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I am very strongly with you here. Why can’t we get an exact cost upfront before Abby services are rendered? A doctor can make orders and should be able to get t

I am very strongly with you here. Why can’t we get an exact cost upfront before Abby services are rendered? A doctor can make orders and should be able to get the exact cost to you before submitting them. These prices should all be public and comparable. Common reasons to go to the doctor should be shown alongside their costs. We got a surprise $19k bill that we were told would be $160 and our insurance would cover the rest. We’re letting them fight it out but would be very disappointed if we had to pay that out of pocket. We would never have ordered the test then, or would have tried to shop around

makmanalp 8y ago
Because hospitals use those prices to negotiate with insurance and other parties. I'm not saying it's right, but it's what happens in a broken system: https://en.wikipedia.org/wiki/Chargemaster https://en.wikipedia.org/wiki/Chargemaster
conanbatt 8y ago
The doctor doesn't know what the claim is going to be. It takes sometimes weeks to know how much you charge at all. This is because insurance companies pay in base on what you did or how long you did it. You itemize each visit like a tax return that later gets reviewed. Then someone reads the return and thinks if it makes any sense. After that, they pay back the doctor, but according to the plan, they also have to charge the patient the copay. That said, a doctors office that is only cash will get very little patients. Because people that are employed will not go to a cash-only doctor's office.
- pg_bot 8y ago
  Not true. I own and run a cash only doctor's office. Coming to us is cheaper than most insurance co-pays.
  - japhyr 8y ago
    Your posts are pretty interesting. If you don't mind a couple questions: - What range of services do you offer? Do you take care of broken bones? Long-term illnesses? What kinds of things do you refer people to a full hospital for? - Are there many offices like yours around? How unusual is your office? - How easily could you build an entire hospital on this model? What would the limits of that be?
    - pillfill 8y ago
      Not OP, but I'm familiar with a couple primary care providers that don't file insurance claims. It's refreshing to see up-front pricing on their website for services they offer, e.g.: https://www.palmettoproactive.com/services-pricing https://www.palmettoproactive.com/services-pricing
      - conanbatt 8y ago
        I agree! Its great, but lots of people have insurance already so they want to use that to get their primary care, so that 200 dollar visit becomes 40 bucks.
    - pg_bot 8y ago
      We run a primary care clinic. The specific type of clinic we run is called "direct primary care". There are around 800 clinics like ours in the United States but the service is generally catered to the wealthy. For more details about the scope of practice you can read the following link.[0] When we cannot provide a service in house we usually help someone navigate the medical system. There is a lot of information asymmetry when dealing with healthcare and we help even that out for our clients. We also partner with other companies to get reduced prices on imaging, labs, and other services. I don't believe you can run an entire hospital on this model. Hospitals/insurance are best suited for unpredictable events. Our model is great for chronic and predictable events. [0]: https://en.wikipedia.org/wiki/Primary_care_physician#Scope_of_practice https://en.wikipedia.org/wiki/Primary_care_physician#Scope_o...
  - conanbatt 8y ago
    Are you primary care? Because I cant see a primary care competing on price vs insurance that charges 20 dollars/30% on copay.
    - pg_bot 8y ago
