Refreshing? Surgical center posts all prices, takes no insurance, charges 90% less.

[skipro33]

That's a free market decision not a government effect. They chose to raise prices because they have something to hide behind. Have cake/eat same. Anybody who doesn't know business operates that way is..... well...unknowlegeable . Yes. Like it's always only just ONE thing. That's the ticket.

No, it's not a free market. When the government mandates you purchase a product from a private company, that if you don't you have broken the law and are found guilty and pay a fine for your law breaking, then it's not a free market.

I sure wish a product I manufactured was required by law for every living person in the nation to purchase or you are fined.

Here's where the business model of ACA fell apart;
It was calculated that IF everyone did indeed purchase the product, medical insurance, then the cost would go down. But not everyone did. Only the sick people did. The healthy people still chose not to. Why? Because the first years there wasn't a fine at all. Even now, the fine is only $700 for the whole year. A 20 to 30 something-year-old healthy single person is quoted a rate of around $700 a month for a medical insurance premium that barely covers the most catastrophic of medical claim. They figure it's simpler and cheaper to pay the $700 fine than to pay $700 a month on a premium that they'll likely never need. And since they usually don't have any savings, equity or other assets, it's not like they have anything to loose by doing so.

Without every person being covered by insurance, the coverage costs are not offset by the healthy for the sick and rates skyrocketed. What ever replaces ACA will have to address how everyone can be forced to sign up and how to enforce everyone to pay their premium.

I have my own personal (political) opinion of a free nation mandating it's citizens purchase a product from a private enterprise under threat of law. But political opinion is for other forums.

 

[skipro33]

The uninsured rate in OK was actually 15% including 27% of hispanics and 25% of African Americans. I'd bet it was a big deal for those people. I know it was for me. And my rates didn't change a penny this year.

Well, if you're in Oklahoma, you better hang onto your wallet. It didn't take long to find lots of news stations reporting this;
Obamacare premiums in Oklahoma skyrocketing | KFOR.com

Short version;
OKLAHOMA - Oklahomans on Obamacare may see their insurance rates skyrocket.
Blue Cross Blue Shield of Oklahoma, the only health insurer offering plans on the federal exchange in 2017, has submitted increases for individual market plans ranging from 58 to 96 percent.
This will affect about 130,000 Oklahomans who have individual plans through the Affordable Care Act’s marketplace.

This link discusses 2016 rates for Oklahoma and other states that are single provider like OK is.
https://www.healthinsurance.org/oklahoma-state-health-insurance-exchange/

 

[Curmudgeon]

I'm wondering how low their prices really are. I took a look and tried to find a procedure that I could compare. The last surgery I had was an appendectomy but they don't do those. So I had to settle for something easy to compare.. circumcision... Yikes. Anyway they charge $2000.

Yeah, but don't forget, you need to leave a tip.

 

[Walt34]

Also, few will be able to fund these things upfront. Like most people's houses. They can afford it for cash. But not right NOW! So you have to get the loan. Maybe you can afford their surgery for cash but few will have that kind of bread on the barrel head

I doubt that many people in OK have the kind of money to keep that many dr's in the green with high incomes.

Exactly. Remember those articles about the high percentage of people who couldn't come up with $1,000 on short notice? I think it was ~40% (I'm sure someone will correct me if I'm mistaken.)

For example they show a total knee replacement w/o complications at $15,500 plus any additional needed hardware like screws. I'd wager that outside of this board few people could write a check for that.

Still, the transparency is a good thing, I think.

 

[samclem]

I agree with Razz. This is a marketing ploy and not a genuine solution to the problem of health care costs.

It's a marketing ploy that has been going on for decades? They have been in business, with posted set fees and not taking insurance, for almost 20 years. The only thing new is that the prices are now posted online.

This can be part of the solution to high healthcare costs. Nobody should be claiming that it is >the< solution, or the only thing we need to do.

I'm wondering how low their prices really are. I took a look and tried to find a procedure that I could compare. The last surgery I had was an appendectomy but they don't do those. So I had to settle for something easy to compare.. circumcision... Yikes. Anyway they charge $2000. Then I googled around to find it for $1400 in Houston. And €750 in Ireland (since I'm there now that's what Google presented me with . So not the cheapest but it is nice to be able to compare.

If those are all publicly-posted prices in a competitive market, then we shouldn't be surprised that they are at least roughly comparable. It would be interesting to see how these prices (and the ones for other procedures at the OK Surgery Center) compare to the prices for similar procedures when paid for with traditional insurance. But, we can't get those prices. Which is the whole problem/point I think.

 

[razztazz]

I agree with Razz. This is a marketing ploy and not a genuine solution to the problem of health care costs. Most people can't and don't shop around for medical care - unless it's elective surgery and not covered by insurance anyway. It's a clever way to get people's attention, but it would be hard to plan my ER visits around their schedule and location.

