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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)

#51

Post by Buttons840 »

harrisreynolds wrote: post #46

I've been wondering for a while now why health insurance companies exist at all. They introduce a massive bureaucracy and massive costs and provide very little value. They evolved from a reasonable idea into a monster that just drains our system and do not provide enough value to justify their existence in my opinion.

Yeah. I've worked a few places in the healthcare industry, and I've always felt that I'm part of some ancillary service that would be better if regulated and automated. For healthcare to get cheaper the system must be made smaller, people will have to find new jobs.

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

#53

Post by otakucode »

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 capitalism.' You can only draw more customers by charging the highest price in the area.

If your customers stop even being the ones footing the bill, it accelerates to a patently insane level. That makes footing peoples insurance bills a ludicrous and idiotic business to get into. Unless, of course, you've got protection from the government or special considerations where antitrust laws do not apply to you so you can engage in price-fixing, intimidation, and other tactics.

Made to compete fairly, medical insurance companies would be out of business overnight because it's a downright stupid business to begin with.

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

#54

Post by javadocmd »

ksenzee wrote: post #28
asmithmd1 wrote: post #18

Cash payments don't count toward a patient's (insurance) deductible This seems like a problem. How is this not an anti-trust violation? In order to benefit from the insurance contact you purchased, you must use a provider who will submit to an insurance company's capricious payment system.

This is probably a simplification. Normally if you use an out-of-network provider, the cost counts against your out-of-network deductible, which is significantly higher than your in-network deductible. So it may well be that his insurance would count this against his out-of-network deductible, which is so high that he would never reach it anyway.

No. In order to utilize your insurance plan's out-of-network services, the insurance company has to be in the loop. A cash-based system completely circumvents insurance.

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

#56

Post by Jemmeh »

killjoywashere wrote: post #30

This whole thread is full of young, SV libertarians who haven't really thought out what healthcare involves. Lawyers don't have an upfront, all inclusive price for divorce, they charge by the hour. I'm pretty sure software developers charge by the hour, at least for the interesting work. Sure, I'll build you a Wordpress blog for $3k. Would you gaurantee you could build a clinic website that supports major insurance a…

There's some things that definitely are going to be uncertain, but there are a -lot- of procedures that could be given a price tag. I can't even get info like, "How much will it cost to have an ultrasound? Not doing anything after that, but just for the ultrasound itself?" I've had somewhat similar issue with getting bloodwork done too. A lot of stuff can be broken down into smaller parts and put a price tag on that. Sure, it might take 5 years to diagnose, but that can be broken down into (5 hrs with doctor examination, 10 bloodwork tests with XYZ factors, 4 checkups, 10 months of X pill, etc).

Unfortunately it's not that simple, the hospital doesn't want to charge everyone the same amount. They want to get the most they can out of everyone. Insurance companies want to pay less. Government laws get thrown in.

There's a lot of issues with healthcare but knowing the general actual cost of standard procedures isn't one of the big problems. That's worked down to an art, after all insurance companies have to estimate that cost.

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

#57

Post by IncRnd »

mcny wrote: post #50
IncRnd wrote: post #38

Earlier quoted context omitted.

The problem really isn't the doctors but the structure of insurance and how people treat health care and health insurance similarly. The worst part is that high costs aren't directly the fault of insurance companies but of government having driven the need for insurance. Health care used to be all cash, and people carried catastrophic health insurance policies only. We are moving back towards that. This isn't stating…

> The problem really isn't the doctors but the structure of insurance and how people treat health care and health insurance similarly. The worst part is that high costs aren't directly the fault of insurance companies but of government having driven the need for insurance. Health care used to be all cash, and people carried catastrophic health insurance policies only. We are moving back towards that. This isn't stati…

> Here's one example. A (probably not domesticated) cat scratched someone. They went to get shots. Waited a couple of hours and got the shot. Bill in the mail for about $8k. Somehow, I really doubt Humana paid their 80% which is $6,400 but of course the patient has to pay the 20%. I suspect what is happening is that Humana pays close to $0 and the patient picks up the whole tab of $1,600.

I totally get your point, but is that real example?

http://health.costhelper.com/cat-scratch-disease.html

Typical costs:

- For patients covered by health insurance, out-of-pocket costs typically consist of doctor visit copays, prescription drug copays of $5-$50 or more, or coinsurance of 10%-50%. Cat scratch fever treatment typically is covered by health insurance.

- For patients not covered by health insurance, cat scratch fever treatment typically costs less than $10 for over-the-counter pain relievers. For severe cases in which antibiotics are required, it typically costs from $30-$90 for oral antibiotics. For example, Drugstore.com charges about $30 for a two-week course of the generic antibiotic rifampin. It charges about $80 for a two-week course of the antibiotic ciprofloxacin. And it charges about $90 for a two-week course of the generic oral antibiotic azithromycin.

- In the extremely rare cases in which serious complications occur and hospitalization is required, cat scratch fever treatment can cost tens of thousands of dollars. According to Medscape.com, the median hospitalization charge[1] for cat scratch disease is about $46,140.

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

#58

Post by Clubber »

maxerickson wrote: post #36
Clubber wrote: post #19

Earlier quoted context omitted.

There is an Adam Ruins Everything episode about that. Basically hospitals were reasonable, then insurance companies came along and brought extra business to hospitals. For that, they felt they deserved a cut. Since the hospitals were mostly non-profits, or low profit, they didn't have anywhere to cut, so in response they raised their rates to provide a cut. There is more to it, but that's the origin of the charge mas…

The American Hospital Association tracks uncompensated care (bad debt and forgiven bills): https://www.aha.org/system/files/2018-01/2017-uncompensated-... It's around $40 billion per year in recent years (for all US hospitals). With hospital spending around $1 trillion, it's 4 or 5% across the industry. There are of course individual hospitals that face higher costs.

Thanks. I must have remembered it wrong. Even with a variance, 25% seems way to high.

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

#59

Post by koolba »

friedButter wrote: post #41
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.

>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? Does that include a situation where say, when emptying out the oil, the nut over the drain breaks off which necessitates changing the oil sump, except they then discover the engine…

> Does that include a situation where say, when emptying out the oil, the nut over the drain breaks off which necessitates changing the oil sump, except they then discover the engine mounts are rusted and now the engine needs to be lifted and the mounts replaced? (I'm not a car guy, but I hope this demonstrates the thought even if inaccurate)

Yes it does because the mechanic is required to call you and say, "Upon further examination we also need to do ______ with will cost $XYZ. Do you want to proceed with this?".

If you say no you can pick up your car and go somewhere else. It's not that the mechanic is taking on the risk of an oil change turning into a full engine rebuild. They're simply required to announce what they're going to bill you for before they start work.

That way if the mechanic say, "It'll be $500 for me to change your cabin air filter." you can find a new mechanic.

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

#60

Post by conanbatt »

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.

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