To the doctors on the forum

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Bacchus01
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To the doctors on the forum

Post by Bacchus01 » Wed Jan 17, 2018 10:42 pm

I just have to ask all the Drs here...

Why, in this day and age of HDHP, is it still so difficult to get a Dr, or the office, to tell you what a procedure will cost?

Recently had an issue where wife needs and MRI. We wanted to shop this to some MRI specialist places. Ortho response was “why? You have insurance.”

Of course we do. But why is it so hard to this day to have some price transparency?

Fortunately, myuhc.com has the procedure costs actuall for each of the local MRI places and the one the ortho referred was in line for the lower cost ones and highly rated by patients.

But why is this still seemingly received as such an odd question? Anyone else have this and how do you deal?

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Sandtrap
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Re: To the doctors on the forum

Post by Sandtrap » Wed Jan 17, 2018 10:44 pm

On my last several MRI's, we got the prescription from the Doc, then shopped MRI places. Found one with an outstanding reputation and was the cheapest in town. Yes. I have insurance. But we called around and shopped prices, nonetheless.
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FrugalProfessor
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Re: To the doctors on the forum

Post by FrugalProfessor » Wed Jan 17, 2018 10:52 pm

Bacchus01, I feel your pain and am equally perplexed at the complete failure of medicine to provide transparent pricing. We have a HDHP plan as well and have faced similar frustrations while pricing out basic procedures/exams (strep test, pink eye, etc) prior to hitting our deductible each year.

At one point in my life I had idea to create a business that crowdsourced this info from a combination of consumers + doctors (think gasbuddy meets expedia). It never got off the ground for many reasons. As more people transition from Cadillac policies to HDHP (which act as if they have no insurance until the deductible is hit...thus HDHP members have every incentive in the world to be price conscious), I think the idea still has merit. I would love for this product to exist.

For most procedures we end up using Minute Clinics which have very clear and transparent pricing.
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jbmitt
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Re: To the doctors on the forum

Post by jbmitt » Wed Jan 17, 2018 10:54 pm

...because most of them have no clue. DS practices employed medicine and doesn’t have control over what she charges and bills. She has signed all of that over to her employer and they submit and collect on her behalf.

staythecourse
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Re: To the doctors on the forum

Post by staythecourse » Wed Jan 17, 2018 11:03 pm

Why would the doctor's office know how much an MRI costs? When you go to McDonalds do they know how much your accountant bills you for? It ISN"T the doctor's office billing for the MRI it is the MRI centers doing the billing. Why not ask the individual MRI centers what their billing is? OF course, that will be different as well as each one may or may not be in network with your insurance (out or in network benefits) AND/ OR have different contracts with the insurance companies. Folks don't seem to understand it is ILLEGAL for one medical provider to know how much they are getting paid for the same service as another provider even from the same insurance. It lends itself to collusion.

Now if you ask your doctor's office how much they are going to charge for something THEY are going to do then a solo guy like me or a true old school private practice guy who sees their own EOBs knows of the top of their head. If it is an employed doc or any new doc who doesn't understand the business of medicine they would have to refer you to their billing service who can get you that answer if you tell them what the CPT billing codes you are inquiring about.

Good luck.
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radiowave
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Re: To the doctors on the forum

Post by radiowave » Wed Jan 17, 2018 11:08 pm

Here's an excellent Times Magazine article by Steven Brill a few years ago that highlights the problem of healthcare costs/bills:

http://content.time.com/time/subscriber ... 4,00.html
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staythecourse
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Re: To the doctors on the forum

Post by staythecourse » Wed Jan 17, 2018 11:10 pm

Just as a small addendum to my last post it is interesting as the push is for MORE separation between clinical responsibilities of patient care and the business side when it comes to medicine. Everyone seems to love it when the doctor is kept at an arms length away from the business side (understandable to minimize money being a motivating factor in clinical decision making), but then you can't ask the same doctor to understand the business side when it becomes convenient for you (the patient).

The most reasonable thing is to ask the doctor's office to talk to the practice manager about business/ billing questions. If they don't have one then ask to talk to their billing department if it has to do with billing and administration if it has to do with how the practice functions.

The days of doctors knowing about how to run a practice is nearly done (sadly enough) and that is why you see less and less doctors really even care about helping answer any question outside of the clinical part. The more doctors are treated like pencil pushers the more they will do only that.

Good luck.
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123
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Re: To the doctors on the forum

Post by 123 » Wed Jan 17, 2018 11:12 pm

We recently has Anthem BlueCross BlueShield coverage. They had a website that gave their negotiated prices for various services and procedures at a variety of places so you could shop around. You had to sign-in so they knew what plan to show prices for. For example a simple blood test that was $45 at a local walk-in lab was over $300 if you used the lab at the hospital. But if insurance is paying for it maybe you don't care (if you're over your deductible).
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sambb
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Re: To the doctors on the forum

Post by sambb » Wed Jan 17, 2018 11:20 pm

why would a doctor know? they dont own the mri! Does the doctor know how much your gym membership is, when they tell you to diet and exercise? do they know the cost of your food when they tell you to diet? if you want the price, ask the owner of the mri machine. The doctor can tell you the cost of an office visit in a close range at a moments notice.