It's also a political statement:

Dr. Keith Smith envisioned a self-sustaining, free market oriented health care facility that would operate completely outside the bounds of government control.

I missed that but it's a pretty obvious tip off. As I initially said, I really don't want to impugn their motives too much at this point but, really. Who else likes to envision operating completely outside the bounds of government control?

(AAAHR, Matees!)

 

[razztazz]

)For example they show a total knee replacement w/o complications at $15,500 plus any additional needed hardware like screws. I'd wager that outside of this board few people could write a check for that.

Still, the transparency is a good thing, I think.

And what about a knee replacement --WITH-- complications? No doctor of any kind anywhere is going to risk anything on --no complications--. They just tell you it's safe, up front. They don't really know how it's going to go, so how would the customer know? Would they permit and accept unlimited law suits to cover for that? Or is that completely outside the bounds of government control ....?

 

[samclem]

The criticisms, so far, of this business model are interesting. Obviously, at some level, this company is meeting a need better than existing alternatives, because they are still in business.

Even those who think our present health insurance construct is great (raise your hand, please) should be cheering these guys on, rooting for their success, and hoping more people follow them. This is one very good way to get the prices for medical services down regardless of who pays for them. If I run HealthGigantaHospitalNet and charge insurance companies $30K to remove a gallbladder, I'm hating these independent agents at OK Surgery Center who are charging $5865. They are showing, for all the world to see, that my $30K fee is way out of bounds. I know I need that $24,135 of extra money to pay big bonuses, help out in some political campaigns for people who will keep this whole game running, build a hospital with even more chrome and glass, run some TV ads to get customers to spend money in my hospital, buy out some independent doctors, sponsor a convention in Las Vegas for state insurance regulators, etc. And, I know if that clinic keep charging just $5865, and letting everyone know it, that it won't be long before some insurance company finds a way to get that lower price, too if there's a reason for them to do it. Their policyholders who are paying deductibles, their business and group planholders, etc, will be leaning on them pretty hard to get that same price. If they are the only insurer, or there are other market-distorting effects (e.g huge bagfulls of "other people's money" that gets dumped in, etc), then the insurance company will be fine with the higher prices, they'll just pass them on to the insureds. After all, if an insurance company gets to keep 20% of premiums if they spend 80% on patient care, they have a perverse long-term incentive to spend >more< on medical services, so their 20% gets larger. "Four for you, one for me. Four for you, one for me . . "

I'm largely an index fund investor. But I benefit from the work of those people who are stock pickers. They keep stock prices in line with their true value, as judged by the market. That's the only way indexing can work. Medical providers like these, and their customers, serve the same function. Even if they (at first) are only a small portion of the total health care picture, they can serve to establish rational (patient-set) prices for medical services and, ultimately, benefit even those who just want to be passive indexers.

Or, you can continue to be be happy paying for that $80 Tylenol in the hospital.

 

[Texas Proud]

I missed that but it's a pretty obvious tip off. As I initially said, I really don't want to impugn their motives too much at this point but, really. Who else likes to envision operating completely outside the bounds of government control?

(AAAHR, Matees!)

I do not know why you seem to have something against this practice.... and as others have pointed out they seem to be doing what enough people want to stay in business...

First there is no way they can operate 'completely' outside as they are Drs and they are regulated...

What I think they want to do is not be involved with insurance and Medicare/Medicaid... FWIK, if you take any patient that is either you fall under rules about what you can and cannot bill..... I have read about a number of docs who do everything they can to not run afoul of the heavy hand of gvmt control over them... there was some ortho doc who was really good who basically did the same as these guys... he was supposed to be one of the best and charged twice as much as others (so, not this model) but had athletes knocking down his door to have him fix them....

 

[Just_Steve]

The diff is if the insurance company isn't in on it on the front end they can deny anything and everything so as not to have to pay. "Hey, you tell us you were going to the doctor?" Especially if something goes wrong. $20,000 surgery for $10,000. OK. But due to some complication, bad drug reaction, infection etc, now it's way up there. They're not going to pay.

If I go out of network the insurance company isn't "in on the front end" in fact they are not in on it until I submit for payment. I still don't see the difference.

 

[meierlde]

The criticisms, so far, of this business model are interesting. Obviously, at some level, this company is meeting a need better than existing alternatives, because they are still in business.

