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That's absolutely not categorically true; if you have an American HMO like Kaiser they have price lists and cost estimators on their website. They also have adv

That's absolutely not categorically true; if you have an American HMO like Kaiser they have price lists and cost estimators on their website. They also have advice lines exactly like the post you're replying to. I can also email my GP or message them through the app if it's less urgent.

takeda 7y ago
Kaiser is very different than the rest of insurances. They have their own facilities and prices are generally known in advance. Any other insurance it's nearly impossible to know. You need to know if the facility accepts your insurance or not (in/out of network), if the service is covered, your copay, deductible, how much the place bills (note this is not how much they are paid), what's the price the insurance company negotiated with the place and actually will pay and bunch of other things. There's no single person who will be able to tell you the price that you will pay. And you need to know a lot and what to ask and who ask. Unrelated to ER, I recently got charged almost $400 for a visit to a primary doctor that should cost $35. Had to go back and forth with doctor bill, hospital bill (apparently if doctor has an office in a hospital zone, they will also issue a bill, even though you don't really use the hospital) and the insurance company. I was going back and forth either side was either everything is correct and that's how much I should pay, or saying that the other side categorized it wrong. After attempting it multiple times. Eventually I gathered enough evidence that when talking to person from insurance she couldn't find excuse, then she suggested that I can submit request to review it. Why didn't they suggest that from the start. Based on information that I collected looks like the doctor's office and hospital categorized everything correctly (despite what insurance person said), I even had to figure out what the medical codes mean on the bill. And the issue is that the insurance company made a mistake. I like Kaiser model it makes things easy to know in terms of billing, but I don't like that Kaiser give bonuses for doctors for minimizing costs. It encourages so called marginal care. For example you generally won't learn about new kind of treatments available from your Kaiser doctors. They will generally suggest them if you're not responding to the cheaper solutions. For example if you have an autoimmune disease they will prefer you to use DMARDs and NSAID type of drugs (even with their side effects) and won't mention biologics, which are much more expensive, but work much better and can often reverse the effects of the disease.

takeda 7y ago

Kaiser is very different than the rest of insurances. They have their own facilities and prices are generally known in advance. Any other insurance it's nearly impossible to know. You need to know if the facility accepts your insurance or not (in/out of network), if the service is covered, your copay, deductible, how much the place bills (note this is not how much they are paid), what's the price the insurance company negotiated with the place and actually will pay and bunch of other things. There's no single person who will be able to tell you the price that you will pay. And you need to know a lot and what to ask and who ask. Unrelated to ER, I recently got charged almost $400 for a visit to a primary doctor that should cost $35. Had to go back and forth with doctor bill, hospital bill (apparently if doctor has an office in a hospital zone, they will also issue a bill, even though you don't really use the hospital) and the insurance company. I was going back and forth either side was either everything is correct and that's how much I should pay, or saying that the other side categorized it wrong. After attempting it multiple times. Eventually I gathered enough evidence that when talking to person from insurance she couldn't find excuse, then she suggested that I can submit request to review it. Why didn't they suggest that from the start. Based on information that I collected looks like the doctor's office and hospital categorized everything correctly (despite what insurance person said), I even had to figure out what the medical codes mean on the bill. And the issue is that the insurance company made a mistake. I like Kaiser model it makes things easy to know in terms of billing, but I don't like that Kaiser give bonuses for doctors for minimizing costs. It encourages so called marginal care. For example you generally won't learn about new kind of treatments available from your Kaiser doctors. They will generally suggest them if you're not responding to the cheaper solutions. For example if you have an autoimmune disease they will prefer you to use DMARDs and NSAID type of drugs (even with their side effects) and won't mention biologics, which are much more expensive, but work much better and can often reverse the effects of the disease.