Bacchus01
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Re: To the doctors on the forum

Post by Bacchus01 » Wed Jan 17, 2018 11:23 pm

staythecourse wrote:
Wed Jan 17, 2018 11:03 pm
Why would the doctor's office know how much an MRI costs? When you go to McDonalds do they know how much your accountant bills you for? It ISN"T the doctor's office billing for the MRI it is the MRI centers doing the billing. Why not ask the individual MRI centers what their billing is? OF course, that will be different as well as each one may or may not be in network with your insurance (out or in network benefits) AND/ OR have different contracts with the insurance companies. Folks don't seem to understand it is ILLEGAL for one medical provider to know how much they are getting paid for the same service as another provider even from the same insurance. It lends itself to collusion.

Now if you ask your doctor's office how much they are going to charge for something THEY are going to do then a solo guy like me or a true old school private practice guy who sees their own EOBs knows of the top of their head. If it is an employed doc or any new doc who doesn't understand the business of medicine they would have to refer you to their billing service who can get you that answer if you tell them what the CPT billing codes you are inquiring about.

Good luck.
But there is the rub. The average consumer is being asked to ask all these questions and the Drs don’t know. They just say “what do you care, you have insurance.” Nor do they say (in this instance) check with the MRI clinic but here are three I recommend.

And try to ask these questions for an inpatient surgery. Good lord. All the docs stand around and point at each other like the McDonalds example (not literally of course).

The industry has to change.

Bacchus01
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Re: To the doctors on the forum

Post by Bacchus01 » Wed Jan 17, 2018 11:26 pm

sambb wrote:
Wed Jan 17, 2018 11:20 pm
why would a doctor know? they dont own the mri! Does the doctor know how much your gym membership is, when they tell you to diet and exercise? do they know the cost of your food when they tell you to diet? if you want the price, ask the owner of the mri machine. The doctor can tell you the cost of an office visit in a close range at a moments notice.
Actually, they can’t. I’ve asked.

As for your MRI response, that’s not transparent to the average consumer. The average consumer, when told to go down the hall to schedule an MRI with imaging or radiology, just goes down the hall and schedules, OT always realizing that they could go to an outside specialist for a fraction of the cost.

I’m not trying to be critical of the Drs per se, I’m just surprised by the lack of transparency still as well as the flippant “what do you care?” Response we still seem to get.

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Pajamas
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Re: To the doctors on the forum

Post by Pajamas » Wed Jan 17, 2018 11:36 pm

Part of the reason is that there's not one price for a procedure. Contracted rates vary depending on who the contract is with and sometimes varies even under the same contract by geographical location and the facility in which the procedure is provided.

There are also multiple components with different rates for one episode of care in many cases. That can even be true for a simple visit to a doctor's office. You might get a bill for the doctor's services and another for the facility's services.

quantAndHold
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Re: To the doctors on the forum

Post by quantAndHold » Thu Jan 18, 2018 12:02 am

Pajamas nailed it. The price I pay for the MRI is different than the price you pay for the MRI from the same provider, because my insurance company negotiated a better or worse deal with the provider than yours did. The doctor has no idea what insurance you have, or what the negotiated fee is for that MRI.

All my large medical corporation employee doctor knows is to refer to his own company. If I want to shop around, I have to shop around on my own, tell him where I want the referral to go, and then he still refers within his own practice, and it takes several round trips by email or phone to get the referral sorted out.

Medicine is broken in this country.

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White Coat Investor
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Re: To the doctors on the forum

Post by White Coat Investor » Thu Jan 18, 2018 12:04 am

Bacchus01 wrote:
Wed Jan 17, 2018 10:42 pm
Why, in this day and age of HDHP, is it still so difficult to get a Dr, or the office, to tell you what a procedure will cost?
Because the doctor doesn't know the price. And even if he did, he doesn't know the price for you. The price is different for everyone. It's impossible to keep track of the 50+ insurance plans people walk in with and how much their co-insurance is and how much of their deductible they've paid and what their co-pays are and what price the insurance company has negotiated with the doc etc. Lots of moving pieces.
Bacchus01 wrote:
Wed Jan 17, 2018 10:42 pm
But why is it so hard to this day to have some price transparency?
Because the lack of price transparency boosts profits for the businesses working in health care (hospitals, pharmacies, drug companies, equipment manufacturers and yes, doctors. People consume more health care when they don't know the price.

Thus, price transparency is key to real health care reform.
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Katietsu
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Re: To the doctors on the forum

Post by Katietsu » Thu Jan 18, 2018 12:13 am

quantAndHold wrote:
Thu Jan 18, 2018 12:02 am
Pajamas nailed it. The price I pay for the MRI is different than the price you pay for the MRI from the same provider, because my insurance company negotiated a better or worse deal with the provider than yours did. The doctor has no idea what insurance you have, or what the negotiated fee is for that MRI.
Worse than that, even the same procedure with the same provider and the same insurance company is not always the same price between patients with two different plans.

Additionally, the doctor often does not know with complete certainty in advance what care will be provided. Even an office visit has several possible levels of service and there are add-on codes that can further increase the price.
Last edited by Katietsu on Thu Jan 18, 2018 12:15 am, edited 1 time in total.

TheNightsToCome
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Re: To the doctors on the forum

Post by TheNightsToCome » Thu Jan 18, 2018 12:14 am

I'm a cardiologist, and I work very hard to be good at the practice of cardiology. I work about 60 fast-paced hours per week, then take an additional 10 nights and one weekend of call every month. On most of my "off days" I try to keep up with the avalanche of medical literature, read charts for the next work day, take care of phone messages and lab reports, and read imaging studies.

I was well-trained for clinical responsibilities, but never had one minute of training regarding the business of medicine. When I started in private practice following fellowship in 1997, I hired a practice management and billing service to run the business. They set my charge master. I have no idea how they decided on the charges (and I didn't know what a "charge master" was until I hired them). I trusted their expertise.

