5 ms·

Hide your health insurance status and pay cash instead

48 points by LVB 14y ago

sixothree 14y ago
There is a huge difference between the price charged to an insurance company and the already agreed upon allowable amount they will pay. Almost all insurance companies make these allowable amounts available to providers; and it is very rare for a provider to bill the allowable amount. In my experience they usually bill double. I find any article that doesn't mention the word "allowable" completely disingenuous.
acabal 14y ago
A good start, but shopping around is hard, if not impossible. I always try to do it when getting care in the states, and more often than not the person you're talking to has no idea what they charge, or else won't discuss it without having the doctor's orders in hand first. ("How much does a chest x-ray cost?" "We'll assess costs after the doctor orders some tests." "But how do I know if I want to see the doctor at this hospital if I don't know how much everything costs?") Worse is the case of emergencies or worry, when you have other things on your mind than shopping around and possibly spending days or weeks slogging through the internet for lists of doctor and test center phone numbers. In that case you're literally trapped into paying whatever they demand. In either case the system is absolutely monstrous and everyone involved (except, of course, the doctors and nurses) should be ashamed of themselves.
- mgkimsal 14y ago
  It's 110% broken from a consumer point-of-view, which is funny because most of the people that defend the status quo in the US are political conservatives who talk about the 'free market' and such. When no one in an entire building of service provides can give you even a ballpark of what a service will cost you, there's no free market at work - at least not at the consumer/individual level.
  - lotharbot 14y ago
    US political conservatives don't "defend the status quo". They complain that the parts of the system they already hate keep expanding.
  - cpher 14y ago
    I agree that it's broken from the consumer's point of view. But, conservatives aren't defending anything. They acknowledge that the system is broken, because there's no free market to speak of. If you think the current state of things resembles a free market in any way, you're sorely mistaken. The ACA/Obamacare isn't an effort to fix health care. It's an attempt to reconfigure and eventually bankrupt the health care insurance industry. And both parties are to blame, ultimately.
- pchivers 14y ago
  >A good start, but shopping around is hard, if not impossible I think shopping around, properly conceived, should be the primary care physician's job. If a doctor is referring e.g. 10 people a month to a specialist, then obviously they are going to be in a much better position to evaluate the options than a patient. I believe that Sherpaa, Jay Parkinson's company, provides this "shopping around" service (https://sherpaa.com/ https://sherpaa.com/).
  - Spooky23 14y ago
    Not really. Hospital networks are merging, affiliating and consolidating. So if your primary care doctor is affiliated with Hospital X, and specialist group Y is also affiliated with hospital X, there's a good chance that you're going to be referred to specialist group Y. The exception is when you have some unusual circumstance, and they try to find the world's authority on your condition.
- yummyfajitas 14y ago
  In India, common procedures (e.g. blood test) usually have prices listed on a sign. I had surgery done there, and each doctor gave me a price estimate with the diagnosis ("approx 85k for the basic, 1 lac if you want the deluxe private room"). Of course, there are many big differences between India and the US. India is mainly free market health care, unlike the US. India also has a 15-20% savings rate. And insurance is really insurance - it covers emergencies, not your monthly birth control/adderall/psychiatrist.
  - amalag 14y ago
    Yes noone expects their car insurance to pay for their oil change, but we expect that from health insurance. The model in Singapore is a mandatory health savings plan with catastrophic health coverage.
- smackfu 14y ago
  Yeah, I ran into the same thing trying to argue a charge. Me: This is outrageous, they charged me $800 to examine my shoulder and called it "external surgery". Receptionist: Oh, let me transfer you to billing. Billing: Oh, that is what was coded on your chart, so we billed accordingly. Let me transfer you to the doctor's staffer. Staffer: Oh, that is what the doctor said he did, and he can't change that to say he did something else or that would be dishonest. He doesn't deal with billing at all. Me: Arrrrrrgh.
- vellum 14y ago
  I'd try shopping around for a GP first, versus a hospital. Find out if they offer cash discounts and which testing centers they use. Then see if the testing center they use offer a discount. If your primary care doctor is cool, he should be able to tell you the estimate and cash discount during the consultation.
casca 14y ago
One of the problems with US health insurance is that it is tax deductible only when "paid" by the employer. Making it deductible by everyone would help. The article does not account for the difficulty of shopping around. If you have the time to travel then it's possible, but often medical care has some urgency so you need to use the closest service provider. If this really is a trend then the best result would be for people to start taking out catastrophic health insurance. The idea is that they would be insured for very large and very unusual events and cover the routine payments by paying cash.
- yummyfajitas 14y ago
  Making it deductible by everyone would help. As would taxing it no matter who pays. I can't see any good reason why health insurance should be tax deductible - it's a private good with minimal external benefits.
