Yes, this non-transparent pricing, and weird discounts you can maybe ask for if you know how to ask (and if you figure out who to ask) drives me nuts. Sometimes you are better off being billed via your insurance; other times you're better off not using your insurance (even if you have one) and negotiating a cash price. And it's often hard to tell which one up front.<p>Supposedly one of the downsides of more socialized systems are that they're bureaucratic, but I think the U.S. system, whatever you want to call it (it's not really either a functioning market <i>or</i> a properly socialized system) is somewhere near Peak Bureaucracy (certainly more than Denmark's, where I now live). It doesn't help that everyone bills separately: if you ever have to visit a hospital, you will get something like 15 different bills, because everyone from the anesthesiologist to the surgeon are apparently independent contractors, or at least bill that way. And you have to go through the same opaque negotiation process with <i>each</i> of them. And many of them are sloppy and contain errors, e.g. billing you for things that insurance actually should have covered.<p>I'd be fine conceptually with a model where catastrophic care is insured and smaller expenses are paid for out of pocket. But then I'd like: 1) the catastrophic care to actually, 100%, guaranteed be covered, without loopholes, lifetime maxima, excluded conditions, etc.; and 2) the smaller expenses to be priced transparently up front.
A few years back I changed jobs; under my previous employer my allergy shots were fully covered under insurance, and I wanted to determine which of my new employer's plans might cover them. At the time I was getting allergy shots on a weekly basis, so if I had to pay it could add up to $80-$100 a month. If "plan A" covered it and cost only $30/month more than "plan B," then it would be worth it to me.<p>The plan summary from HR didn't say. I called the insurance company, but it was tough to get an answer from their CSRs without being a customer. Finally I got someone sympathetic who gave me their direct line and said if I could get the billing codes, they could run it against the terms of the policies my company negotiated and see what comes up. In the meantime they told me it would cost no more than $25 per injection, which was the limit to "usual customary and reasonable" in my area.<p>So then I call my allergist's office. They told me I need to speak to their business manager, who only worked 3 days/week, and I of course called on one of those other two days. When I called back, she categorically refused to give me the billing code they'd use. I asked her to clarify whether she was <i>unable</i> to give me the code or if she was <i>choosing not to do so</i>, and she responded that it was the latter.<p>So basically I just had to wing it and choose a plan. And a new allergist.
Yes, the medical situation in the US is badly broken, and everyone knows it. However, it is unlikely to get fixed within the next several decades. It took decades and an extreme swing in political power (one party fully controlling both houses of Congress and the presidency at once) to get a change to the law that said essentially "Keep doing it the same way you're doing it except that a little over 3/4 of the people with absolutely no insurance will now get insurance." Such a tiny step forward, still unclear whether it will actually hold, and this was the crowning achievement after decades of work.<p>The way we pay for health care in the US may not improve in a substantial way for a LONG, LONG, time.
What I think is really interesting is that my experiences with dental insurance are entirely different. I've gone to the dentist, found I have two cavities, and when I schedule my next appointment on the way out I'm given a detailed treatment plan that includes prices. It even includes details about how some fillings are more expensive because the insurance only covers amalgam fillings in the back but the dentist only uses composite fillings (for example). And it only takes a couple minutes to figure out the prices, and more importantly exactly what the insurance will cover.<p>I realize that the set of things a dentist deals with is probably smaller than what a doctor does, but it seems like it's a much better model for insurance.
The ability of people in the States to insist that our health care system is "the best in the world" because of the action of the <i>free market</i> while simultaneously not understanding why prices are thus important is what usually leads me to believe that most Americans have no idea what a free market is. (Or what health care is, to be honest.)
I have Kaiser HMO in California. I think it's awesome, and the best health care I've ever had.<p>I'm also from Canada, so I'm comfortable with the idea of socialized medicare. However, when I compare stories between me and my friends in Canada, there really is no comparison. I basically pay a $20-30 co-pay per visit (something that was completely foreign to me when I first moved to the US), and then anything and everything gets done for me. I have never experienced the horror stories you hear about where insurance companies try to opt for cheaper treatments or deny services to save money. Any test or procedure I needed, or even asked about, I could get.<p>The longest I waited for things like a MRI was 2 days, and 9 days for an endoscopy. My doctor was willing to get me a CT scan the next day for this stomach problem I had. My friends in Canada have waited 4 months for an MRI and 3 months for a CT scan. My dad had to wait about 6-8 weeks to get a pacemaker installed, even though his heart was stopping for 5-10 seconds several times a day. Seeing a specialist takes months in Canada vs days with Kaiser. On weekends, if I get sick I don't have to wait in Emergency for hours like in Canada, I can just set up an appointment at one of the hospitals and see a GP in around 30-45 mins, and they have full access to all my medical records.<p>The downside is that when I'm out of a Kaiser area, I have to pay out of pocket unless it's an emergency (I believe). The only time I felt vulnerable was when my family was out of state, and they didn't have Kaiser facilities there.
Somebody needs to create international healthcare insurance based in stable non-US jurisdiction similar to travelers insurance. Insurance that would cover medical tourism - flight, lodging and care for Americans.