I never asked what my charges were for a left heart cath and coronary angiogram (or any other service). I presumed it was the market rate.

I practiced in a rural location 90 minutes from a major metro area. One day a family practitioner who was halfway between me and the major metro called to refer a patient for cath. I was happy to help, but asked why she chose to refer in my direction when she was just as close to tertiary care centers in the other direction. She said that no one in the metro area accepted Medicaid patients.

That prompted me to make inquiries. I learned that I was paid about $40 for a 40 minute consultation on Medicaid patients. (It turns out that my service billed a much higher figure, but $40 was all that Medicaid paid.) Meanwhile, my hairstylist charged me $33 for a 20 minute haircut and I tipped her $7 per cut for an even $40.

I was well-compensated in spite of that. Most of my patients were not on Medicaid.

Now I am an employee. The hospital (my employer) sets all charges and does all billing. I am happy to have no part in the business end of medicine. We have "care managers" who are experts in that area. If my patients have a problem with insurance or a question about billing I tell them I don't know much about it (I know virtually nothing about it), but I refer them to the care managers who make it their business to know everything about it.

I didn't go into medicine to learn about insurance and billing. I don't have an interest in it. It is a big job to keep up with my practice and the ever-advancing science of cardiology. If I didn't have patients to care for I could spend all day studying and never run out of new literature to read.

lynneny
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Re: To the doctors on the forum

Post by lynneny » Thu Jan 18, 2018 12:50 am

I understand that doctors can't give me a price list, for all the reasons previous posters have cited -- and I wouldn't want to waste the precious ten minutes or so I have with the doctor asking about billing anyway. Plus I'd rather a doctor be able to focus on saving my life rather than pricing issues. But somebody somewhere is in charge of billing me and so has to know what the charges are, and it's maddeningly difficult to find that person and get them to tell me anything.

We need price transparency!

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woof755
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Re: To the doctors on the forum

Post by woof755 » Thu Jan 18, 2018 1:32 am

It would be so nice for docs to know the prices of the tests we order, but as WCI mentioned earlier, it depends upon the facility which provides the service and the exact policy by which the patient is covered. When I worked for a university hospital system a few years ago, I wanted to know how much we are reimbursed for a certain procedure--because we suspected that the device used in the procedure was more expensive than the reimbursement for the service. Our chief said "We'd be better off financially if we gave the patient $50 and asked them to go get the procedure done elsewhere." Imagine the frustration and consternation that caused us all. So, we asked our business side folks to dig into it and let us know. The answer was that it depended upon the policy, and proceeded to give us a document showing hundreds of different policies. Some states had a dozen or more.

Price transparency would be amazing for patients, but equally so for docs. Imagine the quality of relationship we could achieve if our mutual shared decision making wasn't constantly undercut by mistrust regarding cost?

As it is, we rely on our training, our experience, and our conscience to order only the tests that are necessary. And we are left only to hope that what is necessary doesn't cost the patient an appendage.
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sbh8
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Re: To the doctors on the forum

Post by sbh8 » Thu Jan 18, 2018 2:05 am

I once stumbled upon a forum for physical therapists & PT billing. What gave me a bit of shock was that depending on who your insurance carrier is, they will bill different medical codes for (virtually) the same procedure.

e.g. If they did some sort of manual therapy on your hand, it could be billed under code 123 or code 345, because the codes cover manual therapy under different circumstances or there's some other slight nuance to each one.

Aetna may pay $50 for 123 and $40 for 345
United may pay $35 for 123 and $70 for 345

So the biller needs to now know that when a patient has Aetna insurance, they should bill as code 123, and when a patient has United, they should bill as 345. Even though, the actual therapy was the same thing. It's mind boggling that this is an accepted practice! No wonder a patient has no idea how much the charge will be. They don't even know what code the visit/procedure will be billed under!

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eye.surgeon
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Re: To the doctors on the forum

Post by eye.surgeon » Thu Jan 18, 2018 2:15 am

As others have pointed out, I as the doctor have no idea how much your MRI will cost. That's between your insurance company and the imaging facility. The doctor is not involved in or paid for imaging, lab tests, medication, etc. Those rates are negotiated on your behalf by your insurance agent with the entities involved, not the doctor.
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woof755
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Re: To the doctors on the forum

Post by woof755 » Thu Jan 18, 2018 2:26 am

sbh8 wrote:
Thu Jan 18, 2018 2:05 am
I once stumbled upon a forum for physical therapists & PT billing. What gave me a bit of shock was that depending on who your insurance carrier is, they will bill different medical codes for (virtually) the same procedure.

e.g. If they did some sort of manual therapy on your hand, it could be billed under code 123 or code 345, because the codes cover manual therapy under different circumstances or there's some other slight nuance to each one.

Aetna may pay $50 for 123 and $40 for 345
United may pay $35 for 123 and $70 for 345

So the biller needs to now know that when a patient has Aetna insurance, they should bill as code 123, and when a patient has United, they should bill as 345. Even though, the actual therapy was the same thing. It's mind boggling that this is an accepted practice! No wonder a patient has no idea how much the charge will be. They don't even know what code the visit/procedure will be billed under!
I know nothing about PT billing, but I can tell you with 100% certainty that in my field a colonoscopy is a colonoscopy is a colonoscopy. We don't game the system--and even if one wanted to, the codes are the codes are the codes. I suspect something was lost in translation on that other board.

