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The obligatory comment about how crazy this is on many levels. 1. You are being charged prices that you are not expected to pay, but need to negotiate on 2. W

The obligatory comment about how crazy this is on many levels. 1. You are being charged prices that you are not expected to pay, but need to negotiate on 2. When you go to a doctor to have a procedure or have an emergency then you don't know what you are paying. In normal countries there is A price list, which is THE price list for all hospitals that are part of the national health care system. If they want to have a contract with the national health insurance, then they need to agree to these prices for all the possible procedures. So when someone is saying "but we can't be sure of the price, maybe there are complications and additional costs" then this is bs, many-many other countries manage to have fixed price lists. Or maybe there is an item there for exceptional cases, when something addtional needs to be done in addition to the original procedure? Either way, it's already handled, the patient doesn't need to worry about this stuff. And the same goes for private clinics, they also have a fixed price list, nobody would go to them if you could get a surprise bill that would be 2-3-10x the amount originally agreed upon, that would be insane and.. very bad PR for the clinic.

IggleSniggle 5y ago
Just out of curiosity, which normal countries do you have experience with in this regard?
- _aplt 5y ago
  France, Belgium operate like this. Although in Belgium I've found out that you can still have unexpected costs because for some reason, only one type of procedure per day can be reimbursed. Which means if you have a problem that takes two (or more) ultrasound scans to be diagnosed, only one of those will get reimbursed and you'll have to pay for the others. This happened to us with our kid, first hospital did a scan, concluded that we should go to the children's hospital close by for better treatment, the doctor there did a scan there the same day to see for himself (at 23:30! half an hour later and it would have been reimbursed) and of course this one had to be paid for. Which is beyond stupid IMO. Well at least it wasn't US-level prices.
- opwieurposiu 5y ago
  We took a baby to the hospital while in NZ. Thought baby had chicken pox, turned out to be just "Hand Foot Mouth" which is not as bad. There was a big price list on the wall at check in. Paid $70 up front and baby got to see a german doktor, all done in half an hour. I think the price was cheaper or even free if you were a NZ citizen.
IG_Semmelweiss 5y ago
indeed. Think how far airlines would get if they said: " Sorry! We can't give you a quote. We don't know if you will use the on-flight entertainment on the flight, or if you will end up clogging the toilet midflight, or if you will eat 4 bags of pretzels. There's also the chance we will have to make an unscheduled stop due to weather. That is why we can only bill you once we arrive at your destination"
arethuza 5y ago
"In normal countries there is A price list" I've never even heard of such a thing in the UK NHS - i guess some kind of cost accounting must occur but I don't think it goes anywhere near patients or care givers.
- ChuckNorris89 5y ago
  In Romania there is a price list on display at my public insurance general practitioner which applies if you're uninsured but private practices also have pricelists on display. In Austria I've also never seen a pricelist in the public system as the system assumes everyone must be insured if they live here but you do get a bill at the end of a hospital stay to pay for food and such things. Ironically, many private practices here also have a scummy system where they don't share their pricelist publicly neither online, neither by phone, you only know the prices after a "talk with the doctor" (that you also pay for), presumably to keep their competitors and their customers, sorry, I meant patients, in the dark about the market prices.
- oliwarner 5y ago
  If you're not UK resident or otherwise excused, the NHS charges and therefore does have a price-list. https://www.england.nhs.uk/publication/overseas-patient-upfront-price-list-2021-22/ https://www.england.nhs.uk/publication/overseas-patient-upfr... And even residents are charged prescription fees for drugs given in A&E.
  - arethuza 5y ago
    I wasn't implying that there isn't a price list - just that for the overwhelming majority of cases it is irrelevant to both patients and medical staff. Also, as far as I understand it there are only prescription charges in England and not in the rest of the UK. Certainly here in Scotland there are no prescription charges anywhere.
mrits 5y ago
Before you get too upset you should realize that OP was incorrect.
- deleted 5y ago
  [deleted]
caeril 5y ago
It's worse than this, though. You pay whether the doctor killed you or not. Roughly a quarter million Americans are murdered annually by preventable medical errors, and nobody cares. Furthermore, your estate gets full billing after they kill you. Connecting billing to outcomes would go a long way to fixing this disaster of a system. It would help align incentives for these sociopathic quacks to stop murdering their patients en masse. You pay: $reasonable_amount if your oncologist gets your cancer into remission, but you pay precisely $0 if the attending physician didn't bother reading your chart because they had to tee off at 3pm and then grab dinner at Fleming's with their mistress, so you got the wrong medication/procedure and you're confined to a wheelchair for life, or dead. I can't think of any other profession, other than attorneys, where outcomes aren't intimately tied with compensation. Doctors and nurses, as modernity's new Gods, need to be brought down a few pegs with regard to this extravagant privilege. ... to say nothing of the fact that they are worse diagnosticians than a buggy Expert System written in Perl by a drunk college student in 1994, but because they are human, we should rely on them to make life or death decisions. But that's a discussion for another day.
banana_giraffe 5y ago
> 2. When you go to a doctor to have a procedure or have an emergency then you don't know what you are paying. Even when it's not an emergency, it's an amazing bucket of crap. I take a specialized drug that's very expensive (~85k$/yr). I was considering changing jobs. No one in the HR of the new company, or the CSR side of the new insurer would tell me with any certainty that it'd be covered. The best I could get out of anyone is "we think it's covered, but we cannot promise it will be, nor will we pay out of pocket if it isn't". My doctor's office would just say "most of our patients on <x> insurance can get coverage. Not all, but most" The bit about not covering it out of pocket might be a statement on how much they wanted me, but the first part is just maddening. It's a large part of the reason I didn't switch jobs. At least I know I can get insurance to cover the drug for now.

