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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 Unfo
by 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 agoI'm actually not sure that they know (2), as I've read a number of articles and posts which say that almost no healthcare organization uses cost accounting.
- WalterBright 10y agoIf they can send you a bill with a figure on it, they can produce a quote.
- DollaWilliam 10y agoThat's not true, due to price discrimination. They can't precisely tell how much they can get paid for something until they submit invoices to insurers.
- WalterBright 10y agoIf you opt to submit the claim to your insurance company yourself, this is not an issue.
- richardw 10y agoI think you guys are getting screwed. 1) unless this is the first time they've done it, they'll at least have a range and an explanation for the difference. 2) They're motivated to not tell you. By staying quiet, they prevent you from shopping around. They maintain the ability to decide charges rather than having to negotiate. Telling you only once you owe them is something other businesses would love. Is there a doc in the house who can give us their perspective? What's up with this pricing?
- DollaWilliam 10y agoNot a doctor, but I have spent ~10 years working with data on the reimbursement side of a large hospital. Please see my comment above.
- DollaWilliam 10y agoI can confirm that, at least for an N of 1. Contracts with individual insurers are typically negotiated to be set to a percentage of (known) Medicare reimbursement for a given procedure. As it is with any negotiations, more powerful insurers get better rates. The costs are usually monitored at a macro accounting level, since what really matters is staying in the black. As an aside, in addition to other confounding factors, cost accounting would likely affect physician compensation since it would shine a light on their actual effort. Expect that to Just Not Happen in an organization with more than one provider. They enjoy their compensation, and they will fight to keep it. Edit: perhaps the physician compensation scheme I am familiar with is wildly atypical. Hence the N=1 disclaimer.
- chimeracoder 10y ago> Contracts with individual insurers are typically negotiated to be set to a percentage of (known) Medicare reimbursement for a given procedure It's usually pegged at multiples of what Medicare reimburses (ie, "300% of Medicare rates") > Expect that to Just Not Happen in an organization with more than one provider. They enjoy their compensation, and they will fight to keep it. It has nothing to do with physician compensation, because most are salaried now anyway, and they make a lot less than people think. The problem is that they literally do not know what the reimbursement rates are.
- coredog64 10y agoBy law, nobody can be charged less than Medicare.
- FireBeyond 10y agoGiven that the median salary for a physician (not specialist) is $180K, I'm not sure what you think people think they make if they think it's a "lot more" than that.
- mirimir 10y agoActually, as pmorici notes, there are three relevant prices. Without insurance, you will be charged the "cash price", which is always far greater (maybe 3-4 times) the price that they have negotiated with your insurance company. For large insurance companies, that price can be close to the lowest price that they will accept. Even if you have insurance, they may be able to bill you for the difference between the cash and negotiated prices. It depends on relevant law and terms negotiated with your insurance provider. It's prudent to ask. Also, providers will sometimes "accidentally" bill you for that difference, even if they're not permitted to.
- ashark 10y ago> Also, providers will sometimes "accidentally" bill you for that difference, even if they're not permitted to. It's been my observation that hospital billing departments do many things "accidentally". Strangely, these never involve under-billing. A lot of bad things would have to happen to them (and insurance) before I'd start to feel even a little bad about it.
- tehlike 10y agowhen something involves lots of process, mistakes are inevitable. sometimes by mistake, sometimes maliciously.
- waqf 10y agoIt's worse than that, because there's adverse selection. The hospitals that make errors in the client's favor or that don't make errors at all are more likely to go out of business than the ones that make errors in their own favor. So guess which ones are still around when you need a hospital. In other words, just because the errors are accidental, it doesn't mean they happen at random. (This argument applies to any shady business practice that "looks" like an accident, for example dark patterns on websites, or having great customer service for taking your money but terrible customer service for refunding it.)
- FireBeyond 10y ago