4 ms·

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

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).
  - WalterBright 10y ago
    One example was having a skin lesion removed, a surgical procedure. I asked the dermatologist/surgeon, it was a procedure she did in her facility. Another time I visited a neurologist, the woman behind the checkin front desk told me what it would cost. I said that sounded high, can I get a discount? She chirped sure, 30% off for cash on the spot. Doctors routinely offer discounts for cash on the spot, because then they don't have to deal with patients who are slow payers or don't pay at all. If they don't, find another doctor. They aren't rare. Heck, dentists are always advertising and offering discounts. They're businesses. You can get at least 3% off just by using a check, because then they don't have to pay 3% tribute to the credit card company. I don't recommend being an ass about it. Just be nice and ask for a discount.
    - mgkimsal 10y ago
      "You can get at least 3% off just by using a check, because then they don't have to pay 3% tribute to the credit card company." Tried this by offering cash on some kitchen remodeling work we were doing. I was talking to the sales person and - we were already going to buy - but I asked if they offered cash discount. She got flustered - almost insulted - "these are our best prices!". I tried to explain running $4000 was going to cost them probably close to 4%, and I have more consumer rights re: chargebacks if I'm not happy. $100 off? $150 off? Nope... flat out refusal ("that's not the way we work!"), so we paid with the credit card. But they just lost that money anyway. :/
      - WalterBright 10y ago
        Negotiations don't always work, that's for sure. But it is a learned skill, and one can get better at it. There's a good book on it, "Getting To Yes".
      - coredog64 10y ago
        AIUI, if you take Visa, you aren't allowed to advertise a lower cash-only price. So maybe they were freaked out about losing the ability to take cards. Also, I'd be concerned about a personal check for that amount. The last car I bought I put $2K on my miles credit card (the max they would take) and a check for the rest. They made me fill out loan paperwork anyways so that they would have recourse if the check bounced.
- cmurf 10y ago
  Here's the problem. If you do it outside your insurer, it no longer applies to your deductible. If your annual procedures don't hit deductible anyway, you come out ahead by getting the discount. Otherwise you'll pay more out of pocket for the unclaimed procedure.
  - WalterBright 10y ago
    It's worth having a talk with your insurer to be sure how that works in your case, as every plan is different.
deleted 10y ago
[deleted]
Johnny555 10y ago
Of course, it's easier to do a diagnosis with a car, cars are much better understood than human physiology. Medical science recently discovered (well, recognized) a new organ in the body. I went to the doctor for a non-specific illness. The doctor ran $3000 worth of tests, and by the time the last of the test results came back, it had gone away. The doctor shrugged and said "Huh, I dunno what that was. Probably some kind of infection". Some things are more clear (i.e. a broken arm), but if it doesn't heal well and the $1000 estimate for an X-ray and a cast turns into a $10000 surgical procedure plus 6 months of therapy, are you going to expect the doctor to just eat the cost? Are you going to shop your painful broken arm and medical records around to 3 different doctors to get a new estimate?
rconti 10y ago
I believe they have to give you a written estimate, and if costs are gonna exceed that by 10 or 20%, they have to get authorization from you, and so on. Completely unlike health care. And yeah, there is a "book value" for repairs (body and mechanical). Sometimes they can do it faster, sometimes much faster. They're charging you retail price for parts, not wholesale. Etc. Of course you can negotiate and save money, but it's worlds different from health care.
nitwit005 10y ago
Doctors that specialize in things insurance rarely covers, like cosmetic surgery, are often quite upfront with costs. The complexity of insurance seems to be a big part of the problem. And you see that with cars too. If someone is having an ordeal related to auto-maintenance, you often hear insurance mentioned...
kem 10y ago
It's compounded by the fact that you often don't have any real flexibility in how you fix the problem. To extend your analogy, let's say I want to fix a broken headlight. I know how to do this, and can get better headlights than the one that would be offered through the two mechanics in my neighborhood. I can do this myself more cheaply. Or maybe my friend who used to work as an airline mechanic wants to do it as a favor. Or who knows. With medical care, you might realistically only have one option due to problems with insurance coverage, so even if you were given the price, you'd have no choice. But even if you had two choices, you don't have a third option because it's legislated away. If I need my medication that I've been taking for four years without any problems, and it's a low risk med anyway, why should I have to go to see a PA, NP, or MD to get a prescription for it? It's not just that the costs are opaque and hidden, it's that you are legally mandated in certain respects to accept them. The alternative is generally only to not have the service done.

