6 ms·

It's hard to overstate how bizarrely opaque healthcare pricing is in the US. Despite the quality of the care ranking favorably worldwide, medical bills are an a

• ChuckMcM 10y ago
  It reminds me of the many ways that Congress could legislate better behavior from existing players in the health care field in order to achieve their objectives.
• WalterBright 10y ago
  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.
  • msrpotus 10y ago
    I've tried to do that for relatively routine care and it's a headache and a half. I spent half a workday (because, of course, I could only do it during business hours--good thing I have a job with a flexible schedule) calling up doctors' offices and waiting while they figured out how much they charged for a new patient appointment. If ZocDoc reliably had that information, it would make shopping around easier (my insurance had a directory but most of the price info was wrong). In the absence of that, it's just not so easy to shop around for medical care.
    • WalterBright 10y ago
      I never had such problems. I asked, they answered (even if they had to go ask their accounting dept). I then asked for a discount, and got one. Doctors' offices are a business, and if they balk, tell them you're going to their [insert name of nearby competitor]. Don't let them get away with pretending not to know - after all, they are perfectly capable of sending you a bill.
      • rcraft 10y ago
        I'm genuinely curious where and for what types of procedures you have had so much success in getting pricing/cost info up front for. 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.
        • WalterBright 10y ago
          One way is to show up in person and ask. It's a lot easier to negotiate face to face than over the phone. It's the same when negotiating a price for a car, a hotel, stay, etc. I answered your other question elsewhere in this topic. 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.
          • rcraft 10y ago
            Hmm. Driving from provider to provider when trying to "shop around" is really not that feasible for most people. 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.
      • cbsmith 10y ago
        I don't think you appreciate how fortunate you have been. 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 #@$@#%ing crap shoot.
  • jweir 10y ago
    And ask for the price with insurance or out of pocket. Sometimes out of pocket is 50% less. Truly insane.
  • fixxer 10y ago
    Very often, the answer to that question is not known. I went through this when my wife was pregnant with out first and I was in graduate school. We were sitting down with the accounting rep from the hospital planning the next few months and she had zero idea of what the cost was going to be for routine procedures.
    • WalterBright 10y ago
      An accounting rep with no idea what the bill would be? I'd laugh at them and ask for someone who was actually from the accounting dept. Don't put up with that garbage. What would your reaction be if you went to a dealer to buy a new car and he claimed to be unable to come up with a price?
      • tgokh 10y ago
        Except the problem is that in the car situation you're the one paying for the car, not a third party. This is more like your car getting totaled, and your auto insurance company saying "you go pick a reasonable new car, we'll negotiate a price with the dealer (in secret) and then you'll pay 20% of whatever we agree upon"
      • pwinnski 10y ago
        You seem to be literally the only person who has been able to get straight answers from anyone on anything related to health care. As you can probably see from this thread, most of us would have the same reaction: impotent frustration. I can go to another dealer if I don't get straight answers. I can walk away at any point up until the final signature. This is simply not an analogous situation, as evidenced by the repeated testimony of everyone here. And this guy: https://www.youtube.com/watch?v=Tct38KwROdw https://www.youtube.com/watch?v=Tct38KwROdw
  • cbsmith 10y ago
    Honestly, having asked the question, I can tell you while so few people ask. The answers you get and the effort you have to put in to try to get a real answer is @#$@#$ing absurd.
    • cbsmith 10y ago
      Sorry, that should be "why so few people ask". Autocorrect is so mean.
  • ArtDev 10y ago
    Nobody asks because no one knows the price. "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.
    • WalterBright 10y ago
      > impossible 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.
      • toomuchtodo 10y ago
        > That's certainly not true. Try it. 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.
        • secabeen 10y ago
          We had a home birth, and the billing was pretty straightforward. We paid $5k for the all care through the birth. However, we knew that if at any point the pregnancy became abnormal enough that we needed to transfer to hospital, we would be stuck paying whatever the hospital and our insurer agreed to, and we wouldn't get any of the $5k we paid to the midwives back.
          • deleted 10y ago
  • dkasper 10y ago
    I've definitely asked the price of some non-emergency procedures in advance before and it was rare I could get a straight answer (I live in California). But maybe for some things it's possible.