  - Spooky23 14y ago
    Huh? Say you're a parent. You have a house and three kids. Your spouse makes alot less than you do. Then you get afflicted with a chronic disease like MS. Without healthcare, you eventually cannot perform at work and get fired or laid off. You have some sort of episode, and end up in the ER. You can't pay your mortgage, and you cannot replace your income. So you stop paying the mortgage and go on food stamps. Then your house gets foreclosed. Next, your spouse leaves you and takes the kids. You're indigent, your kids are now on Medicaid (at taxpayer expense) and getting assistance for housing. You're behind on child support because your disability case was rejected and your appealing it. If you add up the costs, you'll find that the cost of providing deductiblity is lower than the costs of all of the other outcomes. Actually, a year of healthcare probably costs less than that 1 ER visit.
    - jonknee 14y ago
      There are a lot of things that are required in life and that are not deductible. Right now the deduction increases prices and makes changing jobs a lot more risky / a pain. Also, corporate write-offs for health insurance benefits has nothing to do with what happens to your healthcare when you get laid off. If anything not having it be deductible would help because then you're insurance has no reason to be tied to your employment so you could just pay for it yourself like you do anything else. What would fix your scenario is universal healthcare.
roc 14y ago
Personally, I've never seen that work. And it doesn't even sound like a reasonable approach, unless you're trying like hell to stay under some annual or lifetime coverage cap. [1] Before I had insurance I was getting ~$1200 quotes for procedures. Paying up-front would get that knocked down to ~$1000. Paying cash would get it knocked down to ~$800. After I had insurance, the claims statements showed the insurance company's negotiated rate at ~$400 for the same exact procedure. If I let the up-front bills go to collections, the due amounts would drop massively from that $800. But that's not a sustainably advantageous strategy. And even then it's not going to be appreciably better than even paying cash at the insurance company's negotiated rate. [1] In which case, you really aren't a person who should have a capped medical plan. It's always going to cost you more to carry such a 'cheap' plan. Even if out-of-pocket payments are cheaper than going through your insurance plan and paying the difference. You'd be better off paying more up-front and getting proper coverage, if at all possible.
- khuey 14y ago
  The Affordable Care Act (popularly known as Obamacare) removes lifetime and annual coverage caps on essential healthcare benefits starting in 2014.
  - tracker1 14y ago
    Except for all the exceptions, which include pretty much every existing coverage plan, which still holds for companies with said plans, even if you are a new hire.
bearmf 14y ago
Not long ago there was an article here which reached an opposite conclusion, for hospital costs. It is just unwise not to have health insurance in this country. Hospitals can charge you arbitrary amounts. If you pay cash and have not agreed on everything in advance it is not a good deal. Paying cash probably makes sense for some routine procedures in case you have a high deductible health plan.
- bearmf 14y ago
  I also do not buy the whole "shopping around" thing, even if it worked. The idea that patient should know almost nothing about costs is a right one. The current implementation of this idea suffers from various problems, but as more people get health insurance under Obamacare, things will get better. Ideally, under single payer system, patient gets no bills at all, because all of the providers are "in network", as there is only one network.
  - JPKab 14y ago
    There is an entire company (Castlight Health) that is centered around trying to allow people to "shop around" for healthcare. Despite cutting edge technology and access to data no one else gets (through member companies insurance statements) the general public can't use it unless their employer signs up for the service. Without this capability, shopping around for healthcare is absolutely impossible. How can you shop around when the prices aren't publically listed and aren't known by the staff/physicians? This article, by the way, is terrible. He gives horrifically bad advice, acting as if the majority of clinics/hospitals actually discount costs for the uninsured. THEY DON'T, as the vastly better researched article "The Bitter Pill" from Time Magazine last week clearly illustrated. I've been a consumer asking for prices as part of a HSA high deductible health plan before. There is no mechanism to support shopping around at all, and the clinics/hospitals still act on a zero price transparency model. See the "chargemasters" discussed in the Time article. They are databases of prices which are not at all publically accessible. The federal gov't should step in, and, at a minimum, force hospitals/clinics to make their chargemaster databases publically accessible. This would be a game changer for consumers in health care.
- 14y ago
pdx 14y ago
This article is completely at odds with Time's article [1] from a few days ago, that showed that out of pocket payers must pay the hospital's chargemaster prices, which are set at ridiculously high levels to act as an anchor in negotiations with insurance companies. If you're not an insurance company, you pay that inflated rate. If you are, you have negotiated it down to as low as 20% of that rate. I think I trust the Time article a lot more than this linkbait. [1] http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/ http://healthland.time.com/2013/02/20/bitter-pill-why-medica...
