"Shopping for Healthcare" - How Use an HSA Effectively

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wilked
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"Shopping for Healthcare" - How Use an HSA Effectively

Post by wilked » Mon May 06, 2019 12:24 pm

First, no medical advice, everyone is clear on that. No political discourse either.

HSAs are becoming more popular. My company introduced one this year and I signed up. Family of 4, couple young kids.

This weekend we had a sick visit to the pediatrician. We handled it as we always do. Today I am emailed the bill, $230. BCBS indicates this is high by almost double vs avg (https://www.bluecrossma.com/blue-iq/pdf ... 042709.pdf ) but I am in Greater Boston and maybe we simply aren't average (HCOL).

I would have never thought to ask the pediatrician what they charge for a sick visit, but now I am considering it and at least considering comparing to other ped's.

There are some obvious stuff, like asking for clarity on exactly what tests are being performed and why they need to be performed before going forward. How far do others go on this? Do you ask for sticker price on everything before moving forward? Have you left a doctor for another doctor due to high prices?

Thanks!

GuySmiley
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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by GuySmiley » Mon May 06, 2019 12:32 pm

This is less about the HSA than the HDHP itself. I have two things to contribute here:

1) Sick visits are cheaper at a Target clinic or place like that vs. normal doctor visit
2) For my plan, annual physical (well check) is free BUT I was recently charged "split billing" since I added a non-routine question -- nagging cough, got a prescription, $100 charge. This was the first year I've been charged extra for something like this. I have not yet ascertained if this practice originated from the doctor or a billing person at the office, should learn more when I visit next year. I tried to appeal, was denied. I'm considering it a lesson learned to segregate and clarify before discussing certain topics.

PeterParker
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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by PeterParker » Mon May 06, 2019 12:36 pm

Yeah I've used an HSA for years. I'm not shocked at the $230 even remotely. I'm out of Chicago. If you go to an urgent care you can even look at $300. Welcome to American healthcare. Where the prices are all made up and the facts don't matter.

The entire system --- the multi-billion dollar industry --- is designed to absolutely prevent you from "knowing the price" before you get the bill.
There is no way in hell any doctor will ever tell you a no-nonsense price estimate or list for any general procedure, appointment, or whatever. Mainly because they don't know it. But again, because the entire multi-billion dollar industry was designed to prevent this.

Unless you find a 1 in 1,000 hospital with transparent pricing, which is as common as a talking unicorn, there's no chance that will ever happen.
Even calling them to ask, a reasonable request of any business --- is tantamount to an Act of War. It's like asking a cigarette company if their products cause cancer. Even asking is a serious threat to their scam.


If you're interested in the actual laughable nature --- which is mostly irrelevant, it's just a system designed to waste your time until you give up -- the reason they don't tell you the price is that Transparency, Competition, Competitive Practices, the Free Market --- this would lower their profits obviously. They would have to make prices competitive.

But it usually goes like this -- there is a "Master Ledger" at the hospital that has general price lists of procedures. But they have different agreements/ bargains with different various insurance companies. And to give you an estimate from such a Ledger, they need your Insurance Information. The exact Doctor you will be seeing (wait what if you haven't picked yet).

Then they need the Procedure Codes for the service(s) you will be receiving. Wait, random, foreign-key pesudo-generated numbers used by back-office Clerks for technical coding of procedure(s), most of which you will have no clue you will actually be billed for? How would you know those?

Exactly.

Well I'm just getting a Physical Exam. Could you tell me the code for that?

No. We don't know it. And if we did, we still wouldn't tell you. And if gave us the code somehow, we wouldn't tell you an estimate still. Or it would be wrong. Screw you. Pay up. Game over.

veggivet
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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by veggivet » Mon May 06, 2019 12:46 pm

Peter Parker speaks the truth! Very well put, Sir!
If you watch your pennies, your dollars will take care of themselves.

