Health Care Costs - Still A Mystery

I admit I didn't read every reply, but here is my rub with medical billing/insurance right now. I went to the dentist to have a filling refilled after it fell out. I have OK dental coverage with the wife's insurance. I went in had x-rays, since I was a new pt, had the work done, and left. Prior to leaving I paid my copay. I think cool I'm done with this visit. Nope. I get a bill nearly 2 months later for $117 related to that visit. that is what is wrong with health care. I know if I had walked in and asked how much either they can't tell me, "because we don't know what is going to get done" or just plain refuse to tell.

And don't get me started with medicare/medicaid because they are the fore-bearers of why this whole issue is a quagmire, on top of the ambulance chasers.

I think a classic example of providers playing with the books is the "This is Not a Bill" statements some practices send out (my Dr's office does):

"Our charge for procedure A cost $X. Big Insurance Co is paying $Y ($Y = something much lower than $X). The resulting balance is $Z. But you aren't responsible for it."

Reading between the lines: "$Z is the amount we are going to write off as a loss in our books."

Will we eventually go to a single-payer system? Perhaps. But there are so many very powerful lobbies involved that it will take a catastrophic event like we've never seen before to make it happen. If/when that happens, major changes in healthcare will be the least of our concerns.

Toyman01 wrote: 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.

In my limited experience, I don't think the end product will suck for the patients. The limitation on who you can and cannot see will evaporate, you'll be more likely to go to the doctor early and you'll make medical decisions based on medical factors instead of costs. The hype about the terrible service in the Canadian medical industry compared to the US one does not hold up to my experience, both at the small (I broke my nobe!) and the large (That bump we found? It's malignant) ends of the scale. And there's a lot to be said about not losing your house just because you got sick.

I've never been a medical professional - heck, I'm barely a medical amateur - so I can't speak to that. But it would seem to me that ending the constant back-and-forth between insurance companies and the doctors would be a benefit.

I agree the transition would be hugely traumatic to the US and Fox News would go insane. But other countries have done it.

Ian F wrote: 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.

Totally not illegal.

Insurance companies may not be happy (and Medicare is the biggest insurance company in the world), but there is no illegal to it.

Plus, the healthcare system can always argue to any insurance company that the individual is providing extra service (that saves REAL costs) by providing no-haggle up-front payment. I imagine the conversation going about like this:

Medicare: Hey - that guy got a better deal than us. Give us that better deal please.
Healthcare system: Sure thing bro, but pay up front and don't haggle please. It costs us a huge amount of time and effort to bill you and collect on your accounts. We'd rather not do all that work and rather not bill you for it anyway.
Medicare: Ummm, nevermind.

By the way, Medicare usually gets the best deal of any other insurance company. Some states have medicaid that gets a better deal. Check guroo.com as another source for making sure you are not paying too much.

To the OP, did you decide on a plan yet?

Coming from the hospital administration side it's obvious there's a lot of misinformation and conjecture about how things work in this thread - lots of embedded beliefs that in my experience aren't accurate. Without in depth exposure, how would folks know? Anyway, most of the folks I know in healthcare would prefer a single payer system. Most of the people I know in insurance, pharma and tech would prefer not.

In reply to oldtin:

your last 2 sentences really tell the tale don't they ?

oldtin wrote: Anyway, most of the folks I know in healthcare would prefer a single payer system. Most of the people I know in insurance, pharma and tech would prefer not.

For dentist visits for our family of 6 this year, we had:

2 people with 2 insurers 3 people with these 2 insurers + a 3rd 1 person with the same 2 insurers + a different 3rd one

That can't be good for anyone when you have to chase that kind of paper-trail...

Keith Tanner wrote:

Toyman01 wrote: 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.

In my limited experience, I don't think the end product will suck for the patients. The limitation on who you can and cannot see will evaporate, you'll be more likely to go to the doctor early and you'll make medical decisions based on medical factors instead of costs. The hype about the terrible service in the Canadian medical industry compared to the US one does not hold up to my experience, both at the small (I broke my nobe!) and the large (That bump we found? It's malignant) ends of the scale. And there's a lot to be said about not losing your house just because you got sick. I've never been a medical professional - heck, I'm barely a medical amateur - so I can't speak to that. But it would seem to me that ending the constant back-and-forth between insurance companies and the doctors would be a benefit. I agree the transition would be hugely traumatic to the US and Fox News would go insane. But other countries have done it.

My parents spend a good bit of time in Canada. Their Canadian friends, who are in their 60s and above, don't really agree. And now that US healthcare has gotten so expensive, they generally fly to Costa Rica for medical care the Canadian system refuses to cover.

Could single payer work. Maybe. Can this country make it work. Not a chance. The US government couldn't pour water out of a boot with the instructions printed on the bottom.

Toyman01 wrote: The US government couldn't pour water out of a boot with the instructions printed on the bottom.

Sad but true, and unfortunately applies to a significant portion of the population as well.

Sounds like you could make some big bucks inventing a way to keep water from getting in boots in the first place.

Ashyukun wrote: There was a really eye-opening article I read some time ago about the completely unregulated and unreasonable state of medical billing where they gathered the data from a number of different hospitals and patients for the exact same procedures being performed (and in some cases at the same hospitals by the exact same staff) and it was completely nonsensical with a massive variation *even within the same hospital* for the exact same care.

That is because, by and large, they don't monitor what things cost because they don't care. They just throw numbers on the bill to see what sticks, because they expect the insurance company to fight them anyway. And when YOU get dinged for it, they figure, well, if we pad the bill high enough, if they only pay 20% before bankruptcy, we still get paid, so who cares?

Slimeballs.

In reply to Knurled: