7 ms·

My wife and I agreed years ago that we would have a discussion before either of us makes a purchase of about $20 or more. (We haven't adhered to that perfectly,

My wife and I agreed years ago that we would have a discussion before either of us makes a purchase of about $20 or more. (We haven't adhered to that perfectly, but it has been a great guideline.) Oddly, we failed to notice that we never have that discussion when it comes to health care, even though the vast majority of our interactions with the health care system are certainly not emergencies. We routinely go to a doctor, we don't ask what it will cost, we do whatever the doctor asks, and insurance covers only part of the bill. Health care is the only exception to our $20 rule. How odd... We realized we've been bamboozled. Nearly every hospital and clinic uses the same trick: the doctors apparently don't know what anything costs, the office staff say they don't know what anything will cost us because it depends on the insurance, and the insurance company won't reveal the price until the office staff charges the insurance. All the indirection makes it difficult to determine even a ballpark figure. (It no longer surprises me when the hospital charges $4000 per night to merely sleep in a bed with nurses and doctors nearby.) We decided we're no longer going to make an exception for health care (except in emergencies). We're going to require a price ahead of time so we can discuss it like we do everything else. We intend to annoy the office staff and insurance company until they comply and tell us what the prices will be. We think about it this way: heavy expenses can easily cause stress that reduce our quality of life, significantly offsetting whatever we might gain from medical procedures. I'm glad the legislation seems to be working in our favor.

ryandrake 7y ago
I've actually tried this. The doctors and office staff will always claim they don't know how much any of their services cost. They will stubbornly stonewall you if you escalate. I've gotten into an actual shouting match with a doctor over this and ended up getting banned from his clinic. Go ahead and threaten to go to another doctor: They don't care because they know every other practice will stonewall you about anything cost-related as well. No clinic will even let you sign up as a new patient anymore unless you sign their form that essentially says "You agree to pay any amount that we decide you owe. If we make a mistake, tough luck. If you can't afford it, tough luck."
- hathawsh 7y ago
  I wouldn't recommend shouting. :-) Also, we don't expect an exact price, just as we don't expect an exact price from a building contractor. We expect rough estimates so we can tell the difference between a $500 procedure and a $5000 procedure.
  - newman8r 7y ago
    That's a good point. Not knowing how much something is going to cost could cause an enormous amount of stress to a patient - which could impact their outcome. I wonder if there have ever been any studies done about outcomes where the patients are fully informed about cost, vs being in the dark.
- garfieldtheduck 7y ago
  The doctors won't know how much the insurance company will reimburse until they receive the reimbursement(except Medicare). They are essentially working in the dark as well. The transparency has to start at the insurance level.
  - Aloisius 7y ago
    I'd take an estimate without insurance reimbursements over nothing at all. At least I'd know what I was on the hook for if my insurance didn't cover it. It is a bit ridiculous that there isn't ever even an attempt at informing a patient of their potential liability beforehand even in nonemergency situations.
- noelsusman 7y ago
  They're not lying though, at least if you're talking about a hospital. It's not an accident either, there's a strong norm in medicine about ignoring costs. Doctors aren't supposed to take cost into consideration when making medical decisions, to the point where they have no idea what anything costs and they fight to keep it that way. Things are changing... very slowly.
  - 7y ago
smsm42 7y ago
I once tried to figure out why two visits to the doctor, apparently exactly the same, by the same person, were billed different sum. The difference wasn't significant monetarily - it was about $20-30 or so - but I wanted to understand how much that visit is supposed to cost. It was an HMO, so there's no question of negotiation or anything - they are setting their own prices. Still, nobody could give me the answer. I called several time, and I spoke to five or so different people, and all I got is "yeah, you've been billed right, there's no mistake" (not what I asked!) and "well, that's how much it costs" and indeterminate mumble. Nobody ever could explain me where these prices come from, where I could see them upfront, and how I am supposed to know which visit will cost me how much. It's basically "you come, and we bill you later whatever we want and you hope it's not too much". Interestingly enough, in dental medicine everybody seems to be completely able to give the full price upfront, and explain all out-of-pocket costs before I even start talking to the doctor. I wonder what's so different there that can't be replicated elsewhere.
- jessaustin 7y ago
  It's an insightful contrast to draw. There are a number of differences between dentistry and other health professions, but I think the most relevant differences are the size of the typical firm together with the total cost for any particular patient. Many dental clinics are just one or two dentists, who have no business relationship with any other clinic. (There are "fast-food" chains like Aspen Dental, but they are a relatively low portion of the overall industry.) Also, although some patients might get low-five-figures worth of dental work in a particular year, that much is fairly uncommon. That same sum could be one day in a hospital, which is usually owned by a firm with thousands of employees. Lots of formerly self-employed physicians have been forced to join big firms to retain admitting privileges etc. Dental insurance firms would probably like to engage in all the price-fixing and patient confusion that other health insurance firms enjoy, but they can't possibly employ enough people to arrange their dastardly schemes with tens of thousands of different dentists. Instead, they have to publish (to dentists, not to the public) lists of reimbursement limits by procedure code. Dentists decide whether they'll accept any particular insurance plan largely based on reimbursement, and many of them are willing to discuss those decisions with their patients. At the same time, most dental patients don't have insurance at all [EDIT: and many are fine with that, since they can afford the care they need]. Single physicians in family practice would be in largely the same position as the typical general dentist, but the work they do is a relatively smaller portion of the overall industry. After all the real screwing from medical costs takes place via hospital visits and high-tech imaging. Even a smaller hospital will start getting calls from insurance executives after they generate a few expensive cardiac procedures in any particular quarter. Don't take this as a defense of dental insurance. It's fine if you get it from an employer, but after working in a dental clinic I don't think anyone should get it privately. If you need a lot of dental work they don't pay for much of it (this is also true of many employer-provided plans). If you don't need a lot of work you end up paying them more than you'd pay the dentist. Most people who need lots of dental work but can't afford it should get loans for that work, from e.g. Care Credit or one of its competitors. Yes, that sucks, but it sucks less than private dental insurance.