- HeyLaughingBoy 14y ago
  I think what's happening is that more physicians are getting sick (pun intended!) of dealing with insurance providers so while that Time article is correct, so is this one. I have only once come across a physician that didn't take any kind of insurance, but know from other anecdotes that it is becoming more prevalent. I also had an experience recently where I went to a specialty provider that didn't accept my insurance, so it was handled as out-of-network. However, they billed me only what I would have paid had it been an in-network provider, which was considerably less.
  - kps 14y ago
    Physicians in private practice can pay half of their gross billing in insurance collection costs, including denied claims (which patients are nominally responsible for, but often don't/can't pay) and hiring experts to deal with the deliberately complex and ever-changing paperwork that insurance companies use to induce excuses to deny claims. That's before all other costs, including staff with an actual non-bureaucratic purpose, office space, malpractice insurance, etc.
moron4hire 14y ago
About 9 months ago, I had a severe bout of food poisoning. I had gotten so dehydrated that I passed out briefly and was physically unable to pick myself up out of an awkward position between the toilet and the wall next to the toilet. I was unemployed at the time (but working, trying to get a software product off the ground on my own) and had no emergency medical insurance. My roommate (thank God I had one) took me to the ER where they gave me a mild anti-nausea drug and pumped me full of fluids. The hospital only charged me about 40% of the full bill, due to my "hardship" of being unemployed. Still, it was $1200 for nothing a little weed and a gallon of Gatorade wouldn't do. Most of the bill was to have a doctor walk in the room, make a few jokes at me, and leave. If I knew I'd be paying for a standup routine, I would have preferred to go see Louis C.K. and saved $1100. I still haven't bought health insurance, which is certainly a gamble, but so is buying health insurance. When you buy health insurance, you're betting against the insurance company that you're going to put less money into insurance premiums than you're going to get out as benefits. In the last 2 and a half years of not having health insurance, that one ER trip is the only medical need I've had. In the end, $1200 was a lot less than I would have paid in premiums. So far, I'm winning my gamble.
- outside1234 14y ago
  the problem is that this is a power law gamble. if you lose big (Cancer), it will cost you either your life or your financial life.
  - moron4hire 14y ago
    Which is actually not that big of a different risk if I had insurance. Just because I have insurance doesn't mean A) that my cancer would be treatable, B) that the treatment would be desirable, or C) that my insurance would be sufficient to cover it. People get screwed over by their insurance companies all the time. In the specific case of cancer, I'm not sure the treatment is worth it. I've seen a lot of people go through really awful treatments that ruined the quality of their last few months/years, only to die anyway. I don't want to put my families through the emotional and financial burden of that. I've personally never seen any insurance that fully covered someone's cancer treatment. In the end, cancer always gets you. You could do everything to try to prevent every other cause of death, but cancer will always eventually get you. That's a big part of why I'm working on the things I care about now, rather than waiting for some nebulous "future" when I have "enough money". That future may never come.
angersock 14y ago
So, an interesting attempt at making a nice transparent marketplace that I know of is SnapHealth ( https://www.snaphealth.com/ https://www.snaphealth.com/ ). These folks are working to provide an easy directory where you can look up all the doctors in your area and get their pricing for services on a cash basis. It's interesting watching as the industry goes through these undulations trying to sort itself out. (Disclaimer: I know the folks working on it, so if you have any comments/questions/concerns I'd love to pass them on.)
UnoriginalGuy 14y ago
This whole situation could get solved with two swift changes in the law: - Employer provided healthcare is now illegal (with exceptions for the military). - Healthcare discounts are now illegal. Insurance and cash-in-hand individuals pay exactly the same rate. These changes would be quite painful in the short term. In fact there would be a queue of people arguing why this was a horrible idea (the "I got mine" group). However in the long term this makes health insurance more similar to auto-insurance (car insurance). People can actually shop around, insurers have to compete for individual's business, and if people want to forgo insurance or go with a smaller insurer (new business!) then they can. Plus insurers and individuals will now both work together to bring hospital care costs down (they're on the same "side"). But people are too short sighted to see what a massive leap forward this would be. It is the very definition of a healthy capitalist market. But their thinking about insurance and how it "should" work is just so muddied with what has been done up until now. Employer insurance in particular is a massive problem - due to the lock-in (both between employees and their employer's insurance company AND between the employee and employer). It really hurts innovation, startups, and growth in America today. Healthcare discounts hurt people without insurance AND make the insurance sector uncompetitive. It is impossible to start a new insurance scheme now because you cannot get big enough discounts to be competitive.
- AndyNemmity 14y ago
