The only problem I have with advocating "self pay" medical care is that it takes a lot of the medical judgment out if the doctors hands.
Is it possible to educate the average American enough to make a good decision on the true costs vs benefits of running a test or taking a medication ? I have my doubts.
In reply to Marjorie Suddard:
Unfortunately, I've also read that doing that - hospitals charging less to cash customers than insurance companies - is illegal. Or at least may cost the hospital their deal with the insurance company.
In reply to Ian F:
Whoa, did not know that.
I had to have a nuclear stress test and a echo-cardiogram, two years ago. When they scheduled it, I was informed my out of pocket was going to be $1700, and my insurance would pay the balance. I told the lady up front I was going to shop her price, because I thought that was ridiculously high, and I would have call her back. She called 15 minutes later with a out of pocket of $1100. I spent an hour making phone calls and had both procedures done for $700 total. That price was on the condition that I paid cash, no insurance, no credit cards.
Your doctors office isn't much better than your auto mechanic. They are happy to run up the bill for frivolous crap, just like a auto repair shop. My insurance was billed $25 for "smoking cessation counciling" on a office visit, a year and a half after I quit smoking. They didn't want to remove the charge until I offed to call the insurance company and discuss it with them. I don't trust them anymore than I would a Jiffy Lube. They are absolutely 100% out to screw you and your insurance company.
Educate yourself, question everything, read the entire bill, and don't be afraid to pick up the phone and dispute charges. Even if they don't help your out of pocket amount.
Until the average person cares about what things cost, rather than what they have to pay, costs will never be under control.
Toyman01 wrote: I had to have a nuclear stress test and a echo-cardiogram, two years ago. When they scheduled it, I was informed my out of pocket was going to be $1700, and my insurance would pay the balance. I told the lady up front I was going to shop her price, because I thought that was ridiculously high, and I would have call her back. She called 15 minutes later with a out of pocket of $1100. I spent an hour making phone calls and had both procedures done for $700 total. That price was on the condition that I paid cash, no insurance, no credit cards. Your doctors office isn't much better than your auto mechanic. They are happy to run up the bill for frivolous crap, just like a auto repair shop. My insurance was billed $25 for "smoking cessation counciling" on a office visit, a year and a half after I quit smoking. They didn't want to remove the charge until I offed to call the insurance company and discuss it with them. I don't trust them anymore than I would a Jiffy Lube. They are absolutely 100% out to screw you and your insurance company. Educate yourself, question everything, read the entire bill, and don't be afraid to pick up the phone and dispute charges. Even if they don't help your out of pocket amount. Until the average person cares about what things cost, rather than what they have to pay, costs will never be under control.
Smoking is bad "M-Kay"...when can I expect my $25.
In reply to RX Reven':
That's exactly how it works. Are you a little heavy? Weight works the same way. Cha-cing!!
They love those tests as well. My doctor wants to run a blood test every time I'm in there.
Pull a muscle? Test! Have a cold? Test! And every test runs up the bill.
I had the exact same results as Margie with 5 different kids (though I did avoid getting myself an epidural).
I've heard that line about negotiating with the hospital being illegal too, and I think it is utter BS.
If no one knows the price, and it varies wildly based on absolutely nothing, how in the heck could anyone EVER claim a particular charge for a procedure was right or wrong?
How would monopoly pricing possibly be the only legal option?
If it is illegal, bring it on. I dare someone to arrest me for it.
There is an independent imaging facility here that will do CT scans and MRIs for a lot less than the hospital.
buddy of mine has an artificial hip … it went bad and he needed it replaced …
went to the hospital to start the process, he worked for himself (wrenching) out of his garage, so no ins.
the hospital quoted him $50k …. if he had had ins. it would have been $25k (disclaimer: rounded off figures) … he begged them to do the job for the ins price, he could find a way to swing that much … all they were willing to do was set up a payment schedule
his Mom died shortly after this was going on, and he inherited a pretty huge amount … so got the procedure done, but the hospital was willing to let him become a cripple, unable to work, a drain on society, rather than let him pay the ins. negotiated price
Having insurance can also make your bill oddly high too. Has to do with the contractual obligations of the insurance policy, which can make up front estimates all but impossible btw.
Here's how my 100% coverage for ambulatory services cost me about $800. ..."maximum policy limit"..."approved service"..."in state"..."responsible for all other charges". I'm sure there were more.
