Frustration with medical providers

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Jerrybaby
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Frustration with medical providers

Post by Jerrybaby » Fri Jun 13, 2014 1:46 pm

I've had health coverage through my employer for all of my adult life, but now I have no health coverage. Its by choice, out of principle, I don't need lectures. I recently had a physical, and the doctor ordered a stress test off site. Someone called to schedule, I said "how much will it cost?" It took phone conversations with five different people with severely limited knowledge to come away with a vague quote of $150 for a stress test. I pushed for confirmation, and was told a stress test costs over $1000, but since I'm paying cash, it is $150. I've been healthy all my life so no need for much health care, but what the heck is going on here?

steve_14
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Re: Frustration with medical providers

Post by steve_14 » Fri Jun 13, 2014 1:53 pm

Jerrybaby wrote:I've been healthy all my life so no need for much health care, but what the heck is going on here?


Sounds to me like you're getting older.

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Crimsontide
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Re: Frustration with medical providers

Post by Crimsontide » Fri Jun 13, 2014 2:30 pm

steve_14 wrote:
Jerrybaby wrote:I've been healthy all my life so no need for much health care, but what the heck is going on here?


Sounds to me like you're getting older.


And if that is true you had better get coverage ASAP...

user5027
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Re: Frustration with medical providers

Post by user5027 » Fri Jun 13, 2014 2:34 pm

Do you pay the sticker price at the auto dealership? :oops:

denovo
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Re: Frustration with medical providers

Post by denovo » Fri Jun 13, 2014 2:47 pm

This forum usually locks posts on medical issues, but I guess if we focus on the consumer aspects of it, maybe it'll stick around. However, I think many self-pay patients have come to the conclusion that pricing is not transparent for medical services.

likegarden
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Re: Frustration with medical providers

Post by likegarden » Fri Jun 13, 2014 3:01 pm

Pricing of medical service is not a medical issue. It is simply to survive financially the non-existence of fair and understandable pricing. That's why I have medical insurance, to give me an honest price and give me support in choosing services. That also applies to dental insurance.

awval999
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Re: Frustration with medical providers

Post by awval999 » Fri Jun 13, 2014 3:06 pm

A lecture?

If you get sick and have to go to the hospital you are at risk of losing everything you have worked your entire life for. Self pay hospital billing is outrageous and atrocious and accountable to no one. And the only people at risk of having to pay full price are people with savings. The fact that you are at Bogleheads implies that you do have savings.

The reason you are frustrated is that no one has any idea what anything costs. Going without insurance, the only way to get "negotiated rates", is literally financial Russian roulette.

oxothuk
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Re: Frustration with medical providers

Post by oxothuk » Fri Jun 13, 2014 3:23 pm

likegarden wrote:That also applies to dental insurance.

Really? My dentist has their prices posted on the web.

richard
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Re: Frustration with medical providers

Post by richard » Fri Jun 13, 2014 3:29 pm

There have been many studies of medical pricing. The usual conclusions are that many providers won't give you a price in advance and pricing is wildly inconsistent, and not just by 2x or 3x.

Are you planning to shop around if you have a heart attack or stroke?

Sidney
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Re: Frustration with medical providers

Post by Sidney » Fri Jun 13, 2014 3:30 pm

My dentist does also. I looked at dental insurance at the time I retired. Didn't make economic sense. Annual limits are low so you aren't protected at the high end if you have a lot of work done.
I always wanted to be a procrastinator.

Sidney
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Re: Frustration with medical providers

Post by Sidney » Fri Jun 13, 2014 3:32 pm

richard wrote:There have been many studies of medical pricing. The usual conclusions are that many providers won't give you a price in advance and pricing is wildly inconsistent, and not just by 2x or 3x.

Are you planning to shop around if you have a heart attack or stroke?

My insurer, Aetna, will give me the price over the phone. All I need to do is tell them who the network provider is and the procedure code(s). Do it all the time.
I always wanted to be a procrastinator.

bobbun
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Re: Frustration with medical providers

Post by bobbun » Fri Jun 13, 2014 3:33 pm

denovo wrote:This forum usually locks posts on medical issues, but I guess if we focus on the consumer aspects of it, maybe it'll stick around. However, I think many self-pay patients have come to the conclusion that pricing is not transparent for medical services.


It's non-transparent for more than just self-pay patients. I had a diagnostic scan last year for which the insurance negotiated rate ended up being $166. The rate before the write off for the insurance company? Over $8000! If one of these numbers makes economic sense (and I don't claim either does), then the other surely does not. Unless you truly are already impoverished, it makes no sense at all to go without health insurance. It's the most important insurance to protect your assets, bar none.

mur44
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Re: Frustration with medical providers

Post by mur44 » Fri Jun 13, 2014 3:52 pm

People with Medicare experience frustration with
billing, coverage, deductibles, co-pays and co-insurance.
Hospitals are notorious for billing and charges.
It is very typical for huge variation in charges
for the same treatment, procedure, medicine,
service or durable medical equipment.