SC Anteater
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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by SC Anteater » Mon May 06, 2019 1:00 pm

Yeah, it's awful. I suppose you can do you research ahead of time if you have an non-urgent reason for seeking care, but other than that you're screwed. I did learn to get xrays at the local rad. clinic rather than the Children's Hospital rad office (not the hospital,part of their network of care) because they were 3x the price. Anything with kids in the name costs more.

one anecdote -- I was sick and went to the doc. They could give me oral antibiotics or they could give me a shot of antibiotics which would probably have cleared things up faster. I asked, well, how much is that. No one could tell me the answer. How am I supposed to 'shop' for care if no one can tell me the price? I went with the oral antibiotics.

welsie
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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by welsie » Mon May 06, 2019 1:49 pm

PeterParker wrote:
Mon May 06, 2019 12:36 pm
Yeah I've used an HSA for years. I'm not shocked at the $230 even remotely. I'm out of Chicago. If you go to an urgent care you can even look at $300. Welcome to American healthcare. Where the prices are all made up and the facts don't matter.

The entire system --- the multi-billion dollar industry --- is designed to absolutely prevent you from "knowing the price" before you get the bill.
There is no way in hell any doctor will ever tell you a no-nonsense price estimate or list for any general procedure, appointment, or whatever. Mainly because they don't know it. But again, because the entire multi-billion dollar industry was designed to prevent this.

Unless you find a 1 in 1,000 hospital with transparent pricing, which is as common as a talking unicorn, there's no chance that will ever happen.
Even calling them to ask, a reasonable request of any business --- is tantamount to an Act of War. It's like asking a cigarette company if their products cause cancer. Even asking is a serious threat to their scam.


If you're interested in the actual laughable nature --- which is mostly irrelevant, it's just a system designed to waste your time until you give up -- the reason they don't tell you the price is that Transparency, Competition, Competitive Practices, the Free Market --- this would lower their profits obviously. They would have to make prices competitive.

But it usually goes like this -- there is a "Master Ledger" at the hospital that has general price lists of procedures. But they have different agreements/ bargains with different various insurance companies. And to give you an estimate from such a Ledger, they need your Insurance Information. The exact Doctor you will be seeing (wait what if you haven't picked yet).

Then they need the Procedure Codes for the service(s) you will be receiving. Wait, random, foreign-key pesudo-generated numbers used by back-office Clerks for technical coding of procedure(s), most of which you will have no clue you will actually be billed for? How would you know those?

Exactly.

Well I'm just getting a Physical Exam. Could you tell me the code for that?

No. We don't know it. And if we did, we still wouldn't tell you. And if gave us the code somehow, we wouldn't tell you an estimate still. Or it would be wrong. Screw you. Pay up. Game over.
I don't think that is entirely fair. We had a HDHP prior to our first baby arriving they walked through the pricing (as they wanted money upfront), they also had a cash option. BlueShield also offers a cost estimator, so you can plug in the procedure and they will tell you what people paid at local facilities, so I already had a sense of what delivery would cost at our particular hospital.

I am not saying you are not largely correct, as there is a lack of transparency in general , however I don't think that is always the case, there are tools/ways to get a sense of costs.

Also, you can use Teledoc, which has very reasonable, upfront pricing, for a lot of simple questions/inquiries about illness or a Minute Clinic.
Last edited by welsie on Mon May 06, 2019 1:58 pm, edited 1 time in total.

miamivice
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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by miamivice » Mon May 06, 2019 1:53 pm

wilked wrote:
Mon May 06, 2019 12:24 pm
First, no medical advice, everyone is clear on that. No political discourse either.

HSAs are becoming more popular. My company introduced one this year and I signed up. Family of 4, couple young kids.

This weekend we had a sick visit to the pediatrician. We handled it as we always do. Today I am emailed the bill, $230. BCBS indicates this is high by almost double vs avg (https://www.bluecrossma.com/blue-iq/pdf ... 042709.pdf ) but I am in Greater Boston and maybe we simply aren't average (HCOL).

I would have never thought to ask the pediatrician what they charge for a sick visit, but now I am considering it and at least considering comparing to other ped's.

There are some obvious stuff, like asking for clarity on exactly what tests are being performed and why they need to be performed before going forward. How far do others go on this? Do you ask for sticker price on everything before moving forward? Have you left a doctor for another doctor due to high prices?

Thanks!
The way it works with my HSA/HDHP is that we pay the insurance company contracted rates, or lower. For us, it is about $160 for an in-network urgent care visit or about $130 for an in-network normal doctor office visit. Lab tests, etc, of course are higher.

It sounds like you may have gone to an out of network provider, or the bill that you received shows the full rack rate and not the contracted rate for your insurance company.

