Jackson Jambalaya

I am just curious, is there ANYONE that has had a medical procedure that did not ask what the cost was UP FRONT? Why does this even need to be done? Is there so high-powered MENU lobby that is wining and dining the idiots that wrote this bill?

many, many people don't ask what a procedure is going to cost up front because it is medical advice coming from their trusted physician. most people believe that when their doctor recommends a procedure, they need to follow those orders without a cost-benefit analysis.

doctors' offices don't exactly encourage the inquiry on pricing either. no schedule (or menu) is provided, and normally if you ask someone in the doctor's office, they can't (or won't) give you a straight answer. usually it is some mixture of "well, it depends on what insurance you have", "I can't tell you because i don't know your deductible and co-pay", etc. they avoid giving a bottom line cost. The reason is because the cost of the procedure is radically different, depending on what the patient's healthcare status is. Medicaid, private insurance, self-insured, all produce different actual payments to the doctor. as usual, the doctor charges the uninsured or self-insured more because he is not constrained by a maximum payment like in the situation with a large insurance company.

if, god forbid, you tell them that you are not insured (even if that is by choice), or "self insured", then you become a pariah and end up bearing the highest cost.

Andrew, I have never NOT asked what something is going to cost and I ALWAYS tell them that I have no insurance. Funny, I have also always found the inverse of what you said to be true. You need new friends and a new ideology.

well, paul, you and i agree about nothing. that is no surprise.

i have chosen to be self-insured at different periods of time, primarily when i was younger, and i am reflecting my experience directly.

i am glad you are very in control of you. pat yourself on the back. you are doing a great job.

Andrew, thanks.

Now, does that mean, profits of insurance companies are capped? If they go over a certain level, then the enrollee gets a rebate?

if, god forbid, you tell them that you are not insured (even if that is by choice), or "self insured", then you become a pariah and end up bearing the highest cost.

Oh yes, those evil doctors. They have a secret list of higher charges they pull out to ding the self-insured. And, holy shit, you should see the ultra 'top secret' list of exorbitant charges they pull out for those that dare to pay for their bills in cash. Never, never, NEVER pay in cash because doctors despise the people who pay in cash more than they do the self-insured. Doctors are evvvvviiiiillllllllll.

Promoting health...maybe they'll pay my Courthouse membership...

Contrary to Andrew's claim, it is ILLEGAL for a physician to charge different rates for the same service, no matter what insurance coverage a patient may have. Some insurance companies negotiate a discount off the charge, which is a feature they use in marketing to attract customers, since it means a reduced co-pay for the patient (i.e., 20% of the discounted charge). If you don't want to pay an insurance premium no one has previously forced you to (that has changed now, of course), and you can save your money to pay the full charge of any service you request in the future. The lack of a discount is what makes a service cost more for the uninsured than the insured. Medicare and Medicaid pay what they want (no matter what the charge is), and physicians can accept Medicaid or Medicare, or not.

Andrew wants us to pay his bills too!

Anon 12:26, not to dispute your statement that it is illegal to charge different rates, but don't you then turn around and dispute your own statement?

Since Medicaid and Medicare pay less than 80% of the cost of most treatments, doesn't that tell you that different rates are charged for different users anyway?

And finally, when doctors do not have to do additional paperwork required for insurance companies, wouldn't logic tell you that using cash would be cheaper than insurance?

Uninsured / Self-insured patients do not in fact pay a higher amount than insured patients pay. This falacy completely discounts the fact that the insured patient has already paid significant sums of money for his/her medical care before they even step into an office or hospital. These may either be in the form of premiums paid by the patient / guardian or premiums paid by the employer (and received by the employee in leiu of money). The premiums purchace health care for the patient (sometimes at a negotiated reduced group fee structure) and also go to pay for insurance against large outlays of money by the patient in the event of catastrophic need (much like a bookie laying off a large bet with a larger bookie in Vegus). The providers (Doc's, hospitals, etc.) accept the reduced fee structure as a trade to gain (sometimes exclusive)something of value namely access to the group with the hope of making up the difference on volume.

That the self-insured patient dosen't have the ability (or gumption) to negotiate a lower fee on the front end for a particular service is not the fault of the insured patient. It is in fact the inherent risk of betting that you will not get sick and forgoing the cost of insurance.

Negotiating fees after the fact (where the only card you are holding is to not pay) reminds me of the scene in "Blazing Saddles" where Clevon Little is holding himself hostage..."Hold it! Next man makes a move, the patient gets it!"

Jawbreaker

Since Medicaid and Medicare pay less than 80% of the cost of most treatments, doesn't that tell you that different rates are charged for different users anyway?

Only the net is different.