Most of the problems can be attributed to third
party payers. It is typical for (provider) billers
to tell that why do you care: 'The insurance
company will pay for it."

Haggling works for reduced health care charges.
The only way to avoid the hassle is to obtain
insurance, preferably with 'supplemental' coverage
so you never see a medical/health care bill.

Disclosure: I am a Certified Volunteer Medicare Counselor from NJ

staythecourse
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Re: Frustration with medical providers

Post by staythecourse » Fri Jun 13, 2014 4:02 pm

Not having medical insurance??

Laughable. Pure and simple.

How could you be on a investing website and be okay taking on the DEFINITE risk you will get sick at some point in your life. Investing all your money in a single company is a better idea. There is a chance the company you invest in won't go under. But the news flash is it is GAURANTEED you will get sick!! It is 100%. What do you think will happen? You will be 100% okay and then just one day have a major heart attack and die??

The irony in this thread is someone having a diagnostic work up done who does not have insurance. What are you going to do if the results come back and they advice a cath? Then if you need stents or open heart surgery? How are you going to swing that out of pocket??

Makes no sense.

Good luck.
"The stock market [fluctuation], therefore, is noise. A giant distraction from the business of investing.” | -Jack Bogle

sambb
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Re: Frustration with medical providers

Post by sambb » Fri Jun 13, 2014 4:06 pm

average profit margin of a hospital is 5% or lower in the USA
That is far lower than apple, tesla, and other successful businesses.
I bet we all have consumer products around with a far higher profit margin in those industries

I have heard that walmart's gross margins are 25% - haven't checked their annual report.

Interesting data, and I think that at $150 for a stress test ,it is pretty cheap.

mathwhiz
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Re: Frustration with medical providers

Post by mathwhiz » Fri Jun 13, 2014 4:08 pm

I hope you your state protects your homestead and assets in tax sheltered accounts from judgments. Likewise, I hope you have very little assets or money in taxable accounts. It will make the eventual bankruptcy filing when you get that heart attack and $1 million + hospital bill for weeks in hospital/ICU easier. If you get cancer, forget about it. Nobody will see you unless you give large cash deposits. You will get taken to the cleaners. You may have to go overseas like Thailand or India for affordable treatment.
Last edited by mathwhiz on Fri Jun 13, 2014 4:10 pm, edited 2 times in total.

richard
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Re: Frustration with medical providers

Post by richard » Fri Jun 13, 2014 4:09 pm

Sidney wrote:
richard wrote:There have been many studies of medical pricing. The usual conclusions are that many providers won't give you a price in advance and pricing is wildly inconsistent, and not just by 2x or 3x.

Are you planning to shop around if you have a heart attack or stroke?

My insurer, Aetna, will give me the price over the phone. All I need to do is tell them who the network provider is and the procedure code(s). Do it all the time.

A doctor is a healthcare provider. An insurance company is not a provider - it's a bulk buyer with bargaining power and a rate schedule. Try surveying prices directly from doctors or hospitals.

Here's a study that says pricing transparency would save $100 billion over the next ten years. http://www.westhealth.org/news/press-re ... r-10-years Sounds good until you realize that's about 0.2% of $41,000 billion projected spending.

lawman3966
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Re: Frustration with medical providers

Post by lawman3966 » Fri Jun 13, 2014 4:45 pm

Jerrybaby wrote:I've had health coverage through my employer for all of my adult life, but now I have no health coverage. Its by choice, out of principle, I don't need lectures. I recently had a physical, and the doctor ordered a stress test off site. Someone called to schedule, I said "how much will it cost?" It took phone conversations with five different people with severely limited knowledge to come away with a vague quote of $150 for a stress test. I pushed for confirmation, and was told a stress test costs over $1000, but since I'm paying cash, it is $150. I've been healthy all my life so no need for much health care, but what the heck is going on here?


If you can get this stress test for $150, I'd go for it. But, if you're really going to "self-insure" by working to stay healthy (and presumably praying a lot), you need to self-educate as well. It's worth researching exactly what different medical clinics mean by the term "stress test," and what level/quality of service they provide.

I know people, including some smart health care providers (my physical therapist for e.g.), who buy catastrophic health insurance, meaning that their premiums are low, but that they will pay heavily in any year in which they get an expensive illness. My PT insists that she is self-insuring on the grounds that she will protect her health through diet and exercise, and that for economic reasons has no choice but to go the "catastrophic" route. If you're going go the high-risk route (which you are already doing), you might consider modifying it to pursue catastrophic coverage, rather than having no coverage at all. I think (someone may correct me) that even with catastrophic coverage, there are still annual out-of-pocket limits that will prevent you from paying $100K or the like for treatment should you get an expensive illness.