The other comment is you said you visited the pediatrician "this weekend". Most standard doctor offices are closed on the weekend, so i am not sure what kind of provider you saw.

FeesR-BullNotBullish
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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by FeesR-BullNotBullish » Mon May 06, 2019 2:20 pm

Your bill doesn't sound bad. Yes going forward ask about the price. Expect to do a lot of asking. Before your appointment ask the front desk people how much the office visit will cost. If the doctor mentions "test", ask him or her how much it will cost. Even though they won't give you a straight answer, maintain an attitude that they should be able to tell you the cost like a cashier can tell you how much your milk costs. I learned that when I asked, my doctor was cognizant that I was paying out of pocket and coded things to help with costs. This wasn't fraudulent or unethical because there is a lot of grey area between code A and code B. He also found a low-cost testing option when I wanted to get blood work done.

And yes, I have left doctors who billed me ridiculous amounts. I have also called to negotiate bills down when I was unpleasantly surprised.

Know that no matter how diligent you are, the medical community will slip in a nasty surprise now and then. Console yourself with how much you are saving on premiums and investing in your HSA. Hopefully you come out ahead.
GuySmiley wrote:
Mon May 06, 2019 12:32 pm
This is less about the HSA than the HDHP itself.
Very true. After years on Obamacare HDHP plans, my wife got a job that offers a health insurance benefit. We weren't even tempted to save money with the HDHP option. We splurged for the better coverage. It is the best money we spend knowing that routine doctor visits are covered with a small copay, and we don't skimp on care anymore.

chessknt
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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by chessknt » Mon May 06, 2019 2:42 pm

PeterParker wrote:
Mon May 06, 2019 12:36 pm
Yeah I've used an HSA for years. I'm not shocked at the $230 even remotely. I'm out of Chicago. If you go to an urgent care you can even look at $300. Welcome to American healthcare. Where the prices are all made up and the facts don't matter.

The entire system --- the multi-billion dollar industry --- is designed to absolutely prevent you from "knowing the price" before you get the bill.
There is no way in hell any doctor will ever tell you a no-nonsense price estimate or list for any general procedure, appointment, or whatever. Mainly because they don't know it. But again, because the entire multi-billion dollar industry was designed to prevent this.

Unless you find a 1 in 1,000 hospital with transparent pricing, which is as common as a talking unicorn, there's no chance that will ever happen.
Even calling them to ask, a reasonable request of any business --- is tantamount to an Act of War. It's like asking a cigarette company if their products cause cancer. Even asking is a serious threat to their scam.


If you're interested in the actual laughable nature --- which is mostly irrelevant, it's just a system designed to waste your time until you give up -- the reason they don't tell you the price is that Transparency, Competition, Competitive Practices, the Free Market --- this would lower their profits obviously. They would have to make prices competitive.

But it usually goes like this -- there is a "Master Ledger" at the hospital that has general price lists of procedures. But they have different agreements/ bargains with different various insurance companies. And to give you an estimate from such a Ledger, they need your Insurance Information. The exact Doctor you will be seeing (wait what if you haven't picked yet).

Then they need the Procedure Codes for the service(s) you will be receiving. Wait, random, foreign-key pesudo-generated numbers used by back-office Clerks for technical coding of procedure(s), most of which you will have no clue you will actually be billed for? How would you know those?

Exactly.

Well I'm just getting a Physical Exam. Could you tell me the code for that?

No. We don't know it. And if we did, we still wouldn't tell you. And if gave us the code somehow, we wouldn't tell you an estimate still. Or it would be wrong. Screw you. Pay up. Game over.
This is only partially correct. A major barrier to getting pricing up front is that without knowing a priori exactly what will happen in the future it is impossible to give anyone an accurate number. A sick pediatric visit could be as simple as reassurance level 3 visit or sepsis requiring critical care time and a trip to the er. Or maybe the kid will need a procedure done in the office but we won't know what procedure is needed until an evaluation is done. Your physical exam is another prime example--without knowing what is actually wrong with you there is one of 6 different codes (most likely one of 3) that could be billed for that and there is no way to know in advance which one applies.

It's like asking a contractor how much it will be to upgrade your kitchen and the only information they have is what you think it looks like now and oh by the way the floor is sagging. No kitchen size or pictures or plan of what needs to be upgraded. No contractor will give an estimate with no information, why would the healthcare system be able to do the same? The difference is that the initial consultation isn't free.

