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Old 03-22-2010, 10:40 AM   #41
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After reading recent posts, I'm not sure if the medical treatment was provided in an office environment at the pediatrician's office, or whether the OP's daughter was referred out to an urgent care center.

And if there was true pricing transparency, then the Dr could have said "ok, looks like you won't need stitches, we'll just clean the wound and slap a band-aid on it". At that point, they would tell the OP that their diagnostic charge is $126.14, and to clean the wound and put a bandaid on would cost another $315.36. Then they would ask you whether you want to pay $315.36 for them to dump some hydrogen peroxide and stick a bandaid on. As to the $315.36, surely some reasonable people would disagree as to whether they would require the professional services of a doctor (at that price) to do the "procedure".

Price transparency in an ideal world...
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Old 03-22-2010, 11:29 AM   #42
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Price transparency in an ideal world...
This works if you have a non-serious wound. It doesn't work if you have tingling up your left arm. You just don't have the time to ask for a price sheet. (We could wear medical bracelets with our hospital preferences?)


Rich, it makes sense that the clinic is spreading non-paying patient costs to ALL the patients.

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I see the uninsured patients, but then make up for my losses by increasing my charges to all my patients. The cycle continues: Insurers increase premiums, choking small businesses that then drop health coverage for their employees, leading more uninsured to come to my practice.
Health bill a milestone -- or a mistake? - CNN.com

But you're suggesting that clinics also spread the cost of the more expensive treatments (requiring machines and IVs and specialists on call) to everyone as well? This begs the question: Why then do the more serious treatments also cost such huge amounts? If the less urgent situations subsidize the more urgent, and the more urgent can financially ruin a middle class family [w/o insurance], then costs are truly out of control.

Really, this leads to: Why does it cost so much more in the US? What is unique about the US that we pay more for less?
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Old 03-22-2010, 11:50 AM   #43
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Really, this leads to: Why does it cost so much more in the US? What is unique about the US that we pay more for less?
I am not an economist, but my gut tells me that the laws of capitalism and a free market do not work well when the commodity in question is required, not just desired. Plus, your ability to shop around is highly limited by circumstance in many cases.

This leads me to conclude that governmental regulation - to the least extent that works - is required for an effective health care system to thrive. It also can protect the truly impaired.

Generally not a regulation enthusiast, I can't escape that conclusion after 35 years of working within (and often around) "the system."
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As if you didn't know..If the above message contains medical content, it's NOT intended as advice, and may not be accurate, applicable or sufficient. Don't rely on it for any purpose. Consult your own doctor for all medical advice.
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Accident at school
Old 03-22-2010, 07:41 PM   #44
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Accident at school

We're currently going through this with 2 of our kids (getting hurt at school). When I went to pick up my daughter to take her to the emergency room, the school nurse was there and handed me the school insurance form already filled out for me to finish and send to their insurance company to open a claim. For my son, they had an ambulance take him to the emergency room and we met him there. The school insurance form came in the mail the next day already filled out.

The school insurance picks up what ever our insurance doesn't pay or if we didn't have insurance. As far as I know schools are required to have insurance that covers the accidents kids have during school or on school sponsored events.

As far as paying the difference the insurance didn't cover. When we've been billed for the difference in the past our insurance company told us to call the hospital/doctor and tell them that they were already paid the fee (usual and customary) that had been agreed upon when they choose to accept that insurance and we weren't required to pay the difference.

We never had a problem or additional invoices sent to us. It may make a difference that we were part of an HMO I don't know.
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Old 03-22-2010, 07:51 PM   #45
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Really, this leads to: Why does it cost so much more in the US? What is unique about the US that we pay more for less?
You could ask the same question about our public education system. We pay more and get less than anywhere else in the world (I think Swiz pays more, but also gets more).

And that is with the 'public option'.

