4 ms·

An an anecdote: I've been on a high-deductible plan for nearly 13 years. I have been regularly met with shock and incredulity that I could possibly want to know

An an anecdote: I've been on a high-deductible plan for nearly 13 years. I have been regularly met with shock and incredulity that I could possibly want to know the cost of a procedure. My wife and I have spent, collectively, hours on the telephone trying to get answers. It's particularly galling when we get "guilt trip" treatment for asking about costs for procedures for our young daughter. We have been met with both tacit and stated insinuations that we're placing a monetary value on her "health" by asking what procedures or drugs might cost. I don't think price transparency will fix much, though. The average person I know has employer-provided insurance and doesn't think a bit about the costs of procedures. Price transparency combined with individuals having to pay for their healthcare expenses would help, but there's blame enough to go around for every player in the system, too.

troyvit 9y ago
That's hilarious. They are making the health of your wife and daughter a profit center yet they act offended when you want to know the cost.
- EvanAnderson 9y ago
  Black comedy, indeed.
  - mtanski 9y ago
    I'm assuming you're ESL, ... in Polish you also call it literaly "black comedy". The proper term you're looking for is "dark comedy". In the US "black comedies" nowadays is a term referring to for/by African Americans; it's a whole sub genre.
    - ukoki 9y ago
      Can't speak for American English but "black comedy" is standard in British English https://en.wikipedia.org/wiki/Black_comedy https://en.wikipedia.org/wiki/Black_comedy
      - mtanski 9y ago
        https://en.wikipedia.org/wiki/Black_comedy_(disambiguation) https://en.wikipedia.org/wiki/Black_comedy_(disambiguation) At best in the US is a ambitious term and accepted colloquial term refers to comedy by/for AA audiences. At least places I live in the US (MI, CA, NY). Anyways English is a fun, dynamic, and at the same terrible language. But I'll take your word for British flavor of the English language.
      - popopobobobo 9y ago
        For this, shall we just stick to the English definition? They invented the language. African American Comedy sound more accurate for the other one.
- deleted 9y ago
  [deleted]
alistairSH 9y ago
The average person I know has employer-provided insurance and doesn't think a bit about the costs of procedures. While that has been true for decades, in my experience, those employer-provided plans are beginning to transfer some of the cost to the consumer through higher deductibles and copays. My last few visits to the doctor tend to support this, as in both cases, the doctor offered cost-saving options and advice.
- SilasX 9y ago
  Yep. And employer plans don't avoid the random bill in the mail from "lol you still have to pay the balance because we decided not to cover all of that even though you never had a chance to know the max downside".
- taurath 9y ago
  And if you have major surgery even on a "platinum" level plan you are still on the hook for tens of thousands of dollars. Fuck the system, its calcified nonsense at every step.
shakestheclown 9y ago
That's part of the reason I ended up switching away from HD. It was a ton of work to get estimates, and there was such a delay if there were multiple invoices from different providers with my deductible that I ended up having to pay several thousand over my deductible and wait to be refunded after everything had processed through the system.
rogerbinns 9y ago
The next stage is asking them what the number needed to treat is for the drugs: https://en.wikipedia.org/wiki/Number_needed_to_treat https://en.wikipedia.org/wiki/Number_needed_to_treat > ... average number of patients who need to be treated to prevent one additional bad outcome ... Here is an example for aspirin preventing a first heart attack or stroke (NNT is ~1,667): http://www.thennt.com/nnt/aspirin-to-prevent-a-first-heart-attack-or-stroke/ http://www.thennt.com/nnt/aspirin-to-prevent-a-first-heart-a...
- Neliquat 9y ago
  I really amused and annoyed a few with this.
watwut 9y ago
In the long term, it is better for your daughter if you don't bancrupt and manage the price down. Especially if she is sick. The guilt tripping of father of sick cold is pretty disgusting tactic.
yellowstuff 9y ago
My dental hygienist once told me to get 3 cleanings a year. I told her my insurance covered 2. She told me that it was like chemotherapy- you should do what's medically necessary whether or not your insurance covers it.
- Spooky23 9y ago
  That's probably good advice. The extra $80 for a cleaning is cheaper than many of the dental procedures that many folks will need.
  - extra88 9y ago
    I find it hard to believe that a two month difference between cleanings (4 months vs. 6 months) is going to prevent any more serious dental procedure.
    - Spooky23 9y ago
      It all depends on you. If you develop plaque more quickly, you want to go more to prevent gum disease. Gum disease never goes away and always requires more intervention and more $$$. The recommendation that you go twice a year literally originates from a toothpaste ad in the 1950s. It was an arbritary number intended to encourage you to get preventative care, aided by their toothpaste. (In those days dentists were mostly tooth pullers)
    - dghughes 9y ago
      I have GERD but before diagnosis the acid from coughing was terrible on my teeth. My dentist with many years experience diagnosed it. I went to the doctor who confirmed it was GERD. I lost my job but when I was working the insurance paid for two cleaning per year. I chose to keep the insurance but it's a lesser plan that only covers one cleaning every nine months. Twice per year was good for me since I got lazy about three or four months after visiting the dentist. I needed the twice yearly pep talk. And I should also say that 75% of people who are diagnosed with IPF a fatal lung disease have GERD. My father has IPF and GERD I have GERD but I hope I don't develop IPF. My grandfather died of emphysema at 52 I really hope there's no connection! So yeah a dentist could point you in a direction that may help you more than you realize.
fencepost 9y ago
For some of these you may have to resort to the "ludicrous claim" approach, because people will provide information to correct you when they would never provide it just because you asked - go look at old Usenet discussions if you don't believe me. When they won't provide price information, act as if they've just told you that it's going to cost more than $100,000 and repeat that to them. If they then say "It's not going to cost that much!" "Oh, you mean you do have some information on how much it costs?" Then work them to more detail from there "Well, is it more than 50,000?" You may also be running into a situation where the person thinks you want an exact price and doesn't have it, so be sure you tell them you're looking for a ballpark number - or if they've irritated you and you wish to unleash the snark, "Ma'am, I'm trying to find out whether I'm going to be feeding my family on rice and beans for a week, a month, a year, or until we lose the house and my child's getting meals at the women and children homeless shelter while I'm out on my own." Edit: It doesn't quite have to be as ludicrous as I started - a simple "Oh man, I really can't afford $5,000 for that test right now." can also get the conversation started and information flowing.
xenadu02 9y ago
It would "help" in the sense that people would forgo care. Sure you might shop around for a non-emergency specialist one-off procedure like an MRI, but the cost of MRIs is a drop in the bucket and wouldn't meaningfully impact overall healthcare costs if they were an order of magnitude more expensive. If you have "normal" insurance plan your insurance provider has presumably already shopped around and only providers willing to take the reduced rate are "in-network". Don't get me wrong: you should be able to get a cost estimate up front and it is silly that it is so difficult. Price transparency isn't the major problem in healthcare. The free market and profit are the major problems with healthcare. To set prices a free market requires price discrimination and the ability to price some people out of the market. That translates into debilitating illness (a deadweight loss to our economy overall) or death for serious medical issues. A free market in healthcare absolutely requires that some people be allowed to die of treatable diseases in order to maximize profit. To put it another way: As a technical matter it is impossible to discover the maximally profitable price for a treatment without raising the price beyond at least some people's ability to pay.