  What about all the people without car insurance even under this program? This would be even worse in your situation.
  - UnoriginalGuy 14y ago
    I don't understand what you mean at all. Prices for cash-in-hand individuals would be a lot lower under this scheme. Insurance covers the same costs cash-in-hand individuals pay, so no matter how many people do or do not have insurance the costs remain roughly the same.
- aneth4 14y ago
  "It is the very definition of a healthy capitalist market." I didn't realize heavy handed, unnecessary regulation bound to cause massive market distortions was "healthy" for capitalism. Employer health insurance is the current method of distributing risk among a larger group, and any prohibition would simply be circumvented by other types of group health insurance and reimbursements. Making discounts illegal is a ridiculous restraint on capitalism. Imagine if wholesalers and retails could not discount for marketing, loyalty, or quantity. Ridiculous. The only thing that should be regulated is the transparency of pricing and services. Consumers simply won't accept paying 5 times the price if they are aware, but they may be willing to pay 20% more to avoid the hassle of insurance. That's "healthy capitalism" - not your complex regulatory scheme. The thought of enforcement of what you suggest is mind-boggling. Illegal to provide your employees with health insurance? Bonkers.
jonknee 14y ago
I have a high-deductible insurance policy so I just pay up front for medical services (out of an HSA, but it's no different to the doc). Despite paying before the visit I got a bill after an appointment and then another warning that it was late. I called today after researching the CPT code and current billing schedule from my area to confirm that what they wanted was BS and as soon as she looked at my account she said "oh, yea they forgot to add the write off". Medical billing is so screwed up. I walk in and pay up front and it still somehow counts as a write off. A write off for what I am not sure, I am supposedly paying list price. I assume they really jack up the prices, have a pool for "uninsured" (regardless of merit) and then mark down from there to get a nice tax benefit because they gave a lot of "charity" care. I'd consider the $135 I paid for a < 10 minute visit to be more than ample compensation, whatever they're getting for the $90 write off should be fraud.
LVB 14y ago
I came across this article out of frustration. My wife went to a clinic that posted an office visit rate of $99. She presented our insurance card just so the outlay would get logged in the system against our out-of-pocket total, but there was no expectation of actually getting any money back. We have a very high deductible (by choice), and we'll see insurance money only in a really bad year, not unlike auto or house insurance. But since she showed them that card, suddenly the amount we owed shot up to $273. Both the clinic's and insurance company's response to us has been basically: suck it up, we have contracts in place.
davidroberts 14y ago
My daughter had an itchy eye. I took her to the doctor at a children's clinic affiliated with a well-known children's hospital. They asked for $150 upfront which I paid. The doctor came, examined her for five minutes and wrote a prescription for an allergy medicine that cost over a hundred dollars. Two weeks later we got the bill. They tacked on another $175 for moving us from one room to another. I forgot how they expressed it, but that seemed to be the reason. Over $400 and the medicine didn't really help.
codva 14y ago
//One of the problems with US health insurance is that it is tax deductible only when "paid" by the employer.// Healthcare expenses are deductible, but only those that exceed 7.5% of your AGI. So if you are a software developer making $100K a year at a start up with crappy health insurance, you can start deducting expenses once they exceed about $7500, depending on your tax situation. Of course, health premiums deducted pre-tax from your paycheck are not deductible at all.
- fr0sty 14y ago
  tax deductible above 7.5% AGI is very different from tax deductible above $0. Your $100k/yr developer would pay $2,100 in tax on the first $7,500 before the deduction takes effect. Also, the reason you can't deduct the "pre-tax" premiums is because you were never taxed on them in the first place.
jackmoore 14y ago
This could make HSAs (health savings accounts) much more desirable.
msluyter 14y ago
Incidentally, if you have an HSA account and can still afford to pay out of pocket, that basically allows your HSA money to continue to accrue over time. (From http://en.wikipedia.org/wiki/Health_savings_account http://en.wikipedia.org/wiki/Health_savings_account): "There is no deadline for self-reimbursements of qualified medical expenses. High-income individuals can take advantage of this by paying for medical costs out of pocket, retaining receipts and allowing their accounts to grow tax-free. Money can then be withdrawn years later for any reason, up to the value of the receipts. [23]"
joshuaheard 14y ago
It's not just the costs, it's the treatment. This happened to me: I went into a doctor after I had an accident. He said I needed an MRI and prescription painkiller. I said, doctor, I have no insurance. He said, in that case, you need an X-ray and Tylenol.
philsnow 14y ago
"""A recent article in the Los Angeles Times reported a CT scan of the abdomen costs about $2,400 for patients insured by Blue Shield of California, while the Los Alamitos (Calif.) Medical Center cash price is only $250. That is a 89% discount by my calculation. [snip] If you tell them you have insurance, they will be bound to charge you the insurance company’s negotiated rate. Those are the up to 89% higher fees documented in the previous paragraph.""" 2400 is 860% higher than 250, not 89% higher.