The 1076 for the procedure and 300 for the visit were the full billable charges for those codes.<p>If the insurance had covered them at their contracted rate, the provider would have received probably about 250 for the procedure and 50-120 for the office visit.<p>Because it fell within your deductible, the initial bill to insurance would have been denied payment and sent back with "patient responsibility" and the 1376.00 would then be your problem. Since you don't have a contract with your provider he tries to get the whole thing.<p>This is where you can discount it with negotiation.<p>I am a medical provider, I believe that transparency will help the situation. I also believe that prices should be within a 5-10% window of each provider instead of a price variance of 100-400% depending on secretive contracts.<p>Unfortunately even providers have been trained to game the system to maximise profit and productivity. It is common to hear surgeons talk about complicated patients and tell them to see a university guy because "frankly its not worth the time and effort" when they can get low hanging easy fruit that pays better/unit-time with less liability.<p>I'd like to hear what the poster thinks he should have paid for his office visit and 5 minute procedure.
Just some anecdotal data from my wife's pregnancy & delivery process and the costs/charges are just from her 2 days of hospital stay for her normal/vaginal delivery without any complications.<p>- The hospital (NJ if it matters) billed the insurance company $30,000. She was there for usual 48 hours. The insurance company has a thing called "Amount Allowed" which knocked it down to $5880. Then our share of co-insurance came to about 20% of that = $920.<p>- For baby, separate hospital bill of $8779. amount allowed = $2,232, our share = $566<p>- The Anesthesia consultant billed separately for $3000, amount allowed = $1100 and our share = $220<p>- OBGYN billed $4200, amount allowed = $2800, our share = $560<p>- Newborn clinic charge = $375, allowed = $375, our share = $289 (deductible not reached)<p>- Neonatology for baby - $590, allowed = $100, our share = $100 (deductible not reached)<p>So here is total just for Labor/delivery/baby which was 100% normal without any complications.<p>- total bill = $52,824<p>- Allowed by insurance = $12,487<p>- Our responsibility to pay = $2655<p>I get chills just to imagine if we did not have insurance.
Perhaps the hacker community could come up with some alternative solution, similar to bitcoin in finance, to try to force out the non-transparent pricing? ;)
One thing that's a bit confusing: In both the UK[1] and the US[2] medication non-compliance is very high. Many people don't take their prescription meds properly. Many people are so bad at taking meds that the meds are ineffective - they may as well not take the meds at all. Rates are similar in the US and UK.<p>About half of the UK £9billion budget for prescribed meds is sub-optimal spending because of medication non-compliance.<p>And severity of illness doesn't seem to be a factor. People who've had an organ transplant often die after rejection when they stop taking the meds, even though they know that they must keep taking the meds.<p>There's probably money somewhere if you can improve medication compliance.<p>[1] Prescriptions usually cover 28 day supply of medication. Each line item on a prescription costs £7.40; but most people don't pay because there are many exemptions and if you need long term meds you can pre-pay.<p>[2] I dunno how it works in the US.
I loved the Michael Moore movie <i>Sicko</i>. Regardless of what you think of him in general, he did a good job with it. What surprised me was the fact that 95% of what he found was what <i>insured</i> people have to deal with.<p>I feel like the only thing that has prevented our health insurance system from touching off a violent revolution is that severely ill people aren't exactly in top shape for carrying AK-47's into executive lobbies.<p>The <i>whole point</i> of private health insurance is that sick people are the easiest to rob-- they don't fight back-- but they also have no money, so it's best to collect payment while they're young and well.
I wonder how long this is gonna keep going until someone gets pissed off, and creates a website to take care of the transparency issue by themselves- "upload your hospital bill here. We'll mine your bill for pricing data, anonymize you, and make the bill publicly available so people can shop for better prices".
> "...medical care is one of the core things that a 1st world country should make available to anyone, for cheap, by subsidizing it and enforcing transparency and price normalization for common needs..."<p>Yes, exactly. This is pretty hard to accomplish in our current state of political inaction, misinformation and 24-hour news cycles. I'm sensing a build up to a tipping point on public awareness about how we're all being swindled by these hospitals and insurance companies, but perhaps I'm just paying more attention to this now that I'm starting to get a little older.<p>For what it's worth, and for those of you who haven't seen this yet: <a href="http://truecostofhealthcare.org/" rel="nofollow">http://truecostofhealthcare.org/</a>
I highly recommend reading the ebook here...It sheds light on actual costs and gives a very detailed analysis on the issues at hand: <a href="http://truecostofhealthcare.org" rel="nofollow">http://truecostofhealthcare.org</a>
Granted, the OP indicates that indeed it is difficult to get advanced pricing because it entails asking the doctor for the code, then checking with the insurance company.<p>But what's stopping people from voluntarily posting the procedure_code=>price information they obtain? Are there contractual/legal reasons that prevent you from sharing that information? If patients get that price in the normal course of getting healthcare, then why not share it all, and force transparency in the market?
One conjecture he made is definitely wrong. Medical bills for uninsured individuals are usually higher than those for insured (due to insurance companies negotiating a better price).
<i>It appears most states in the U.S do not require hospitals and medical providers to list their prices</i><p>This and the tax breaks given to companies sponsoring health insurance plans that create a nearly immovable useless middle man are the root of all evil in the American healthcare industry.
just to clarify: $300 for a doctor visit isn't inflating costs because he's covered by insurance. in ny, which i think is safe to assume is comparable in cost to the part of CA i'm assuming the OP is in, that's the normal amount you'd pay for a specialist visit.
If your auto insurance included new tires, oil changes and gasoline, imagine what would happen to the price of both auto insurance and gasoline? They'd both skyrocket. So why the hell are we doing it with healthcare? Insurance is about sharing risk and a large part of the cost isn't sharing the risk it is about pre-paying for normal, expected ailments and when consumers become insensitive to cost prices are bound to rise.<p>The healthcare industry is greatly in need of cost sensitivity and transparency.