Cost-Conscious, Self-Managed Care

[pb4uski]

Quote:

Originally Posted by sengsational Sounds like it's too late, here's a link to a <$10 OTC prep. When I was prescribed the expensive one, I did this sugar-free gatoraid and PEG3350 (on my own). When the doc asked about the prep, I told him what I did, he didn't react at all, as if "everybody does that".

So I wonder, if this OTC prep was universally adopted, how much would US patients save in a year? I'm guessing that it is a sh!tload of money (pun intended).

[athena53]

Docs don't seem to care what you use as long as it works. Selling the whole "prep package", though, seems to be a new profit center. Mine offered that for $38 but at first there was no info on what was included. They sent me another e-mail nagging me and I looked again and there were pictures. No giant gallon jugs, so I ordered it. I did see a box of generic brand lemon jello mix. Yeah, definitely a profit center. Will give a full report when it arrives in the mail.

[travelover]

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Originally Posted by athena53 .......... Will give a full report when it arrives in the mail.

Let us know how it comes out.

[Walt34]

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Originally Posted by travelover Let us know how it comes out.

Uh, be careful what you ask for....

[Options]

A cancer diagnosis can also cause severe financial burden:

Financial burden of cancer can harm quality of life | Reuters

Quote:

Almost a third of U.S. cancer survivors face financial burdens, and physical and mental health tends to be worse for those who do, according to a new study. There are more than 14 million cancer survivors in the U.S., the authors wrote in a paper released by the journal Cancer. “We found that cancer survivors with three or more financial problems had clinically meaningful differences in their physical and mental health-related quality of life and were two to three times more likely to report depressed mood and six to eight times more likely to worry about cancer recurrence,” lead author Hrishikesh P. Kale of Virginia Commonwealth University in Richmond told Reuters Health by email. “Financial burden results from the high cost of cancer care,” added senior author Norman V. Carroll, also of Virginia Commonwealth University. “This is especially true for the newer, biologically-derived specialty drugs,” which can require patient copays of several hundred dollars per month, Carroll said.

Emphasis added

[Dash man]

Quote:

Originally Posted by travelover This sounds crazy. I just had my annual physical and most of the time was spent talking about ongoing health concerns and medications that I am taking to control those conditions.

Ditto. I have numerous ongoing conditions and my doctor always discusses how things are with them along with questions and discussions on any new concerns. Never paid a cent out of pocket for these annual physicals. I've also never felt rushed with her.


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[swakyaby]

Quote:

Originally Posted by travelover 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.

I once had a patient's spouse inquire about the cost of my services just minutes before I was about to place an epidural catheter for alleviation of labor pains. I hesitated, not because I didn't want them to know what it would cost, rather it was because the answer was complex. Each insurance company has a different negotiated rate of pay for my medical group's services, and the charge for a labor epidural is not a static amount. The management of the epidural could be for 2 hours or for 14 hours. The patient could then go on to a Cesarean section using the same epidural. The rate of pay increases because it is now anesthesia for an operation and requires more intensive management. The negotiated rate of pay for each insurance changes from year to year, and the billing becomes so complex it requires a billing service to keep track of it all.

I told the husband that I could provide him a phone number for my medical group, that he should ask for the billing dept, that he will need to provide information of her insurance. The wife, in the middle of a painful contraction, shot her husband a look of exasperation, and said, "Never mind! I want the d--n epidural!"

[travelover]

Quote:

Originally Posted by swakyaby I once had a patient's spouse inquire about the cost of my services just minutes before I was about to place an epidural catheter for alleviation of labor pains. I hesitated, not because I didn't want them to know what it would cost, rather it was because the answer was complex. Each insurance company has a different negotiated rate of pay for my medical group's services, and the charge for a labor epidural is not a static amount. The management of the epidural could be for 2 hours or for 14 hours. The patient could then go on to a Cesarean section using the same epidural. The rate of pay increases because it is now anesthesia for an operation and requires more intensive management. The negotiated rate of pay for each insurance changes from year to year, and the billing becomes so complex it requires a billing service to keep track of it all. I told the husband that I could provide him a phone number for my medical group, that he should ask for the billing dept, that he will need to provide information of her insurance. The wife, in the middle of a painful contraction, shot her husband a look of exasperation, and said, "Never mind! I want the d--n epidural!"