48 points by LVB 14y ago

There is a huge difference between the price charged to an insurance company and the already agreed upon allowable amount they will pay. Almost all insurance companies make these allowable amounts available to providers; and it is very rare for a provider to bill the allowable amount. In my experience they usually bill double. I find any article that doesn't mention the word "allowable" completely disingenuous.

acabal 14y ago

A good start, but shopping around is hard, if not impossible. I always try to do it when getting care in the states, and more often than not the person you're talking to has no idea what they charge, or else won't discuss it without having the doctor's orders in hand first. ("How much does a chest x-ray cost?" "We'll assess costs after the doctor orders some tests." "But how do I know if I want to see the doctor at this hospital if I don't know how much everything costs?") Worse is the case of emergencies or worry, when you have other things on your mind than shopping around and possibly spending days or weeks slogging through the internet for lists of doctor and test center phone numbers. In that case you're literally trapped into paying whatever they demand. In either case the system is absolutely monstrous and everyone involved (except, of course, the doctors and nurses) should be ashamed of themselves.

mgkimsal 14y ago
It's 110% broken from a consumer point-of-view, which is funny because most of the people that defend the status quo in the US are political conservatives who talk about the 'free market' and such. When no one in an entire building of service provides can give you even a ballpark of what a service will cost you, there's no free market at work - at least not at the consumer/individual level.
- lotharbot 14y ago
  US political conservatives don't "defend the status quo". They complain that the parts of the system they already hate keep expanding.
- cpher 14y ago
  I agree that it's broken from the consumer's point of view. But, conservatives aren't defending anything. They acknowledge that the system is broken, because there's no free market to speak of. If you think the current state of things resembles a free market in any way, you're sorely mistaken. The ACA/Obamacare isn't an effort to fix health care. It's an attempt to reconfigure and eventually bankrupt the health care insurance industry. And both parties are to blame, ultimately.
pchivers 14y ago
>A good start, but shopping around is hard, if not impossible I think shopping around, properly conceived, should be the primary care physician's job. If a doctor is referring e.g. 10 people a month to a specialist, then obviously they are going to be in a much better position to evaluate the options than a patient. I believe that Sherpaa, Jay Parkinson's company, provides this "shopping around" service (https://sherpaa.com/ https://sherpaa.com/).
- Spooky23 14y ago
  Not really. Hospital networks are merging, affiliating and consolidating. So if your primary care doctor is affiliated with Hospital X, and specialist group Y is also affiliated with hospital X, there's a good chance that you're going to be referred to specialist group Y. The exception is when you have some unusual circumstance, and they try to find the world's authority on your condition.
yummyfajitas 14y ago
In India, common procedures (e.g. blood test) usually have prices listed on a sign. I had surgery done there, and each doctor gave me a price estimate with the diagnosis ("approx 85k for the basic, 1 lac if you want the deluxe private room"). Of course, there are many big differences between India and the US. India is mainly free market health care, unlike the US. India also has a 15-20% savings rate. And insurance is really insurance - it covers emergencies, not your monthly birth control/adderall/psychiatrist.
- amalag 14y ago
  Yes noone expects their car insurance to pay for their oil change, but we expect that from health insurance. The model in Singapore is a mandatory health savings plan with catastrophic health coverage.
smackfu 14y ago
Yeah, I ran into the same thing trying to argue a charge. Me: This is outrageous, they charged me $800 to examine my shoulder and called it "external surgery". Receptionist: Oh, let me transfer you to billing. Billing: Oh, that is what was coded on your chart, so we billed accordingly. Let me transfer you to the doctor's staffer. Staffer: Oh, that is what the doctor said he did, and he can't change that to say he did something else or that would be dishonest. He doesn't deal with billing at all. Me: Arrrrrrgh.
vellum 14y ago
I'd try shopping around for a GP first, versus a hospital. Find out if they offer cash discounts and which testing centers they use. Then see if the testing center they use offer a discount. If your primary care doctor is cool, he should be able to tell you the estimate and cash discount during the consultation.

casca 14y ago

One of the problems with US health insurance is that it is tax deductible only when "paid" by the employer. Making it deductible by everyone would help. The article does not account for the difficulty of shopping around. If you have the time to travel then it's possible, but often medical care has some urgency so you need to use the closest service provider. If this really is a trend then the best result would be for people to start taking out catastrophic health insurance. The idea is that they would be insured for very large and very unusual events and cover the routine payments by paying cash.

