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View Poll Results: Would you share the price you paid for medical procedures?
Yes, I would want to do my part to build a database of prices that helps healthcare consumers. 40 52.63%
Yes, But only if .... (fill in the blank) 1 1.32%
Maybe, Depending on how I felt about the site/organization. 15 19.74%
No, Even if they said personal info would be removed, I don't trust them. 7 9.21%
No, Just too much of a pain to upload or scan. 0 0%
No, Building a price database wouldn't help healthcare consumers. 5 6.58%
N/A, I don't live in the US and/or it's not a problem where I live. 8 10.53%
Voters: 76. You may not vote on this poll

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Old 11-14-2015, 04:38 PM   #21
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I really like this idea. Wish I thought of it.
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Old 11-14-2015, 05:06 PM   #22
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I'd sure contribute. We need something like this.
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Old 11-15-2015, 09:50 AM   #23
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I just realized that there is a use-case (function) that having this database built would enable: Price My EOB
I think there will a be gazillion uses for this data and an incredible number of researchers / economists who would like to access it. Also, I wonder if the BLS would be interested in it for CPI? (side question does CPI-U actually track any healthcare costs besides premiums?)

The only problem I see is how do you get a critical mass of users uploading photos/scans/screenshots of their EOB?
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Old 11-16-2015, 09:22 AM   #24
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I think there will a be gazillion uses for this data and an incredible number of researchers / economists who would like to access it. Also, I wonder if the BLS would be interested in it for CPI? (side question does CPI-U actually track any healthcare costs besides premiums?)

The only problem I see is how do you get a critical mass of users uploading photos/scans/screenshots of their EOB?
You hit the nail on the head. I know for a fact that if you build it, they will NOT come unless something compels them.

The "what's in it for me" would have to be, I think, the ability to have their historic EOB's priced-out under different insurance companies / different insurance plans. The first batch of people wouldn't get information since there would be none. Maybe there could be a message that they could log back in at a later date and get the pricing.

Another possible benefit could be an analysis of if the collection of services (group of codes) that made-up a procedure. For instance, my colonoscopy had 15 codes, yours had 20. What are the other 5 and am I getting more or less than I need? This would be a report on the differences between the doctors and facilities more than the insurance company's secret pricing.

For the BLS to want it, there would have to be a whole bunch of people from all walks of life using it. Unfortunately, I only see a sliver of the population that would use it, even if it could deliver perfect results on day one.
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Old 11-16-2015, 09:51 AM   #25
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HMO providers receive a monthly capitation payment for routine services, not the EOB allowed amount.
https://www.acponline.org/residents_...standcapit.htm

For providers not in capitation agreements:
1) You would need access to the claim's DUT field for any procedure that could be billed in multiple units, such as ambulance mileage and minutes under anesthesia. Example: A physical therapy procedure code specifies "each 15 minutes" so an hour of PT is billed with 4 DUTs. The EOB allowed amount is 4x the fee schedule rate. Another EOB will have half that amount because they received 30 minutes of PT.

2) Some claims have modifiers appended to the procedure code which adjusts the fee schedule rate (150%, 62.5%, 50% etc) altering the EOB allowed amount.

3) On some claims the rendering provider is a PA, NP, CRNA, or PT which adjusts the fee schedule rate (85%, 65%, etc) altering the EOB allowed amount.

4) After the above adjustments are made, the provider's contracted rate is applied. Group A may be contracted at 97% and B at 110%. The EOB allowed amount is after this adjustment also.

5) Medicare Part B fee schedule rates are public. TRICARE and Medicare Advantage plans also use these rates. This is what private insurers should do.
https://www.cms.gov/Medicare/Medicar...ct=/pfslookup/

6) The Medicare Part A pricers used to determine allowable amounts are public. MA plans also use these. TRICARE uses these except they modify the Inpatient PPS (IPPS) pricer for maternity.
https://www.cms.gov/Medicare/Medicar...ment/PCPricer/
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Old 11-16-2015, 10:47 AM   #26
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No admission: Emergency room, heart function threat: $2000
Angiogram, no stents: $8700 closure device: $600 recovery room: $1300
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Old 11-16-2015, 12:30 PM   #27
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Here is a site that keeps a database of prices for medical services.

FH Consumer Cost Lookup

It's interesting, but it's all based on "Usual and Customary Rates" (UCR). In other words, not on the secret negotiated rates, just a percentage of UCR. Nice to give someone a ballpark estimate, but of no use when you are shopping for an insurance company.
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Old 11-17-2015, 08:40 AM   #28
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I posted about this in another thread but there's a startup called SmartShopper that has data on how much a procedure will cost and will pay you to use a cheaper provider: Episode 655: Pay Patients, Save Money : Planet Money : NPR
The site they talk about is https://www.vitalssmartshopper.com and sounds like a really good thing. I'm going to investigate.
My hope was that this site was enabled by state insurance commissioners demanding that there be a 3rd party that would provide customers pricing, but would not let the insurance companies see each others' pricing en masse.

That wasn't it. My hopes were dashed when they called me back today; the business model only works for employer sponsored health insurance.