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).
- WalterBright 10y ago
  One example was having a skin lesion removed, a surgical procedure. I asked the dermatologist/surgeon, it was a procedure she did in her facility. Another time I visited a neurologist, the woman behind the checkin front desk told me what it would cost. I said that sounded high, can I get a discount? She chirped sure, 30% off for cash on the spot. Doctors routinely offer discounts for cash on the spot, because then they don't have to deal with patients who are slow payers or don't pay at all. If they don't, find another doctor. They aren't rare. Heck, dentists are always advertising and offering discounts. They're businesses. You can get at least 3% off just by using a check, because then they don't have to pay 3% tribute to the credit card company. I don't recommend being an ass about it. Just be nice and ask for a discount.
  - mgkimsal 10y ago
    "You can get at least 3% off just by using a check, because then they don't have to pay 3% tribute to the credit card company." Tried this by offering cash on some kitchen remodeling work we were doing. I was talking to the sales person and - we were already going to buy - but I asked if they offered cash discount. She got flustered - almost insulted - "these are our best prices!". I tried to explain running $4000 was going to cost them probably close to 4%, and I have more consumer rights re: chargebacks if I'm not happy. $100 off? $150 off? Nope... flat out refusal ("that's not the way we work!"), so we paid with the credit card. But they just lost that money anyway. :/
    - WalterBright 10y ago
      Negotiations don't always work, that's for sure. But it is a learned skill, and one can get better at it. There's a good book on it, "Getting To Yes".
    - coredog64 10y ago
      AIUI, if you take Visa, you aren't allowed to advertise a lower cash-only price. So maybe they were freaked out about losing the ability to take cards. Also, I'd be concerned about a personal check for that amount. The last car I bought I put $2K on my miles credit card (the max they would take) and a check for the rest. They made me fill out loan paperwork anyways so that they would have recourse if the check bounced.
cmurf 10y ago
Here's the problem. If you do it outside your insurer, it no longer applies to your deductible. If your annual procedures don't hit deductible anyway, you come out ahead by getting the discount. Otherwise you'll pay more out of pocket for the unclaimed procedure.
- WalterBright 10y ago
  It's worth having a talk with your insurer to be sure how that works in your case, as every plan is different.

deleted 10y ago

[deleted]

Johnny555 10y ago

Of course, it's easier to do a diagnosis with a car, cars are much better understood than human physiology. Medical science recently discovered (well, recognized) a new organ in the body. I went to the doctor for a non-specific illness. The doctor ran $3000 worth of tests, and by the time the last of the test results came back, it had gone away. The doctor shrugged and said "Huh, I dunno what that was. Probably some kind of infection". Some things are more clear (i.e. a broken arm), but if it doesn't heal well and the $1000 estimate for an X-ray and a cast turns into a $10000 surgical procedure plus 6 months of therapy, are you going to expect the doctor to just eat the cost? Are you going to shop your painful broken arm and medical records around to 3 different doctors to get a new estimate?

rconti 10y ago

I believe they have to give you a written estimate, and if costs are gonna exceed that by 10 or 20%, they have to get authorization from you, and so on. Completely unlike health care. And yeah, there is a "book value" for repairs (body and mechanical). Sometimes they can do it faster, sometimes much faster. They're charging you retail price for parts, not wholesale. Etc. Of course you can negotiate and save money, but it's worlds different from health care.

nitwit005 10y ago

Doctors that specialize in things insurance rarely covers, like cosmetic surgery, are often quite upfront with costs. The complexity of insurance seems to be a big part of the problem. And you see that with cars too. If someone is having an ordeal related to auto-maintenance, you often hear insurance mentioned...

kem 10y ago

It's compounded by the fact that you often don't have any real flexibility in how you fix the problem. To extend your analogy, let's say I want to fix a broken headlight. I know how to do this, and can get better headlights than the one that would be offered through the two mechanics in my neighborhood. I can do this myself more cheaply. Or maybe my friend who used to work as an airline mechanic wants to do it as a favor. Or who knows. With medical care, you might realistically only have one option due to problems with insurance coverage, so even if you were given the price, you'd have no choice. But even if you had two choices, you don't have a third option because it's legislated away. If I need my medication that I've been taking for four years without any problems, and it's a low risk med anyway, why should I have to go to see a PA, NP, or MD to get a prescription for it? It's not just that the costs are opaque and hidden, it's that you are legally mandated in certain respects to accept them. The alternative is generally only to not have the service done.