This is important to me, because I don't like the mistrust that these kinds of ideas engender. I suppose there are scoundrels everywhere, but most docs just do their thing, bill accurately to the best of their ability, and go home to their spouse and kiddos/pets/etc.
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afan
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Re: To the doctors on the forum

Post by afan » Thu Jan 18, 2018 5:56 am

Your doctor will have no idea what a procedure will cost except that increasingly insurance plans will tell them. The insurers give referring physicians access to this information to encourage them to refer to low cost providers. Then they reward or penalize the docs based on the costs of the care they recommend. Under a system like this the doc is given this info by the insurance company. If your insurer does not do this your doctor cannot help you.

You could try to call your insurer to find the cost of a specific procedure at a number of places. Again, depending on your plan the company may or may not be set up to tell you.
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johnubc
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Re: To the doctors on the forum

Post by johnubc » Thu Jan 18, 2018 7:10 am

Price Transparency.

Sadly, that is something that the industry is still fighting to protect a broken system. The person with no insurance pays the full freight, whereas the person with insurance pays a negotiated rate that bears little resemblance to the actual costs. I do not blame the individual doctor - it is the way it happens. The negotiated rate is really not even negotiated - but the groups decide what each procedure will cost and game the system back and forth, up this charge, reduce that charge - so that as a whole the provider is compensated. The consumer would not accept this in any other industry, but is at the mercy of the insurance companies.

As far as the Doctor knowing the pricing - like many other industries, like car care - I do not expect the technician (they are no longer mechanics) to know how much something will cost, the front desk will know better. Healthcare needs to modernize, the insurance companies needs to get to where they provide insurance, not dictate pricing. Price and Cost transparency is the cure.

ENT Doc
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Re: To the doctors on the forum

Post by ENT Doc » Thu Jan 18, 2018 7:12 am

The reason for your concern is not necessarily price transparency, but the separation of those providing care (doctor) and those assuming risk and controlling payment (insurance companies). The insurers have the prices. Ask them as others above have alluded to. They all have different negotiated rates. Ultimately, yes, we need price transparency (and quality transparency) if you want to have medicine operate like a normal market at the site of care, but the way to get there is to stop the separation of provider and payer. For example, Kaiser assuredly can provide price transparency because they are the same. This is the concept Stephen Brill talks about in the writing he has done, just like in the article above.

bondsr4me
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Re: To the doctors on the forum

Post by bondsr4me » Thu Jan 18, 2018 7:15 am

I have been with my Doctor since he hung his shingle 40+ years ago. I chose him after my Doctor retired. My Doctor is, IMHO, the very best general practitioner I could have chosen. I don’t want him to be worrying about the financial part of his practice. I want him to continue to be the best Doctor he can be. I remember when he would come into the exam room carrying my chart. Now he comes in carrying a laptop. This change wasn’t easy for him; he told me so.

I am a (retired) financial person and I don’t know the slightest thing about medicine, but I am darned glad Doctors do. They shouldn’t have to be concerned about all the insurance rules/rates, only practicing medicine.

To all the Doctors here, and everywhere else, I say a heartfelt “Thank You” for taking care of all of us.

Just my 2 cents worth...no charge :) ha-ha.

Have a great day everyone.

Don

Suman
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Re: To the doctors on the forum

Post by Suman » Thu Jan 18, 2018 7:26 am

Because everyone controls the profession of medicine except the doctors. I wish for the day when there are no insurance including Medicare and we can do transactions in cash with our patients without all these regulatory burdens.

Jack FFR1846
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Re: To the doctors on the forum

Post by Jack FFR1846 » Thu Jan 18, 2018 7:30 am

As a big medical user, I've seen that the amount charged can be what looks like a random number. The facility is contracted separately with each insurance company who sets what payment will be made for each code. So there is no "real" answer.

The cool thing with that (sarcasm) is that the insurance company can decide not to cover a procedure, decide to use a totally new network, decide that a facility is no longer contracted, decide that a doctor within the facility is no longer covered, decide that a lab is not covered and they absolutely DO limit the number of doctors in their network (we have one doctor who has been trying to get into one of the networks for years....when I contacted the insurance co to ask how he can get into the network, they said they had enough doctors in the specialty. I went on a research binge and found doctors in-network according to the insurance list who were: no longer accepting patients, had left the practice, had retired, had moved out of area, had died).

So what to do? We've accepted that we're going to hit the family max out of pocket every year (usually by July) and then enjoy half a year of free everything.
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pepperz
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Re: To the doctors on the forum

Post by pepperz » Thu Jan 18, 2018 7:43 am

I had an MRI a few months ago and asked this question as I was checking out:

Me: “By the way, I’m just curious— how much does this cost?”

Lady: “About $8,000.”

Me: “What?! $8,000 for The 10 mins I spent in there?”

Lady: “Well it doesn’t mean the insurance company is going to pay that much...”

Me: “How much do they usually pay?”

Lady: “$800”

LOL

runner540
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Re: To the doctors on the forum

Post by runner540 » Thu Jan 18, 2018 7:56 am

Here's the story of a guy trying to figure out how much to budget for his wife's delivery (one of the most common procedures/treatments):
https://www.vox.com/2016/5/5/11591592/b ... ital-bills

magicrat
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Re: To the doctors on the forum

Post by magicrat » Thu Jan 18, 2018 7:57 am

I recently inquired about a surgery that is not covered by insurance. The surgeon was able to immediately give me an exact price for the procedure, including the hospital / anesthesia charge. I found it very interesting that this was the only example of price transparency I'd seen - when insurance was no where near it.

