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I actually stiffed a doctor once because he refused to give a price up front and when I got the bill it was outlandish. I also made a huge scene in the intake/w

I actually stiffed a doctor once because he refused to give a price up front and when I got the bill it was outlandish. I also made a huge scene in the intake/waiting room about this. I was leaving the United States at the time so I didn't really care about my credit record. To be slightly more honest: he wasn't the doctor assigned to me on intake, he was another doctor from another hospital across the street as a consultant IMHO trying to get onto my case so he could bill me.

tehlike 8y ago
most doctors in the US actually do not know about the prices of treatments as it changes based on insurance administrator/insurer, and then what the patient pays also have huge variability based on insurance administrator/insurer.
- throwaway12iii 8y ago
  Most doctors in the US actually do know how pricing works.
  - homero 8y ago
    They know how it works but not the exact price of an aspirin. They can't exactly tell you to go to the pharmacy out of your hospital bed to get a $2 bottle vs a $50 pill from them.
    - benj111 8y ago
      Is it not reasonable for them to ask, if they don't know? Also should they not have a general ballpark idea? I'm British and would expect Drs to be aware of costs before advising treatment (ruling out cheaper to rule out things etc).
      - jacobr1 8y ago
        No, because it will be different for every patient (for the same treatment) and will fluctuate widely from year to year. Also there is a general ethical sense of recommending the best treatment and dealing with cost as an afterthought.
        benj111 8y ago
        Car insurance prices vary widely from year to year, and person to person. I still expect a somewhat accurate price when I give some minimal information. Agree with the ethics, but if someone presents with a broken leg do you xray it (cheap) or mri (expensive)? For anything vaguely complicated the Dr is basically just eliminating likely culprits. Its preferable for everyone (that doesn't have a profit motive) if they try the cheap/quick ones first.
        tehlike 8y ago
        If you have a solid isurance provider and an insurer(e.g. google) they work with you to find out the most reasonable treatment and ballpark estimation of the costs. So there is that.
  - Johnny555 8y ago
    They know in generalities how it works, but I doubt that most doctors in a hospital setting can tell you how much a particular procedure will cost you. Even my dentist in a private practice often doesn't know "Well, we'll bill this to the insurance company, but they might not cover it all so we'll have to bill you"
  - mirimir 8y ago
    That's not what parent said. Sure, they arguably "know how pricing works". Their staff (or at least, their data systems) know about each patient's insurance. And hopefully, what physician services it covers. But I doubt that physicians themselves know that stuff. It's not what they focus on. In my experience, staff generally know how to code referrals for lab work and specialists so patients' insurance will cover it. But sometimes they screw up. So for example, I've been prescribed a testosterone supplement. But insurance won't cover testing for blood testosterone, level unless they use the right diagnostic code. Also for prostate-specific antigen checking. They have to code "enlarged prostate" in order to have it covered. There's another code for routine testing, but it isn't enough.
  - JamesBarney 8y ago
    95% of the time if ask a doctor the cost of a procedure they have more idea what the cash price is, not to mention whatever my copay will be calculated to be based on my insurance and its agreements with the service providers.
- Sacho 8y ago
  I get why they might not be able to tell you how much you'll pay because of your specific insurer, but why would the overall price of the treatment change with it? That seems bizarre.
  - StudentStuff 8y ago
    The doctor has no clue how the nurse (or assistant that handles billing) will bill the interaction, as they'll often optimize billings to extract the most money possible from your insurer. Its scummy and fraudulent, but issuing a large bill to an insurer, then getting a much smaller check back is how medical billing works here in the USA. Having your insurance pay for a trip to the ER after a car accident would be $7k for them, or $84k for your car insurance, hence why one should carry a car insurance policy with good driver/passenger injury coverage :P
  - conanbatt 8y ago
    The cost for the provider is the same, but what the insurance pays is in someone elses hands. If you wished not to abide by the insurance, just pay out of pocket. Insurance should really be only high deductible plans, so the patient really looks into pricing for his general care/periodic care.
QuantumGood 8y ago
Had new insurance and a sore shoulder. Was billed ~$1,400 for a physical therapist to examine it ("evaluation"). No treatment. Very little covered by insurance. The next day had a chiropractor treat it and shoulder was fine. $25 with coupon. Funny part is, as it was new insurance, I spent over 30 minutes with insurance rep in advance on phone going over options and trying to get an idea of likely costs. When I had a heart problem and no insurance, we called providers all over town (Minneapolis) to try to get prices in advance. Most would only give estimates over a wide range. Some flat out said it was there policy to not give estimates. Eventually found a cardiologist who worked basically free ($30 plus donation). I bought a Kardio to record my own ECG so I can have more data to improve my communication with cardiologists, who are (understandably) a bit alarmist about what can go wrong and tend to err on the side of (expensive) caution without sufficient data. Feels like a broken system.
- mastef 8y ago
  The differences in the prices you mentioned are astronomical... I'm already getting angry here to be charged $50 instead of $25 when the doctor "touches" you during some basic evaluation. But at least they tell you about any massive amounts coming up before any treatment happens.
  - QuantumGood 8y ago
    It's not sane. With insurance, was hospitalized for a heart condition. ~$45,000. Found no problem in testing, so they kept ordering more tests, sending in more cardiologists. Kept hearing "I know you've said this several times already, but please repeat for me...". Each time I repeated the story to a different doctor there was a large bill. Clearly the hospital new how to pad the bill. I eventually left "against doctor's advice" though there was a doctor there that agreed with me leaving. Pursued lower cost versions of remaining tests recommended on outpatient basis. The funny part that time was there was a "patient billing advocate" in the hospital, who was magically never available over the three days I was there despite repeated efforts by us each day.
    - 8y ago

tehlike 8y ago

most doctors in the US actually do not know about the prices of treatments as it changes based on insurance administrator/insurer, and then what the patient pays also have huge variability based on insurance administrator/insurer.

