Cost transparency issue: how to attack?

[Capwest28]

This trickery nearly happened to me as well. The cost for test was $50 but the reading was $250! So I did not have the 3D test. Really makes you want to throw a pie in someone's face. Smelly, not sweet.


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[John Galt III]

The latest edition of Consumer Reports has suggestions on how to avoid unexpected medical charges including what to do if you don't take the precautions suggested and have to negotiate the bill. Most of the suggestions have been discussed on this forum in the past.

CR is behind a paywall, but most libraries carry it.

Thanks for that reference. I will read it. I may be going for an ultrasound soon. Charges I can think of off the bat are : ultrasound technician fee. Radiologist fee to interpret results. Possibly a facility fee. Possibly a fee from some physician's group that the radiologist belongs to. Plus who knows what tack-ons they can come up with! In the past when I have asked all the questions of all available people, and checked everything with my insurance company, there often are still surprise costs popping up. And the most annoying thing is when the insurance company says they might cover something and might not, and I will just have to wait and see !!

 

[Dreamer]

I went for my mammogram on 10/2/15. I had called the day before to make the appt and they had a cancellation the next afternoon, so I took it. I change clothes and put on their gown and go into the room and the technician tells me that they will be doing it using 3-D. I had just read this thread. I asked her if my insurance would cover it and she said yes. I asked her if they would cover the reading also and she said yes. She told me that she had been a technician for I believe 41 years. She said they had some trouble with some insurance companies in the beginning and that BC/BS was the worst. I told her that was my company. She wrote down for me the billing business manager's name, phone number and 3-D Blue Cross Billing not paying for 3-D and told me to call her if I had any problems with them paying. She indicated they would not make me pay, because their facility does not think it is fair that only some ladies get the newest technology. We shall see, when I receive my explanation of benefits.

PS. She stated that she was 67 yrs old and hoped to work another 2-3 years, since there is only so much cleaning you can do. She winced one time and when I asked if she was okay, she said she was fine. She had a foot operated on and the surgery did not go as well as planned. She said she was able to do 2 patients and then had to sit down for at least 20 seconds. She seemed very nice, but I felt sorry for her, if her retirement plans were cleaning.

 

[Brat]

What annoys me is that radiology facilities are pushing the increased cost of 3-D mams without data that demonstrates that they are more effective, increasing the cost of health care for all. Unfortunately the patient is caught in the middle.

FWIW I have been treated for breast cancer, hate to call myself a 'survivor' as the tumor was so small it was hardly worth the surgeon's time.. and my diagnosis mam was not a 3-D. The radiologist's skill is much more important than the latest and greatest x-ray equipment.

 

[MooreBonds]

I have an outstanding bill from radiologist from 6 months ago that is being a PITA. I'm not sure exactly how it works to tell the truth, but best I can understand is they are a third party contracted by specialist doctor I saw, or perhaps contracted by the hospital where CTScan was done? Point is, I never initiated a request for their service, except by way of being scheduled for CTScan as part of a routine-for-me followup.

I am signed up with several market research companies, and have been picked for (among other focus groups) 2 focus groups on medical malpractice lawsuits. One involved someone who was referred by their GP for a CT Scan (?) at a hospital due to some stomach pains, and it showed a suspicious blob in their lower stomach/intestinal area. 3 scans over a period of 4 months lead to the last report not even mentioning the blob, so everyone assume the blob disappeared (even though it was still there, and was noted as the sole reason for the follow-up tests). Later on, turned out to be cancer. Patient started treatment, but died.

The focus group documentation given to us explained that it is common for hospitals to own the expensive equipment, maintain the facility, and everything else, and to have an outside 3rd party group (radiologists, et. al.) do the actual reading of the scan. And most hospitals (in Missouri) have contracts that say that if you end up suing the hospital for some malpractice involving a medical equipment service, their contract with the 3rd party group automatically sues the 3rd party group and requires payment to the hospital equal to the lawsuit against the hospital.

