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> 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

> 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.
    - dragonwriter 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. “If you have to ask, you can't afford it.” Or, more to the point, medical procedures often have an unbounded upper limit on potential billed costs, without the opportunity to stop work and inform the customer and get new instructions when it is realized that the original estimate will be exceeded, and even getting a reasonable idea of the statistical distribution of charges for a particular procedure under costly comparable conditions by the same provider wouldn't be easy. Now, providers could adopt a flat fee structure and eat the risk of long-tail costs, but that creates a lot of risk (and some perverse incentives) for providers.
      - jsoc815 8y ago
        > “If you have to ask, you can't afford it.” Unless we're discussing medical care as a luxury good-- and if that's the way that we really want to approach this, okay, let's just be honest about that-- this is incorrect. In my experience, med professionals have made assumptions about what I could and couldn't afford based on their mental databases of flawed correlations. Things they thought I probably couldn't pay for, not only could I have if necessary, but didn't need to because my insurance was willing to cover it any way. I'm not going to address the rest of what you've written because, quite frankly, I have a difficult time believing that you are being serious, for a number of reasons. If I'm mistaken, then I thank you for sharing an interesting thought pattern and apologize in advance.

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.
  - dragonwriter 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. “If you have to ask, you can't afford it.” Or, more to the point, medical procedures often have an unbounded upper limit on potential billed costs, without the opportunity to stop work and inform the customer and get new instructions when it is realized that the original estimate will be exceeded, and even getting a reasonable idea of the statistical distribution of charges for a particular procedure under costly comparable conditions by the same provider wouldn't be easy. Now, providers could adopt a flat fee structure and eat the risk of long-tail costs, but that creates a lot of risk (and some perverse incentives) for providers.
    - jsoc815 8y ago
      > “If you have to ask, you can't afford it.” Unless we're discussing medical care as a luxury good-- and if that's the way that we really want to approach this, okay, let's just be honest about that-- this is incorrect. In my experience, med professionals have made assumptions about what I could and couldn't afford based on their mental databases of flawed correlations. Things they thought I probably couldn't pay for, not only could I have if necessary, but didn't need to because my insurance was willing to cover it any way. I'm not going to address the rest of what you've written because, quite frankly, I have a difficult time believing that you are being serious, for a number of reasons. If I'm mistaken, then I thank you for sharing an interesting thought pattern and apologize in advance.