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I had this experience with imaging (MRI), cost 10% more with insurance than without. I asked a friend in the healthcare industry about this - they said that si

by cascom 8y ago

I had this experience with imaging (MRI), cost 10% more with insurance than without. I asked a friend in the healthcare industry about this - they said that since insurance companies negotiate all the services at once - the insurance company is trying to lower the total cost for the whole insured pool, this often means that they will marginally overpay for high margin services in order to get big discounts for the really costly things. The hospital makes more gross margin, and the insurance company lowers it’s total spend. The offshoot is that individual people may bear the brunt of this grand bargain... No idea if it’s true, but had a ring of truth to it...

tantalor 8y ago
Sounds like price fixing; a crime
- fipple 8y ago
  Price fixing is a crime only when coordinated among multiple suppliers.
  - ipython 8y ago
    A crime is only what legislature declares is a crime... One would consider why it is the law for a mechanic to give you a written estimate for work to your vehicle, and be required to call you before exceeding by a notional amount- yet, a hospital can legally withhold all cost information from you and yet you’re responsible for the bill in full after the service.
    - Gibbon1 8y ago
      My refrain. If a mechanic conducted business like a hospital they'd have their business license pulled and the owner would go to jail.
matwood 8y ago
> I had this experience with imaging (MRI), cost 10% more with insurance than without. Depending on where you went it could have been much more than 10%. Non-emergency imaging is definitely one of those things you ask about other locations and if they have cash pricing. When I needed an MRI if I was to use my insurance it was going to be ~$1000 because of high deductible plan. A different place took payment at the time and it was $350. According to the doctor who wanted me to get the MRI, hospitals are far and away the most expensive places to get one.
antjanus 8y ago
I had the same situation with multiple services: 1. ultrasound cost around $300 with insurance...$150 without 2. ER visit cost $4K with insurance....$900 without 3. specialist visit with insurance cost around $200...$150 without And don't get me started on labs. It's really a rip off to use insurance for anything other than: 1. general doctor visit (cheap co-pay, pretty expensive cash option) 2. really expensive shit (c-section w/o insurance runs $25-$30K -- cost me around $5K with insurance) Anything in between seems to be cheaper when you pay individually. As a disclaimer this is "gold-level" insurance coverage which costs around $1200-$1300/month for a family of 4.
- cosmie 8y ago
  One thing to keep in mind when paying individually is that many insurance providers won't count the payments toward your deductible or maximum out of pocket expenses, since it wasn't processed through your insurance. If you're nowhere near hitting your deductible for the year, and don't anticipate hitting it, then looking for cash-only discounts make sense. But if you anticipate hitting your deductible anyway, sometimes it makes sense to pay the inflated price on that individual item, since you'll make up for it later when you hit your deductible and switch to only paying your coinsurance amount (or hitting your max OOP).
- sandworm101 8y ago
  Wow. I used to live in the US but thank you for the reminder. I am very glad i now work a government job in a country with public health care. I went to the dentist last week. Walking out without paying anything, not a single form, feels like stealing. I cannot understand how anyone in the US can pay such costs. Simply staying alive seems a constant battle.
  - maroonblazer 8y ago
    What dental services were performed? In the U.S. I frequently pay nothing nor fill out any forms for dental work.
    - 8y ago
siruncledrew 8y ago
In such case, could someone just deny the service, ask for a referral, then go someplace else and say they don't have insurance?
- shawnz 8y ago
  Why can't they just say that they'd like to pay without insurance? Is it some kind of crime to not use insurance even though you have it?
  - koolba 8y ago
    No but they may try to make you think it is. I’ve seen this first hand at an urgent care center.
- cascom 8y ago
  Absolutely - but they might still ask themselves why they are paying an insurance company to negotiate a rate above what they can obtain on their own. In vs out of network, deductibles, and co-insurance can also complicate the calculus
  - conanbatt 8y ago
    This gets to the core of Milton Friedmans criticism of the healthcare system. PAtients might ask themselves that but they get healthcare services through the employer, so they show little to no elasticity between insurance companies and their premiums. If you untied healthcare from employers, then you would unleash a massive competitive force, where if one insurance outperforms another one, patients will react as you say. But today, changing insurance companies would mean changing jobs.
    - Gibbon1 8y ago
      > Milton Friedmans That guys a quack and everything he's done has been debunked. The definitive work on this was Kenneth Arrows work in the early 60's. See Uncertainty and the Welfare Economics of Medical Care. http://www.who.int/bulletin/volumes/82/2/PHCBP.pdf http://www.who.int/bulletin/volumes/82/2/PHCBP.pdf tl;dr: Markets don't work for healthcare. Full stop.