yummyfajitas 14y ago
Making it deductible by everyone would help. As would taxing it no matter who pays. I can't see any good reason why health insurance should be tax deductible - it's a private good with minimal external benefits.
- Spooky23 14y ago
  Huh? Say you're a parent. You have a house and three kids. Your spouse makes alot less than you do. Then you get afflicted with a chronic disease like MS. Without healthcare, you eventually cannot perform at work and get fired or laid off. You have some sort of episode, and end up in the ER. You can't pay your mortgage, and you cannot replace your income. So you stop paying the mortgage and go on food stamps. Then your house gets foreclosed. Next, your spouse leaves you and takes the kids. You're indigent, your kids are now on Medicaid (at taxpayer expense) and getting assistance for housing. You're behind on child support because your disability case was rejected and your appealing it. If you add up the costs, you'll find that the cost of providing deductiblity is lower than the costs of all of the other outcomes. Actually, a year of healthcare probably costs less than that 1 ER visit.
  - jonknee 14y ago
    There are a lot of things that are required in life and that are not deductible. Right now the deduction increases prices and makes changing jobs a lot more risky / a pain. Also, corporate write-offs for health insurance benefits has nothing to do with what happens to your healthcare when you get laid off. If anything not having it be deductible would help because then you're insurance has no reason to be tied to your employment so you could just pay for it yourself like you do anything else. What would fix your scenario is universal healthcare.

roc 14y ago

Personally, I've never seen that work. And it doesn't even sound like a reasonable approach, unless you're trying like hell to stay under some annual or lifetime coverage cap. [1] Before I had insurance I was getting ~$1200 quotes for procedures. Paying up-front would get that knocked down to ~$1000. Paying cash would get it knocked down to ~$800. After I had insurance, the claims statements showed the insurance company's negotiated rate at ~$400 for the same exact procedure. If I let the up-front bills go to collections, the due amounts would drop massively from that $800. But that's not a sustainably advantageous strategy. And even then it's not going to be appreciably better than even paying cash at the insurance company's negotiated rate. [1] In which case, you really aren't a person who should have a capped medical plan. It's always going to cost you more to carry such a 'cheap' plan. Even if out-of-pocket payments are cheaper than going through your insurance plan and paying the difference. You'd be better off paying more up-front and getting proper coverage, if at all possible.

khuey 14y ago
The Affordable Care Act (popularly known as Obamacare) removes lifetime and annual coverage caps on essential healthcare benefits starting in 2014.
- tracker1 14y ago
  Except for all the exceptions, which include pretty much every existing coverage plan, which still holds for companies with said plans, even if you are a new hire.

bearmf 14y ago

Not long ago there was an article here which reached an opposite conclusion, for hospital costs. It is just unwise not to have health insurance in this country. Hospitals can charge you arbitrary amounts. If you pay cash and have not agreed on everything in advance it is not a good deal. Paying cash probably makes sense for some routine procedures in case you have a high deductible health plan.

bearmf 14y ago
I also do not buy the whole "shopping around" thing, even if it worked. The idea that patient should know almost nothing about costs is a right one. The current implementation of this idea suffers from various problems, but as more people get health insurance under Obamacare, things will get better. Ideally, under single payer system, patient gets no bills at all, because all of the providers are "in network", as there is only one network.
- JPKab 14y ago
  There is an entire company (Castlight Health) that is centered around trying to allow people to "shop around" for healthcare. Despite cutting edge technology and access to data no one else gets (through member companies insurance statements) the general public can't use it unless their employer signs up for the service. Without this capability, shopping around for healthcare is absolutely impossible. How can you shop around when the prices aren't publically listed and aren't known by the staff/physicians? This article, by the way, is terrible. He gives horrifically bad advice, acting as if the majority of clinics/hospitals actually discount costs for the uninsured. THEY DON'T, as the vastly better researched article "The Bitter Pill" from Time Magazine last week clearly illustrated. I've been a consumer asking for prices as part of a HSA high deductible health plan before. There is no mechanism to support shopping around at all, and the clinics/hospitals still act on a zero price transparency model. See the "chargemasters" discussed in the Time article. They are databases of prices which are not at all publically accessible. The federal gov't should step in, and, at a minimum, force hospitals/clinics to make their chargemaster databases publically accessible. This would be a game changer for consumers in health care.
14y ago

pdx 14y ago

This article is completely at odds with Time's article [1] from a few days ago, that showed that out of pocket payers must pay the hospital's chargemaster prices, which are set at ridiculously high levels to act as an anchor in negotiations with insurance companies. If you're not an insurance company, you pay that inflated rate. If you are, you have negotiated it down to as low as 20% of that rate. I think I trust the Time article a lot more than this linkbait. [1] http://healthland.time.com/2013/02/20/bitter-pill-why-medical-bills-are-killing-us/ http://healthland.time.com/2013/02/20/bitter-pill-why-medica...

