26 ms·
Part of the problem is that hospitals don't disclose prices before performing services. So patients must agree to a procedure -- yet only afterward find out ho
by toomim 8y ago
Part of the problem is that hospitals don't disclose prices before performing services.
So patients must agree to a procedure -- yet only afterward find out how much it costs. That price can be shocking, and the patient never agreed to pay it. No wonder it becomes hard to collect from them.
In the rest of the economy, we agree on a price beforehand. That makes customers more likely to pay.
The medical system, however, has given up on disclosing prices to patients, because everything is paid by insurance. And now we have Doctors who say:
> “It's harder to collect from the patient than it is from the insurance,” said Amy Derick, a doctor who heads a dermatology practice outside Chicago.
If you want people to pay, then make an agreement with them before you perform the service!
- pishpash 8y agoExactly. Fed up with being turned into debt collectors? Then don't be shady loan sharks using debt collection as a price negotiation tool.
- aczerepinski 8y agoFinding out the price is only half the battle - finding out every doctor who might be involved in a procedure so you can make sure they're in network is the other half. Getting healthcare - even with insurance - can be terrifying.
- badwolf 8y agoGah. This is such a shitty thing. "Sorry, the anesthesiologist was out of network, though everyone else in the hospital is in network"
- sumoboy 8y agoIf you're in an in-network hospital it's not your job to interview every doctor that sees you and determine if they're in or out of network. Take it up with the hospital billing when you get the bill is what I was told by hospital admin people and tell them it's not my problem.
- telchar 8y agoThey'll tell you the exact opposite once you get your bill and they're trying to collect. I just had that conversation with a provider myself, after I got the bill.
- tfigment 8y agoThis did literally happened to my dad. I guess the fact that he is so poor helped negotiate the quoted price down later after much harassment. You have flesh eating bacteria eating away your leg and you need to make sure that everyone is in the same network and its not like you have other concerns or even really the ability to figure this out easily. After that I went to Kaiser because I'm not sure its possible to go out of network at least like that.
- pmiller2 8y agoThat's part of why I have Kaiser, too. I don't need to worry about providers of any sort being out of network (nurses, assistants, docs, labs, etc.)
- Balgair 8y agoHappens to my SO constantly. We went in for a urology visit, scheduled for months beforehand by the urologist, get a test done, yadda yaddda yadda. Now, up to 3 years later, we still get bills for that particular visit (in addition to other follow-ups) on a monthly basis. It's ~4/8 hours per week of extra work nearly every week in dealing with this nonsense. It's as if they don't even bother with sending us a bill anymore, they just go straight to collections companies. At this point, I know better than to think it's ever going to be fixed. The insurance and Hospital billing phone numbers are literally on speed dial. On particular phone call stands out. We got our insurance on a 3-way call with my SO and the hospital billing. For a urology test they charged us ~$800 for the test strip (just a single one!), which the hospital tried to claim was not covered (nothing, it seems, is ever 'covered'). Even the insurance person on the phone was aghast at the hospital: "Wait, so you are telling us that even urological tests, like a basic pH strip, at the specific office for urology, is $3000? What is our client even paying for, like, what is it exactly, that a urologist does? How much does a smile cost?" US Medical billing makes Kafka blush.
- sjg007 8y agoThis is not really a thing.
- ceejayoz 8y agoIt definitely is. https://www.tdi.texas.gov/news/2018/tdi10082018.html https://www.tdi.texas.gov/news/2018/tdi10082018.html > The problem meant consumers couldn’t get in-network anesthesia services at more than 20 hospitals and surgical centers in three of the state’s largest metro areas. https://www.vox.com/2018/5/23/17353284/emergency-room-doctor-out-of-network https://www.vox.com/2018/5/23/17353284/emergency-room-doctor... > Except he wasn’t: While the emergency room where Kohan was seen was in his insurance network, the oral surgeon who worked in that ER was not. That’s how Kohan ended up with a $7,924 bill from the oral surgeon that his health plan declined. > Separate data from the Center for Public Policy Priorities, an Austin-based think tank, finds that a staggering number of Texas emergency rooms have zero in-network emergency physicians — meaning that patients are guaranteed to see a doctor who does not accept their health insurance.
- sjg007 8y agoAnd it is still not a thing because the State prohibited said action.
- desdiv 8y agoYes, just like how the federal government prohibited marijuana and therefore no one in the United States of America consumes marijuana. Someone up thread made a claim and the burden of proof was on them. Now multiple reliable sources have been provided to satisfy that proof. You claim an unspecified law prohibit this and that this prohibition actually works. So now the burden of proof falls on you to actually cite the law and provide reliable sources of this law actually working.