If I ever need an ambulance ride, in my state, and I get it from an approved service (unidentified btw), it will be covered 100%. Unless it's not.
But get hurt out of state, or get service from an unapproved or out of network ambulance? My 100% coverage becomes something like $40, and specifically states I am responsible for all charges related to the ambulance service.
Which would explain why the first bill from the ambulance company was a simple bill. Once the check was cut the billing people for the ambulance knew the insurance provider. And my how the padding of the bill then began. Mileage fees, wear and tear fees, drivers fees, park pass fee, supplies, convenience, conveyance, etc.
It was in the fighting that I learned I am indeed legally liable for anything they can dream up to pad the bill with under the terms of my insurance policy.
spitfirebill wrote: There is an independent imaging facility here that will do CT scans and MRIs for a lot less than the hospital.
My ortho office said they'd accept images from 3rd party facilities, but they gave a list of ones that they claimed had too low of an image quality. I'm sure it had absolutely nothing to do with the fact that they had their own MRI machine on the 2nd floor. Total coincidence.
The only reason to have insurance imo is to take advantage of the negotiated amount for the insurance carrier if you need a procedure. Under my policy, I have to meet the deductible(I am not within $2k of it now in November) plus pay a percentage as co-pay. My long term Dr who sold out to a medical management group wont see me now because I am out of network even though I have told him and his office that I will be paying cash. I am just glad that I have made it this long in life without any significant medical issues. YMMV
Keith Tanner wrote:Ian F wrote: In reply to Keith Tanner: Could you retire back to Canada? (serious question).It should be possible and I've thought about it. I don't think I could convince my wife to leave Colorado, though.
Yes, if you're already a Canadian citizen the health care kicks back in 90 days after you officially move back. In the case of a non-citizen it would be 90 days after your "landed immigrant" status is official. I've considered moving back, now that I'm retired.
SVreX wrote: I had the exact same results as Margie with 5 different kids (though I did avoid getting myself an epidural). I've heard that line about negotiating with the hospital being illegal too, and I think it is utter BS. If no one knows the price, and it varies wildly based on absolutely nothing, how in the heck could anyone EVER claim a particular charge for a procedure was right or wrong? How would monopoly pricing possibly be the only legal option? If it is illegal, bring it on. I dare someone to arrest me for it.
I hope it is B.S. Since posting that comment, I've been trying to find the article I read about it, but it's been awhile. I can definitely see it as something insurance companies would like people to believe. "Do not question! Just bend over and take it!"
Like most things, it seems the devil is in the details and it can vary depending on what state you're in and the contract the provider has with the insurance companies. I was able to find this article about the subject, written from the provider POV, although it's mostly an ad for his book and doesn't tell much: http://www.drjarodcarter.com/partial-cash-practice-pricing-legalities/
SVreX wrote: I had the exact same results as Margie with 5 different kids (though I did avoid getting myself an epidural). I've heard that line about negotiating with the hospital being illegal too, and I think it is utter BS. If no one knows the price, and it varies wildly based on absolutely nothing, how in the heck could anyone EVER claim a particular charge for a procedure was right or wrong? How would monopoly pricing possibly be the only legal option? If it is illegal, bring it on. I dare someone to arrest me for it.
Either I'm missing your point or your missing the point. It's illegal for the hospital to charge different amounts if you pay cash or if your insurance pays. It has nothing to do with how you pay. Everyone know the hospitals are charging more to the insurance companies. The insurance companies are fine with that because then the get to charge Joe the Plumber more too. Its the fleecing of America!
I get the impression it's not illegal in the "going to jail" aspect, but more in a "breaking a contract" aspect. Regardless, I agree it shouldn't matter to the individual doing the paying. If the provider is willing to take the risk (if any), that's their business.
In reply to RossD:
The problem is the true price is really poorly defined and inconsistent.
If you are paying cash you have to compare it to what who's insurance pays? Different insurance companies pay different amounts. Different policies within one insurance company pay different amounts. Do you mean the amount they bill the insurance company or the amount the insurance company pays? Is it the amount they bill the insurance company including or not including the co-pay some policies have? If it is spelled out somewhere it is spelled out much more precisely than "people who pay cash have to pay the same as the insurance company" because what the insurance company pays is not consistent across every situation or often even known by the people who bill you.