To some of the people in the focus group, they were only focused on the 'deep pockets' theory, and thought the hospital bore 25%-50% liability even though they only provided the equipment, and felt it was unfair that the hospital can't be liable to some degree (assuming it wasn't due to faulty equipment).....but I asked the group "what if the tables were turned, and an outside 3rd party owned the machine, building, waiting area, and the hospital ONLY provided the radiologist to read the report? Would you feel this 3rd party is responsible for 25%-50% of the suit, even though all they did was provide a machine?" However, that didn't seem to sink in too far, and the "deep pockets" theory seemed to prevail far too common.

 

[karen1972]

Well this is the one thing ACA SHOULD have done and something we should write our congressmen to implement. When I go to the auto dealership they give you an expected price and if they find something and they go over, you need to sign off on that BEFORE they do that. (Yeh sure if its life and death then fine waive it).

I don't get why I can't get an itemized list ahead of time of what the bill will be and what the insurance will pay. Some doctors will do this, not sure why we can't make a law to force them too... it would change medicine dramatically.

I also think they should have to POST their rates. There are some dentist plans that now have those pre-posted rates so everything is itemized and you know exactly what that dentist charges for each procedure... the only reason doctors don't is so they can hose you. Call around about any procedure, especially MRIs and you can find a difference of $2500 in costs for the exact same procedure in the exact same town.

 

[swakyaby]

I have also been asked at checkin for routine screening mammograms if I would agree to the computer-assisted diagnostic readings of my mammogram. She said it would only cost $35.00 up front, and then quietly added but it could cost up to $200 more. I noted she slightly squirmed when she mumbled that. She said it was "like spell-check" for the radiologist. I thought about it for 2 seconds, and thought to myself that I'm paying a professional (the radiologist) to scrutinize my mammogram for abnormalities. Would a computer readout make him/her look just as closely, or merely sign off on the computer readout after a brief glance at the mammogram? I decided to decline.

When I read the recent medical news that the additional cost did not result in improved detection, I was not too surprised.

To the OP, I would have disputed paying the additional $31 if that was not disclosed upfront. You paid the agreed upon $35.00 already. The hospital should have to write off the cost of their "computer oversight."

 

[gauss]

I also think they should have to POST their rates. There are some dentist plans that now have those pre-posted rates so everything is itemized and you know exactly what that dentist charges for each procedure... the only reason doctors don't is so they can hose you. Call around about any procedure, especially MRIs and you can find a difference of $2500 in costs for the exact same procedure in the exact same town.

I think most would want to see the rates posted that are contracted for one's insurance company -- not the retail rates. I suspectthis is considered proprietary information and that is the real problem.

I would like to see the insurance companies post the
contracted rates that would apply to any procedure for that year.

Short of that I have found healthcarebluebook.com a useful proxy for this information, at least in my case.

-gauss

 

[pb4uski]

I'm going through another version of this now. As background, when DW went for her annual physical in the spring, they miscoded her routine blood work and we got a bill from the hospital that took forever to get sorted out.

So I'm going for my annual physical and at three different touchpoints make it clear that they need to code the bloodwork correctly so the insurance company will pay it as part of the annual physical... when I make the appointment for the physical and they set up an appointment to have the blood draw, at the hospital when they do the blood draw and with my doc when I have my physical. Well, guess what... shortly after the physical I get a bill from the hospital for $183 (after a $67 insurance adjustment) for bloodwork.

I really think they do this intentionally since many people will just pay the bill... after all... "it's only $183"... even though it should be covered.

 

[pb4uski]

Epilogue: The other day I had called the hospital about the bill and they said that "it wasn't their fault" and that the problem was with the doctor's office and that they would call over there to get it straightened out. I vented a bit that this had happened to us before and this time I had make it clear at three different times that they needed to code it correctly and they still screwed it up and that I was frustrated with the constant fingerpointing to others (the doctor's office and hospital are affiliated under the same university hospital umbrella and are in the same building) and that they needed to "get their sh!t together". The CSR admonished me for "swearing" at her and I told her that I did no such thing.