ryandrake 7y ago

I've actually tried this. The doctors and office staff will always claim they don't know how much any of their services cost. They will stubbornly stonewall you if you escalate. I've gotten into an actual shouting match with a doctor over this and ended up getting banned from his clinic. Go ahead and threaten to go to another doctor: They don't care because they know every other practice will stonewall you about anything cost-related as well. No clinic will even let you sign up as a new patient anymore unless you sign their form that essentially says "You agree to pay any amount that we decide you owe. If we make a mistake, tough luck. If you can't afford it, tough luck."

hathawsh 7y ago
I wouldn't recommend shouting. :-) Also, we don't expect an exact price, just as we don't expect an exact price from a building contractor. We expect rough estimates so we can tell the difference between a $500 procedure and a $5000 procedure.
- newman8r 7y ago
  That's a good point. Not knowing how much something is going to cost could cause an enormous amount of stress to a patient - which could impact their outcome. I wonder if there have ever been any studies done about outcomes where the patients are fully informed about cost, vs being in the dark.
garfieldtheduck 7y ago
The doctors won't know how much the insurance company will reimburse until they receive the reimbursement(except Medicare). They are essentially working in the dark as well. The transparency has to start at the insurance level.
- Aloisius 7y ago
  I'd take an estimate without insurance reimbursements over nothing at all. At least I'd know what I was on the hook for if my insurance didn't cover it. It is a bit ridiculous that there isn't ever even an attempt at informing a patient of their potential liability beforehand even in nonemergency situations.
noelsusman 7y ago
They're not lying though, at least if you're talking about a hospital. It's not an accident either, there's a strong norm in medicine about ignoring costs. Doctors aren't supposed to take cost into consideration when making medical decisions, to the point where they have no idea what anything costs and they fight to keep it that way. Things are changing... very slowly.
- 7y ago

smsm42 7y ago

I once tried to figure out why two visits to the doctor, apparently exactly the same, by the same person, were billed different sum. The difference wasn't significant monetarily - it was about $20-30 or so - but I wanted to understand how much that visit is supposed to cost. It was an HMO, so there's no question of negotiation or anything - they are setting their own prices. Still, nobody could give me the answer. I called several time, and I spoke to five or so different people, and all I got is "yeah, you've been billed right, there's no mistake" (not what I asked!) and "well, that's how much it costs" and indeterminate mumble. Nobody ever could explain me where these prices come from, where I could see them upfront, and how I am supposed to know which visit will cost me how much. It's basically "you come, and we bill you later whatever we want and you hope it's not too much". Interestingly enough, in dental medicine everybody seems to be completely able to give the full price upfront, and explain all out-of-pocket costs before I even start talking to the doctor. I wonder what's so different there that can't be replicated elsewhere.

jessaustin 7y ago
It's an insightful contrast to draw. There are a number of differences between dentistry and other health professions, but I think the most relevant differences are the size of the typical firm together with the total cost for any particular patient. Many dental clinics are just one or two dentists, who have no business relationship with any other clinic. (There are "fast-food" chains like Aspen Dental, but they are a relatively low portion of the overall industry.) Also, although some patients might get low-five-figures worth of dental work in a particular year, that much is fairly uncommon. That same sum could be one day in a hospital, which is usually owned by a firm with thousands of employees. Lots of formerly self-employed physicians have been forced to join big firms to retain admitting privileges etc. Dental insurance firms would probably like to engage in all the price-fixing and patient confusion that other health insurance firms enjoy, but they can't possibly employ enough people to arrange their dastardly schemes with tens of thousands of different dentists. Instead, they have to publish (to dentists, not to the public) lists of reimbursement limits by procedure code. Dentists decide whether they'll accept any particular insurance plan largely based on reimbursement, and many of them are willing to discuss those decisions with their patients. At the same time, most dental patients don't have insurance at all [EDIT: and many are fine with that, since they can afford the care they need]. Single physicians in family practice would be in largely the same position as the typical general dentist, but the work they do is a relatively smaller portion of the overall industry. After all the real screwing from medical costs takes place via hospital visits and high-tech imaging. Even a smaller hospital will start getting calls from insurance executives after they generate a few expensive cardiac procedures in any particular quarter. Don't take this as a defense of dental insurance. It's fine if you get it from an employer, but after working in a dental clinic I don't think anyone should get it privately. If you need a lot of dental work they don't pay for much of it (this is also true of many employer-provided plans). If you don't need a lot of work you end up paying them more than you'd pay the dentist. Most people who need lots of dental work but can't afford it should get loans for that work, from e.g. Care Credit or one of its competitors. Yes, that sucks, but it sucks less than private dental insurance.