Your example is interesting, but I still don't buy the argument that it is so complicated that we should cut off the conversation. And yes, you know that you have us by the short hairs, i.e. "The wife, in the middle of a painful contraction, shot her husband a look of exasperation, and said, "Never mind! I want the d--n epidural!", but we must do something to control costs. If physicians won't lead, then they will be forced to follow.

[swakyaby]

Quote:

Originally Posted by travelover Your example is interesting, but I still don't buy the argument that it is so complicated that we should cut off the conversation. And yes, you know that you have us by the short hairs, i.e. "The wife, in the middle of a painful contraction, shot her husband a look of exasperation, and said, "Never mind! I want the d--n epidural!", but we must do something to control costs. If physicians won't lead, then they will be forced to follow.

This was not about anyone trying to "cut off the conversation." I was perfectly willing to hold off on the procedure while the couple researched the price. But minutes before a procedure to negotiate on cost when they knew she might want anesthesia services months ago was not good timing. To be angry that there wasn't an immediate price quote requires some understanding that it's not that simple for some procedures.

[redduck]

[QUOTE=travelover;1712917]
...but we must do something to control costs. /QUOTE]

Agreed something should be done to control costs. A small step might be requiring in-network hospitals to only use and/or refer to docs whom are also in the patient's network. If the hospital can't find an in-network doc, the patient needs to be told beforehand (I don't know how much before). Out-of-network treatment is a financial catastrophe.

[Sunset]

[QUOTE=redduck;1712933]

Quote:

Originally Posted by travelover ...but we must do something to control costs. /QUOTE] Agreed something should be done to control costs. A small step might be requiring in-network hospitals to only use and/or refer to docs whom are also in the patient's network. If the hospital can't find an in-network doc, the patient needs to be told beforehand (I don't know how much before). Out-of-network treatment is a financial catastrophe.

+1
And so annoying because as the patient I select in-network doctor, hospital, and then get surprised afterwards to find out some supporting doctor I had no choice about is not in network

[ziggy29]

Quote:

Originally Posted by redduck Agreed something should be done to control costs. A small step might be requiring in-network hospitals to only use and/or refer to docs whom are also in the patient's network. If the hospital can't find an in-network doc, the patient needs to be told beforehand (I don't know how much before). Out-of-network treatment is a financial catastrophe.

Agreed, but at this point, what you are describing is very much starting to resemble an HMO.

Even many medical providers probably can't always tell when someone is in or out of network for a given procedure, or if your insurance covers it.

I do believe the state of New York does something like this now. When a patient goes to an in network ER hospital, for example, I believe the cost of all the out of network care has to be negotiated between the provider and the insurer, and they can't balance bill the patient. To me this is one of the biggest flaws in the system overall; even when a patient does their homework and chooses in-network facilities, they don't always know if the ER doc, or the radiologist or the anesthesiologist is in network. And sometimes the patient has no choice -- in an emergency you go to an in-network facility and if it's a true emergency you aren't going to wait for hours until an in-network practitioner is available.

[travelover]

Quote:

Originally Posted by travelover ...but we must do something to control costs.

Quote:

Originally Posted by redduck Agreed something should be done to control costs. A small step might be requiring in-network hospitals to only use and/or refer to docs whom are also in the patient's network. If the hospital can't find an in-network doc, the patient needs to be told beforehand (I don't know how much before). Out-of-network treatment is a financial catastrophe.

Exactly. If an out of network resource is used, their charge should be capped at a reasonable level like a multiple of Medicare or an in network allowance.

And docs should have some idea of what things cost. If drug A is almost as effective as drug B, but costs 1/10 as much, this should be known. Otherwise the patient may just not fill a prescription for B, and not control their condition at all.