That being said you should be able to get figures for specific procedures with the caveat that the cost can escalate rapidly if there is any deviation from the procedure. Like you said though the existence of private health insurance that negotiates different rates and artificially inflate the cash price makes these estimates very challenging to obtain. That and the reward for doing so is essentially nonexistent and just opens them up to liability if things end up being priced differently due to factors beyond their control.

CoastalWinds
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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by CoastalWinds » Mon May 06, 2019 2:46 pm

PeterParker wrote:
Mon May 06, 2019 12:36 pm
Yeah I've used an HSA for years. I'm not shocked at the $230 even remotely. I'm out of Chicago. If you go to an urgent care you can even look at $300. Welcome to American healthcare. Where the prices are all made up and the facts don't matter.

The entire system --- the multi-billion dollar industry --- is designed to absolutely prevent you from "knowing the price" before you get the bill.
There is no way in hell any doctor will ever tell you a no-nonsense price estimate or list for any general procedure, appointment, or whatever. Mainly because they don't know it. But again, because the entire multi-billion dollar industry was designed to prevent this.

Unless you find a 1 in 1,000 hospital with transparent pricing, which is as common as a talking unicorn, there's no chance that will ever happen.
Even calling them to ask, a reasonable request of any business --- is tantamount to an Act of War. It's like asking a cigarette company if their products cause cancer. Even asking is a serious threat to their scam.


If you're interested in the actual laughable nature --- which is mostly irrelevant, it's just a system designed to waste your time until you give up -- the reason they don't tell you the price is that Transparency, Competition, Competitive Practices, the Free Market --- this would lower their profits obviously. They would have to make prices competitive.

But it usually goes like this -- there is a "Master Ledger" at the hospital that has general price lists of procedures. But they have different agreements/ bargains with different various insurance companies. And to give you an estimate from such a Ledger, they need your Insurance Information. The exact Doctor you will be seeing (wait what if you haven't picked yet).

Then they need the Procedure Codes for the service(s) you will be receiving. Wait, random, foreign-key pesudo-generated numbers used by back-office Clerks for technical coding of procedure(s), most of which you will have no clue you will actually be billed for? How would you know those?

Exactly.

Well I'm just getting a Physical Exam. Could you tell me the code for that?

No. We don't know it. And if we did, we still wouldn't tell you. And if gave us the code somehow, we wouldn't tell you an estimate still. Or it would be wrong. Screw you. Pay up. Game over.
This. 100% spot on, sadly.

miamivice
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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by miamivice » Mon May 06, 2019 3:06 pm

Again, if you have a HDHP, you receive contracted rates (or less). I am not sure what the need is to shop around for cost if you receive contracted rates.

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dodecahedron
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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by dodecahedron » Mon May 06, 2019 3:21 pm

miamivice wrote:
Mon May 06, 2019 3:06 pm
Again, if you have a HDHP, you receive contracted rates (or less). I am not sure what the need is to shop around for cost if you receive contracted rates.
I disagree. A very well-regarded local HMO (top ranked nationally) has negotiated deals with virtually all the local providers but apparently those deals vary signficantly. Many local employers offer HSA-eligible HDHP plans provided by this HMO.

The HMO offers a ¨Price Check service designed to provide cost transparency by giving you estimated costs on a range of health services before you choose a provider.¨

So apparently the contracted rates can differ depending on which health care provider you choose.
Last edited by dodecahedron on Mon May 06, 2019 3:22 pm, edited 1 time in total.

miamivice
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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by miamivice » Mon May 06, 2019 3:22 pm

dodecahedron wrote:
Mon May 06, 2019 3:21 pm
miamivice wrote:
Mon May 06, 2019 3:06 pm
Again, if you have a HDHP, you receive contracted rates (or less). I am not sure what the need is to shop around for cost if you receive contracted rates.
I disagree. A very well-regarded local HMO (top ranked nationally) has negotiated deals with virtually all the local providers but apparently those deals vary signficantly. Many local employers offer HSA-eligible HDHP plans provided by this HMO.

