Insured price $2,758, cash price $521 • Hacker News Board

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

#321

Post by greedo » Sat, Aug 03, 2019, 3:23 PM UTC

JudgeWapner wrote: post #269

greedo wrote: post #245

Earlier quoted context omitted.

Seeing a GP isn't necessarily a guarantee that you will get diagnosed properly. Most PAs know their limits and will consult with a doctor if they're not comfortable. Doctors complain about malpractice insurance, but the rates are high for a reason. I was misdiagnosed when I had cancer, my wife was mis-prescribed when doing fertility treatments. Hell, being rich doesn't help; look at Bill Paxton and Neil Armstrong.

> Seeing a GP isn't necessarily a guarantee that you will get diagnosed properly. so, because even the best make mistakes, that's a good reason to let under-trained (relative to an MD) people with even less skill make mistakes? Not following your logic here.

Seeing a PA for relatively normal issues frees up doctors for more serious cases. A triage system if you will. Doctors don't like this because it will hurt them financially. They want people to think of PAs as second rate, and that doctors are infallible.

In my case, my doctor felt that because colorectal cancer (at the time) was relatively unusual for my age demo, that he didn't really need to consider it. Instead of doing an actual DRE, or a fecal occult blood test, he simply dismissed it out of hand (pun intended) as internal hemorrhoids. A year later, I was having a full resection, chemo, radiation treatment, and a permanent colostomy. Thanks!

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

#322

Post by zepto » Sat, Aug 03, 2019, 3:58 PM UTC

mettamage wrote: post #167

residentfoam wrote: post #160

Earlier quoted context omitted.

I have mixed feelings about this. As society, we seem to be ok with millennials fresh out of college making hundreds of thousands of $$$ a year for a bunch Javascript that allows people to share pictures of their butt with their friends BUT we are not ok with doctors who literally - save lives - getting paid according to their responsibilities? Same goes with football/basketball/etc.. players whose sole purpose in li…

Don't worry, that's only the in the US. In Switzerland, for example, many people are paid a lot. They also pay a lot. In The Netherlands, psychiatrists have a higher entry level salary than the average CS grad.

That’s why so many Netherlands tech companies are international household names.

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

#323

Post by mewop » Sat, Aug 03, 2019, 5:14 PM UTC

ITT: people who assume doctors are accountants and go home in their sports car every night to tweak their prices and count the stacks of 100s they made that day

The reality is is doctors often have no control over cost. Yes, if you are the increasingly rare private group that is physician owned you do but certainly not if you are employed. These are 100% set by the bean counters who are paid twice my salary and have no idea about what we do on a day-to-day basis.

I have no idea what my services cost and for ethical reasons I don't want to. That inflicts bias and can lead to misdiagnosis.

I sacrificed 10 years of my life and took on over $275,000 of debt that continues to grow thanks to compound interest. I live in an average house and drive an average car because I have this debt to pay back.

Daily I am responsible for not harming dozens of patients while trying to make their lives better. With each decision I make I have the risk of being sued and losing everything I have worked for. All the while, my mid-level providers work relatively liability free because they work under my license and their mistakes are on my back. Adminstration pushes for higher numbers of patients andmore uncompensated work. When was the last time you spoke to a lawyer on the phone or had them complete a 5 page document for free?

Think twice before you criticize doctors and the sacrifices we have made. I didn't do this for the money, I assure you.

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

#324

Post by squirrelicus » Sat, Aug 03, 2019, 7:12 PM UTC

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…

This was highly unethical. There is a minimum operational overhead to offering minimum care, including the availability of emergency equipment and staff. I have a local ER I've visited twice this year and there's almost never any patients there in the middle of the night. But dozens of medical personnel and the building and all the medical equipment i could imagine are always there and ready for me when I need it, on demand, no questions asked. This is what the American medical system optimizes for. And it costs a lot of money.

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

#325

Post by omegaworks » Sat, Aug 03, 2019, 7:24 PM UTC

moate wrote: post #72

omegaworks wrote: post #52

Earlier quoted context omitted.

[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 reallocat…

> they know that the insurance companies can afford it since they have such large pools of money

This is exactly why Medicare for All is touted as a solution. It would create the largest pool.

It would also reduce the significant overhead presently involved with billing N different insurance companies. Why isn't the conversation about those costs imposed by the current system?

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

#326

Post by np_tedious » Sat, Aug 03, 2019, 7:31 PM UTC

cosmie wrote: post #143

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 never received a ding on my credit report. Non-medical and medical collections tend to get different treatment nowadays[1][2]. It may have ended up on your credit but after a super long delay, or it'd disappear entirely if they were able to get something out of your insurance instead. And even if it shows up on your credit report, depending on the specific scoring model being used, it still may not have had much…

Is there any potential for an incident like this without a loan agreement to impact credit history / score?

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

#327

Post by nonbel » Sat, Aug 03, 2019, 7:46 PM UTC

crazygringo wrote: post #320

nonbel wrote: post #318

Earlier quoted context omitted.

There is a "cash price" in many contracts between the insurance company and provider. If you tell them you have insurance the provider must quote you this inflated price. You need to go to a place that does not know you have insurance, say you do not have any, and then get the cash price from them.

How do you know that? I'm looking online and can't find any mention whatsoever. What's the contract term for it? And what percentage of health plans in the US does that apply to? And how often do doctors actually follow that? In my case, the doctors in this office are certainly unaware of anything like that. Like I said, the doctor quotes the cash price, which is standard for the office, not having the slightest idea…

Read here: https://selfpaypatient.com/2015/05/12/insured-but-not-lettin...

How can it otherwise possibly make sense that they charge more for not having to deal with insurance company bureaucracy?

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

#328

Post by Noumenon72 » Sat, Aug 03, 2019, 7:51 PM UTC

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…

I presume you were billed $85 for the tuning fork?

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

#329

Post by Stratoscope » Sat, Aug 03, 2019, 7:58 PM UTC

Noumenon72 wrote: post #328

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…

I presume you were billed $85 for the tuning fork?

No, only the normal charge for an office visit.

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

#330

Post by EliRivers » Sat, Aug 03, 2019, 8:49 PM UTC

eragone wrote: post #312

throwaway100773 wrote: post #98

Earlier quoted context omitted.

Well said. I get a lot of flak from, well, pretty much everyone for pointing out that your neighborhood doctor is likely a scam artist. Clearly I’m generalizing but just suggesting it may be the case is usually met with undue skepticism. Not to mention, having an inside look at med school gives you a different perspective on the motivations of most rising doctors. It’s rarely about anything but lifestyle and money. I…

Not sure where you went to med school, but couldn't be different for me for med school and residency. Very little of being a doctor has to do with money. If I wanted money, I would have stayed in software and not gone another half a million in debt.

But the median salary of a doctor is much higher than the median salary of a software engineer; or is it just the debt that you mean?