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>Everybody has gotten so conditioned to the idea that "health insurance" pays for everything health related, that we all seem to take this for granted. But it d

>Everybody has gotten so conditioned to the idea that "health insurance" pays for everything health related, that we all seem to take this for granted. But it doesn't have to be so. Try this experiment. Walk into your doctor's office and ask what a procedure would cost. Ask the doctor, the receptionist, the billing clerk - ask everyone. No one will be able to give you an answer. That's why they are conflated. Fix that (very ripe for disruption) problem and you'll fix health care. PS: I agree with you, it should generally be affordable without insurance.

mindcrime 8y ago
Try this experiment. Walk into your doctor's office and ask what a procedure would cost. Ask the doctor, the receptionist, the billing clerk - ask everyone. No one will be able to give you an answer. That's why they are conflated. Fix that (very ripe for disruption) problem and you'll fix health care. Agreed.
jsoc815 8y ago
> Try this experiment. ...ask everyone. No one will be able to give you an answer. Funny you say this. A friend just went through this. Not even the insurance company could say. The calls to everyone got so ridiculous that I had to construct lawyerly questions so that people couldn't default to weaselly answers. The provider billing staff seemed to feel put upon that they were being asked to coordinate w/the insurer to figure out patient out of pocket cost would be. And in the end they still couldn't figure it out.
- poulsbohemian 8y ago
  Here's what gets to me as well... providers love to talk about how little they get reimbursed from medicare and from many insurers. But, for example, I'm not going to have a surgery that I would really like to have (and that a doctor agreed I should have) because nobody can tell me what the cost would be. The 15 minute appointment with the doctor who recommended it to me was $700 out of pocket - so I'm unlikely to return if that's the kind of bill I get hit with for having a cup of coffee with them. So, I'd like to believe that at some point, given the current environment in which people are paying for insurance but can't afford to go to the doctor, that we'll see providers realize they are losing out on revenue opportunities by not actually serving their customers.
  - jsoc815 8y ago
    >I'm not going to have a surgery... because nobody can tell me what the cost would be. Exactly this! I thought having my friend appeal to the provider's interest in being paid might spur them to figure it out. Surprise! It didn't. Even when explicitly mentioning that the point of asking for this information was to ensure that (s)he had the $$ to pay them, the provider('s billing team) still balked at being asked to figure out out of pocket cost(s). When (s)he threatened to cancel the procedure, they just said "Fine." (s)He tried w/another provider, who was a little more diligent in trying to figure things out, but the best that they could do was figure out that the insurance company would approve the procedure, and what some of the involved parties were billing. Mind you, (s)he was actually dealing with the hospital where the procedure was to be performed. But of course, since all of the people involved are not hospital staff, they "can't" figure out everything. It's all ridiculous and the result of bad policy and planning. On a separate note, I once noticed a billing error. When I called the insurance company to ask if they had any standards/definition for what constitutes delivery of a particular service/procedure, the rep said, "No. We just look at the amount charged and pay if it makes sense."
  - dragonwriter 8y ago
    > of bill I get hit with for having a cup of coffee with them. So, I'd like to believe that at some point, given the current environment in which people are paying for insurance but can't afford to go to the doctor, that we'll see providers realize they are losing out on revenue opportunities by not actually serving their customers. The customers from which the providers drive revenue are the ones who can afford to go to the doctor. The ones who can't (even if they pay for insurance) are ones providers wouldn't be getting revenue by serving.
    - poulsbohemian 8y ago
      But you are missing my point and that of joc815 below you - if I knew the cost, then I could determine whether or not to become a customer. In the absence of a clear cost structure, I can't answer the question of whether I can afford the care or not.

mindcrime 8y ago

Try this experiment. Walk into your doctor's office and ask what a procedure would cost. Ask the doctor, the receptionist, the billing clerk - ask everyone. No one will be able to give you an answer. That's why they are conflated. Fix that (very ripe for disruption) problem and you'll fix health care. Agreed.

jsoc815 8y ago

> Try this experiment. ...ask everyone. No one will be able to give you an answer. Funny you say this. A friend just went through this. Not even the insurance company could say. The calls to everyone got so ridiculous that I had to construct lawyerly questions so that people couldn't default to weaselly answers. The provider billing staff seemed to feel put upon that they were being asked to coordinate w/the insurer to figure out patient out of pocket cost would be. And in the end they still couldn't figure it out.

poulsbohemian 8y ago
Here's what gets to me as well... providers love to talk about how little they get reimbursed from medicare and from many insurers. But, for example, I'm not going to have a surgery that I would really like to have (and that a doctor agreed I should have) because nobody can tell me what the cost would be. The 15 minute appointment with the doctor who recommended it to me was $700 out of pocket - so I'm unlikely to return if that's the kind of bill I get hit with for having a cup of coffee with them. So, I'd like to believe that at some point, given the current environment in which people are paying for insurance but can't afford to go to the doctor, that we'll see providers realize they are losing out on revenue opportunities by not actually serving their customers.
- jsoc815 8y ago
  >I'm not going to have a surgery... because nobody can tell me what the cost would be. Exactly this! I thought having my friend appeal to the provider's interest in being paid might spur them to figure it out. Surprise! It didn't. Even when explicitly mentioning that the point of asking for this information was to ensure that (s)he had the $$ to pay them, the provider('s billing team) still balked at being asked to figure out out of pocket cost(s). When (s)he threatened to cancel the procedure, they just said "Fine." (s)He tried w/another provider, who was a little more diligent in trying to figure things out, but the best that they could do was figure out that the insurance company would approve the procedure, and what some of the involved parties were billing. Mind you, (s)he was actually dealing with the hospital where the procedure was to be performed. But of course, since all of the people involved are not hospital staff, they "can't" figure out everything. It's all ridiculous and the result of bad policy and planning. On a separate note, I once noticed a billing error. When I called the insurance company to ask if they had any standards/definition for what constitutes delivery of a particular service/procedure, the rep said, "No. We just look at the amount charged and pay if it makes sense."
- dragonwriter 8y ago
  > of bill I get hit with for having a cup of coffee with them. So, I'd like to believe that at some point, given the current environment in which people are paying for insurance but can't afford to go to the doctor, that we'll see providers realize they are losing out on revenue opportunities by not actually serving their customers. The customers from which the providers drive revenue are the ones who can afford to go to the doctor. The ones who can't (even if they pay for insurance) are ones providers wouldn't be getting revenue by serving.
  - poulsbohemian 8y ago
    But you are missing my point and that of joc815 below you - if I knew the cost, then I could determine whether or not to become a customer. In the absence of a clear cost structure, I can't answer the question of whether I can afford the care or not.