- ceejayoz 8y agoBy that logic, murder's not a thing. Texas got mad here because there were no in-network anesthesia services. Having some out-of-network providers is depressingly common, and hard to guard against: https://www.modernhealthcare.com/article/20180917/NEWS/180919898 https://www.modernhealthcare.com/article/20180917/NEWS/18091... > About 25% of patient visits to hospitals in their insurance network result in balance billing from care by out-of-network physicians. Also, from the Vox article: > The problem with that law, Pogue argues, is that it requires patients to contact the state — and patients often aren’t aware of the option. Kohan, for example, didn’t know he had these rights until I told him. Pogue’s research suggests this is really common: Only 3,824 Texas patients have used the law to resolve their surprise bills since 2009. CPPP estimates that this is a tiny fraction of the 250,000 surprise medical bills sent out in the same time frame. This is just Texas, too. Plenty of states don't have their 2009 state law to work with.
- nowarninglabel 8y ago>In the rest of the economy, we agree on a price beforehand This occurs in auto repair as well (though maybe less than it used to). Those repairs, in my opinion, have been quite stressful as well. Are there other industries where we bill afterward?
- pishpash 8y agoIt's worse than auto repair since that requires you to give a written estimate and material changes require approval. Healthcare providers will straight up refuse to give any estimate. The galls.
- FigBug 8y agoSoftware Development. I won't do fixed price contracts unless it's really simple. Always time & materials. Home renovation. You'll get a quote, but the final price can be way higher. Any service when you are dealing with unknowns, the price is going to have to be flexible.
- monocasa 8y agoYou'll at least quote an hourly rate, a doctor won't do that.
- rubicon33 8y agoFor super obvious reasons. A developers cost is almost entirely their time. That is the "unknown" for a developer. For a doctor, the unknown includes many possible things like drugs administered, blood administered, emergency care, hospital costs, etc. It's not as simple as an hourly rate estimate, unfortunately.
- monocasa 8y agoI mean, every time I've dealt with a contractor it's time and materials. And the markups that hospitals charge on materials would be considered fraudulent by a court if someone tried to pull that as a freelancer.
- brightball 8y agoThe price is also different depending on which insurance company is paying for the service. You’d be shocked to find out the cost of a service if you were willing to pay up front with cash. It’s so much cheaper for everyone involved.
- dirkdk 8y agoI once needed an MRI, insurance company couldn't work out a deal before my appointment. MRI company offered to do the job if I paid up front and handled reimbursement myself. Costs up front were $500, compared to $1250 if the insurance company would pay after the procedure. Mind = blown.
- DoofusOfDeath 8y ago> Mind = blown Sounds like they put the MRI machine on the wrong setting.
- kwhitefoot 8y agoYou were still fleeced. Whatever happened to efficient markets? And why doesn't this kind of behaviour get fixed by the courts, it sounds like a lot of the players are in collusion to keep the prices high.
- sitharus 8y agoI find this baffling. I live in a country with free healthcare but have used private hospitals here in the past. They give an estimate of costs from every practitioner involved before you agree to the procedure. It's not exact but they give a best to worst case range. I'm not sure how this would apply to emergency care, but for non-urgent procedures I don't see why a quote isn't provided. It feels like a failure of the care providers to me.
- almostdeadguy 8y agoThere is no set price for receiving treatment because there are dozens of different systems of benefits and methods of calculating that cost from those benefits, determining eligibility, etc. The private insurer system is demonstrably the cause of the difficulty in determining prices, and the administrative overhead they incur is an enormous part of the cost of healthcare in the US [1]. People don't become debtors simply because they don't want to pay their bills, they become debtors because they can't afford to pay their bills. The number one cause of bankruptcies in the US is medical debt, and no amount of "price transparency" is going to fix that. [1]: https://www.nejm.org/doi/full/10.1056/nejmsa022033 https://www.nejm.org/doi/full/10.1056/nejmsa022033
- crusso 8y agoOur daughter's doctor recommended a blood test for a possible minor condition she has. We said, sure, without thinking that it was something special. We received a bill for $5k and the insurance only paid $3k of it. You'd think that for such an expensive test, the doctor or his staff would have a policy of getting our specific sign-off on the cost.
- kevin_thibedeau 8y agoThe doctor and his staff know how the game is played.
- Johnny555 8y agoPart of the problem is that hospitals don't disclose prices before performing services Even my vet gives an estimate before treatment -- with a "low", "typical" and "high" estimates. I have to sign off on it before they'll provide treatment. Why can't hospitals do the same for non-emergency care?
- jiveturkey 8y agoit would take a month to come back with the estimate. you don’t just call the insurance and get a price.
- true_religion 8y agoThey could tell you what they will try to collect from insurrance then you know your risks.
- telchar 8y agoOften they don't know themselves. It takes an elaborate back and forth negotiation with the insurance company to come to a final cost even when you wind up on the hook for it.
- joncp 8y agoThe reverse is also an issue. You go to the in-network doctor's office for a routine visit and then get a multi-hundred-dollar bill from their affiliated hospital. So, doctors can't pay their own rent?
- sjg007 8y agoHospitals != private practice.