  • soccerdave 10y ago
    When I needed an MRI, I called five different places and only one of them would actually tell me a price. All of the others said "we don't know the price until we submit the claim to insurance". Not sure if they were telling the truth or just being lazy at their jobs. Either way, getting a price in advance is not as simple as just asking.
    • clamprecht 10y ago
      I wonder if someone has made a video of this - asking for a price and getting a response like "we can't tell you" or "we don't know." It shows how absurd the system is.
      • swyman 10y ago
        Why yes: https://www.youtube.com/watch?v=Tct38KwROdw https://www.youtube.com/watch?v=Tct38KwROdw
    • WalterBright 10y ago
      Sometimes they need a little prodding. Tell them you're getting a price from [name of competitor].
    • pmorici 10y ago
      Tell them you want to know the "cash" price.
    • ethbro 10y ago
      In fact, they know two exact prices: (1) the price they will bill your particular insurance company & (2) the lowest price in actual total they can accept 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).
      • nickff 10y ago
  • getpost 10y ago
    My experience is that few physicians have any idea what various procedures cost, especially in a hospital setting. Advance cost information is very difficult to obtain, and often there isn't time to obtain it. 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.
  • deleted 10y ago
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  • maxxxxx 10y ago
    "Shopping around" is often a fantasy because you will very rarely actually get a price.
  • hillz 10y ago
    I've tried asking multiple times (for non-emergency procedures) and each time they've said they don't know. (Kaiser)
  • taurath 10y ago
    I ask, every time. They will do just about anything to not tell you, or to tell you only the insurance rate. You're screwed if you go to the ER. I had to get an EKG done - they managed to charge my insurance over $1000, something that in almost any other country would be around $50, and even some hospitals in the US. I think the hugest problem in the US thats not been looked at is regulating the providers - I don't think competition alone will help in emergency situations, but at least with doctors visits knowing how much something would cost would be incredibly helpful.
  • pavon 10y ago
    I'll echo what others have said. I have requested rates multiple times, and gotten numbers, but the numbers they give is the amount they bill insurance. However that number is practically meaningless. Even for something as simple as a yearly preventative care visit, my wife and I each went to a different doctors, both of which billed the insurance about the same amount, and both of which were in-network. However, they had different negotiated rates with the insurance, and coded things slightly differently the end result being a factor of 10 difference in our out-of-pocket expenses for the two visits. None of this information was available in the computer systems of the providers who file the claims, nor have I been able to get it from my insurance in advance.
    • tehlike 10y ago
      it's because they don't know. What insurance provider considers preventive care is different from what doctors think it is. Recent anectode: 10minute chat to doctor about general health costed my wife 200$. 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.
  • joe_the_user 10y ago
    I remember accompanying a friend and having her arrive at a hospital for an extremely expensive, previously planned plastic surgery procedure and being confronted with unexpected, unannounced costs of several thousand dollars. It was one of the most traumatic experiences of my life.
  • kem 10y ago
    Eh, I've tried that many many times for many different things, and I've never been able to get an exact price quote beforehand. The response is always "you need to talk with so-and-so" who is always someone or something else. It's a maze of runarounds, with no one willing to commit to anything in particular. 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.
• suddenseizure 10y ago
  My wife went for routine blood tests yesterday and they didn't even bother to tell her that the insurance her employer switched to in 2017 treats this lab as out of network (it was in network with the previous insurance just a week ago). She could have gone to an in network lab a few blocks away if they'd told her. Now we're worried about a huge unnecessary out of network bill in addition to the in network deductible / max out of pocket we were expecting to hit with her cancer treatment.
  • tehlike 10y ago
    That's quite absurd. Especially since it was a routine place you were going. You might try calling your insurance (if you havent) and talk them into reducing the bill: you just didn't know and your wife sticked with where she has been going to in the past. If you can, if your healthcare is through your employer, try writing to your benefits team as well. PS: My prayers are goes for your wife. I hope she beats the cancer.
  • gscott 10y ago
    Go back and ask for the cash price if you pay it right there. It should cost about 1/3 of the normal price. The cost of billing insurance companies and all drives the price way up.
  • cylinder 10y ago
    I throw those bills in the trash, nothing ever happens. Admin staff at medical practices are horribly incompetent generally. You can push them before the fact aggressively to figure out your eligibility under insurance, and then you'll still get an incorrect bill afterwards for an amount you don't actually owe.