Cost-Conscious, Self-Managed Care

[jim584672]

I was watching a show on hospital rates for supplies and services. Apparently they just make up prices out of thin air for their list. That is how you get a charge of $10 for a Tylenol. They expect to be negotiated downward if they bill a person.

 

[John Galt III]

There's a website called walkinlab.com where you can go and order blood tests. They take your money by CC and then refer you to the local Quest or whatever. You don't need your docs prescription to go there as they get around that by having "their doctor" order it. My PSA cost $110 at the normal doctor recommended place , but only $37 here.

Also, on the Blue Shield website there's a way of comparing local places for the cost of X-rays, MRIs, blood tests etc. Quite interesting to look at the major differences locally. Definitely stay away from hospitals for any tests.


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Bmcgonig, Thanks for the referral to walkinlabs.com. I assume you do not need insurance there? And I agree the Blue Shield website is good for discovering costs. I used it when I had bcbs. Funny thing though, bcbs was telling me to avoid hospitals for tests since they were so expensive, but when I went to the website, it recommended a hospital for an ultrasound, when there was a much cheaper independent lab available. I called them up about it and they said just go to the hospital for the ultrasound, no problem, just a small copay for me. Oh well, I tried. to keep costs down but they didn't seem to care. I decided to go tothe expensive hospital since that is where my doctor suggested I go. I saw the bill for the ultrasound, which was $1,500 for the actual ultrasound, and another $1,500 for a doctor interpreting the ultrasound. bcbs paid the hospital about $600 for the ultrasound and paid the doctor $600 for the interpretation. So bcbs paid them almost half of what they billed, as opposed to the usual 20 percent. I guess I'm not supposed to care since I just have the small copay.

 

[John Galt III]

Your friend can't be right.... MLR requires that at least 80% of health insurance premiums (for individual health insurance, 85% for large groups) be spent on care so that leaves 20% or less for overhead and profit/return on capital.

Hmmm. It now makes sense why my bcbs policy paid so much for my ultrasound, which was done in December, 2015. Maybe bcbs realized they had to pay out more in claims to reach the 80%, so they started funneling high payments to certain hospitals where they have some sort of kickback program established. That way bcbs doesn't have to rebate as much (or any) money to the premium payers for 2015. They'd keep it all *in house*. Just a theory....

 

[audreyh1]

One of my FaceBook contacts posted an item stating compensation of CEOs of 4 major health insurers and blaming high premiums in CEO pay. I did a little math and responded that if those 4 companies covered 80% of the US population and we reduced their pay to zero, it would decrease the average policy by $71. (Even if it's 40% due to Medicare, Medicaid and the uninsured, it's not a major dent in annual premiums.)

When I posted a link to a Harvard study calculating the extra costs on our healthcare system due to obesity and its consequences (I think it was $1.5 billion in 2009) she was livid. I had to back off.

$71 a month or a year? Because the former would be significant to most people.

 

[audreyh1]

I was watching a show on hospital rates for supplies and services. Apparently they just make up prices out of thin air for their list. That is how you get a charge of $10 for a Tylenol. They expect to be negotiated downward if they bill a person.

That's my understanding.

 

[pb4uski]

Hmmm. It now makes sense why my bcbs policy paid so much for my ultrasound, which was done in December, 2015. Maybe bcbs realized they had to pay out more in claims to reach the 80%, so they started funneling high payments to certain hospitals where they have some sort of kickback program established. That way bcbs doesn't have to rebate as much (or any) money to the premium payers for 2015. They'd keep it all *in house*. Just a theory....

Did they make you remove your tin-foil hat before they did your ultrasound?

 

[MichaelB]

Did they make you remove your tin-foil hat before they did your ultrasound?

Did you take an extra grumpy pill for breakfast this morning?

 

[pb4uski]

No, just the usual one grumpy pill. Nothing extra today. Thanks for asking.

 

[athena53]

$71 a month or a year? Because the former would be significant to most people.

Year.

 

[razztazz]

I was watching a show on hospital rates for supplies and services. Apparently they just make up prices out of thin air for their list. That is how you get a charge of $10 for a Tylenol. They expect to be negotiated downward if they bill a person.

HA! Just like a Mexican flea market. Or Mr Haney on Green Acres

 

[athena53]

I was watching a show on hospital rates for supplies and services. Apparently they just make up prices out of thin air for their list. That is how you get a charge of $10 for a Tylenol. They expect to be negotiated downward if they bill a person.

I read an interview with the authors of a book on "Spinglish"- phrases or words used as euphemisms, or in the interests of political correctness, or just to obfuscate. They had sources for the everything- you don't have to make this stuff up. One hospital bill reflected a charge for a "disposable mucus extraction system". Said system was a box of Kleenex.

 

[John Galt III]

Did they make you remove your tin-foil hat before they did your ultrasound?

No, but unfortunately it appears that you may be the wearer of an ***hat.

 

[MichaelB]

Let's disagree without being disagreeable, eh?