The HMO offers a ¨Price Check service designed to provide cost transparency by giving you estimated costs on a range of health service before you choose a provider.¨
I was referring to standard pediatrician visits like mentioned in the OP.

of course I don't know every insurance plan, this is just based on my experience. My contracted rates are generally the same for all providers for the same service.

Traveler
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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by Traveler » Mon May 06, 2019 9:23 pm

Ah, the joy of our healthcare system. Healthcare is the only thing I buy that I have absolutely no idea how much it costs until weeks or months after the fact. It is absurd to me that a doctor can't tell me how much an office visit costs. My dentist sure can, down to the penny and can even tell me at the time of the visit how much my insurance will pay, within $1. So short of my cynicism that the entire medical system is rigged against a normal consumer, I'm not sure why a doctor's office can't give me a price for a service I'm looking to purchase. I'm sure some doctors on here can give you some good excuses.

I have an HSA plan and max the contribution and will use it as a retirement healthcare account after it appreciates over time. In the meantime, I cash flow my medical expenses.

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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by tfb » Mon May 06, 2019 11:26 pm

wilked wrote:
Mon May 06, 2019 12:24 pm
I would have never thought to ask the pediatrician what they charge for a sick visit, but now I am considering it and at least considering comparing to other ped's.
You don't have to call the doctors' offices. Many health insurance companies offer a cost estimator tool, similar to what dodecahedron described below. It tells you what you are expected to pay at each contracted providers. Just google the name of your insurance company plus "cost estimator."
dodecahedron wrote:
Mon May 06, 2019 3:21 pm
The HMO offers a ¨Price Check service designed to provide cost transparency by giving you estimated costs on a range of health services before you choose a provider.¨
Harry Sit, taking a break from the forums.

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wilked
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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by wilked » Tue May 07, 2019 4:40 am

Good feedback... let me see in more detail how it applies for my plan

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dodecahedron
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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by dodecahedron » Tue May 07, 2019 7:49 am

Traveler wrote:
Mon May 06, 2019 9:23 pm
Ah, the joy of our healthcare system. Healthcare is the only thing I buy that I have absolutely no idea how much it costs until weeks or months after the fact. It is absurd to me that a doctor can't tell me how much an office visit costs. My dentist sure can, down to the penny and can even tell me at the time of the visit how much my insurance will pay, within $1. So short of my cynicism that the entire medical system is rigged against a normal consumer, I'm not sure why a doctor's office can't give me a price for a service I'm looking to purchase. I'm sure some doctors on here can give you some good excuses.
In fairness to your physician, I believe that there are far more medical procedures than dental procedures AND also far more medical insurance companies than dental insurance companies AND any given medical insurance provider may have a dozen or more different plans with a variety of different provisions while dental insurance companies typical only have one or two different plans.

The complexity of the wide variety of medical insurance plans is a huge burden on providers. In some specialties (e.g., psychiatry), many providers have just given up on accepting medical insurance of any kind. The cost of the staff to deal with all the billing administrivia is prohibitive. They take full payment at time of service and give the patient an itemized bill and let the patients take it up with their insurance company to see if they can get it reimbursed.

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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by rantk81 » Tue May 07, 2019 8:02 am

I'm in Chicago. $230 for an office visit? Bargain! I've paid upwards of $360 for an office visit -- and that's to an in-network provider AFTER the "negotiated discount" with my insurance company. That was at one of the top tier facilities here though. I'm sure if I went to one of the lower tier facilities (the ones that look run-down, are visibly less clean, have less bells/whistles, longer wait times, etc.) I could have saved a few dollars.

But pretty much yeah, for what everyone else said about lack of price transparency. I do the HDHP thing too -- almost entirely because I want the HSA tax benefits, with the intention of using it as a retirement account -- and cash-flowing my medical expenses. Yeah, I've tried, in vain, to price out things. In the end, it's just not worth the time/hassle/frustration. I just assume that I'm going to hit my deductible, and then get into co-insurance territory on my plan... If I were to "shop around", it would probably take more time than it is worth, after hitting the 70/30 cost sharing on my plan. I just take solace in the fact that my out of pocket maximum for my family is capped at 10k -- theoretically. I'm far more concerned about surprise-out-of-network bills that don't get any negotiated discount and aren't applied to out of pocket maximums for me... or for my insurance balking at paying an in-network provider for something that the insurance company later deems to be "unnecessary" or "experimental" or "didn't get precertification" or some other BS reason.