Good point Jawbreaker. KF, as to you question, I believe the bill means exactly as you think.....the government has legislated the profit margin for the insurance companies. Such actions were also part of FDR's National Recovery Act, which was struck down as unconstitutional by the Supreme Court.....and subsequently led to FDR's schemes to restructure the Supreme Court, by forcing madatory retirement at 70 and increasing the number of justices to 15.

If you can't beat them.....buy them.

KF, In response to your question, here is a web link of interest regarding how Mass. is dealing with the problem of price controls.

http://globaleconomicanalysis.blogspot.com/2010/04/health-care-price-controls-hit.html

Shhhhhh. The Social Democratic Party doesn't want you to know about their plans to mandate wage and price controls. They fear people would see it as ... you know ... that word they want to run away and hide from ... Socialism.

I am a nurse. The reason most Doctors and nurses cant give you a price of something is because they dont do the billing. They perform tests and use a code system that all insurance companys use to identify what was done.Any person can find a medical coding book at the book store. Doctors and nurses never see how much is being billed. this is why they dont know. you need to ask the billing dept.

Doctors don't give you fees because they do not want to. The task is delegated to another so that the Dr. can remain compasionate and caring. It is hard to remain so when bartering or bargining with a patient about the cost of their health care. In addition most doctors have no idea what the cost of a hospital stay, a radiographic procedure or a time in the OR as charged by the hospital or outpatient facility. Furthermore the facility dosen't want them to know and actively keeps them in the dark.

JB

You've made the point for me, J.B. Only in the field of medicine can the practitioner say "we don't want to haggle with you because if we do, then we may not be compassionate and caring."

So much for that Hippocratic oath, I guess.

Lawyers don't get to elect to pass on describing their fee structure and haggling with clients about what is reasonable. This happens with clients frequently. When a client tells me he can only pay X amount, I don't get to do less of a job representing him vigorously. I have to determine if I can represent him on that basis.

That goes the same for accountants, architects, and the people who offer lawn care services, for that matter.

The idea that medicine is somehow different than any other service is what creates the cognitive dissonance between the consumer and the doctor.

And, to the nurse, again, the fact that you don't know, and that you refer people to buy a book to explain your doctor's fees is hysterical. If you went to a mechanic and asked him how much it was going to cost to fix your alternator, and he couldn't answer because he wasn't the bookkeeper, you'd be pissed.

Then, if you pressed him for details, and he told you that if you really wanted to know, there was a book you could go buy, you would probably think about going to a different mechanic.

Healthcare is a service, like any other. The idea that doctors are miracle workers because their service affects health is what has perpetuated the idea that they are somehow above the tedium of actually dealing with their patients regarding the costs of their services.

I was not clear in stating that doctors have different rates for insured v. uninsured. The initial rates might be the same. But, uninsured patients do pay a higher rate than insured patients, as end users.

Ex: I have a $600 employer paid plan that requires me to only pay $25 for a visit that the doctor charges $300 for, but only gets paid $100 by the insurance company. I, as an end user, pay $25 for care and the doctor only makes $125.

Same person without insurance goes for the same visit, and is required to pay the $300 "at the time service is rendered", as the cute signs in most offices require.

The rates are the same, except that the doctor realizes the only time he'll get his full charge is from the uninsured. If they can't pay, they don't get to see the doctor.

Andrew

1) Paul Mitchell - wrong again. If you ever get an EOB after a service you will see the initial charge. It is the same for all patients who received the same service. Other columns list adjustments (e.g., discounts negotiated by insurance plans, other contracted adjustments) that may apply to an individual's situation, and affect the net payment. Gross and net are very different concepts.

2) Andrew - I see that you are a lawyer, which may explain why you can't seem to grasp simple concepts. A physician is responsible ONLY for his or her own performance, not for other physicians or facilities. If a study (e.g., a CT scan) is recommended to help determine a diagnosis or prognosis, why should anyone expect the family doctor in Duckberg to know what the radiologist in the Big City to charge? If you need a muffler and tires, is would any reasonable person expect the counter clerk at Meineke to be able to accurately know the current tire prices at Walmart?

Anon 10:11, I appreciate your opinion, but I have always paid less with cash. And that appears to be the case with everyone (minus one person) that has chimed in to me.

Ex: I have a $600 employer paid plan that requires me to only pay $25 for a visit that the doctor charges $300 for, but only gets paid $100 by the insurance company. I, as an end user, pay $25 for care and the doctor only makes $125.

Same person without insurance goes for the same visit, and is required to pay the $300 "at the time service is rendered", as the cute signs in most offices require.

The rates are the same, the net charges differ.

What a rigged example. "Employer paid" plans are few and far between in the private sector.

Thanks for identifying your profession. It sheds a great deal of light on the bias within your commentaries.