Bacchus01
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Re: To the doctors on the forum

Post by Bacchus01 » Thu Jan 18, 2018 8:04 am

TheNightsToCome wrote:
Thu Jan 18, 2018 12:14 am
I'm a cardiologist, and I work very hard to be good at the practice of cardiology. I work about 60 fast-paced hours per week, then take an additional 10 nights and one weekend of call every month. On most of my "off days" I try to keep up with the avalanche of medical literature, read charts for the next work day, take care of phone messages and lab reports, and read imaging studies.

I was well-trained for clinical responsibilities, but never had one minute of training regarding the business of medicine. When I started in private practice following fellowship in 1997, I hired a practice management and billing service to run the business. They set my charge master. I have no idea how they decided on the charges (and I didn't know what a "charge master" was until I hired them). I trusted their expertise.

I never asked what my charges were for a left heart cath and coronary angiogram (or any other service). I presumed it was the market rate.

I practiced in a rural location 90 minutes from a major metro area. One day a family practitioner who was halfway between me and the major metro called to refer a patient for cath. I was happy to help, but asked why she chose to refer in my direction when she was just as close to tertiary care centers in the other direction. She said that no one in the metro area accepted Medicaid patients.

That prompted me to make inquiries. I learned that I was paid about $40 for a 40 minute consultation on Medicaid patients. (It turns out that my service billed a much higher figure, but $40 was all that Medicaid paid.) Meanwhile, my hairstylist charged me $33 for a 20 minute haircut and I tipped her $7 per cut for an even $40.

I was well-compensated in spite of that. Most of my patients were not on Medicaid.

Now I am an employee. The hospital (my employer) sets all charges and does all billing. I am happy to have no part in the business end of medicine. We have "care managers" who are experts in that area. If my patients have a problem with insurance or a question about billing I tell them I don't know much about it (I know virtually nothing about it), but I refer them to the care managers who make it their business to know everything about it.

I didn't go into medicine to learn about insurance and billing. I don't have an interest in it. It is a big job to keep up with my practice and the ever-advancing science of cardiology. If I didn't have patients to care for I could spend all day studying and never run out of new literature to read.
This is a fantastic perspective. Thank you.

mptfan
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Re: To the doctors on the forum

Post by mptfan » Thu Jan 18, 2018 8:09 am

johnubc wrote:
Thu Jan 18, 2018 7:10 am
Price Transparency.

Sadly, that is something that the industry is still fighting to protect a broken system. The person with no insurance pays the full freight, whereas the person with insurance pays a negotiated rate that bears little resemblance to the actual costs.
I think it's the other way around...the person with no insurance pays a highly inflated rate, whereas the person with insurance pays a more reasonable rate that bears a closer resemblance to the actual cost that was negotiated by their insurer.

mptfan
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Re: To the doctors on the forum

Post by mptfan » Thu Jan 18, 2018 8:12 am

bondsr4me wrote:
Thu Jan 18, 2018 7:15 am
I have been with my Doctor since he hung his shingle 40+ years ago. I chose him after my Doctor retired. My Doctor is, IMHO, the very best general practitioner I could have chosen. I don’t want him to be worrying about the financial part of his practice.
I don't meant to argue, I am just curious...do you feel the same way about your mechanic, or your lawyer?

mptfan
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Re: To the doctors on the forum

Post by mptfan » Thu Jan 18, 2018 8:14 am

Duplicate deleted.
Last edited by mptfan on Thu Jan 18, 2018 8:16 am, edited 1 time in total.

Bacchus01
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Re: To the doctors on the forum

Post by Bacchus01 » Thu Jan 18, 2018 8:15 am

eye.surgeon wrote:
Thu Jan 18, 2018 2:15 am
As others have pointed out, I as the doctor have no idea how much your MRI will cost. That's between your insurance company and the imaging facility. The doctor is not involved in or paid for imaging, lab tests, medication, etc. Those rates are negotiated on your behalf by your insurance agent with the entities involved, not the doctor.

So maybe I’m reacting to this one thing. Most people treat their doctor with incredibly high reverence and take them at face value. They are the experts.

So maybe instead of telling my wife “what do you care? You have insurance,” he could have said “check with your insurance company. Here is the one I recommend, but you are free to check around”

Bam, problem solved.

bondsr4me
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Re: To the doctors on the forum

Post by bondsr4me » Thu Jan 18, 2018 8:47 am

mptfan wrote:
Thu Jan 18, 2018 8:12 am
bondsr4me wrote:
Thu Jan 18, 2018 7:15 am
I have been with my Doctor since he hung his shingle 40+ years ago. I chose him after my Doctor retired. My Doctor is, IMHO, the very best general practitioner I could have chosen. I don’t want him to be worrying about the financial part of his practice.
I don't meant to argue, I am just curious...do you feel the same way about your mechanic, or your lawyer?
the car dealer maintenance dept is pretty good; but they don't get the rating my doctor does.

staythecourse
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Re: To the doctors on the forum

Post by staythecourse » Thu Jan 18, 2018 9:13 am

Bacchus01 wrote:
Wed Jan 17, 2018 11:23 pm
The average consumer is being asked to ask all these questions and the Drs don’t know.
I do agree with this. I don't know other fields, but I will admit doctors for whatever reason (insecurity) do NOT like to say they don't know. The reasonable answer from the doctor should have been something like, "I don't know the billing side, but let me refer you to x who is our admin who can help try to get that answer". For whatever reason most docs feel like they need to have all the answers and/ or just don't care about the financial side of getting care done. Either is wrong. This is likely why compliance in medical care is so poor as it is a breakdown in aspects of communication between patient and doctor.