troyvit 9y ago

That's hilarious. They are making the health of your wife and daughter a profit center yet they act offended when you want to know the cost.

EvanAnderson 9y ago
Black comedy, indeed.
- mtanski 9y ago
  I'm assuming you're ESL, ... in Polish you also call it literaly "black comedy". The proper term you're looking for is "dark comedy". In the US "black comedies" nowadays is a term referring to for/by African Americans; it's a whole sub genre.
  - ukoki 9y ago
    Can't speak for American English but "black comedy" is standard in British English https://en.wikipedia.org/wiki/Black_comedy https://en.wikipedia.org/wiki/Black_comedy
    - mtanski 9y ago
      https://en.wikipedia.org/wiki/Black_comedy_(disambiguation) https://en.wikipedia.org/wiki/Black_comedy_(disambiguation) At best in the US is a ambitious term and accepted colloquial term refers to comedy by/for AA audiences. At least places I live in the US (MI, CA, NY). Anyways English is a fun, dynamic, and at the same terrible language. But I'll take your word for British flavor of the English language.
    - popopobobobo 9y ago
      For this, shall we just stick to the English definition? They invented the language. African American Comedy sound more accurate for the other one.
deleted 9y ago
[deleted]

alistairSH 9y ago

The average person I know has employer-provided insurance and doesn't think a bit about the costs of procedures. While that has been true for decades, in my experience, those employer-provided plans are beginning to transfer some of the cost to the consumer through higher deductibles and copays. My last few visits to the doctor tend to support this, as in both cases, the doctor offered cost-saving options and advice.