      It depends on what your deductible is. With the increasing cost of healthcare, we are seeing companies go with higher and higher deductible plans. We don't compete solely on price, however our prices are extremely competitive even for people who have insurance. (we are often cheaper than medicare/medicaid) We also work with businesses as part of their benefit plans. The major benefit of this system is time, we can schedule longer appointments with a more flexible schedule than most other doctor's offices.
pg_bot 8y ago
This is how we run our medical clinic in South Carolina. All of our prices are public and we try to get you the lowest possible cost. You will never receive a bill for which you did not know the price ahead of time. We support this by having a $49/month membership fee and by not accepting insurance. (Most additional charges are under $20)
- chimeracoder 8y ago
  > We support this by having a $49/month membership fee and by not accepting insurance. This is the trick. Accepting insurance - in particular, Medicare and Medicaid, because of their particular reimbursement model - makes it impossible for most providers to provide up-front pricing. Typically the providers who can are for specialized treatments that don't intersect with other specialists much, like outpatient psychiatry or psychotherapy (you'll see this a lot in places like New York, where the demand is high enough that good psychiatrists can ensure a steady stream of patients even if they don't accept any insurance, and they rarely need to refer people to other specialists). I'm glad you're able to operate a practice like this elsewhere, especially for a non-psychiatric (I'm assuming) medical clinic.
  - npongratz 8y ago
    > Accepting insurance - in particular, Medicare and Medicaid, because of their particular reimbursement model - makes it impossible for most providers to provide up-front pricing. I must be missing something. Suppose I tell the provider I am going to pay them cash, directly; I will not use Medicare, Medicaid, or any other insurance. Are you saying that because said provider accepts Medicare/Medicaid for other patients, it is impossible for them to tell me ahead of time what they are going to charge me?
    - robotrout 8y ago
      Yes. I believe the problem is that they negotiate the prices with the insurance companies. They have to start high, so they can negotiate down. They actually do have a price list, that you can sometimes bully them into giving you, which are the prices that they submit to begin negotiations with the insurance companies. But, as you can imagine, those prices on that list are crazy high, as they are intended to be negotiated down, not actually paid.
kbart 8y ago
Wow, so do I understand right, that in USA you don't know the cost of medicine before buying them? What's the reasoning behind that?
- refurb 8y ago
  For a script you fill at a pharmacy? Sure, you can find out exactly what it will cost before buying. Medical treatment by a physician or hospital? No, you can't really find out.
- hackeraccount 8y ago
  Third parties payers is the reason. As a general matter if you have insurance - private, medicare, medicaid - and the reason isn't anything crazy / chronic then the price is never out of the world. Chronic conditions add up but the people in those cases generally know what the cost is ahead of time. And if you don't have insurance either you're able to pay out of pocket or you just don't pay and then get care anyway. Which is to say it's all madness.
tathougies 8y ago
My wife and I visited the Mayo Clinic this year, and I was surprised and relieved that they had a giant PDF file of every service they offer (which is a lot) and the associated price. I don't understand why all hospitals don't have this. The price we ended up paying, since it wasn't covered by insurance, is basically exactly what it said on the pricing sheet.
tomohawk 8y ago
These guys https://surgerycenterok.com/ https://surgerycenterok.com/ are able to provide up front pricing. But if they were to accept medicare, they wouldn't be able to.

