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What Happens When Doctors Only Take Cash (2017)

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Re: What Happens When Doctors Only Take Cash (2017)

#131

Post by mikestew »

Agathos wrote: post #115
mikestew wrote: post #72

Earlier quoted context omitted.

I'll let an ex-mechanic answer: me. In that situation the service writer (my go between me and the customer) calls the customer and tells them what is needed. If they don't want to do it, button it up and send them on their way. In your made-up example, there are fixes for a stripped drain plug that don't require dropping the oil pan. If it weren't for Jiffy Lube (who, more than once, stripped it before it got to me)…

People leap straight for the heart surgery example as if to imply it justifies the lack of price transparency for routine medical procedures where the patient is fully conscious. Why is that?

There's a perfectly reasonable explanation, but your adversarial tone suggests that you don't actually care what it is.

Re: What Happens When Doctors Only Take Cash (2017)

#132

Post by crpatino »

otakucode wrote: post #53

You son has broken his arm. The doctors in your town will only take cash. One of the doctors charges $50 to set the broken arm. The other doctor charges $500. Which one are you going to take your child to? Most likely, the $500 one. Because going to the bargain basement doctor is not something you do when dealing with medical issues if there is absolutely any way to afford it. It creates what I call 'reverse capitali…

> Which one are you going to take your child to? Most likely, the $500 one.

To some degree, yes. Notice also that if your are has only two doctors, there will be plenty of people for whom a $500 bill would be cause of financial disruption. And the cheap doctor is going to notice that people see such price as a synonim of bad quality, so both doctors will likely move towards the center and end up charging $150 vs $350 instead.

In more populated areas, the same effect creates a sort of consensus about what a "fair price" should be, corrected by prestige, seniority etc. Individual doctors deviate from that "fair price" based on their ability/willingness to provide more "value added" paraservices. Eventually, they end up serving different market segments.

p.s. This is informed speculation on my part, from the child of a pediatrician in Mexico, where public healtcare, US-style private insurance, and cash based practice coexist on a day to day basis.

Re: What Happens When Doctors Only Take Cash (2017)

#133

Post by [deleted] »

nybble41 wrote: post #125
jimbokun wrote: post #89

Earlier quoted context omitted.

But the heart surgery example is the exception. Many medical procedures and therapies have very predictable costs and outcomes. And have checkpoints to re-evaluate whether to proceed further. And accountants and could probably also price in the cost of the occasional problematic case and include a buffer in the standard price to account for it. There are plenty of straight forward ways to provide prices for the vast…

And for the cases where a decision is needed mid-surgery, the patient should have someone standing by to represent their interests and make those decisions on their behalf.

[deleted]

Re: What Happens When Doctors Only Take Cash (2017)

#134

Post by FLGMwt »

serichsen wrote: post #122

From my german perspective, every assumption in this article looks quite gross and barbaric. Here, everyone is insured. If you break your arm, you get it fixed. If you get cancer, you get therapy. If you get the flu, you get a prescription. The overall cost is paid by the entire population, through the insurance system. For what is the alternative? Maybe the overall monetary cost would be lower if everyone had to wat…

As an American working in healthcare tech: it is absolutely barbaric.

We have the most expensive medicine in the world, but it's all treatment, not prevention and both only for those who can afford it.

Re: What Happens When Doctors Only Take Cash (2017)

#135

Post by inopinatus »

maxxxxx wrote: post #76
sethammons wrote: post #32

Earlier quoted context omitted.

Heh. I have tried to call to see the cost. I see a retina specialist twice a year. I recently changed to a high deductible plan with an HSA. I called to see what the cost of my appointment would be. They could not or would not tell me. Incall three separate times, talking to different people and different departments. I went in and continued asking the front desk. "It depends on the services you end up getting." Ok,…

The same happened to me when I had an HSA. Estimated price for a procedure was first $4000, then $2000, then $100. Eventually paid $500. they just seem to make up prices.

As the anecdotes offered in these threads illustrate, it is not possible to cost or value healthcare on an individual basis.

Therefore, any market for individual purchase of healthcare (whether via insurance or directly) can only have faulty price signals.

Systems based on markets with faulty price signals are wide open to manipulation.

The perpetuation of such markets is contemptible, and particularly so in the case of healthcare since there is a straight line to be drawn from dysfunctional systems to human suffering.

Re: What Happens When Doctors Only Take Cash (2017)

#136

Post by chrisbennet »

javadocmd wrote: post #101
c3534l wrote: post #83

Earlier quoted context omitted.