HeyLaughingBoy 14y ago
I think what's happening is that more physicians are getting sick (pun intended!) of dealing with insurance providers so while that Time article is correct, so is this one. I have only once come across a physician that didn't take any kind of insurance, but know from other anecdotes that it is becoming more prevalent. I also had an experience recently where I went to a specialty provider that didn't accept my insurance, so it was handled as out-of-network. However, they billed me only what I would have paid had it been an in-network provider, which was considerably less.
- kps 14y ago
  Physicians in private practice can pay half of their gross billing in insurance collection costs, including denied claims (which patients are nominally responsible for, but often don't/can't pay) and hiring experts to deal with the deliberately complex and ever-changing paperwork that insurance companies use to induce excuses to deny claims. That's before all other costs, including staff with an actual non-bureaucratic purpose, office space, malpractice insurance, etc.

moron4hire 14y ago

About 9 months ago, I had a severe bout of food poisoning. I had gotten so dehydrated that I passed out briefly and was physically unable to pick myself up out of an awkward position between the toilet and the wall next to the toilet. I was unemployed at the time (but working, trying to get a software product off the ground on my own) and had no emergency medical insurance. My roommate (thank God I had one) took me to the ER where they gave me a mild anti-nausea drug and pumped me full of fluids. The hospital only charged me about 40% of the full bill, due to my "hardship" of being unemployed. Still, it was $1200 for nothing a little weed and a gallon of Gatorade wouldn't do. Most of the bill was to have a doctor walk in the room, make a few jokes at me, and leave. If I knew I'd be paying for a standup routine, I would have preferred to go see Louis C.K. and saved $1100. I still haven't bought health insurance, which is certainly a gamble, but so is buying health insurance. When you buy health insurance, you're betting against the insurance company that you're going to put less money into insurance premiums than you're going to get out as benefits. In the last 2 and a half years of not having health insurance, that one ER trip is the only medical need I've had. In the end, $1200 was a lot less than I would have paid in premiums. So far, I'm winning my gamble.

outside1234 14y ago
the problem is that this is a power law gamble. if you lose big (Cancer), it will cost you either your life or your financial life.
- moron4hire 14y ago
  Which is actually not that big of a different risk if I had insurance. Just because I have insurance doesn't mean A) that my cancer would be treatable, B) that the treatment would be desirable, or C) that my insurance would be sufficient to cover it. People get screwed over by their insurance companies all the time. In the specific case of cancer, I'm not sure the treatment is worth it. I've seen a lot of people go through really awful treatments that ruined the quality of their last few months/years, only to die anyway. I don't want to put my families through the emotional and financial burden of that. I've personally never seen any insurance that fully covered someone's cancer treatment. In the end, cancer always gets you. You could do everything to try to prevent every other cause of death, but cancer will always eventually get you. That's a big part of why I'm working on the things I care about now, rather than waiting for some nebulous "future" when I have "enough money". That future may never come.

angersock 14y ago

So, an interesting attempt at making a nice transparent marketplace that I know of is SnapHealth ( https://www.snaphealth.com/ https://www.snaphealth.com/ ). These folks are working to provide an easy directory where you can look up all the doctors in your area and get their pricing for services on a cash basis. It's interesting watching as the industry goes through these undulations trying to sort itself out. (Disclaimer: I know the folks working on it, so if you have any comments/questions/concerns I'd love to pass them on.)

UnoriginalGuy 14y ago

This whole situation could get solved with two swift changes in the law: - Employer provided healthcare is now illegal (with exceptions for the military). - Healthcare discounts are now illegal. Insurance and cash-in-hand individuals pay exactly the same rate. These changes would be quite painful in the short term. In fact there would be a queue of people arguing why this was a horrible idea (the "I got mine" group). However in the long term this makes health insurance more similar to auto-insurance (car insurance). People can actually shop around, insurers have to compete for individual's business, and if people want to forgo insurance or go with a smaller insurer (new business!) then they can. Plus insurers and individuals will now both work together to bring hospital care costs down (they're on the same "side"). But people are too short sighted to see what a massive leap forward this would be. It is the very definition of a healthy capitalist market. But their thinking about insurance and how it "should" work is just so muddied with what has been done up until now. Employer insurance in particular is a massive problem - due to the lock-in (both between employees and their employer's insurance company AND between the employee and employer). It really hurts innovation, startups, and growth in America today. Healthcare discounts hurt people without insurance AND make the insurance sector uncompetitive. It is impossible to start a new insurance scheme now because you cannot get big enough discounts to be competitive.