SilasX 9y ago
Yep. And employer plans don't avoid the random bill in the mail from "lol you still have to pay the balance because we decided not to cover all of that even though you never had a chance to know the max downside".
taurath 9y ago
And if you have major surgery even on a "platinum" level plan you are still on the hook for tens of thousands of dollars. Fuck the system, its calcified nonsense at every step.

shakestheclown 9y ago

That's part of the reason I ended up switching away from HD. It was a ton of work to get estimates, and there was such a delay if there were multiple invoices from different providers with my deductible that I ended up having to pay several thousand over my deductible and wait to be refunded after everything had processed through the system.

rogerbinns 9y ago

The next stage is asking them what the number needed to treat is for the drugs: https://en.wikipedia.org/wiki/Number_needed_to_treat https://en.wikipedia.org/wiki/Number_needed_to_treat > ... average number of patients who need to be treated to prevent one additional bad outcome ... Here is an example for aspirin preventing a first heart attack or stroke (NNT is ~1,667): http://www.thennt.com/nnt/aspirin-to-prevent-a-first-heart-attack-or-stroke/ http://www.thennt.com/nnt/aspirin-to-prevent-a-first-heart-a...

Neliquat 9y ago
I really amused and annoyed a few with this.

watwut 9y ago

In the long term, it is better for your daughter if you don't bancrupt and manage the price down. Especially if she is sick. The guilt tripping of father of sick cold is pretty disgusting tactic.

yellowstuff 9y ago

My dental hygienist once told me to get 3 cleanings a year. I told her my insurance covered 2. She told me that it was like chemotherapy- you should do what's medically necessary whether or not your insurance covers it.

Spooky23 9y ago
That's probably good advice. The extra $80 for a cleaning is cheaper than many of the dental procedures that many folks will need.
- extra88 9y ago
  I find it hard to believe that a two month difference between cleanings (4 months vs. 6 months) is going to prevent any more serious dental procedure.
  - Spooky23 9y ago
    It all depends on you. If you develop plaque more quickly, you want to go more to prevent gum disease. Gum disease never goes away and always requires more intervention and more $$$. The recommendation that you go twice a year literally originates from a toothpaste ad in the 1950s. It was an arbritary number intended to encourage you to get preventative care, aided by their toothpaste. (In those days dentists were mostly tooth pullers)
  - dghughes 9y ago
    I have GERD but before diagnosis the acid from coughing was terrible on my teeth. My dentist with many years experience diagnosed it. I went to the doctor who confirmed it was GERD. I lost my job but when I was working the insurance paid for two cleaning per year. I chose to keep the insurance but it's a lesser plan that only covers one cleaning every nine months. Twice per year was good for me since I got lazy about three or four months after visiting the dentist. I needed the twice yearly pep talk. And I should also say that 75% of people who are diagnosed with IPF a fatal lung disease have GERD. My father has IPF and GERD I have GERD but I hope I don't develop IPF. My grandfather died of emphysema at 52 I really hope there's no connection! So yeah a dentist could point you in a direction that may help you more than you realize.

fencepost 9y ago

For some of these you may have to resort to the "ludicrous claim" approach, because people will provide information to correct you when they would never provide it just because you asked - go look at old Usenet discussions if you don't believe me. When they won't provide price information, act as if they've just told you that it's going to cost more than $100,000 and repeat that to them. If they then say "It's not going to cost that much!" "Oh, you mean you do have some information on how much it costs?" Then work them to more detail from there "Well, is it more than 50,000?" You may also be running into a situation where the person thinks you want an exact price and doesn't have it, so be sure you tell them you're looking for a ballpark number - or if they've irritated you and you wish to unleash the snark, "Ma'am, I'm trying to find out whether I'm going to be feeding my family on rice and beans for a week, a month, a year, or until we lose the house and my child's getting meals at the women and children homeless shelter while I'm out on my own." Edit: It doesn't quite have to be as ludicrous as I started - a simple "Oh man, I really can't afford $5,000 for that test right now." can also get the conversation started and information flowing.

xenadu02 9y ago

It would "help" in the sense that people would forgo care. Sure you might shop around for a non-emergency specialist one-off procedure like an MRI, but the cost of MRIs is a drop in the bucket and wouldn't meaningfully impact overall healthcare costs if they were an order of magnitude more expensive. If you have "normal" insurance plan your insurance provider has presumably already shopped around and only providers willing to take the reduced rate are "in-network". Don't get me wrong: you should be able to get a cost estimate up front and it is silly that it is so difficult. Price transparency isn't the major problem in healthcare. The free market and profit are the major problems with healthcare. To set prices a free market requires price discrimination and the ability to price some people out of the market. That translates into debilitating illness (a deadweight loss to our economy overall) or death for serious medical issues. A free market in healthcare absolutely requires that some people be allowed to die of treatable diseases in order to maximize profit. To put it another way: As a technical matter it is impossible to discover the maximally profitable price for a treatment without raising the price beyond at least some people's ability to pay.