> They introduce a massive bureaucracy and massive costs and provide very little value. I very much disagree. When I didn't have medical insurance, doctors charged me twice what they charged the insurance companies. Insurance companies have a vested interest in reducing the costs of medical care, while doctors have a vested interest in increasing them. Screwing patients out of payments is not an aligned business mode…

> When I didn't have medical insurance, doctors charged me twice what they charged the insurance companies. You've identified the symptom but misattributed the cause. You ran afoul of the charge master system of billing, which is a byproduct of our insurance-based healthcare system and the laws which uphold it. In short, providers are "forced" to set their base rates high in the knowledge that insurance companies (th…

”Meanwhile, federal law enforces (under very stiff penalty) that individuals cannot negotiate nor be given a discount from the base rate.” I negotiated a discount for an operation a few years ago. Is this law you’re speaking of relatively new?

Re: What Happens When Doctors Only Take Cash (2017)

#137

Post by derekp7 »

conanbatt wrote: post #60
linsomniac wrote: post #24

My local mechanic is required by law to tell me how much something is going to cost me before they start work. Why is my doctor not held to the same standard. Ever tried calling a provider to find out how much something is going to cost? Sounds like the medical industry had better lobbyists.

Because the cost is unknown until treatment is over. Also, funny comparison, try to make it with software engineering.

Car mechanics have "book hours" for each task. It may take them less time, or more, but they charge what is in the book. For example, changing a headlight is 1/4 hour, at $120.00 an hour, so they charge $30.00 plus parts.

What I'd like to see for medical services, is something like an apendepticamy takes 1 hour to perform, plus 4 hours of prep, and 2 hours follow up spread over several weeks. The procedure uses one primary surgeon, one assistant, 2 nurses, an and anesthesiologist, each charging x per hour (depending on role / specialty). The hospital charges y per hour for the room, z for the supplies.

All of this is known ahead of time. Yes, there can be complications. Just like a mechanic can run across rusted on bolts that take longer to remove. But going by book time for everyone works out in the averages.

Heck, both dentists and optometrists work in this fashion for most of their services. Why can't the rest of the medical world get it together?

Re: What Happens When Doctors Only Take Cash (2017)

#138

Post by wrycoder »

javadocmd wrote: post #101
c3534l wrote: post #83

Earlier quoted context omitted.

> They introduce a massive bureaucracy and massive costs and provide very little value. I very much disagree. When I didn't have medical insurance, doctors charged me twice what they charged the insurance companies. Insurance companies have a vested interest in reducing the costs of medical care, while doctors have a vested interest in increasing them. Screwing patients out of payments is not an aligned business mode…

> When I didn't have medical insurance, doctors charged me twice what they charged the insurance companies. You've identified the symptom but misattributed the cause. You ran afoul of the charge master system of billing, which is a byproduct of our insurance-based healthcare system and the laws which uphold it. In short, providers are "forced" to set their base rates high in the knowledge that insurance companies (th…

My last visit to the dermatologist was over $1000 for an office visit that involved a skin tag clip with a scissors and two squirts of LN. Medicare negotiated that down 70% to their preapproved rate and paid about $300, of which I paid 20%. Medicare is just another insurance payer, not a health provider.

If you are talking about the US, we have several times in the past negotiated our bills down as much as 20%. It does not appear to me that there is anything illegal about that.

But it does gall that they try to charge someone without insurance and with no bargaining power the full rate, well knowing it’s a fake rate.

Re: What Happens When Doctors Only Take Cash (2017)

#139

Post by maxxxxx »

jimbokun wrote: post #86
linsomniac wrote: post #24

My local mechanic is required by law to tell me how much something is going to cost me before they start work. Why is my doctor not held to the same standard. Ever tried calling a provider to find out how much something is going to cost? Sounds like the medical industry had better lobbyists.

In a sane world, this would be the free market solution being pushed by the supposedly free market crusading Republicans. Seems like the obvious market-oriented approach to bring down costs: tell people what the costs are! Instead, the only plan Republicans can come up with is kick more people off their insurance, and don't change anything else.

Indeed! If any of the "free market" guys would advocate price transparency and other measures to create functioning market I would start listening. Instead the only thing they seem to want is the freedom for providers and insurances to screw their patients and if the patient can't afford it, just die.

Re: What Happens When Doctors Only Take Cash (2017)

#140

Post by jjeaff »

maxxxxx wrote: post #76
sethammons wrote: post #32

Earlier quoted context omitted.

Heh. I have tried to call to see the cost. I see a retina specialist twice a year. I recently changed to a high deductible plan with an HSA. I called to see what the cost of my appointment would be. They could not or would not tell me. Incall three separate times, talking to different people and different departments. I went in and continued asking the front desk. "It depends on the services you end up getting." Ok,…

The same happened to me when I had an HSA. Estimated price for a procedure was first $4000, then $2000, then $100. Eventually paid $500. they just seem to make up prices.

I don't think they necessarily make up the prices, but I wonder if there is an accounting reason for the "MSRP" on procedures being so high. I will frequently see things like a $2,000 charge to the insurance company and then it will show that they ended up paying something like $185 for the service and they disallow the rest.

Perhaps it is just to make sure they always get the max from the insurance companies. Or maybe they are able to write off the portion that the insurance company won't pay as a loss or bad debt.

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