Good luck.
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Re: To the doctors on the forum

Post by Ellie » Thu Jan 18, 2018 9:24 am

afan wrote:
Thu Jan 18, 2018 5:56 am
You could try to call your insurer to find the cost of a specific procedure at a number of places. Again, depending on your plan the company may or may not be set up to tell you.
Having been through this recently, I've learned this path doesn't work either because the insurance company needs to know so many things about the doctor, facility and the procedure that there is no way for the patient to know. Even with all that information, the insurance company said they would snail mail me a response in 2-3 weeks (!).

The best bet is to work with the doctor's billing department to have them call the insurance company to determine the negotiated rate. Of course, if you aren't already a patient, the billing department may not be willing to do this, which makes "shopping" difficult.

Also, I am disappointed in the doctors on this board saying essentially "I am too busy being a medical expert to even think about billing". You may not know the cost of a specific procedure (and I don't expect you to), but you should know who your patient can go to for billing questions, and should be making sure that the billing department is properly assisting your patients. If you aren't doing this, I (by necessity and absent an emergency) will have to get medical services elsewhere from someone who understands this reality, even if they aren't my favorite doctor.
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student
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Re: To the doctors on the forum

Post by student » Thu Jan 18, 2018 9:38 am

Bacchus01 wrote:
Thu Jan 18, 2018 8:15 am
eye.surgeon wrote:
Thu Jan 18, 2018 2:15 am
As others have pointed out, I as the doctor have no idea how much your MRI will cost. That's between your insurance company and the imaging facility. The doctor is not involved in or paid for imaging, lab tests, medication, etc. Those rates are negotiated on your behalf by your insurance agent with the entities involved, not the doctor.

So maybe I’m reacting to this one thing. Most people treat their doctor with incredibly high reverence and take them at face value. They are the experts.

So maybe instead of telling my wife “what do you care? You have insurance,” he could have said “check with your insurance company. Here is the one I recommend, but you are free to check around”

Bam, problem solved.
While I agree that he/she could have said "check with your insurance company," I do not think it is wise for him/her to recommend a company. Patients may think he/she is getting a kickback or he/she will get blamed if it does not work out. Yes. I know you added a disclaimer "but you are free to check around."

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Re: To the doctors on the forum

Post by lthenderson » Thu Jan 18, 2018 9:42 am

Bacchus01 wrote:
Wed Jan 17, 2018 10:42 pm
Why, in this day and age of HDHP, is it still so difficult to get a Dr, or the office, to tell you what a procedure will cost?
As others have pointed out, they don't for many reasons. However, there are some doctors that have cash only businesses and they are well versed in the costs and are extremely transparent. But the caveat is that they don't deal with insurance companies. It is cash only. In my neck of the woods which is very rural and very poor, they are running thriving practices because so many people are paying the government penalty for not having insurance and self insuring instead. I suspect now that the penalty has been repealed, their business will increase even more.

afan
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Re: To the doctors on the forum

Post by afan » Thu Jan 18, 2018 10:10 am

If you contact a particular provider and tell them your insurance plan they should be able to figure out the rate insurance will cover. The PHYSICIAN will have no idea, this is accounting, not medicine. But the people who do the accounting at the provider site will know what insurance will cover.

Keep in mind that the allowed rate by the insurer is not what the procedure will cost an individual. The patient will have an annual deductible. Early in the year they may not have met the deductible and they may have to pay the full cost. That full cost will be at the rate negotiated between the insurer and the provider. That rate will depend not only on the insurance company but also on the particular plan. Often an insurer will have different prices, not just different premiums but different prices for services, for the SAME plan depending on the employer that arranged that coverage for it's employees.

Later in the year, after having met the full deductible, the patient might only pay their co-pays. Or their co-pays plus their coinsurance percentage. Same price from the provider but the cost to the patient can be completely different.

In between there may be some deductible left, so the cost to the patient could be anywhere from "the total cost of the procedure as negotiated by the insurer with the provider" to "co-pays perhaps plus coinsurance".

All of the above assumes the provider has agreed to accept the rates the insurer offers. If not, the patient may be in the hook for the difference between what the insurance company will pay and what the provider charges.
The accounting people at the provider and at the insurance company would know whether the provider had agreed to the insurers' prices.

Managing medical billing is a full time job. There are large companies that do nothing else. No way doctors would be able to give an answer unless they gave up medicine and became insurance company or medical billing executives.

Many insurance plans "help" patients navigate this mess by designating certain providers as "in network". As long as the patient gets care from a place that is in network they can know that the prices are agreed upon. Some plans simplify this by establishing standardized cahrgea for broad categories of procedures as long as one goes in network.

The extreme of this might be an HMO that may have very low charges per procedure, as long as the procedure was recommended by docs in the HMO, approved by the HMO and performed within the HMO.
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Re: To the doctors on the forum

Post by goodenyou » Thu Jan 18, 2018 10:12 am

If you asked the doctor how much he or she was going to get paid for your visit that day, they wouldn't know that either. Unless the doctor owns the MRI unit, why would they know how much someone else is going to charge for a study? It is akin to asking the doctor how much your prescription is going to cost. How would they know? Doctors don't set fees for non-cash paying patients. It is a (significantly) reduced fee-for-service model with many different contracts. Consumers want transparency in pricing and doctors want reimbursement that is not arcane, capricious and chaotic. This is result of a 3rd party system. Did you ever wonder why dentists are not subject to this mess? They, for the most part, don't deal with 3rd party insurance. And, as a result, price transparency.
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Mitchell777
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Re: To the doctors on the forum

Post by Mitchell777 » Thu Jan 18, 2018 10:15 am

I'm not a doctor but in my area the local hospitals are gobbling up everything in sight. My insurance will not pay as much for imaging if I go to a site controlled by a hospital. I assume the costs are higher. I think the difference was 20% co insurance but 30% if a hospital owned site. Last time I needed imaging I had the choice of 12 or 13 sites within about 30 miles that were in network. Every one of them was owned by one of three hospitals.