makmanalp 8y ago

Because hospitals use those prices to negotiate with insurance and other parties. I'm not saying it's right, but it's what happens in a broken system: https://en.wikipedia.org/wiki/Chargemaster https://en.wikipedia.org/wiki/Chargemaster

conanbatt 8y ago

The doctor doesn't know what the claim is going to be. It takes sometimes weeks to know how much you charge at all. This is because insurance companies pay in base on what you did or how long you did it. You itemize each visit like a tax return that later gets reviewed. Then someone reads the return and thinks if it makes any sense. After that, they pay back the doctor, but according to the plan, they also have to charge the patient the copay. That said, a doctors office that is only cash will get very little patients. Because people that are employed will not go to a cash-only doctor's office.

pg_bot 8y ago
Not true. I own and run a cash only doctor's office. Coming to us is cheaper than most insurance co-pays.
- japhyr 8y ago
  Your posts are pretty interesting. If you don't mind a couple questions: - What range of services do you offer? Do you take care of broken bones? Long-term illnesses? What kinds of things do you refer people to a full hospital for? - Are there many offices like yours around? How unusual is your office? - How easily could you build an entire hospital on this model? What would the limits of that be?
  - pillfill 8y ago
    Not OP, but I'm familiar with a couple primary care providers that don't file insurance claims. It's refreshing to see up-front pricing on their website for services they offer, e.g.: https://www.palmettoproactive.com/services-pricing https://www.palmettoproactive.com/services-pricing
    - conanbatt 8y ago
      I agree! Its great, but lots of people have insurance already so they want to use that to get their primary care, so that 200 dollar visit becomes 40 bucks.
  - pg_bot 8y ago
    We run a primary care clinic. The specific type of clinic we run is called "direct primary care". There are around 800 clinics like ours in the United States but the service is generally catered to the wealthy. For more details about the scope of practice you can read the following link.[0] When we cannot provide a service in house we usually help someone navigate the medical system. There is a lot of information asymmetry when dealing with healthcare and we help even that out for our clients. We also partner with other companies to get reduced prices on imaging, labs, and other services. I don't believe you can run an entire hospital on this model. Hospitals/insurance are best suited for unpredictable events. Our model is great for chronic and predictable events. [0]: https://en.wikipedia.org/wiki/Primary_care_physician#Scope_of_practice https://en.wikipedia.org/wiki/Primary_care_physician#Scope_o...
- conanbatt 8y ago
  Are you primary care? Because I cant see a primary care competing on price vs insurance that charges 20 dollars/30% on copay.
  - pg_bot 8y ago
    It depends on what your deductible is. With the increasing cost of healthcare, we are seeing companies go with higher and higher deductible plans. We don't compete solely on price, however our prices are extremely competitive even for people who have insurance. (we are often cheaper than medicare/medicaid) We also work with businesses as part of their benefit plans. The major benefit of this system is time, we can schedule longer appointments with a more flexible schedule than most other doctor's offices.

pg_bot 8y ago

This is how we run our medical clinic in South Carolina. All of our prices are public and we try to get you the lowest possible cost. You will never receive a bill for which you did not know the price ahead of time. We support this by having a $49/month membership fee and by not accepting insurance. (Most additional charges are under $20)

chimeracoder 8y ago
> We support this by having a $49/month membership fee and by not accepting insurance. This is the trick. Accepting insurance - in particular, Medicare and Medicaid, because of their particular reimbursement model - makes it impossible for most providers to provide up-front pricing. Typically the providers who can are for specialized treatments that don't intersect with other specialists much, like outpatient psychiatry or psychotherapy (you'll see this a lot in places like New York, where the demand is high enough that good psychiatrists can ensure a steady stream of patients even if they don't accept any insurance, and they rarely need to refer people to other specialists). I'm glad you're able to operate a practice like this elsewhere, especially for a non-psychiatric (I'm assuming) medical clinic.
- npongratz 8y ago
  > Accepting insurance - in particular, Medicare and Medicaid, because of their particular reimbursement model - makes it impossible for most providers to provide up-front pricing. I must be missing something. Suppose I tell the provider I am going to pay them cash, directly; I will not use Medicare, Medicaid, or any other insurance. Are you saying that because said provider accepts Medicare/Medicaid for other patients, it is impossible for them to tell me ahead of time what they are going to charge me?
  - robotrout 8y ago
    Yes. I believe the problem is that they negotiate the prices with the insurance companies. They have to start high, so they can negotiate down. They actually do have a price list, that you can sometimes bully them into giving you, which are the prices that they submit to begin negotiations with the insurance companies. But, as you can imagine, those prices on that list are crazy high, as they are intended to be negotiated down, not actually paid.

kbart 8y ago

Wow, so do I understand right, that in USA you don't know the cost of medicine before buying them? What's the reasoning behind that?

refurb 8y ago
For a script you fill at a pharmacy? Sure, you can find out exactly what it will cost before buying. Medical treatment by a physician or hospital? No, you can't really find out.
hackeraccount 8y ago
Third parties payers is the reason. As a general matter if you have insurance - private, medicare, medicaid - and the reason isn't anything crazy / chronic then the price is never out of the world. Chronic conditions add up but the people in those cases generally know what the cost is ahead of time. And if you don't have insurance either you're able to pay out of pocket or you just don't pay and then get care anyway. Which is to say it's all madness.

tathougies 8y ago

My wife and I visited the Mayo Clinic this year, and I was surprised and relieved that they had a giant PDF file of every service they offer (which is a lot) and the associated price. I don't understand why all hospitals don't have this. The price we ended up paying, since it wasn't covered by insurance, is basically exactly what it said on the pricing sheet.

tomohawk 8y ago

These guys https://surgerycenterok.com/ https://surgerycenterok.com/ are able to provide up front pricing. But if they were to accept medicare, they wouldn't be able to.