throwaway12iii 8y ago
Most doctors in the US actually do know how pricing works.
- homero 8y ago
  They know how it works but not the exact price of an aspirin. They can't exactly tell you to go to the pharmacy out of your hospital bed to get a $2 bottle vs a $50 pill from them.
  - benj111 8y ago
    Is it not reasonable for them to ask, if they don't know? Also should they not have a general ballpark idea? I'm British and would expect Drs to be aware of costs before advising treatment (ruling out cheaper to rule out things etc).
    - jacobr1 8y ago
      No, because it will be different for every patient (for the same treatment) and will fluctuate widely from year to year. Also there is a general ethical sense of recommending the best treatment and dealing with cost as an afterthought.
      - benj111 8y ago
        Car insurance prices vary widely from year to year, and person to person. I still expect a somewhat accurate price when I give some minimal information. Agree with the ethics, but if someone presents with a broken leg do you xray it (cheap) or mri (expensive)? For anything vaguely complicated the Dr is basically just eliminating likely culprits. Its preferable for everyone (that doesn't have a profit motive) if they try the cheap/quick ones first.
        tehlike 8y ago
        If you have a solid isurance provider and an insurer(e.g. google) they work with you to find out the most reasonable treatment and ballpark estimation of the costs. So there is that.
- Johnny555 8y ago
  They know in generalities how it works, but I doubt that most doctors in a hospital setting can tell you how much a particular procedure will cost you. Even my dentist in a private practice often doesn't know "Well, we'll bill this to the insurance company, but they might not cover it all so we'll have to bill you"
- mirimir 8y ago
  That's not what parent said. Sure, they arguably "know how pricing works". Their staff (or at least, their data systems) know about each patient's insurance. And hopefully, what physician services it covers. But I doubt that physicians themselves know that stuff. It's not what they focus on. In my experience, staff generally know how to code referrals for lab work and specialists so patients' insurance will cover it. But sometimes they screw up. So for example, I've been prescribed a testosterone supplement. But insurance won't cover testing for blood testosterone, level unless they use the right diagnostic code. Also for prostate-specific antigen checking. They have to code "enlarged prostate" in order to have it covered. There's another code for routine testing, but it isn't enough.
- JamesBarney 8y ago
  95% of the time if ask a doctor the cost of a procedure they have more idea what the cash price is, not to mention whatever my copay will be calculated to be based on my insurance and its agreements with the service providers.
Sacho 8y ago
I get why they might not be able to tell you how much you'll pay because of your specific insurer, but why would the overall price of the treatment change with it? That seems bizarre.
- StudentStuff 8y ago
  The doctor has no clue how the nurse (or assistant that handles billing) will bill the interaction, as they'll often optimize billings to extract the most money possible from your insurer. Its scummy and fraudulent, but issuing a large bill to an insurer, then getting a much smaller check back is how medical billing works here in the USA. Having your insurance pay for a trip to the ER after a car accident would be $7k for them, or $84k for your car insurance, hence why one should carry a car insurance policy with good driver/passenger injury coverage :P
- conanbatt 8y ago
  The cost for the provider is the same, but what the insurance pays is in someone elses hands. If you wished not to abide by the insurance, just pay out of pocket. Insurance should really be only high deductible plans, so the patient really looks into pricing for his general care/periodic care.

QuantumGood 8y ago

Had new insurance and a sore shoulder. Was billed ~$1,400 for a physical therapist to examine it ("evaluation"). No treatment. Very little covered by insurance. The next day had a chiropractor treat it and shoulder was fine. $25 with coupon. Funny part is, as it was new insurance, I spent over 30 minutes with insurance rep in advance on phone going over options and trying to get an idea of likely costs. When I had a heart problem and no insurance, we called providers all over town (Minneapolis) to try to get prices in advance. Most would only give estimates over a wide range. Some flat out said it was there policy to not give estimates. Eventually found a cardiologist who worked basically free ($30 plus donation). I bought a Kardio to record my own ECG so I can have more data to improve my communication with cardiologists, who are (understandably) a bit alarmist about what can go wrong and tend to err on the side of (expensive) caution without sufficient data. Feels like a broken system.

mastef 8y ago
The differences in the prices you mentioned are astronomical... I'm already getting angry here to be charged $50 instead of $25 when the doctor "touches" you during some basic evaluation. But at least they tell you about any massive amounts coming up before any treatment happens.
- QuantumGood 8y ago
  It's not sane. With insurance, was hospitalized for a heart condition. ~$45,000. Found no problem in testing, so they kept ordering more tests, sending in more cardiologists. Kept hearing "I know you've said this several times already, but please repeat for me...". Each time I repeated the story to a different doctor there was a large bill. Clearly the hospital new how to pad the bill. I eventually left "against doctor's advice" though there was a doctor there that agreed with me leaving. Pursued lower cost versions of remaining tests recommended on outpatient basis. The funny part that time was there was a "patient billing advocate" in the hospital, who was magically never available over the three days I was there despite repeated efforts by us each day.
  - 8y ago