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Re: To the doctors on the forum

Post by afan » Thu Jan 18, 2018 10:40 am

This is one of the factors driving small independent outfits to merge into large organizations. The cost of management of these financial concerns is beyond most small shops. Those hospital chains will have whole departments devoted to contracting and billing.
We don't know how to beat the market on a risk-adjusted basis, and we don't know anyone that does know either | --Swedroe | We assume that markets are efficient, that prices are right | --Fama

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WoodSpinner
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Re: To the doctors on the forum

Post by WoodSpinner » Thu Jan 18, 2018 10:55 am

Suman wrote:
Thu Jan 18, 2018 7:26 am
Because everyone controls the profession of medicine except the doctors. I wish for the day when there are no insurance including Medicare and we can do transactions in cash with our patients without all these regulatory burdens.
I am really puzzled by this comment. It feel 1000% the opposite—looking for a simple Universal Care plan.

My perspective is that Health Care is a right, not a privilege.

WoodSpinner :?:

voodoo72
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Re: To the doctors on the forum

Post by voodoo72 » Thu Jan 18, 2018 11:05 am

Ellie wrote:
Thu Jan 18, 2018 9:24 am
afan wrote:
Thu Jan 18, 2018 5:56 am
You could try to call your insurer to find the cost of a specific procedure at a number of places. Again, depending on your plan the company may or may not be set up to tell you.
Having been through this recently, I've learned this path doesn't work either because the insurance company needs to know so many things about the doctor, facility and the procedure that there is no way for the patient to know. Even with all that information, the insurance company said they would snail mail me a response in 2-3 weeks (!).

The best bet is to work with the doctor's billing department to have them call the insurance company to determine the negotiated rate. Of course, if you aren't already a patient, the billing department may not be willing to do this, which makes "shopping" difficult.

Also, I am disappointed in the doctors on this board saying essentially "I am too busy being a medical expert to even think about billing". You may not know the cost of a specific procedure (and I don't expect you to), but you should know who your patient can go to for billing questions, and should be making sure that the billing department is properly assisting your patients. If you aren't doing this, I (by necessity and absent an emergency) will have to get medical services elsewhere from someone who understands this reality, even if they aren't my favorite doctor.
More and more, the age of the solo practitioner is ending in medicine, most doctors are employees of larger corporations now, so they have no choice to direct you to the billing dept and be done, couple that with the fact that insurance companies are continually cutting reimbursement rates doctors and nurses are being pushed to do more in less time. The reality is for many doctors, if you leave there will be many more willing to come in as the landscape has changed, particularly if you are talking about primary medicine.

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Re: To the doctors on the forum

Post by hightower » Thu Jan 18, 2018 11:07 am

Bacchus01 wrote:
Wed Jan 17, 2018 10:42 pm
I just have to ask all the Drs here...

Why, in this day and age of HDHP, is it still so difficult to get a Dr, or the office, to tell you what a procedure will cost?

Recently had an issue where wife needs and MRI. We wanted to shop this to some MRI specialist places. Ortho response was “why? You have insurance.”

Of course we do. But why is it so hard to this day to have some price transparency?

Fortunately, myuhc.com has the procedure costs actuall for each of the local MRI places and the one the ortho referred was in line for the lower cost ones and highly rated by patients.

But why is this still seemingly received as such an odd question? Anyone else have this and how do you deal?
Easy to answer...because most of us docs have no idea what these things cost. Most of us are W2 employees and remain completely separated from the business side of the practice. I literally have no idea what anything costs that I order. I have a rough idea that ordering an MRI is generally more expensive than ordering an Xray, but as far as specific costs. No clue.
If I owned my own practice and my own testing equipment, etc, then I'd probably be able to tell you. But in today's insanely complex medical world, there are very few docs who do this. Medicine is mostly corporate owned these days. If you want to know the price of things, talk to the executives that run the corporation that owns your doctor's practice;)

MiddleOfTheRoad
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Re: To the doctors on the forum

Post by MiddleOfTheRoad » Thu Jan 18, 2018 11:45 am

It is a cat and mouse game.
- Facilities try to negotiate for as much as they can get above what they need to run the business, to maximize profit.

- Insurance try to negotiate to minimize the cost to them to maximize profit. They were losing leverage so they invent high deductible plans to make the end consumer aware of the cost, in effect putting even more pressure on providers (facilities, MDs) to be transparent. BUT, the insurance themselves are not that transparent.

- The doctor are caught in between, not aware of all the agreements/negotiations between all these entities (insurance, facilities, which plan the patient decide to pay for). BUT since the doctor is “the face of the franchise” they are blamed for a lot of things. It is amzing to realize that the doctors authorize almost everything that cost in medicine but they are shielded from how much it cost. Have any of the doctor here asked the hospital what their contracted rate for certain thing? The administrator will dance around like crazy.

- while I don’t think the patients should pay for the most expensive insurance, what you pick also put a certain amount of work/responsibilities on you. Think full service financial advisor vs boglehead dyi. You want everything cover without insurance hassle? There is that ultra platinum ppo plan and not the hdhp.