The system sucks. The way health care is priced out and billed in this country is 100% a screw-job. I can't wait until it is replaced. Don't care if the replacement comes from TeamRed or TeamBlue, as long as it is better than the crapshow we have now.

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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by rantk81 » Tue May 07, 2019 8:33 am

dodecahedron wrote:
Tue May 07, 2019 7:49 am
In fairness to your physician, I believe that there are far more medical procedures than dental procedures AND also far more medical insurance companies than dental insurance companies AND any given medical insurance provider may have a dozen or more different plans with a variety of different provisions while dental insurance companies typical only have one or two different plans.

I am a software engineer, and my perspective is:

The amount billed to a patient, for an in-network service at an insurance-and-provider-contracted-rate really only has three inputs: The providers NPI/Tax ID, and the procedure codes that are billed for, and which "Plan" you have for that particular insurance company. With those three numbers (NPI id, insurance plan code, and procedure code), your insurance company KNOWS ahead of time what the rate is. It's in their database. Sure, you may not know what specific procedure codes the doctor, or the hospital's back-end coders will apply.... But if you could guess or know these codes, you SHOULD be able to find out the costs.

That data absolutely exists, and it is my opinion that this data is intentionally hidden from the patient/customer. It could be as easy as having each insurance company website allow for their customers to input CPT codes and provider NPI IDs, and spit out the amount that would eventually turn up on an EOB. Of course, the insurance company websites intentionally don't provide this functionality.

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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by dodecahedron » Tue May 07, 2019 9:32 am

rantk81 wrote:
Tue May 07, 2019 8:33 am
Sure, you may not know what specific procedure codes the doctor, or the hospital's back-end coders will apply.... But if you could guess or know these codes, you SHOULD be able to find out the costs.
That is a big if. I know some people who are experienced full-time medical coders and their work seems mysterious and inscrutable, with rules constantly changing. I tried some practice questions from the medical coding certification exam and found them pretty challenging.

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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by rantk81 » Tue May 07, 2019 9:37 am

dodecahedron wrote:
Tue May 07, 2019 9:32 am
rantk81 wrote:
Tue May 07, 2019 8:33 am
Sure, you may not know what specific procedure codes the doctor, or the hospital's back-end coders will apply.... But if you could guess or know these codes, you SHOULD be able to find out the costs.
That is a big if. I know some people who are experienced full-time medical coders and their work seems mysterious and inscrutable, with rules constantly changing. I tried some practice questions from the medical coding certification exam and found them pretty challenging.
In some cases, yes. In other cases, no. Some things are very clear-cut and you will know ahead of time -- like lab work -- a standard lipid panel is CPT=80061. You know at the time of "ordering" what it will be. Other things are more nebulous, like an office visit that can have multiple different "levels of complexity"... But at least providing a way to query for the cost of these things, it can give you a foundation for beginning to understand how much something will cost -- instead the cloak of darkness around the process that we have now.

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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by Dottie57 » Tue May 07, 2019 9:56 am

rantk81 wrote:
Tue May 07, 2019 8:33 am
dodecahedron wrote:
Tue May 07, 2019 7:49 am
In fairness to your physician, I believe that there are far more medical procedures than dental procedures AND also far more medical insurance companies than dental insurance companies AND any given medical insurance provider may have a dozen or more different plans with a variety of different provisions while dental insurance companies typical only have one or two different plans.

I am a software engineer, and my perspective is:

The amount billed to a patient, for an in-network service at an insurance-and-provider-contracted-rate really only has three inputs: The providers NPI/Tax ID, and the procedure codes that are billed for, and which "Plan" you have for that particular insurance company. With those three numbers (NPI id, insurance plan code, and procedure code), your insurance company KNOWS ahead of time what the rate is. It's in their database. Sure, you may not know what specific procedure codes the doctor, or the hospital's back-end coders will apply.... But if you could guess or know these codes, you SHOULD be able to find out the costs.

That data absolutely exists, and it is my opinion that this data is intentionally hidden from the patient/customer. It could be as easy as having each insurance company website allow for their customers to input CPT codes and provider NPI IDs, and spit out the amount that would eventually turn up on an EOB. Of course, the insurance company websites intentionally don't provide this functionality.
I agree whole heartedly with most of the analysis above. You health insurance co should be able to know the cost of a procedure.