So today, after writing the post above, I call the doctor's office to follow up and am referred to the office manager who tells me that she did get a call from the hospital and will straighten it out. She then goes on to tell me that I should not have been so rough on the hospital CSR and that it is really the doctor's fault. Funny that someone else is always to blame. I tell her that if this is a persistent problem then they need to reassess their processes and that they will continue to get calls like this if they don't get their act together.

This doc and hospital are where we used to live. We moved about 30 minutes away a few years ago but resisted moving our doc or hospital since we had been with them a long time but I think it may be time to reassess that decision and move to a clinic and hospital closer to home.

 

[Brat]

I am signed up with several market research companies, and have been picked for (among other focus groups) 2 focus groups on medical malpractice lawsuits. One involved someone who was referred by their GP for a CT Scan (?) at a hospital due to some stomach pains, and it showed a suspicious blob in their lower stomach/intestinal area. 3 scans over a period of 4 months lead to the last report not even mentioning the blob, so everyone assume the blob disappeared (even though it was still there, and was noted as the sole reason for the follow-up tests). Later on, turned out to be cancer. Patient started treatment, but died.

The focus group documentation given to us explained that it is common for hospitals to own the expensive equipment, maintain the facility, and everything else, and to have an outside 3rd party group (radiologists, et. al.) do the actual reading of the scan. And most hospitals (in Missouri) have contracts that say that if you end up suing the hospital for some malpractice involving a medical equipment service, their contract with the 3rd party group automatically sues the 3rd party group and requires payment to the hospital equal to the lawsuit against the hospital.

To some of the people in the focus group, they were only focused on the 'deep pockets' theory, and thought the hospital bore 25%-50% liability even though they only provided the equipment, and felt it was unfair that the hospital can't be liable to some degree (assuming it wasn't due to faulty equipment).....but I asked the group "what if the tables were turned, and an outside 3rd party owned the machine, building, waiting area, and the hospital ONLY provided the radiologist to read the report? Would you feel this 3rd party is responsible for 25%-50% of the suit, even though all they did was provide a machine?" However, that didn't seem to sink in too far, and the "deep pockets" theory seemed to prevail far too common.

They definitely have some liability as they selected the radiologist. I have read that some systems are using radiologists in places like India. There is no reason to assume that they have lesser skills than US radiologists BUT who carries the malpractice insurance?

My other concern about the patient's treatment is the failure to refer for a colonoscopy. They are cheap, minimally invasive, and would have ID's the 'blob'.

 

[slingshot]

I spent half a day going back between HI and colonoscopy team. Unable to get a price. "Between $3 and $10k" was the best answer I could get. Colon Assist sent me to a board certified doc at a respected facility for $1000 complete. Just because you have insurance, you are not required to use it. Paid $280 cash for an MRI.

 

[athena53]

I spent half a day going back between HI and colonoscopy team. Unable to get a price. "Between $3 and $10k" was the best answer I could get. Colon Assist sent me to a board certified doc at a respected facility for $1000 complete. Just because you have insurance, you are not required to use it. Paid $280 cash for an MRI.

Is that colonoscopyassist.com? I just checked that site out and will likely use it if I can't get a straight answer about costs from the provider my doc recommends.

As for my original post, the thought occurred to me that if the overcharge was "a known issue with the new billing system", the hospital should be sending out letters to everyone who paid the $200 sticker price, offering a refund. I'm not holding my breath.

 

[travelover]

........
As for my original post, the thought occurred to me that if the overcharge was "a known issue with the new billing system", the hospital should be sending out letters to everyone who paid the $200 sticker price, offering a refund. I'm not holding my breath.

The failure to refund the $200 is also "a known issue with the new billing system"

 

[slingshot]

Yes, colonoscopyassist.com. Created for individuals with high deductible health insurance or those with no insurance.
My husband and I have each used the service. Very straightforward and NO little hidden "Gotcha" moments.