Paul, you must not be much of a consumer.
If you paid cash for a car from a dealer, you paid MORE than if you financed the car.
Anybody business owners that don't know they'll make more money if they finance the goods they sell ( offered credit and get to charge interest) is probably struggling if not already out of business.
If you paid cash " off the books" ,you are aiding and abetting a businessman engaged in tax fraud...way to go. Thanks for raising all our taxes with that.
There are exceptions but good grief!
Did you pay cash for your house because if you NEVER buy on credit, I don't know how you got a loan!
Are you in a nursing home?

No one is attacking doctors...frankly, I don't know why they aren't PO'd about how the insurance industry controls what they can charge. I actually believe a highly competent doctor should be able to charge more for a procedure than the doctor at the bottom of his profession.
I'm old enough to remember when medicine and the law were professions not BUSINESSES. I think things worked better.

Anon 5:30, do you really believe if you pay cash for a car, you pay MORE than someone who finances a car? REALLY?

If so, I think this is an utterly useless conversation.

Paul, I don't just THINK it, I know it if YOU bought from a car dealer. IF you bought in a private sale, sure...maybe and maybe you have a great mechanic so you had zero " as is" risk. And, maybe you haven't figured into the cost of the car any repair costs.

They got you on what you paid for the vehicle.

IF you were as smart as you imagine, you'd finance, get a pay off clause and have it both ways. Or, you'd get a price saying you'll finance with the dealer and then accept the price and whip out your check book ( or do you carry that much on you?) Do you believe ONLY GMAC made money on the interest on a Chevy sale?

And, NO, I don't buy NEW. Not since my relative with the dealership died.

Whaddaya do , Paul, offer them cash at less than Blue Book and think you walked away with a DEAL?

You advise Deuce on how to make money in the car biz?

ROFL

Again, if you believe for one second that you pay LESS by financing a car, we really have nothing else to discuss.

The term is BECLOWN.

If you paid cash for a car from a dealer, you paid MORE than if you financed the car.

Absolutely and categorically FALSE.

Let the Kapt. take care of this foolishness...

TIME VALUE OF MONEY.

GO get your MBA...

It's cash value of money,not time value and I do...have an MBA.

We can all agree...one hopes...that when you finance a car, you pay much more for the car.

When you finance a car through the dealership, the dealership and the manufacturer will make more of a profit on the transaction.

That is true especially for the manufacturer so it's in their interest to encourage and reward financing through them.

Are you all with me so far?

If you make more profit, you have more room to negotiate. Like if you mark up a widget 150% of your cost, you can put the widget on sale for 75% off and still profit.

Of course, I did not assume illegal transactions. If you are criminals, nevermind.

Oh, and I hope none of you have ever traded in a car during these " cash deals"

IF you guys were nearly as good at " horse trading" as the dealerships lead you to believe, the car industry might not have gotten so screwed up.

And, pray tell, which MBA course did you take that dealt with automobile industry practices in detail? You took finance and marketing and accounting and business law and statistics and economics, etc. like the rest of us. Learned all the formulas, did case analysis, read theories,problem solved, did critical paths. You can talk in jargon now and dazzle everyone.

The dealer has a car on his lot from the manufacturer. What is the difference in what he pays the manufacturer for that car if he sells that car through financing from the manufacturer vs what he receives if you buy that same car for cash?

Now, can we get on to health care.
Poor KF...all this work and all he gets are the same old " I'm agin it" and next to NOTHING specific about what's wrong with the sections provided.

Can we call you (12:51+1:18) the idiot troll?

Back to healthcare, here is what you said in response to my post:

The rates are the same, the net charges differ.

What a rigged example. "Employer paid" plans are few and far between in the private sector.

Thanks for identifying your profession. It sheds a great deal of light on the bias within your commentaries.

Let's see: ad hominem attack because you don't have any valid justification for your post, check.

random claim unsupported by any citation or fact (private plans are few), check.

arguing your way right into my point, check.

the net charges do differ. that's the point. the end user, the patient, has different outcomes depending on the level of insurance that he/she has. and the less insurance, the worse the net outcome for the patient. that was my point to begin with; that, and the fact that doctors don't feel like they need to be transparent about their billing.

I have a employer paid health plan, as does my wife. I can only speak from personal experience, but since we both have it (and four out of the four friends that I asked do as well, including lawyers, UPS employees, photojournalist), I can't agree that private employer paid plans are few and far between.

I don't have any bias because I am a lawyer. I have a bias because of my personal experiences with the healthcare system, such as having an insurance company try to deny my mother's coverage in the middle of cancer treatment based on a pre-existing condition. Such as asking a doctor how much a surgery for my son was going to be, and having them tell me that I needed to give them my insurance info before they could give me an approximation. having to get a letter from my wife's ob that stated the exact date of conception of our first son so that his delivery would be covered under a policy.

y'know; little stuff like that.

Andrew

Flame on, flamer.

Rational and logical and accurate, Andrew. How refreshingly different.