IggleSniggle 5y ago

Just out of curiosity, which normal countries do you have experience with in this regard?

_aplt 5y ago
France, Belgium operate like this. Although in Belgium I've found out that you can still have unexpected costs because for some reason, only one type of procedure per day can be reimbursed. Which means if you have a problem that takes two (or more) ultrasound scans to be diagnosed, only one of those will get reimbursed and you'll have to pay for the others. This happened to us with our kid, first hospital did a scan, concluded that we should go to the children's hospital close by for better treatment, the doctor there did a scan there the same day to see for himself (at 23:30! half an hour later and it would have been reimbursed) and of course this one had to be paid for. Which is beyond stupid IMO. Well at least it wasn't US-level prices.
opwieurposiu 5y ago
We took a baby to the hospital while in NZ. Thought baby had chicken pox, turned out to be just "Hand Foot Mouth" which is not as bad. There was a big price list on the wall at check in. Paid $70 up front and baby got to see a german doktor, all done in half an hour. I think the price was cheaper or even free if you were a NZ citizen.

IG_Semmelweiss 5y ago

indeed. Think how far airlines would get if they said: " Sorry! We can't give you a quote. We don't know if you will use the on-flight entertainment on the flight, or if you will end up clogging the toilet midflight, or if you will eat 4 bags of pretzels. There's also the chance we will have to make an unscheduled stop due to weather. That is why we can only bill you once we arrive at your destination"

arethuza 5y ago

"In normal countries there is A price list" I've never even heard of such a thing in the UK NHS - i guess some kind of cost accounting must occur but I don't think it goes anywhere near patients or care givers.

ChuckNorris89 5y ago
In Romania there is a price list on display at my public insurance general practitioner which applies if you're uninsured but private practices also have pricelists on display. In Austria I've also never seen a pricelist in the public system as the system assumes everyone must be insured if they live here but you do get a bill at the end of a hospital stay to pay for food and such things. Ironically, many private practices here also have a scummy system where they don't share their pricelist publicly neither online, neither by phone, you only know the prices after a "talk with the doctor" (that you also pay for), presumably to keep their competitors and their customers, sorry, I meant patients, in the dark about the market prices.
oliwarner 5y ago
If you're not UK resident or otherwise excused, the NHS charges and therefore does have a price-list. https://www.england.nhs.uk/publication/overseas-patient-upfront-price-list-2021-22/ https://www.england.nhs.uk/publication/overseas-patient-upfr... And even residents are charged prescription fees for drugs given in A&E.
- arethuza 5y ago
  I wasn't implying that there isn't a price list - just that for the overwhelming majority of cases it is irrelevant to both patients and medical staff. Also, as far as I understand it there are only prescription charges in England and not in the rest of the UK. Certainly here in Scotland there are no prescription charges anywhere.

mrits 5y ago

Before you get too upset you should realize that OP was incorrect.

deleted 5y ago
[deleted]

caeril 5y ago

It's worse than this, though. You pay whether the doctor killed you or not. Roughly a quarter million Americans are murdered annually by preventable medical errors, and nobody cares. Furthermore, your estate gets full billing after they kill you. Connecting billing to outcomes would go a long way to fixing this disaster of a system. It would help align incentives for these sociopathic quacks to stop murdering their patients en masse. You pay: $reasonable_amount if your oncologist gets your cancer into remission, but you pay precisely $0 if the attending physician didn't bother reading your chart because they had to tee off at 3pm and then grab dinner at Fleming's with their mistress, so you got the wrong medication/procedure and you're confined to a wheelchair for life, or dead. I can't think of any other profession, other than attorneys, where outcomes aren't intimately tied with compensation. Doctors and nurses, as modernity's new Gods, need to be brought down a few pegs with regard to this extravagant privilege. ... to say nothing of the fact that they are worse diagnosticians than a buggy Expert System written in Perl by a drunk college student in 1994, but because they are human, we should rely on them to make life or death decisions. But that's a discussion for another day.

banana_giraffe 5y ago

> 2. When you go to a doctor to have a procedure or have an emergency then you don't know what you are paying. Even when it's not an emergency, it's an amazing bucket of crap. I take a specialized drug that's very expensive (~85k$/yr). I was considering changing jobs. No one in the HR of the new company, or the CSR side of the new insurer would tell me with any certainty that it'd be covered. The best I could get out of anyone is "we think it's covered, but we cannot promise it will be, nor will we pay out of pocket if it isn't". My doctor's office would just say "most of our patients on <x> insurance can get coverage. Not all, but most" The bit about not covering it out of pocket might be a statement on how much they wanted me, but the first part is just maddening. It's a large part of the reason I didn't switch jobs. At least I know I can get insurance to cover the drug for now.