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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by BogleFanGal » Tue May 07, 2019 11:36 am

The way it works with my HSA/HDHP is that we pay the insurance company contracted rates, or lower. For us, it is about $160 for an in-network urgent care visit or about $130 for an in-network normal doctor office visit. Lab tests, etc, of course are higher.

Geez...our cost to visit an urgent care center last year was $700 - and that was the IN network negotiated insurance rate. This was for a bad flu/high fever issue that resulted in a Saturday visit with doctor's exam, facility fees and lab work. Paying just $30 more for urgent care vs normal office visit is a real steal. You're lucky.

OP: Make sure you know the diff between a routine "clinic" like walgreens/target and a more robust urgent care center. The latter can be 5-10x as expensive. They're more medically-sophisticated facilities for diff needs. I knew the difference, but still wasn't expecting a bill that high. (And to an earlier poster's point: zero help understanding the cost. I asked when we went in what the basic fees were to see a doctor, for labs, etc and then asked again after we were leaving and they already knew the services performed...they wouldn't give me any pricing info and just told me to call my insurer.)

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BogleFanGal
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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by BogleFanGal » Tue May 07, 2019 11:50 am

miamivice wrote:
Mon May 06, 2019 3:06 pm
Again, if you have a HDHP, you receive contracted rates (or less). I am not sure what the need is to shop around for cost if you receive contracted rates.
Your plan sounds like a very good one...but realize that not all HDHPs work the same. Yours may have the same contracted rates no matter which provider, but mine was different. When I had to get an ultrasound imaging scan, my PCP recommended her affiliated outpatient facility -- it was "in-network" and the "negotiated" price was around $500. I found a neighborhood freestanding imaging facility also in network that charged $75.

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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by susa » Tue May 07, 2019 2:00 pm

PeterParker wrote: There is no way in hell any doctor will ever tell you a no-nonsense price estimate or list for any general procedure, appointment, or ...
.....except that Oklahoma Surgical Center tells you full price in advance for every procedure and you will never pay above the online posted price no matter what item you pick from their medical menu

MrBeaver
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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by MrBeaver » Tue May 07, 2019 4:02 pm

What surprises me is that efforts like this have not been more successful yet:
https://www.forbes.com/sites/zinamoukhe ... 61a0c25c31

I understand that for any emergency or even sick visits, it's not practical. But for planned procedures like surgeries, etc., Insurance companies should be bending over backwards to pay me cash if I choose a provider that costs them less money. As near as I can tell, the "multi-billion dollar industry" has so far squashed pretty much all of these efforts, sadly.

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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by SDLinguist » Tue May 07, 2019 4:18 pm

Using an HSA compatible plan is really easy:

1. During open enrollment pick the plan with the OOP Max that you are willing to pay.

2. Fill HSA to reap tax benefits

3. Pay all the bills until you hit the max how you want.

All the caveats about in vs out of network apply as with any other plan type.

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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by DWesterb2iz2 » Tue May 07, 2019 4:42 pm

SDLinguist wrote:
Tue May 07, 2019 4:18 pm
Using an HSA compatible plan is really easy:

1. During open enrollment pick the plan with the OOP Max that you are willing to pay.

2. Fill HSA to reap tax benefits

3. Pay all the bills until you hit the max how you want.

All the caveats about in vs out of network apply as with any other plan type.
To put money in an HSA, the plan has to be a qualified plan, right? Not just what you feel comfortable paying. And you can’t “fill the HSA”. There is a limit to what you can contribute annually. Isn’t that true?

The rules this year for HSA qualifying plans are:

The following requirements must be met:

Minimum deductible: $1,250 individual; $2,500 family

Out-of-pocket maximum (includes deductible): $5,000 individual; $10,000 family
No services paid for prior to meeting deductible (except for preventive care)
No deductible required for preventive care
For family coverage: family deductible must be met before any reimbursement can be made
No prescription drug copayments
Higher limits allowed for non-participating provider services


https://www.bcbsil.com/country/hsa_qualifies.htm

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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by SDLinguist » Tue May 07, 2019 6:03 pm

Right all those are true as I said for an HSA compatible plan. My main point was probably lost in trying to be snarky.