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Old 03-23-2010, 08:02 AM   #46
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I am not an economist, but my gut tells me that the laws of capitalism and a free market do not work well when the commodity in question is required, not just desired. Plus, your ability to shop around is highly limited by circumstance in many cases.
Your gut is smart. Those laws work quite well indeed they say the providers can charge anything they want and that prices do not go down when the supply is advantaged.

Quote:
This leads me to conclude that governmental regulation - to the least extent that works - is required for an effective health care system to thrive. It also can protect the truly impaired.

Generally not a regulation enthusiast, I can't escape that conclusion after 35 years of working within (and often around) "the system.
What troubles me the most about our current system and the reform is that there is some regulation. This has forced many service providers to undertake some pretty dramatic cost-shifting and allowed others to engage in exploitation. I suspect that is in part what leads us to the OP situation. And dont see yet all the changes that would remedy this, although they are clearly setting the framework.

I will say that since we FIREd and began to deal with individual health care insurance issues, we have successfully navigated the minefield with some invaluable help from family Docs who seem to know the workings better than just about everybody else - and exactly how to get through the system.
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Old 03-23-2010, 02:02 PM   #47
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I am not an economist, but my gut tells me that the laws of capitalism and a free market do not work well when the commodity in question is required, not just desired. Plus, your ability to shop around is highly limited by circumstance in many cases.
Your gut is smart. Those laws work quite well indeed they say the providers can charge anything they want and that prices do not go down when the supply is advantaged.
Actually, it isn't such a problem if we have transparency. An example:

If my furnace goes out on a -15F day, the furnace guys are all backed up with service calls. Furnaces will go out proportionately more during cold weather when they run proportionately more, and you can't wait till the next day or so like you can in mild weather.

But the furnace guy does not show up at the house after making several other calls and say 'mmmm, it's been 5 hours, house is getting cold, before long your pipes will freeze and you will have thousands of $ of water damage, and plumbing bills to deal with. BTW, did you know my BIL is a plumber? Well, I know all the other furnace guys are backed up, I'll come back in 5 hours, right about the time your pipes are ready to freeze up, and we will discuss rates then. I'll be back. Heh-heh-heh.'

Nope, it doesn't happen (not in my experience). They post rates, maybe 1.5x or 2x or 2.5x on w/e, holidays, etc, but they are consistent. Why? Is there a law, or a 'furnace repair fee regulation committee'? Not that I know of. But these guys have established businesses in the area, and if they screw with you word will get around and their business will fail.

No reason we can't have that kind of transparency in the medical field. It might take some regulation to get the transparency in place (like the performance/fee rules for mutual fund performance), but I'd rather see that than a bunch of bureaucrats trying to monitor all this - the kind of people who missed Madoff and Geithner.

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Old 03-23-2010, 02:42 PM   #48
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Is there a law, or a 'furnace repair fee regulation committee'? Not that I know of. But these guys have established businesses in the area, and if they screw with you word will get around and their business will fail.
That doesn't mean that there aren't furnace repair guys ripping people off in less detectable ways and getting away with it. If he charges outside of his normal fees because you're desperate that falls into the category you're talking about. But what if he adds on a little here and a little there just depending on what he thinks the traffic will bear? He charges the same for a call, the same hourly charge, and has the same markup on parts that every furnace guy in town has - it's just that he takes longer to fix your furnace, needs to replace more parts, etc. A dirty igniter that could be cleaned and adjusted is replaced, or the circuit board that controls the igniter has to be replaced. It's a reasonable assumption on his part that if you really knew what needed to be done and could do it yourself, you would probably be up there doing it yourself.

With visibility you can compare one thing to another, but when the consumer is in dire need and the provider is an expert in the field in which the consumer is mostly ignorant the consumer is at a disadvantage. Apples to apples comparisons are fine until it comes time to pay the bill and you find yourself charged for a lovely fruit basket.
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Old 03-23-2010, 03:21 PM   #49
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That doesn't mean that there aren't furnace repair guys ripping people off in less detectable ways and getting away with it.
True, but I just don't see all that much outrage from consumers when they buy a product/service offered in a relatively free market ( 'free-ness' is a matter of degrees).

