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Insured price $2,758, cash price $521

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Re: Insured price $2,758, cash price $521

#71

Post by evrydayhustling »

avocado4 wrote: post #41
johnwheeler wrote: post #25

I took my 4 year old to the ER because he had a 103 fever. The doctor put an ear thermometer to him and told me to give him some childrens ibuprofen. The visit lasted all of 5 minutes. The cost: $756.00. I refused to pay it. It was the first time I did not pay a debt and the first time I was sent to collections. I refused based on principle, and not because I couldn’t afford it. Collections called me for about 3 mont…

https://www.politico.com/agenda/story/2017/10/25/doctors-sal... Providers are the core problem. Various doctor associations (AMA et al) have strangled supply side of healthcare through State licensure and scope of practice laws. Just read medical forums to get an idea of what an average doctor thinks about competition in the form of midlevels: https://www.auntminnie.com/Forum/tm.aspx?m=581583 "Don’t teach your mid le…

That forum is amazing! Thanks for the primary source! That said, two quibbles/questions:

Those same threads have logins like "indebt4life" and "kids2feed", which matches what I've heard from doctor friends: the length and cost of medical training and insurance are so brutal that the folks gatekeeping are themselves in an unhealthy lifestyle and don't want it to get worse. In other words, and benefits of gatekeeping accrue to the school and hospital complex more than the individual practirioners.

Separately, what's the breakdown of specialist labor costs vs drugs and equipment? My experience has been that the crazy bills are for stuff , not people.

Re: Insured price $2,758, cash price $521

#72

Post by moate »

omegaworks wrote: post #52
pkaye wrote: post #2

My understanding is the insured patients are subsidizing all the others covered by medicare, medicaid or those uninsured.

[citation needed] This is a common talking point that smells like an oversimplification.

I can't speak to Medicare/Medicade but the general idea is this: Doctors and the things they use/services they provide have a cost associated with them. Insurance works by spreading risk. Guy who breaks his wrist essentially takes money from the pool that wasn't used by the guy who hasn't been to a hospital in 6 years. So far everything is fine.

When you have people who exist outside that system of resource reallocation, the doctors have to find ways to ensure they're still getting enough money to cover their costs. One way they can do this is by suing patients who don't pay, but that takes time and more money and doesn't always work. Another option, would be that they then raise their rate to the insurance companies because they know that the insurance companies can afford it since they have such large pools of money. The insurance companies then raise the rates for everyone buying into the resource reallocation pool, and eventually everything spirals out into our current non-system.

Is it more complicated than this: yes, but that's the elevator pitch on it.

Re: Insured price $2,758, cash price $521

#73

Post by cwilkes »

johnwheeler wrote: post #25

I took my 4 year old to the ER because he had a 103 fever. The doctor put an ear thermometer to him and told me to give him some childrens ibuprofen. The visit lasted all of 5 minutes. The cost: $756.00. I refused to pay it. It was the first time I did not pay a debt and the first time I was sent to collections. I refused based on principle, and not because I couldn’t afford it. Collections called me for about 3 mont…

If it was so easy to diagnose then why didn’t you do it yourself?

What you are paying for is piece of mind and expert advice.

What would you do if someone wanted your expert advice on something you told them your fee and then solved their problem in 5 minutes and they balked at paying you?

This is the old saw about $1 for the work and $999 to know where to hit the machine with a hammer.

Re: Insured price $2,758, cash price $521

#74

Post by dshep »

johnwheeler wrote: post #25

I took my 4 year old to the ER because he had a 103 fever. The doctor put an ear thermometer to him and told me to give him some childrens ibuprofen. The visit lasted all of 5 minutes. The cost: $756.00. I refused to pay it. It was the first time I did not pay a debt and the first time I was sent to collections. I refused based on principle, and not because I couldn’t afford it. Collections called me for about 3 mont…

I recently took my GF to the ER because she had been stung by a bee and was worried she was allergic. She was feeling dizzy but once we were in the ER she started feeling better. They basically took her vitals, waited 30 minutes or so, gave her a steroid, and then sent us home. They told us it probably wouldn't be very expensive as she was uninsured.