Even those who think our present health insurance construct is great (raise your hand, please) should be cheering these guys on, rooting for their success, and hoping more people follow them. This is one very good way to get the prices for medical services down regardless of who pays for them. If I run HealthGigantaHospitalNet and charge insurance companies $30K to remove a gallbladder, I'm hating these independent agents at OK Surgery Center who are charging $5865. They are showing, for all the world to see, that my $30K fee is way out of bounds. I know I need that $24,135 of extra money to pay big bonuses, help out in some political campaigns for people who will keep this whole game running, build a hospital with even more chrome and glass, run some TV ads to get customers to spend money in my hospital, buy out some independent doctors, sponsor a convention in Las Vegas for state insurance regulators, etc. And, I know if that clinic keep charging just $5865, and letting everyone know it, that it won't be long before some insurance company finds a way to get that lower price, too if there's a reason for them to do it. Their policyholders who are paying deductibles, their business and group planholders, etc, will be leaning on them pretty hard to get that same price. If they are the only insurer, or there are other market-distorting effects (e.g huge bagfulls of "other people's money" that gets dumped in, etc), then the insurance company will be fine with the higher prices, they'll just pass them on to the insureds. After all, if an insurance company gets to keep 20% of premiums if they spend 80% on patient care, they have a perverse long-term incentive to spend >more< on medical services, so their 20% gets larger. "Four for you, one for me. Four for you, one for me . . "

I'm largely an index fund investor. But I benefit from the work of those people who are stock pickers. They keep stock prices in line with their true value, as judged by the market. That's the only way indexing can work. Medical providers like these, and their customers, serve the same function. Even if they (at first) are only a small portion of the total health care picture, they can serve to establish rational (patient-set) prices for medical services and, ultimately, benefit even those who just want to be passive indexers.

Or, you can continue to be be happy paying for that $80 Tylenol in the hospital.

Interestingly some insurance companies have shopped hospitals for things like joint replacement surgeries and the like. They found the median price and set the payment for the operation at that amount. Because the variation is over 200% (unless on Medicare where a standard fee is paid per diagnosis), it turns out to be cheaper to provide transportation and a hotel room for a companion and have the operation done in one of the cheaper hospitals.
When my mother was in the hospital years ago, the bill came out to a large itemized total then the total was zeroed out and the medicare amount for the diagnosis was inserted. (That eliminated the $10 kleenex box etc). Now typically the top teaching hospitals charge a lot more than others.
Under the insurance companies plan you get the amount, and are free to spend more on a more expensive hospital but you get to pay the difference.

 

[razztazz]

If I go out of network the insurance company isn't "in on the front end" in fact they are not in on it until I submit for payment. I still don't see the difference.

Sorry That is not Gospel applying all the time to everyone. Ergo just another roll of the dice. I know that what I stated is exactly what happened to some people who thought they were being nice and avoided using their insurance then had a bad outcome and the insurance co said "It was all behind our backs we're not covering anything." But you can rationalize a pleasant trip. Might some co some place cover a thing like that? Maybe? The should we say: Yes! That is a good and right way to proceed." Only if crazy

 

[samclem]

If I go out of network the insurance company isn't "in on the front end" in fact they are not in on it until I submit for payment. I still don't see the difference.

If these types of low-cost medical care providers become more commonplace, customers (individuals, employers, groups) would get serious about choosing an insurance company that allowed/encouraged people to use them. It would become a selling point that insurance companies can use to gain customers >and< save on payouts to providers.

 

[razztazz]

I do not know why you seem to have something against this practice....

I don't. Let's see where it goes. Just because I see shall we say, something worth looking at doesn't mean I'm against it.

First there is no way they can operate 'completely' outside as they are Drs and they are regulated...

We know. That is not part of my statement

What I think they want to do is not be involved with insurance and Medicare/Medicaid...

Kill people (OK, let them die) but as long as it's for professional reasons and turns a profit it's..... freedom.

FWIK, if you take any patient that is either you fall under rules about what you can and cannot bill.....

Jeez! Who ever thought we'd have rules? What demographic strives to relieve itself of rules? yes of course, Bill for anything you can get away with.

 

[Texas Proud]

I don't. Let's see where it goes. Just because I see shall we say, something worth looking at doesn't mean I'm against it.



We know. That is not part of my statement



Kill people (OK, let them die) but as long as it's for professional reasons and turns a profit it's..... freedom.



Jeez! Who ever thought we'd have rules? What demographic strives to relieve itself of rules? yes of course, Bill for anything you can get away with.

Well, I do not think they are killing people or they would probably be out of business... so a non-starter IMO...

Any yes, a Dr can bill for anything they want and get away with it if they are not involved with gvmt coverage... that is the American way.... you get to choose if you want to be 'in' and follow the gvmt rules or be 'out' and charge what you want to charge... simple...

 

[samclem]

Any yes, a Dr can bill for anything they want and get away with it if they are not involved with gvmt coverage... that is the American way.... you get to choose if you want to be 'in' and follow the gvmt rules or be 'out' and charge what you want to charge... simple...