You are not the first person I've heard say that legally cash pay has to equal insurance pay, but I don't understand what it really means.
I don't think there is anything illegal about different pricing based on insurance or no insurance. It could be a contractual violation (between the facility and your insurance company) if a contract exists and the provider offers a special price of you forgo making an insurance claim and pay cash, but that is not the same thing as illegal. Different pricing depending on who pays is common practice. Every insurance company negotiates it's own payment terms with providers, you acting as your own "self insurer" by paying cash is no different.
Since others have been mentioning articles about how medical billing is ripping us off I recommend googling "Health Care and the $20,000 Bruise"
Toyman- I know very well personally that healthcare costs can bankrupt you. It seems insane.
Everyone in direct patient care understands that there are too many who can't afford the costs of care today. Many of those who can't afford it work in healthcare actually. And yet hospitals are not grossly profitable. Most wages in healthcare have been stagnant for many years. We aren't getting rich.
I will admit I do not know the answer to spiraling health care costs. i wish it were as simple as making physicians quit doing unnecessary tests. That would be an easy fix.
I apologize if my previous post came across as callous. Your anger is justified. I personally believe it's misdirected, and I hope my belief in the medical community as a whole is not.
In reply to bastomatic:
No worries. We are both looking at the situation from opposite angles and seeing different things.
I'm afraid there is no magic bullet. I foresee single payer in our future, but the transition is going to be a nightmare and the end product will probably suck for the patients and professionals alike.
bastomatic wrote: And yet hospitals are not grossly profitable.
Sorry. I can't swallow that.
In reply to SVreX:
Do a search on healthcare construction. September 2015 was $41.35B. Link
It's a great place to not show a profit and they get nice shiny equipment and buildings to play with.
In reply to Toyman01:
Spending profits on capital improvements does not change the gross profitability.
It only converts the cash asset to a capital asset.
It's still profit, even if it doesn't look like it in a P&L statement.
Hospitals are exceedingly accomplished at doctoring their books.
TLDR, get it fixed. Knee pain is no joke and it will lower your quality of life when you can't walk without pain. I don't know a single person that regrets knee surgery.
I had a knee rebuilt a few years ago: ACL, MCL and some meniscus repair. When it was all said and done it was about $10k. In the weeks waiting for my surgery I could barely walk and fell a lot when I did. It could have been $100k and I would have paid it just to be able to walk.
Second, find out what ortho in your area is the best for knees. You're going to spend $3500 either way, so you may as well get the best. When you meet with them to discuss your surgery, get all of the details and talk about best and worst case scenarios. Tell them what you want to be able to do after the repair. Get a good idea of recovery time and therapy and prepare yourself for the healing time.
My surgery went great. My surgeon was a team doctor for a bunch of college and pro teams. He was actually the one that told me he wanted not just to fix me up, but to also make me stronger so that I could go back to the activities I like to do (and got hurt doing: skiing). He made me walk to the car after my surgery and had me on a schedule with OTC pain killers, activity, and using a CPM machine as often as I could handle. He personally called me a few times the week of the surgery to make sure I was doing these things and that I wasn't having complications. He had me in PT for 4 months. He told me to take the race season off. He told me to expect 18 months until a full recovery. He prescribed a knee brace to protect his work.
It has now been 3 years. I walk about 3 miles a day. I am back in the race car. I took 4 ski trips last year. I don't have to wear a brace anymore (but I do). I have stretches and exercises to keep it in good shape.
If insurance policies all paid out the same for identical services rendered, their might be a point to the argument. They don't. Which is why different doctors will accept different insurances, but not others.
The doctor/hospital/whatever bills X. Insurance pays Y. They are not the same. There may be a co-pay, a deductable and even unpaid expenses. The amounts all vary, depending on the insurance company and policy.
Insurance companies have leverage to negotiate better rates for themselves. Be it auto insurance policies when it comes to fixing your car for a discounted rate with sub-standard parts, or a medical insurance policy that can force a doctor to accept a $12 payment on a $600 bill.
You have the same right to negotiate, but you lack the leverage. You aren't going to affect their practice or business by covering hundreds of clients. You're just you. As such, the doctor/hospital/whatever are much less inclined to take the time to negotiate costs with you. Not that they can't, they just won't. And they aren't legally required to. Though if they don't provide a cost estimate up front, if you demand it, well, then you've got a wobbly leg to stand upon, or at least lean upon.
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