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I spent 45 minutes at the hospital where I was to get a lab test done, trying to get a quote for said test. Prescribing doctor didn't know the cost. Lab tech d

• js2 7y ago
  From a Bogleheads topic titled “How to Minimize Your Emergency Care Expenses”: > Fifth, nobody you interact with at the hospital at the time of your visit has any idea how much anything costs. Part of that is the whole price transparency thing. Those who know the price don't want the front line workers to know it. Part of it is the fact that there are so many moving parts. Medicine gets inappropriately compared to aviation a lot, but it really isn't a fair comparison. Every one getting on a flight is basically getting the same thing. Medicine is like an airline flight where every row has its own flight attendant, every one on the plane is going somewhere different, and they all get a different movie and meal hand delivered to them. Imagine how much that flight would cost? Finally, despite the fact that there are hundreds of different products and services being sold, everybody pays a different price for them. This is due to dozens of different insurance plans each of which has negotiated a different price for every product and service, co-insurance plans, government plans, and various different levels of deductibles and co-insurance and different amounts of previously consumed care already in the year. (The full post is worth reading.) https://www.bogleheads.org/forum/viewtopic.php?t=238610 https://www.bogleheads.org/forum/viewtopic.php?t=238610
  • istjohn 7y ago
    Thing is, this was self-pay for a single routine lab test. It's the simplest possible scenario.
    • randall 7y ago
      Which nobody is prepared for because they’re used to the Byzantine style.
    • noelsusman 7y ago
      So few people self pay that hospitals just aren't set up to make the experience make sense. All of their resources are devoted to dealing with insurers and the government.
      • Broken_Hippo 7y ago
        Sure, few people self-pay for the entire thing. Many, many people pay a deductible, though. Many people pay a copayment. For these, you can still quote the cash price, I would thing, or give a range for what the entire thing costs, explaining the range is because of insurance discounts. In the age of modern tech, this shouldn't be a big deal.
        • perl4ever 7y ago
          I had an appointment that was billed at $400, if I recall correctly, while one insurance allowed $140 and another $70. That's the total cost, none of which was paid by insurance due to a large deductible. LabCorp I think has been similarly marked down from hundreds to tens, although I don't remember numbers. I don't think it's uncommon to have the official price be multiples of what's reasonable just in case someone might pay it. A long time ago, I was told that a local hospital automatically gave half off if you paid cash. But that could well be gouging relative to insurance or Medicare.
    • EpicEng 7y ago
      That is not the simplest scenario for the people you were asking for information. Their process isn't optimized for that because almost no one does it.
    • wil421 7y ago
      Couldn’t you have called Labcorp and got the test from a lab? My doctor doesn’t do any lab testing. It goes to the lab in my county that’s connected to the hospital or to lab corp.
  • noja 7y ago
    > Medicine is like an airline flight where every row has its own flight attendant, every one on the plane is going somewhere different, and they all get a different movie and meal hand delivered to them. In the bloodwork example isn't it like me walking into a parts store and talking to the guy to buy an auto part?
  • lucozade 7y ago
    Sure, this is the reason why you can't get an answer but it's not a justification. There are 2 parts to it. The first, which is reasonable, is that a lot of treatments are bespoke. Fine. That's a justification for their being costly not for your having to imagine the cost because no one can tell you. Even for flights, the truth is I can get a bespoke flight if I can afford it. And if I want to know how much it is then I ring them up. The idea that you can't know what something costs, until after the event, because it's expensive is perverse. But the second part, that everyone pays a different price, is solely a function of the lack of transparency and has no justification beyond perpetuating the scam. Even in that socialist utopia that is the UK, we have private health care. If I wish to use it without insurance, then they'll tell me the cost upfront. If I use it with insurance then they'll tell me the same cost but I'll only pay the excess. At each stage in the process you get the cost information upfront because TBH it's insane to think that you wouldn't. Honestly, this is a solved problem. The only real reason it's not solved in the US is because a lot of interested parties are very determined that it doesn't get solved.
    • notyourday 7y ago
      > The first, which is reasonable, is that a lot of treatments are bespoke. Fine. That's a justification for their being costly not for your having to imagine the cost because no one can tell you. Treatments are billed using billing codes so they are definitely not bespoke.