[Sunset]

Quote:

Originally Posted by Options A cancer diagnosis can also cause severe financial burden: Financial burden of cancer can harm quality of life | Reuters Emphasis added

So true.

My sibling takes a bunch of drugs for cancer, one used to be $70,000/yr but has since been replaced by a cheaper version at only $57,000/yr.

One time a nurse ruined the medicine to be injected, and it was quite a situation to get a replacement dose at $5,000.

[ziggy29]

Quote:

Originally Posted by travelover And docs should have some idea of what things cost. If drug A is almost as effective as drug B, but costs 1/10 as much, this should be known. Otherwise the patient may just not fill a prescription for B, and not control their condition at all.

Except that these TV commercials have patients convinced that they NEED Drug B.

[travelover]

Quote:

Originally Posted by ziggy29 Except that these TV commercials have patients convinced that they NEED Drug B.

That is yet another issue, but my point is that prescribing drugs and procedures with no idea of their cost is a recipe for $9000 per year per American medical expenses.

[redduck]

Quote:

Originally Posted by ziggy29 ... even when a patient does their homework and chooses in-network facilities, they don't always know if the ER doc, or the radiologist or the anesthesiologist is in network. And sometimes the patient has no choice -- in an emergency you go to an in-network facility and if it's a true emergency you aren't going to wait for hours until an in-network practitioner is available.

I was going to mention ER's and should have, got lazy and didn't. But, I guess if it's an ER, all bets are off and the patient gets what he gets.
(I'm also too lazy to do the he/she thing).

While it seems impossible for the hospital to know what a patient's insurance covers (and how much it covers) the hospital should be able to match a patient with an in-network MD--or die trying. If there is no match they should be required to give the patient that information.

I wonder if the out-of-network situation occurs mainly in small hospitals or hospitals in less-populated areas--or, if the patient has some "off-brand" type of insurance.

[simple girl]

Quote:

Originally Posted by Sunset So true. My sibling takes a bunch of drugs for cancer, one used to be $70,000/yr but has since been replaced by a cheaper version at only $57,000/yr. One time a nurse ruined the medicine to be injected, and it was quite a situation to get a replacement dose at $5,000.

Yep. I have never been so thankful for good insurance. Although paying our high deductible in full the past 5 years (going on 6, counting this year) hasn't been fun, the amount pales in comparison to what my insurance company has paid out. My reconstruction surgeries have NOT been cheap (each surgery costs them at a minimum $100K)...coming up on #6 to try and fix radiation damage. My poor insurance company, I feel bad for it...I truly do.

[athena53]

Quote:

Originally Posted by redduck While it seems impossible for the hospital to know what a patient's insurance covers (and how much it covers) the hospital should be able to match a patient with an in-network MD--or die trying. If there is no match they should be required to give the patient that information. I wonder if the out-of-network situation occurs mainly in small hospitals or hospitals in less-populated areas--or, if the patient has some "off-brand" type of insurance.

I wish. I'm too lazy to figure out how to post a link with my phone, but look up the case of Cristiano vs. The Valley Hospital in NJ last year. The couple selected an OB in network. The hospital was in the network. They got nailed for $1,800 in out-of-network charges from the only anesthesiology group that practices at Valley.

I know this hospital- I used to live near there and Catherine Zita-Jones and Michael Douglas selected Valley for the birth of their last child. It's no second-rate outfit. The couple in the lawsuit had Cigna, not Joe's Insurance of the Turks ad Caicos. It happens everywhere. And the couple lost their case.

[pb4uski]

And my understanding is that states are legislating against these outrageous situations.

IMO if a consumer has an in-network doc or specialist and an in-network hospital then any out-of-network specialists who perform work should be deemed to have agreed to accept the insurer's in-network rate for the service and no balance billing is allowed (unless specifically agreed to in writing by the patient 48 hours prior to the services being performed so the patient can't be shaken down in pre-op).