Medical Care

[matt819]

I'm posting this here because I can't seem to find a health insurance topic/forum.

Minor rant about health care costs.

My wife has a pretty low level ACA plan. You know - high deductible, few providers. No surprise there.

She might need an MRI, so I checked around our small state. Only two providers. That's fine, but the price at the large medical center is more than double the price at an imaging clinic. And it's even lower at a smaller hospital, though, weird as this is, the hospital is in the same health care system as the large medical center. So she may end up going as a private patient rather than as an insurance patient and pay 25% of the large medical center charge. Is that fucked up, or what?

Related issue. Since she can't get an appointment with her PCP, despite what we think is an urgent matter, she's going to go to the walk in clinic associated with our local hospital The service there is fantastic. So I called to check on the price for an office visit there as opposed to an office visit to her PCP (if she could wait, which she can't). All I want is the "rack rate" for an office visit. No can do. Check with your insurance company on the cost of that service. The insurance company is not providing that service; the clinic is. But they can't give me a price. So not much has changed. When I had cataracts removed about 8 years ago I asked the eye doctor what it would cost. He said he didn't know, check with billing.

Picture this. You have a business. You sell widgets. Big widgets, small widget. A widget for every job. Sorry, though, I can't tell you what it costs. Depends on so many things. I'd really love to sell you the widget, but I can't tell you what you need to know to buy our widgets. You'll have to call my insurance company to get the price of the widgets I make. Better yet, call your own insurance company to get a price on my widget.

Yes, I know it's a convoluted analogy, but it's so fucked up.

[guillaumeb]

1. The two word solution/answer is:

Single payer.

Eliminate the need for specialized personnel who deal with the hundreds of plans, all with different reimbursement rates and limitations.

Eliminate the profit motive that deforms and motivates this system.

Eliminate the contributions from the healthcare industry to Democratic and Republican politicians.

[SheilaT]

2. The reason the clinic cannot give you a "rack rate" price is that

they have no such thing. The cost for each and every procedure is negotiated separately with each and every insurance they take.

Some places will have a price for uninsured walk-ins, and that's usually the highest price there is. Usually you can negotiate a substantial discount if you pay cash within thirty days.

Yes, the system is totally awful, but this is what it is.

Oh, and the doctor not knowing the price of cataract surgery is even more understandable if you think about it, because he has absolutely nothing to do with the amount that's billed. And again, the price they get will be different depending on exactly what coverage an individual patient has. And there will be different prices for the cataract surgery depending on just what lens is inserted.

Perhaps more to the point, medical care is NOTHING like making and selling widgets. Really, it isn't.

[REP]

3. I have Medicare with a Group Advantage Plan and an HMO; my doctor has no idea what anything costs me

In ACA terms, I have a Diamond-Encrusted Platinum Plan, but there's so many of them that cover different things at different co-pays, it's unreasonable to expect a doctor to know what you're particular co-pay will be. Your doctor will know if you need emergency, urgent or an office visit; if a planned procedure is in or outpatient; and what tests and imaging is needed but can't know what your plan covers or charges for those.