I've never heard of that happening in the US before the fact; I have heard about negotiating down your medical bill with hospitals after the services have been rendered, though that seems like a crapshoot to me.
  - mgkimsal 10y ago
    Can't reply for walter but... I've had a few experiences over the last decade with healthcare services. Had a consultation, some bloodwork and a other bits and bobs - nothing serious. Got a bill a month later for.. $430. This was done through insurance from my employer at the time, but my portion was still ~$430. I went to their office and said this was a little more than I'd be able to pay quickly (not a total lie - would have hurt at the time). Office manager there said "if you can pay cash we can call it $300 and be done with it". I paid the $300 cash and it was fine. This was a small private dr office in a professional office plaza place. Looking back... they could wait another few months for $430... and maybe have to take me to collections, or take $300 cash on the spot. Whatever averages they saw on collections, this was probably not a bad deal. Few years later, I have same insurance provider, but self-employed, so 'individual/family' plan. My wife got very sick, and we ended up in ER. X-rays, drips, sent home with medication, etc. Got a bill almost 3 months later for ~$3000. Called hospital and asked for some sort of discount. I got (same line from 3 different people on different tries) "this already is a discounted price, because you have insurance, these are the negotiated/discounted rates". Looking more closely at the paperwork, the 'retail' price was somewhere north of $5000, but the insurance company's 'negotiated' rate was ~$3000 ($2800 IIRC). It never hurts to ask, and maybe ask a lot, but it's not some magic "you'll always pay half price by just asking for a discount". And the point many others have made before - when you're having to go to ER, you don't have the luxury of shopping around, and generally the majority of folks you're seeing there are in no way cognizant of billing/pricing stuff (especially on a sunday when we went).

johng 10y ago

Imagine that you get charged for a $600 gown after the fact, but you can get that same exact gown from the manufacturer or any other company for $80 -- You should be able to reimburse the hospital to replace this item at that cost and a max of 20%... this would keep them from raping people on items of no importance.