Later the bills arrived: $1300 from the ER ($1900 minus a $600 uninsured discount) and $600 from the PA who saw us. Insane!

Re: Insured price $2,758, cash price $521

#75

Post by nonbel »

rolltiide wrote: post #47

It's random from a user experience perspective. There are many times when a practice will quote you a much higher cash price just because you don't have an insurance company negotiating for you. I have privileged foreign friends with private "worldwide insurance" from a European provider, but it is just a reimbursement scheme. So they appear uninsured to American providers and have to float potentially extremely larg…

> things like birth control aren't insured

Why would you use insurance for something you know you are going to need? I got new glasses and an eye exam and they were surprised I didn't pay via insurance? Why would I want to pay extra to insure for something I know I will need to get? This makes no sense at all.

Re: Insured price $2,758, cash price $521

#76

Post by aianus »

velcrovan wrote: post #59
aianus wrote: post #29

Earlier quoted context omitted.

As mentioned below, the price doesn't matter when nobody is available to see you. Also, the opportunity cost of sitting around with a broken hip waiting to be seen can be higher than going to a privatized country/province and paying for the surgery, in which case you're a super-sucker who paid extra taxes for decades just to end up paying out of pocket for surgery anyways. Anyways, the US system is probably worse ove…

Funny, I have a sister in Canada and a sister in Switzerland, neither of them have had trouble getting ultrasounds. My wife's grandmother is also in Canada and was treated the same day for her broken hip. I'm really sick of being told things are impossible in the US that are normal in other developed countries.

I live in Canada and have waited 4 months for a specialist at great personal cost (but not financial cost).

I have also seen my mother suffer for 6 months on a surgery wait list and then recover slowly and painfully in a room with 4 other people who were constantly screaming during the night. And she was a lucky one because the hospital was so overcrowded that other patients were living, sleeping, and recovering in the literal hallway. Google "hallway medicine Ontario" to see I'm not making this up.

It's not a perfect system by any stretch and it's much better than nothing but I bet upper-middle-class and above citizens in the USA enjoy better care.

Re: Insured price $2,758, cash price $521

#77

Post by pkaye »

youeseh wrote: post #12
devoply wrote: post #3

Earlier quoted context omitted.

Why? Why are insurance companies not demanding cash price and reducing premiums? There should be lawsuits against hospitals, this seems like something which is generally considered highly illegal at this sort of scale... charging different customers different prices -- especially when the ones paying more are more than capable of taking hospitals to court.

Hospitals could also be charging insurance companies more, but not for subsidizing cash patients but for greater profit.

I found this interesting article on the situation. They say 1/3 are profitable, 1/3 are break even and 1/3 are losing money. And a lot of those losing money are in rural areas. And "In general, hospitals lose money on Medicare and Medicaid patients, but make up for that by charging private-sector insurers more."

https://www.nbcnews.com/business/business-news/hospitals-mad...

Re: Insured price $2,758, cash price $521

#78

Post by seanmcdirmid »

neya wrote: post #66
point78 wrote: post #35

Earlier quoted context omitted.

Well as screwed up as the system is one little part of why prices are so high is to cover when people don't pay.

Then how do you explain countries like India where it's drastically affordable and high quality at the same time?

You pay at the entrance, not at the exit. Also, standards of care, facility costs, and compensation for medical professionals is much lower.

Re: Insured price $2,758, cash price $521

#80

Post by moate »

vonmoltke wrote: post #23
youeseh wrote: post #12

Earlier quoted context omitted.

Hospitals could also be charging insurance companies more, but not for subsidizing cash patients but for greater profit.

For-profit hospitals, maybe, but what about the non-profit ones?

"non-profit" doesn't mean "doesn't make money" its just rules on how you have to spend that money.

There's nothing saying a non-profit can't raise prices of service and then expand the hospital to buy a new wing, or better equipment or hire more doctors. They need the money to provide their services.

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