Megacorps that self-insure have a little bit of leverage with insurance companies such that they got this concession in their contract. The way it works, as far as I know, is that the Megacorp has an insurance company manage everything, but whatever "the insurance company" pays to providers comes right out of Megacorp's bank account. That means if I can get my employees to go to a stand-alone place to get imaging done instead of a hospital, that possibly huge sum that makes up the difference will stay in the bank. The insurance company doesn't care...they get paid on handling claims, not on the dollar value of the claims.
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Old 11-17-2015, 08:44 AM   #29
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Insurance companies will kill an owner of such a website before it goes live
From what I'm reading it's the big providers that would rather keep us in the dark.
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Old 11-18-2015, 11:40 AM   #30
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Yep, the big providers don't like the idea that we could see a price and act on it.

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...
Thanks for sharing that information. Good info on how the system works and a reminder that there would be enough wrinkles in the data from submitted EOB's that it would take a lot of smart people to get the site to function well.
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Old 11-18-2015, 12:03 PM   #31
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I use United Health Care and they have a spot to check "what does this procedure typically cost". I found it to be in the ballpark...though sometimes its hard to figure out what you will all be billed for.. ie my ER visit they charged $1500 for the room which I've never been charged for before if it wasn't an overnight stay.. so SURPRISE but at least I've been able to use their site to get some guestimates.
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Old 11-18-2015, 07:10 PM   #32
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Yes, Once you are a customer, they will give you general estimates for various procedures. That can be helpful, especially if you have a choice between getting a procedure done at a hospital vs a stand-alone facility. I'm thinking that the site proposed in this thread is primarily for helping the public when shopping for insurance. When I'm shopping for insurance, I'd like to be able to fully examine what they're selling and do some comparison shopping. Since the best thing for me is a high deductible policy, what I'm buying (if the seven are good to me), is the rates that the insurance company has negotiated for health services and drugs.
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Old 11-18-2015, 08:04 PM   #33
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I recently discovered the BCBS cost estimator. I search on preventative mammograms and they gave me 3 local providers and their estimate of what they would bill (not what BCBS would pay). There was a factor of 2.3X between the lowest and highest cost.

I wish I had found this tool earlier. I'm not sure it was available a couple of years ago when I needed it.
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Old 11-18-2015, 08:45 PM   #34
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Living in Canada most people are unaware of what they pay for their healthcare as it comes out of their taxes. If they were interested in what MDs were paid for procedures, they could go to this site and find out. http://www.health.gov.on.ca/english/...13_flumist.pdf
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Old 12-07-2016, 10:24 AM   #35
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I've had United Healthcare for the year, but just now went for a physical. Guess what. The EOB they offer does not include procedure codes, or even detailed procedure descriptions!

So much for this idea, unless we convince our lawmakers to compel insurance companies to provide the information.

Does your EOB have CPT codes?
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Old 12-07-2016, 10:54 AM   #36
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I've had United Healthcare for the year, but just now went for a physical. Guess what. The EOB they offer does not include procedure codes, or even detailed procedure descriptions!

So much for this idea, unless we convince our lawmakers to compel insurance companies to provide the information.

Does your EOB have CPT codes?
All of our previous insurers always had the CPT codes. For 2016 we switched insurers (again, we seem to switch often with ObamaCare) and our current one does not show CPT codes on the EOB. If we get a bill from the provider the bill may have the CPT codes.
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Old 12-07-2016, 03:57 PM   #37
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No CPT codes on the EOB, but they are there at the plan's website (BS in WA). YOu should be able to look at your claim on line and see far more detail to support the payment calculations.

- Rita
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Old 12-07-2016, 05:19 PM   #38
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I dont understand why people aren't outraged that its almost impossible to know what we are being charged for medical procedures before hand.
Absolutely agree with that.

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If we overhauled the insurance system anyway, why didnt Obamacare fix that?


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Tell me what else we buy without knowing what it costs?
Kinda like writing a blank check, isn't it. But when you are being wheeled in unconscious, delirious, bleeding to death or in great pain, what are you going to do? Negotiate rates and services with the doctors before they proceed? Even when the procedure or visit is planned in advance, it can be difficult to get any solid estimates for much more than an office visit or flu shot.
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Old 12-07-2016, 06:03 PM   #39
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I've had United Healthcare for the year, but just now went for a physical. Guess what. The EOB they offer does not include procedure codes, or even detailed procedure descriptions!

So much for this idea, unless we convince our lawmakers to compel insurance companies to provide the information.

Does your EOB have CPT codes?
I just checked my UHC online account and they don't show procedure codes just a procedure description.
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Old 12-07-2016, 06:03 PM   #40
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Kinda like writing a blank check, isn't it. But when you are being wheeled in unconscious, delirious, bleeding to death or in great pain, what are you going to do? Negotiate rates and services with the doctors before they proceed? Even when the procedure or visit is planned in advance, it can be difficult to get any solid estimates for much more than an office visit or flu shot.
I had this conversation as a result of really bad insurance with the VP and director of HR in '92! Well it wasn't a great conversation, more me venting! Honestly if I had known the VP almost became a nun I wouldn't have dropped near as many F bombs.

Back then the same issue existed but it was a lot less expensive when something was suddenly your issue to pay. I got hit later that year when my first panic attack disguised as a heart attack sent me to the ER. My insurance had no mental coverage, so it was all between the hospital and me. Glad that was '92 costs.
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