Two parties reaching an agreement that benefits each of them. Seems pretty simple.
What is NOT simple is the coding, billing, paperwork, and waiting to get paid that medical providers endure when they participate in Medicaid, Medicare, and private insurance. It requires a lot of extra staff in the office (and somebody to manage them).
Also, if a doctor sees even one Medicaid or Medicare patient, they may not charge any other patients a lower amount than they charged the Medicare/Medicaid patient (even if their fees were below the standard rate that the government allows under these programs for these procedures). So, the business would have to put up with all the paperwork BS and cost and not get compensated for it. It makes perfect sense for them to avoid getting involved with the entire complex, litigious mess. They probably want to spend their time practicing medicine.

 

[bmcgonig]

Personally I think it's a terrific step in the right direction.

Here's a more expansive list from an excellent hospital in Bangkok. Full price list 'estimate' of everything they do.


https://www.bumrungrad.com/en/realcost-thailand-surgery/procedures-surgery-cost-pricing

Here an appendectomy is around 7k versus the 44k mine cost in SF (allowed cost)

 

[samclem]

Here's a more expansive list from an excellent hospital in Bangkok. Full price list 'estimate' of everything they do.


https://www.bumrungrad.com/en/realcost-thailand-surgery/procedures-surgery-cost-pricing

Here an appendectomy is around 7k versus the 44k mine cost in SF (allowed cost)

Thanks. The prices look roughly similar to the prices charged by the Oklahoma center:
. . . . . . . . . . . . . Thailand Surgery Center. . . . . . . . .Surgery Center of OK
. . . . .. . . . . . . . . . . (median price)
Gall bladder removal...........$7,390..............................$5,865
Laparoscopic hernia repair...$7,479..............................$5,750
Hysterectomy (open).........$7,409..............................$8,000 (incl overnight stay)
Knee Replacement............$15,047.............................$15,500
The appendectomy in Thailand would have been 16% of what your insurance allowed for the surgery in SF, which is right in line with the estimate of cost savings at the Surgery Center of OK (10%-15% of typical insurance-paid prices).

Lots of choices! If you want a good steak, get your knee replaced in OKC. If you want to see Chaing Mai, get it done in Thailand.

 

[Montecfo]

I missed that but it's a pretty obvious tip off. As I initially said, I really don't want to impugn their motives too much at this point but, really. Who else likes to envision operating completely outside the bounds of government control?

IS this a trick question?

Seriously, lack of quoted prices is one huge reason health care costs are out of control. And, no, ACA did not fix that, even for employer plans. While by some measures cost increases have moderated, it is not by much at all, and continues to outpace wage growth and inflation.

As far as reform, we would benefit from posting all prices and from having various policy designs from which people can pick and choose, based upon their ability to pay. You know, just like restaurants, housing and cars. When neither the service provider nor its recipient knows what a service costs, you have eliminated the positive effect of market forces. Fix that, and you can begin to make health care more affordable. These guys are making a step in the right direction, as I see it.

 

[athena53]

When neither the service provider nor its recipient knows what a service costs, you have eliminated the positive effect of market forces. Fix that, and you can begin to make health care more affordable. These guys are making a step in the right direction, as I see it.

I agree. DH was getting weekly treatment for a small leg ulcer. I was curious what each treatment was costing (hadn't seen any bills) and when he asked, they told him, "Most of it should be covered by insurance"- which was not the question he asked. I don't want anyone's money wasted- ours, the taxpayers' (DH had Medicare) or the Medicare Supplement provider's. A few months later when the bills began to roll in, the negotiated price looked reasonable for what they did. If it hadn't, I might have asked about moving to visits every other week. They were every Thursday and, mysteriously, when an upcoming visit would have been on Thanksgiving they changed the frequency to every other week.

 

[Yarnstormer]

The rate increases were on policies bought through the marketplace. Employer based insurance has not seen the same rate increases. In fact, ACA has reduced the rate of health care inflation and non-marketplace health insurance inflation.

Not true! My employer has raised rates (more than pay increases) the last couple of years + increased employee responsibility from 25% to 30% for 2017. They blame rising healthcare costs and aca related fees.

 

[razztazz]

IS this a trick question?

Seriously, lack of quoted prices is one huge reason health care costs are out of control. And, no, ACA did not fix that, even for employer plans. While by some measures cost increases have moderated, it is not by much at all, and continues to outpace wage growth and inflation.

As far as reform, we would benefit from posting all prices and from having various policy designs from which people can pick and choose, based upon their ability to pay. You know, just like restaurants, housing and cars. When neither the service provider nor its recipient knows what a service costs, you have eliminated the positive effect of market forces. Fix that, and you can begin to make health care more affordable. These guys are making a step in the right direction, as I see it.

You are correct but I don't see what that has to do with what you quoted.

Not a trick question. A rehtorical question.