AndyNemmity 14y ago
What about all the people without car insurance even under this program? This would be even worse in your situation.
- UnoriginalGuy 14y ago
  I don't understand what you mean at all. Prices for cash-in-hand individuals would be a lot lower under this scheme. Insurance covers the same costs cash-in-hand individuals pay, so no matter how many people do or do not have insurance the costs remain roughly the same.
aneth4 14y ago
"It is the very definition of a healthy capitalist market." I didn't realize heavy handed, unnecessary regulation bound to cause massive market distortions was "healthy" for capitalism. Employer health insurance is the current method of distributing risk among a larger group, and any prohibition would simply be circumvented by other types of group health insurance and reimbursements. Making discounts illegal is a ridiculous restraint on capitalism. Imagine if wholesalers and retails could not discount for marketing, loyalty, or quantity. Ridiculous. The only thing that should be regulated is the transparency of pricing and services. Consumers simply won't accept paying 5 times the price if they are aware, but they may be willing to pay 20% more to avoid the hassle of insurance. That's "healthy capitalism" - not your complex regulatory scheme. The thought of enforcement of what you suggest is mind-boggling. Illegal to provide your employees with health insurance? Bonkers.

jonknee 14y ago

I have a high-deductible insurance policy so I just pay up front for medical services (out of an HSA, but it's no different to the doc). Despite paying before the visit I got a bill after an appointment and then another warning that it was late. I called today after researching the CPT code and current billing schedule from my area to confirm that what they wanted was BS and as soon as she looked at my account she said "oh, yea they forgot to add the write off". Medical billing is so screwed up. I walk in and pay up front and it still somehow counts as a write off. A write off for what I am not sure, I am supposedly paying list price. I assume they really jack up the prices, have a pool for "uninsured" (regardless of merit) and then mark down from there to get a nice tax benefit because they gave a lot of "charity" care. I'd consider the $135 I paid for a < 10 minute visit to be more than ample compensation, whatever they're getting for the $90 write off should be fraud.

LVB 14y ago

I came across this article out of frustration. My wife went to a clinic that posted an office visit rate of $99. She presented our insurance card just so the outlay would get logged in the system against our out-of-pocket total, but there was no expectation of actually getting any money back. We have a very high deductible (by choice), and we'll see insurance money only in a really bad year, not unlike auto or house insurance. But since she showed them that card, suddenly the amount we owed shot up to $273. Both the clinic's and insurance company's response to us has been basically: suck it up, we have contracts in place.

davidroberts 14y ago

My daughter had an itchy eye. I took her to the doctor at a children's clinic affiliated with a well-known children's hospital. They asked for $150 upfront which I paid. The doctor came, examined her for five minutes and wrote a prescription for an allergy medicine that cost over a hundred dollars. Two weeks later we got the bill. They tacked on another $175 for moving us from one room to another. I forgot how they expressed it, but that seemed to be the reason. Over $400 and the medicine didn't really help.

codva 14y ago

//One of the problems with US health insurance is that it is tax deductible only when "paid" by the employer.// Healthcare expenses are deductible, but only those that exceed 7.5% of your AGI. So if you are a software developer making $100K a year at a start up with crappy health insurance, you can start deducting expenses once they exceed about $7500, depending on your tax situation. Of course, health premiums deducted pre-tax from your paycheck are not deductible at all.

fr0sty 14y ago
tax deductible above 7.5% AGI is very different from tax deductible above $0. Your $100k/yr developer would pay $2,100 in tax on the first $7,500 before the deduction takes effect. Also, the reason you can't deduct the "pre-tax" premiums is because you were never taxed on them in the first place.

jackmoore 14y ago

This could make HSAs (health savings accounts) much more desirable.

msluyter 14y ago

Incidentally, if you have an HSA account and can still afford to pay out of pocket, that basically allows your HSA money to continue to accrue over time. (From http://en.wikipedia.org/wiki/Health_savings_account http://en.wikipedia.org/wiki/Health_savings_account): "There is no deadline for self-reimbursements of qualified medical expenses. High-income individuals can take advantage of this by paying for medical costs out of pocket, retaining receipts and allowing their accounts to grow tax-free. Money can then be withdrawn years later for any reason, up to the value of the receipts. [23]"

joshuaheard 14y ago

It's not just the costs, it's the treatment. This happened to me: I went into a doctor after I had an accident. He said I needed an MRI and prescription painkiller. I said, doctor, I have no insurance. He said, in that case, you need an X-ray and Tylenol.

philsnow 14y ago

"""A recent article in the Los Angeles Times reported a CT scan of the abdomen costs about $2,400 for patients insured by Blue Shield of California, while the Los Alamitos (Calif.) Medical Center cash price is only $250. That is a 89% discount by my calculation. [snip] If you tell them you have insurance, they will be bound to charge you the insurance company’s negotiated rate. Those are the up to 89% higher fees documented in the previous paragraph.""" 2400 is 860% higher than 250, not 89% higher.