The main thing is #1. You need to decide how much you are willing to spend out of pocket.

Many people look at the HSA plans their employers offer and see they are much cheaper than a PPO but don't understand why and so pick them to save money only to get a shock down the line.

I am <30, I go to urgent care maybe once or twice a year when I get sick on a weekend and don't want to wait for an appointment. I spend maybe $400-600 a year OOP. I take the least expensive HDHP at my work with a 6k OOP max.

In essence I treat it like an old school disaster plan. The plan costs 1/3 of our PPO choice and I shove $3500 into an HSA tax free. If I keep my costs under 2k a year or above 12k a year I save money compared to the PPO.

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DWesterb2iz2
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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by DWesterb2iz2 » Tue May 07, 2019 7:52 pm

SDLinguist wrote:
Tue May 07, 2019 6:03 pm
Right all those are true as I said for an HSA compatible plan. My main point was probably lost in trying to be snarky.

The main thing is #1. You need to decide how much you are willing to spend out of pocket.

Many people look at the HSA plans their employers offer and see they are much cheaper than a PPO but don't understand why and so pick them to save money only to get a shock down the line.

I am <30, I go to urgent care maybe once or twice a year when I get sick on a weekend and don't want to wait for an appointment. I spend maybe $400-600 a year OOP. I take the least expensive HDHP at my work with a 6k OOP max.

In essence I treat it like an old school disaster plan. The plan costs 1/3 of our PPO choice and I shove $3500 into an HSA tax free. If I keep my costs under 2k a year or above 12k a year I save money compared to the PPO.
Yep. I much prefer having a high-deductible ACA compliant plan and building up (and using) an HSA rather than pay higher premiums. That worked for us for years. It’s getting harder and harder for us to find HSA qualifying plans, tho. The high deductible is no issue, but those HD plans usually have out of pocket maxes that are now too high to qualify for adding to an HSA. Makes no sense, but that’s how it is.
Last edited by DWesterb2iz2 on Tue May 07, 2019 8:23 pm, edited 1 time in total.

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Re: "Shopping for Healthcare" - How Use an HSA Effectively

Post by tmcc » Tue May 07, 2019 7:56 pm

PeterParker wrote:
Mon May 06, 2019 12:36 pm
Yeah I've used an HSA for years. I'm not shocked at the $230 even remotely. I'm out of Chicago. If you go to an urgent care you can even look at $300. Welcome to American healthcare. Where the prices are all made up and the facts don't matter.

The entire system --- the multi-billion dollar industry --- is designed to absolutely prevent you from "knowing the price" before you get the bill.
There is no way in hell any doctor will ever tell you a no-nonsense price estimate or list for any general procedure, appointment, or whatever. Mainly because they don't know it. But again, because the entire multi-billion dollar industry was designed to prevent this.

Unless you find a 1 in 1,000 hospital with transparent pricing, which is as common as a talking unicorn, there's no chance that will ever happen.
Even calling them to ask, a reasonable request of any business --- is tantamount to an Act of War. It's like asking a cigarette company if their products cause cancer. Even asking is a serious threat to their scam.


If you're interested in the actual laughable nature --- which is mostly irrelevant, it's just a system designed to waste your time until you give up -- the reason they don't tell you the price is that Transparency, Competition, Competitive Practices, the Free Market --- this would lower their profits obviously. They would have to make prices competitive.

But it usually goes like this -- there is a "Master Ledger" at the hospital that has general price lists of procedures. But they have different agreements/ bargains with different various insurance companies. And to give you an estimate from such a Ledger, they need your Insurance Information. The exact Doctor you will be seeing (wait what if you haven't picked yet).

Then they need the Procedure Codes for the service(s) you will be receiving. Wait, random, foreign-key pesudo-generated numbers used by back-office Clerks for technical coding of procedure(s), most of which you will have no clue you will actually be billed for? How would you know those?

Exactly.

Well I'm just getting a Physical Exam. Could you tell me the code for that?

No. We don't know it. And if we did, we still wouldn't tell you. And if gave us the code somehow, we wouldn't tell you an estimate still. Or it would be wrong. Screw you. Pay up. Game over.
Healthcare is a multi-trillion dollar per year enterprise - nearly 20% of GDP in 2017

https://www.cms.gov/Research-Statistics ... lights.pdf

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