      • enjo 7y ago
        Those billing codes are CRAZY complex tho. One example: when you see a doctor you may generate multiple billing events. For instance they may draw blood, take an X-Ray, and perform a specific type of test. In a sane world you would generate three billing codes, sum them, and you'd have your price. But that's not how it really works. Instead certain billing codes can be combined to form new billing codes which makes things stupid crazy hard to reason about. Those rolled up billing codes can then even roll up to different billing codes when combined with other procedures or other grouped billing codes. When billing is this complex the treatments do begin to look relatively bespoke. Basically we're inefficient from basically every direction in the USA. Because every player in the system negotiates with basically everyone else individually you end up with a nightmare of complexity and all of the associated insanity. Hospitals love it because it means that they can take advantage of the complexity to bill for all sorts of things that they otherwise couldn't simply because no one can audit this stuff effectively.
  • mc32 7y ago
    I wonder if the gov is willing to use the heft of Medicare to help persuade hospitals and clinics to see them to enlightenment.
• rhacker 7y ago
  I think people that sit in the offices that directly face customers are told not to discuss price. I think they prohibit any verbal pricing because they want that to go through the insurance system, so they can maximize profits. If they told you the real price in person, especially before you finished the procedure - they would fear you cancelling before the work is done.
• lotsofpulp 7y ago
  And god forbid anyone in healthcare communicate to you in writing or via email.
  • noelsusman 7y ago
    That's because it's illegal.
    • lotsofpulp 7y ago
      Is it illegal to write “we will bill your insurance for procedure codes x y z for your visit”? They don’t need to tell you the cost, but they know what they’re going to charge you beforehand. They should be able to tell you the codes so you can give it t your insurance company to find out how much it will cost. The reason healthcare providers don’t give out codes for known predictable procedures is it would enable customers to shop around. Instead, they want you to sign a paper saying you’re liable for whatever they claim you’re liable for.
      • noelsusman 7y ago
        Yes, it is illegal to send that information to your email account or your mailbox. These days most providers have services that enable them to communicate with patients electronically, but it's a totally separate system that you have to login to. Your private health information will never show up in your email inbox.
        • lotsofpulp 7y ago
          They won't reply via online accounts either. I will send them messages via the portal, and I always get generic responses. And doctors will never respond, it's always second hand from nurses, but they will just ask to call the office.
        • munk-a 7y ago
          This is generally incorrect, sending PHI over email is not inherently a HIPAA violation, it all depends on factors that really need to be reviewed by a compliance officer.
• Thriptic 7y ago
  Lab tests are particularly complicated to price because usually they are being processed by someone else. Usually labs won't even try to get an authorization from insurance until they get your sample and start working on it as it affects their turnaround time which is one of their main differentiators, and each insurer will have different rules about what they will pay for under what conditions (insurers also have separate deals with each individual hospital and potentially individual doctors or groups of doctors). The short answer is they can't tell you because they don't know.
  • mywittyname 7y ago
    > The short answer is they can't tell you because they don't know. Bingo. My partner works in revenue cycle management (arguing with insurance companies to pay their bills) for a large hospital chain, and even she can't get accurate prices for procedures. She can walk down the hall to the finance department, and ask them, but even they can't figure it out. I found this out after asking her why they don't prioritize cases with the largest bills, and she said it's because the billed price of the procedure has no relation to the actual priced paid. They could review a $800,000 cancer case and only recover $750.
    • notyourday 7y ago
      > Bingo. My partner works in revenue cycle management (arguing with insurance companies to pay their bills) for a large hospital chain, and even she can't get accurate prices for procedures. She can walk down the hall to the finance department, and ask them, but even they can't figure it out. That's because they are not properly incentivized. It is very simple to solve this problem: charge them with fraud. Same way as a doctor who overbills Medicare would be charged with fraud. We had this kind of things before Enron - CEOs pretended that they cannot possibly know if the numbers in the accounting documents were correct because it was oh so complicated. Now, however begrudgingly, they do sign off on the books and since they are personally responsible they have all the needed incentives.
    • stevep98 7y ago
      This is one of the reasons that medical pricing is out of control. If nobody knows the pricing for anything, how can anybody (not just patients, but anybody else involved with the system) make rational decisions?