by cascom 8y ago

tantalor 8y ago

Sounds like price fixing; a crime

fipple 8y ago
Price fixing is a crime only when coordinated among multiple suppliers.
- ipython 8y ago
  A crime is only what legislature declares is a crime... One would consider why it is the law for a mechanic to give you a written estimate for work to your vehicle, and be required to call you before exceeding by a notional amount- yet, a hospital can legally withhold all cost information from you and yet you’re responsible for the bill in full after the service.
  - Gibbon1 8y ago
    My refrain. If a mechanic conducted business like a hospital they'd have their business license pulled and the owner would go to jail.

matwood 8y ago

> I had this experience with imaging (MRI), cost 10% more with insurance than without. Depending on where you went it could have been much more than 10%. Non-emergency imaging is definitely one of those things you ask about other locations and if they have cash pricing. When I needed an MRI if I was to use my insurance it was going to be ~$1000 because of high deductible plan. A different place took payment at the time and it was $350. According to the doctor who wanted me to get the MRI, hospitals are far and away the most expensive places to get one.

antjanus 8y ago

I had the same situation with multiple services: 1. ultrasound cost around $300 with insurance...$150 without 2. ER visit cost $4K with insurance....$900 without 3. specialist visit with insurance cost around $200...$150 without And don't get me started on labs. It's really a rip off to use insurance for anything other than: 1. general doctor visit (cheap co-pay, pretty expensive cash option) 2. really expensive shit (c-section w/o insurance runs $25-$30K -- cost me around $5K with insurance) Anything in between seems to be cheaper when you pay individually. As a disclaimer this is "gold-level" insurance coverage which costs around $1200-$1300/month for a family of 4.

cosmie 8y ago
One thing to keep in mind when paying individually is that many insurance providers won't count the payments toward your deductible or maximum out of pocket expenses, since it wasn't processed through your insurance. If you're nowhere near hitting your deductible for the year, and don't anticipate hitting it, then looking for cash-only discounts make sense. But if you anticipate hitting your deductible anyway, sometimes it makes sense to pay the inflated price on that individual item, since you'll make up for it later when you hit your deductible and switch to only paying your coinsurance amount (or hitting your max OOP).
sandworm101 8y ago
Wow. I used to live in the US but thank you for the reminder. I am very glad i now work a government job in a country with public health care. I went to the dentist last week. Walking out without paying anything, not a single form, feels like stealing. I cannot understand how anyone in the US can pay such costs. Simply staying alive seems a constant battle.
- maroonblazer 8y ago
  What dental services were performed? In the U.S. I frequently pay nothing nor fill out any forms for dental work.
  - 8y ago

siruncledrew 8y ago

In such case, could someone just deny the service, ask for a referral, then go someplace else and say they don't have insurance?

shawnz 8y ago
Why can't they just say that they'd like to pay without insurance? Is it some kind of crime to not use insurance even though you have it?
- koolba 8y ago
  No but they may try to make you think it is. I’ve seen this first hand at an urgent care center.
cascom 8y ago
Absolutely - but they might still ask themselves why they are paying an insurance company to negotiate a rate above what they can obtain on their own. In vs out of network, deductibles, and co-insurance can also complicate the calculus
- conanbatt 8y ago
  This gets to the core of Milton Friedmans criticism of the healthcare system. PAtients might ask themselves that but they get healthcare services through the employer, so they show little to no elasticity between insurance companies and their premiums. If you untied healthcare from employers, then you would unleash a massive competitive force, where if one insurance outperforms another one, patients will react as you say. But today, changing insurance companies would mean changing jobs.
  - Gibbon1 8y ago
    > Milton Friedmans That guys a quack and everything he's done has been debunked. The definitive work on this was Kenneth Arrows work in the early 60's. See Uncertainty and the Welfare Economics of Medical Care. http://www.who.int/bulletin/volumes/82/2/PHCBP.pdf http://www.who.int/bulletin/volumes/82/2/PHCBP.pdf tl;dr: Markets don't work for healthcare. Full stop.