 

[M Paquette]

I was watching a show on hospital rates for supplies and services. Apparently they just make up prices out of thin air for their list. That is how you get a charge of $10 for a Tylenol. They expect to be negotiated downward if they bill a person.

That's the current solution for the "wealthy Arab sheikh" problem. Seriously. There is a real concern with hospital management groups that they maximize revenue opportunities from some classes of customers that self-insure. That leads to the insane charge master pricing for a Tylenol or mucous recovery system (or the bag to hold your clothes, only $20, cheap...).



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[Walt34]

I had lunch with an intern recently and I asked him why he thought that medical costs were so high. He said it was simple, the insurance companies were charging too much.

 

[audreyh1]

That's the current solution for the "wealthy Arab sheikh" problem. Seriously. There is a real concern with hospital management groups that they maximize revenue opportunities from some classes of customers that self-insure. That leads to the insane charge master pricing for a Tylenol or mucous recovery system (or the bag to hold your clothes, only $20, cheap...).

But I have seen the opposite of this for routine procedures like screening colonoscopies. Cash price lower than what is billed to the insurance company, and even lower than what the insurance company discounts!

It's just a mess.

 

[HadEnuff]

My step-son was charged $22,000 for 12 stitches in the ER in Brooklyn NY...

Not a misprint...22,000...twenty-two thousand dollars....insurance knocked down to something in the neighborhood of $400 for the entire visit.

 

[pb4uski]

Perhaps they need to limit the amount of a discount that they can offer off of the rack price for any procedure in order to get some sensibility in pricing. For example the most a provider can discount is 80% and their "best" price for a procedure is $400 then the most they could charge is $2,000 (even to an Arab sheikh).

 

[zinger1457]

My step-son was charged $22,000 for 12 stitches in the ER in Brooklyn NY...

That is crazy. Maybe there was more to your step-sons treatment than a simple stitch up but two weeks ago I had a cut stitched (5 stitches) at my local urgent care. They billed my insurance company $81, my insurance paid $53.

 

[redduck]

... If you simply believe I'm just ignorant, that's okay. I'm not.

... us as consumers and and health care professionals as providers. That was my point.

Well, maybe a bit ignorant in some areas.

note: bold by redduck

 

[r2021t]

Well, maybe a bit ignorant in some areas.

note: bold by redduck

Hell, redduck, I'll bet there are more than just that one. We could turn my grammatical errors into a drinking game!

I just hope the moderators don't start charging for all my mistakes. I'll have to go back to work.

 

[redduck]

...Yes, we definitely need to be aware of out of pocket costs. I also have a Group Health plan in Washington and mine is a bronze high deductible plan with a $4500 per person deductible...

Just using as the above quote as an example of why a doctor can't tell a patient how much medical treatments/procedures may cost.

The doctor would have to know which insurance company you are using (e.g. Blue Cross); which plan (e.g. Gold, Silver, Bronze, etc.); where you are in your deductible; if there are there any medical bills that have not yet been processed; if your policy contains some sort of clause regarding not only a per person deductible but also a family deductible (and many other variables that don't immediately come to mind).

And, then there's that pesky co-pay along with hospital fees (if applicable) and consultant fees (if applicable).

The conversation goes like this:
Pt. I have sore throat, eight days now.
Doc: Sore throat, huh?
Pt. Yep.
Doc. OK, I'll need to look down your throat.
Pt. What will it cost?
Doc. Well, it might depend if you want me to use a tongue depressor or my finger, but I will need to charge you if you want me to wash my finger. Depending on the plan, it may pay in part for the washing. Also, keep in mind, some plans pay for the tongue depressor, some don't. So, which insurance to you have? Which plan?, etc.

Doc: Okay, now I need to look in your ears.
Pt. What's that going to cost me?
Doc: Want me to look in both ears?

 

[MichaelB]

I just hope the moderators don't start charging for all my mistakes. I'll have to go back to work.

No worries. Not gonna happen, nohow, nowhere. Otherwise lots of us would have to follow suit.

 

[travelover]

Just using as the above quote as an example of why a doctor can't tell a patient how much medical treatments/procedures may cost.

The doctor would have to know which insurance company you are using (e.g. Blue Cross); which plan (e.g. Gold, Silver, Bronze, etc.); where you are in your deductible; if there are there any medical bills that have not yet been processed; if your policy contains some sort of clause regarding not only a per person deductible but also a family deductible (and many other variables that don't immediately come to mind).

And, then there's that pesky co-pay along with hospital fees (if applicable) and consultant fees (if applicable).

......

Your example is humorous, but with all of your data in their computer, this information should be a click or a finger flick away. With annual per person medical costs in the USA about $9000 per, I think it is past time for docs to know what things cost. Maybe not a tongue depressor but surely an MRI.

 

[pb4uski]

Well... I've already given them my insurance card when I made the appointment and when I checked in for the appointment, so they have had that information for some time and should at least be able to tell me what the negotiated charge is for the proposed procedure or test and that it could be lower if I have satisfied my deductible.