• ddlatham 7y ago
  How does contract law fit in here? If a business performs a service for me and won't tell me ahead of time how much it costs, can it afterward decide I must pay whatever it wants? One trillion dollars? For those without insurance, is there some contract agreed to with the hospital? For those with insurance, in which contract do I end up bound to pay an amount that isn't told me until after I've already made the decision to purchase the service? Are there limits to these amounts in that contract or somewhere else?
  • pnutjam 7y ago
    Check this out. I had decent and expensive insurance when my wife had surgery. We hit the max Out-of-pocket, which according to my employee docs was about $6500. However, when I get the information from my insurance company it has totally different copy information with a OOP of $7300. I talked to my employer several times and eventually filed a Dept. of Labor complaint because everyone is telling me it's ultimately my employers problem to fix. Fast forward 3 months and after multiple go arounds and hours of phone calls they finally fix it. So what does my insurer do? They claw back fully paid payments for stuff that was done after my OOP was met. I have to call multiple doctors and argue with the insurance company for every bill.
  • nix0n 7y ago
    One of the things you sign when you visit a doctor or hospital says that you'll pay whatever insurance doesn't cover. I've seen maybe 10 versions of this and none list any limits. If you were charged $1T you might be able to challenge it in court. If you simply don't pay, the bill collectors will start harassing you, and your credit score will suffer. I'm not sure at what stage they are allowed to take your wages etc. Medical bills are a leading reason for bankruptcy in the USA.
    • distances 7y ago
      Going a bit off topic, but this is one difference many are perhaps not aware: personal bankruptcy isn't a thing in many European countries. In my home country you don't have a mechanism for simply shedding your debt. Generally any debt is garnishable. Your best hope is debt restructuring with part of the debt forgiven (in perhaps 10 years). On one hand this probably makes financing considerably cheaper as the risk for the bank is quite a bit lower. On the other hand you do not want to have personal liabilities anywhere near a risky venture.
• Berobero 7y ago
  I was in Japan two years ago; got pneumonia and needed antibiotics. Went to a hospital with no insurance and no appointment. I was being seen by a doctor within 30 minutes. Doctor wanted to do some additional labs just to rule other things out, but he was worried that it would be expensive for me given the lack of insurance. He called up billing with me still in the room and had a price within a couple minutes: ~$70 USD. Ultimately I left the hospital after being seen, getting chest xrays, the additional labs, and antibiotics in hand. No insurance and I paid less than ~$160 USD.
  • deleted 7y ago
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  • brutal_boi 7y ago
    Similar story, s/France/Japan. I had to go into emergency for a bronchitis, after all tests and getting everything the spot, the bill was around 40eur. The doctor asked me if I wanted the additional forms and paperwork to claim it on my US insurance. I just said no.
  • programmertote 7y ago
    Exactly the way it works in a SE Asian country I grew up. The private and public hospitals have price quotes on different procedures and it's for everyone to see. The comments above using Boglehead's quote as a justification of why medical pricing has a lot of variance is mostly a lie. My wife, who is a doctor trained in our home (SE Asian) country and is doing her residency in the US, and I were just laughing at the fact that it's much, much more expensive to get an X-ray here in the US than it is in our country (which costs ~$4 at most). Here, there's no price list for procedure as simple as taking an X-ray. Hospitals, doctors, insurance companies and pharma companies are all scamming the US population. Every evening, my wife and I watch TV (WNBC to be exact) and we see many commercials from hospital networks, insurance companies and drug companies. This reminds us everyday that medicine and healthcare is commercialized to the max in this country and the only way from here is downhill. We both don't hope to retire in the US; when we grow old, we will go back to our home country and live there in the hope of getting much more affordable (and yet, of more or less similar quality) medical treatments.
• rolltiide 7y ago
  I just want a way to sue the fuck out of all medical professionals that told me something would be covered by my insurance Getting evidence of these statements is a challenge but a civil court would easily put them on the hook for the cost they said I wouldn't incur and 3x it with punitive damages and then double whammy with a review of their license They'll go ahead and try to argue what "covered" meant, and everyone will laugh them back to med school because of the shared experience of this bullshit
  • JustSomeNobody 7y ago
    I just want all of my medical needs covered no matter where I go or who I see. The burden of in- or out- network should not be on me especially when ins providers can change each year because the U.S. still thinks you should have to have a job to have insurance that you can afford.