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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
by 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 agoThing is, this was self-pay for a single routine lab test. It's the simplest possible scenario.
- randall 7y agoWhich nobody is prepared for because they’re used to the Byzantine style.
- noelsusman 7y agoSo 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 agoSure, 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 agoI 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 agoThat 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 agoCouldn’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.
- frankharv 7y agoMy father has been monitoring his calcium levels and uses Labcorp directly. It is great that you can cut out the middleman. They draw blood right there and you can view your results very quickly online. This process is a hidden gem in our bloated system. Go directly to the lab. Now obviously this is just for health maintenance and dietary checkups. Not to many people are aware that you can go right to the lab directly.
- perl4ever 7y agoWhat? Who doesn't go "directly" to Labcorp? They have obviously cut costs to the bone, but that makes me nervous. They have basically one person per location who does everything, and I worry that they are too stressed/tired/burned out/disgruntled to do their job right. I heard something years ago about a medical lab that was just throwing out all their samples and using a simple statistical model to return results. That's what you can get if you are just rewarding efficiency.
- istjohn 7y agoUltimately, yes, I went to an independent lab that quoted me a price over the phone on the spot.
- 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 agoSure, 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 agoThose 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 agoI wonder if the gov is willing to use the heft of Medicare to help persuade hospitals and clinics to see them to enlightenment.