I bet someone could do a fairly scientific analysis of this. Compare customer satisfaction ratings in different markets. I'm quite certain we would see a correlation between CS and the 'free-ness' of that market.

Very few people really understand how a TV works, or could determine if high reliability components were used in them or not, yet I bet most people are pretty satisfied with the price/performance of their TV purchases. Lots of competition there, a fair amount of transparency.

Cable and Satellite TV services aren't life-threatening emergency purchases. But there isn't a very free market there, and IIRC a recent consumer reports recc Sat over cable because of the CS numbers. Essentially, a high % of people were dissatisfied with their Cable or Sat providers, but... fewer people 'hated' their Satellite co, so CR recc Satellite. The lesser of two evils.

Throw cell phone providers in the mix.

There is no 'perfect' answer, but increasing transparency in the medical field would certainly help, IMO. I don't see how it could hurt.

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Old 03-23-2010, 03:30 PM   #50
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tapper, how is your daughter doing?

(aside from that $441 hit to her allowance...)
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Old 03-23-2010, 03:35 PM   #51
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There is no 'perfect' answer, but increasing transparency in the medical field would certainly help, IMO. I don't see how it could hurt.

-ERD50
Definitely agree there. For years I've suggested via e-mail and face to face with BCBS company rep that their EOB's should list the procedures and treatments so that I could confirm that this is correct and help stop fraud. The only times I really push the issue is if I have a large bill to pay and on a few occasions I have been rewarded with a reduced bill because of a "coding error".

Today for example I get the first of the EOB's for DW's annual physical last month. We don't have a penny to pay so why bother, but it bugs me that I can see 7 line items, all with the same claim number but I have no idea if BCBS is paying for things / tests that weren't done or were not necessary.
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Old 03-23-2010, 03:46 PM   #52
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Cleaning the wound and applying the bandage cost $19.95

The rest goes into the help-the-poor fund.


Thanks for doing your "Fair Share"
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Old 03-23-2010, 03:54 PM   #53
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tapper, how is your daughter doing?

(aside from that $441 hit to her allowance...)
She is doing fine and her finger is fully functional although it now has a large scar.

Thanks for asking.
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Old 03-23-2010, 03:58 PM   #54
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Today for example I get the first of the EOB's for DW's annual physical last month. We don't have a penny to pay so why bother, but it bugs me that I can see 7 line items, all with the same claim numbe,r but I have no idea if BCBS is paying for things / tests that weren't done or were not necessary.
I just finally (I hope) labeled "done" to a medical bill that has been a comedy of errors. It was for anesthesia services from my son's operation in June, and they have billed half the insurance companies in town except mine. Then they would send me the bill when that company refuses to pay. The numbers are always different, explanations are different, etc.

I've got BCBS as well, and the bill I received for a surgery and multi-day hospital stay had 8 line items. No detailed billing at all. I hope they got more detailed info other than: "Medical/Surgical Supplies and Services" $3,466.00.
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Old 03-23-2010, 06:14 PM   #55
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My 6 year old son fell here in our home late into the night a few months ago. My husband took him to the emergency room where the attending physician didn't believe he needed stiches but instead used a special type of glue and put a bandage on it. The cut was small, under the chin. The bil was for $1262.....our health insurance pays for the first 1200 per year and we are responsible for the next $3000 per year, so there you have it....a small chin cut used almost all our insurance allowance. I did give my husband a piece of my mind...lol...I was of the opinion not to take him and to wait to the next morning to go to the peditricians office to see if stiches were needed.....live and learn.
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Old 03-24-2010, 01:56 AM   #56
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I've got BCBS as well, and the bill I received for a surgery and multi-day hospital stay had 8 line items. No detailed billing at all. I hope they got more detailed info other than: "Medical/Surgical Supplies and Services" $3,466.00.
I've called BCBS to report potential provider fraud and they couldn't have cared less.
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