- if you read this board long enough, you will see thatmost of the doc will not work until full retirement age. They are blamed for a lot of the things they have no control over.

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Re: To the doctors on the forum

Post by Ollie123 » Thu Jan 18, 2018 11:53 am

Not a doctor, but am a healthcare provider who bills (psychologist) in a hospital. Wife works for a major insurer, so we have a fairly unique perspective/insight:)

Folks above who mentioned the incredible complexity are spot on. The complexity of this cannot be understated. As a psychologist, there are really only 4-5 billing codes that I actually use on even a semi-regular basis. This is a small fraction of what someone in say, surgery, might be dealing with. Yet despite that, I still have no earthly idea what it costs to see me unless you are paying out of pocket. The number is different for every insurer and can even differ by plan within the same insurer. These are contracts that are renegotiated frequently and we take dozens of plans. This would be a nightmare to keep up on even for someone like me for whom billing is comparatively simple.

On the insurance side, hospital and systems (or individual providers) are negotiating with insurance at a macro-level. The cardiologist above was an excellent example. If whoever set things up for them knew what they were doing...they knew the market. They knew the proportion of medicaid consults was likely not to be an overwhelming proportion of the practice based on the region, demand, etc. So chances are, they agreed to an exceedingly low contracted rate on that code in the hopes of getting a higher rate on other things that will have more of an impact on the bottom line. The insurance company is playing the same game from the other side. People doing this are looking at the big picture (i.e. maximizing profit based on all possible procedures, what a typical practice entails, etc.) and not individual procedures. Which is why you end up with weird situations where hospitals can't even cover costs for some things and make an absolute killing on others. From what I can tell, this is largely unpredictable as there isn't really any medical rationale for how these negotiations happen and what gets accepted at a lower rate by which carrier...its strictly economic.

In sum...picture the bastard offspring of a large retail store willing to offer loss leaders to attract consumers and drive the local competition out of business and with a team of bureaucrats undertaking a congress-like negotiation process as individuals who: A) Do not know any more about what they are negotiating than joe schmoe off the street; and B) Are not directly impacted by the outcomes, waddling through and figuring out what to do. Welcome to modern healthcare.

As a patient (remember - healthcare providers also need healthcare!), I find it infuriating too. I fully agree that your doctor did not handle it well. Whenever I'm asked, I confess my ignorance and direct the patient to my billing folks. I tell them to let me know if they aren't able to help and to come back to me if there are questions or concerns. When my patients get a weird or confusing bill, I will go to bat for them. As a provider, I would willingly waive my fees when some major misunderstanding occurred but obviously in a salaried position I am not entitled to do so. Nonetheless, I do agree many providers pass the buck on this one. I understand why it happens, but I do think its wrong. As a profession, I do think providers bear some responsibility for not pushing hard against our administrative overlords (both hospital admin and insurance) if we feel a patient was misled and is now stuck with a bill. We still have a helluva lot more power than they do in that situation. I think its immoral to just say "Not my problem" and walk away.

One thing I've been struck by throughout all of this is actually how genuine and good-hearted most people involved in this process are. The mistrust is created by the system. Virtually everyone I know in healthcare genuinely cares about the patients and wants to do everything possible to help them. There is a reason we go into a field like this and money isn't it for the majority of folks. There are vastly easier paths to a high salary these days. Its easy for those of us on the provider side to forget, but through my wife I actually see the same thing on the insurance side. They can and will do anything to try to make things right for their members. They stay late, have endless meetings, etc. to try and make things work. They need to stay solvent too. Just like the healthcare provider. And just like the patient. But unfortunately, because healthcare in this country is often viewed as a luxury until it is you or a family member who needs it...the patient often ends up getting screwed. In part because the large organizations indemnify themselves and are in a position to do so.

Transparency won't fix healthcare, though it would help. Understand that we are incredibly far off from being able to achieve that right now for many different reasons. We could list our billing rates for every single thing on the front page of the hospital website and it would still be a complete trainwreck.

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Re: To the doctors on the forum

Post by White Coat Investor » Thu Jan 18, 2018 12:08 pm

WoodSpinner wrote:
Thu Jan 18, 2018 10:55 am


I am really puzzled by this comment. It feel 1000% the opposite—looking for a simple Universal Care plan.

My perspective is that Health Care is a right, not a privilege.

WoodSpinner :?:
Universal care may very well be the best way. But I think this idea that it is a right not a privilege is just a sound bite and indicates someone doesn't quite get it.

Is food a right? Why not? You can live longer without health care than without food. Why can't I walk into the grocery store and take out whatever I want? What about housing? Why can't I just walk into the Marriott and sleep in their beds? Why would health care somehow be on a higher plane than food and shelter?

Second, "health care" includes a whole lot of stuff. When you say it should be a right, define exactly what you mean by it. You mean someone should be able to go see the doctor as much as they want for whatever reason they want at any time they want no matter what it costs? Do you include MRIs that are questionably indicated, Viagra, and cosmetic surgery? What about essential oils, chiropractors, and acupuncture? Vaccines? Which ones? Medications? Which ones? Some cost 10 times more than others that are almost as good. Should we have a right to the best ones?

Those who think "health care should be a right" likely haven't thought through most of these questions. I've interacted with three universal health care environments (US military, UK system, and the Qatari system.) If you want to give health care to everyone, you've got to define it carefully, be ready to tell people "no" on a lot of stuff they think they have a right to, and even then expect it to cost a great deal.
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