For now, I suppose cheaper treatment in India and Thailand is an option. However, I keep up with sites that track retirement costs in Thailand, and people report that medical costs there are rising fast. They may be close to or at the U.S. level within a few years. Cheaper treatment elsewhere might be nice, but you can't be sure you'll be able to get there in an emergency situation, or that treatment will be as cheap as it now is, when you need it.

Sidney
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Re: Frustration with medical providers

Post by Sidney » Fri Jun 13, 2014 4:48 pm

richard wrote:A doctor is a healthcare provider. An insurance company is not a provider - it's a bulk buyer with bargaining power and a rate schedule. Try surveying prices directly from doctors or hospitals.

Don't need to. They have too many contracts (with various insurers) and it takes too long to have them sort through the discount price. They also don't know where you stand on deductible and out of pocket max. The insurance company knows exactly and can tell you more quickly.
I always wanted to be a procrastinator.

jebmke
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Re: Frustration with medical providers

Post by jebmke » Fri Jun 13, 2014 4:55 pm

Sidney wrote:
richard wrote:There have been many studies of medical pricing. The usual conclusions are that many providers won't give you a price in advance and pricing is wildly inconsistent, and not just by 2x or 3x.

Are you planning to shop around if you have a heart attack or stroke?

My insurer, Aetna, will give me the price over the phone. All I need to do is tell them who the network provider is and the procedure code(s). Do it all the time.

I do the same. I have done this many times on things like MRI, stress test etc. The provider gives me the procedure codes and I call the insurance company and they tell me what the cost (contract cost) will be and how much is applied to deductible.
When you discover that you are riding a dead horse, the best strategy is to dismount.

Jack FFR1846
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Re: Frustration with medical providers

Post by Jack FFR1846 » Fri Jun 13, 2014 5:02 pm

I can understand your frustration with pricing, but please don't lose sight of the fact that if something happens, you could be financially wiped out without insurance.

I get that you think you are healthy. But if your doctor is recommending a stress test, understand that it is entirely possible that you will have the same experiance as I had this january. During the stress test, my ekg showed a clear blockage. I was immediately transferred to the top hospital in Boston for angioplasty and before the day ended had 3 stents. Insurance covered the (i'm guessing ) well over $100k cost. That is what insurance is for

Oh, and the $50k finger surgery I had last year
Bogle: Smart Beta is stupid

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AAA
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Re: Frustration with medical providers

Post by AAA » Fri Jun 13, 2014 6:18 pm

In addition to unexpected health issues, what if you have an accident and need medical care?

mhalley
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Re: Frustration with medical providers

Post by mhalley » Fri Jun 13, 2014 6:40 pm

So you have the stress test for 150. That is great, assuming it is normal. But what if they tell you it shows a blockage, and you need a cath. This shows multple blockages and you need a bypass. Where does the 50k plus come from?
Mike

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pjstack
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Re: Frustration with medical providers

Post by pjstack » Fri Jun 13, 2014 10:18 pm

I have Medicare plus a supplemental insurance policy that pays the 20% that Medicare doesn't pay.

Medicare periodically sends an Explanation of Benefits (EOB) accounting in the mail. In it I see the initial hospital/doctor/testing charge (usually astonishingly high), the next column shows Medicare "allowed" (a drastic reduction), the next column shows what Medicare actually paid (80% of Medicare "allowed"), the next column shows what the supplemental insurance paid (usually the remaining 20%), and the last column shows what you owe (usually nothing).

The difference between what the hospital/doctor originally presented and what Medicare actually paid (and therefore what the doctor/hospital accepted) is shocking!!

If you think you can negotiate down to Medicare (or other insurance) levels, I can only say, "Good luck"!

(Added edit) You said you didn't have insurance "out of principle". I don't know what that means, but don't bother to explain because I (like the people in the billing department) don't care, but I'll guess that it has to do with money, premium costs, etc. Whatever the principle is, the situation in the real world is that health insurance is a real need. I hope you don't find out the hard way too soon.
pjstack

HAMnEGGr
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Re: Frustration with medical providers

Post by HAMnEGGr » Sat Jun 14, 2014 9:01 am

I agree that the best way to get a true estimate is to ask for the procedure codes (known as CPT codes) and to check with your insurance... The reason it is essentially impossible for docs to be transparent in pricing (i.e. post the prices on a web site) is that every doc has a different contracted reimbursement rate with every insurance (dozens and dozens).

Are you planning to shop around if you have a heart attack or stroke?[/quote]
My insurer, Aetna, will give me the price over the phone. All I need to do is tell them who the network provider is and the procedure code(s). Do it all the time.[/quote]

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