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Insured price $2,758, cash price $521

latimes.com

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

#101

Post by thatoneuser »

beebmam wrote: post #90
rpmisms wrote: post #14

Earlier quoted context omitted.

That's extremely cool, and has my gears turning about how to encourage that kind of behavior.

That ISN'T cool, that's quite dangerous, because if it was indeed broken, that may cause harm. Rule #1 of being a doctor is violated. X-ray imaging on a finger is virtually harmless. Using a tuning fork to vibrate a potentially broken bone and causing a patient to feel pain is not harmless.

I don't see how it could be that dangerous assuming the doc first looked it over and couldn't find anything by hand. How would a tubing fork seriously hurt a small fracture if applied with skill?

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

#102

Post by nonbel »

crazygringo wrote: post #96

(American here.) Funny, my last several doctors visits the cash price has always been higher than the negotiated price. These are all for services in the $150-300 range, and I was told upfront what the cash price would be, but they couldn't tell me what my negotiated plan rate was. (I inquired because I have a high deductible plan so I'll pay in the end no matter what.) The negotiated prices were all at least 1/3 low…

> Funny, my last several doctors visits the cash price has always been higher than the negotiated price.

There is nothing funny about it. Once you tell the provider that you have insurance, the price they can quote you is in their contract with the insurance company. You need to go somewhere new and tell them you do not have insurance to get the real price.

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

#103

Post by roywiggins »

ceejayoz wrote: post #82
Shivetya wrote: post #49

Earlier quoted context omitted.

if you are upset over their pay imagine how you must feel about those in public service, let alone their pensions. you can pull down those numbers being a city manager and get over 100k in pension to boot! the medical profession is not easy and i don't begrudge them their fees.

> you can pull down those numbers being a city manager Where? NYC's mayor doesn't even make those numbers.

There are NYC employees making 350k salaries.

https://data.cityofnewyork.us/City-Government/Citywide-Payro...

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

#104

Post by jopsen »

rpmisms wrote: post #14
Stratoscope wrote: post #9

Beyond opaque and variable pricing for the same service, there is also the question of whether something simpler would do the trick. Some years ago, I thought I might have broken my finger. I went to the doctor and it was actually the physician's assistant who saw me. I'd explained at the front desk that I had a high-deductible policy and I would be paying in full for the visit. The PA said "Usually we would send som…

That's extremely cool, and has my gears turning about how to encourage that kind of behavior.

If the x-ray is better in any way, it's not wise to recommend anything else. It's better to ensure that the very treatment is affordable

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

#105

Post by markdown »

cwilkes wrote: post #73
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.

> $1 for the work and $999 to know where to hit the machine with a hammer.

In your example, $999 would be fair, but they're charging $9999.

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

#106

Post by Balgair »

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 have a similar story about vaccinations in grad school, religious waivers, and a racket that the medical school's insurance was running here:

https://news.ycombinator.com/item?id=19760317

TLDR: Single payer, yesterday!

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

#107

Post by drblast »

Insurance is not supposed to make routine things more affordable. It's supposed to spread the risk of catastrophic loss from unlikely events around to a large group of people so you don't have to worry about losing your house if you get struck by lightning. Everyone needs routine medical care at some point so an insurance model doesn't work there.

You don't have gas or grocery insurance, do you? If that were a thing would we all expect to pay less for gas and groceries, or would we just be tacking on overhead for routine expenses for no reason?

Using insurance for routine, affordable expenses is one of the problems. But it's a race to the bottom where insurance companies win, because everyone in the U.S. thinks "good" insurance pays for everything and makes a 17% profit out of nothing.

In addition to the transparency the article advocates for, we'd probably be way better off with a universal health care stipend and very high deductible insurance for rare catastrophic events. Insurance should not be involved in routine care.

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

#108

Post by rolltiide »

nonbel wrote: post #75
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.

privileged people have the option of using pre-tax + employer funded FSA/HSA accounts, where a wide array of hygienic purchases, medical purchases and even copays can be paid for and further subsidized.

These are part of your overall “insurance package”, in conversation this is typically called being insured with no regard to whether an insurance company is actually picking up the tab.

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

#109

Post by rhacker »

crazygringo wrote: post #96

(American here.) Funny, my last several doctors visits the cash price has always been higher than the negotiated price. These are all for services in the $150-300 range, and I was told upfront what the cash price would be, but they couldn't tell me what my negotiated plan rate was. (I inquired because I have a high deductible plan so I'll pay in the end no matter what.) The negotiated prices were all at least 1/3 low…

Another option is to just let it go to insurance, and if they fully reject it, then call the place and tell them the insurance wont cover anything - then you'll get heavy discounts (usually they just feel bad and remove codes and what not). Unless you had gone to a corporate place, of course, which they all tend to be now.

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

#110

Post by refurb »

rlpb wrote: post #81
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 have read elsewhere, but cannot find a reference right now, that insurers typically pay only a percentage of any bill and expect the provider to accept it in final settlement. The percentage gets negotiated around. If this is true, then it makes sense that the providers inflate their original bills so that when they get the proportional settlement, the amount they receive is reasonable. The claim was that individua…

There a few different drivers of the ridiculous list prices at hospitals.

1. The gov't forces them to disclose a price and they can't charge higher than it. Thus, they have every incentive to make it really high, then give preferred customers (insurers) a discount.

2. The system is firmly locked into a cycle of "percent of charges". Basically the insurer says "I know your chargermaster prices are inflated, so let's agree on 20% of that". The following year the hospital jacks up the chargemaster prices during negotiation so they start from a higher initial point.

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