In case anyone didn't receive the memo...

[gerisullivan]

...how health care expenses are charged and paid for in the United States of America is utterly screwed beyond belief.

My own absurdity du jour? According to the outpatient billing department at medical center where I've been having lab work done for the past 3.5 years, they can't tell me what anything costs. Basic tests, ultrasounds, nothing. They can't (or won't) quote prices for any outpatient services because they might get it wrong, and they can't (or won't) say what past prices were because "prices go up." Y'know, I can allow for that in my planning. But I can't make wise or even sensible financial decisions about which of 100+ insurance plans to buy for the coming year without knowing at least the ballpark prices for the services I can reasonably expect to need.

The medical center has an ombudsman, but only for internal staff and physicians. There is no ombudsman for patients. The billing department rep referred me to the secretary for the vice president of ambulatory services. Her own supervisor wasn't available, and she didn't know who else to point me at.

At least my doctor's office was able to give me the price range for "normal" office visits. Of course, that took two days and a helpful desk clerk. Much as everything is computerized, the price list is kept only in a 3-ring binder in the Nurse Manager's office. The list is so lengthy and confusing that the clerk had a hard time figuring out what prices to give me, and even though they have a lab there, she couldn't find any prices detailing what the tests cost.

I'll see if my insurance company can (or is willing) to provide any useful information.

Comments

[richardthe23rd.livejournal.com]

The difference between my doctor and my mechanic is the mechanic will tell me in advance how much the repair is going to cost. My eye doctor wants $400 and the hospital $1400 for zapping my right eye with a laser for three minutes. Good luck with that, I tell them.

[madfilkentist]

Thanks to many political pressures and maneuvers, the customer of medical services is now the insurance company, not the patient, for nearly all purposes. Medical service providers have no economic reason to give a damn about you.

[gerisullivan.livejournal.com]

The insurance company can't (or won't) tell me, either. They have a list of approximate prices paid by their customers for common services, but nothing specific to my use or consumption of heath care services.

[madfilkentist]

The insurance company isn't selling you medical services retail; they're selling you a policy. It's a losing proposition all the way around.

[gerisullivan.livejournal.com]

It's a losing proposition for the patient. Insurance company profits would indicate that it's rather a win for them.

[sethb.livejournal.com]

How much something costs depends on who is paying for it. Different insurance companies have negotiated different prices.

People pay the highest rate because they lack negotiating power.

[gerisullivan.livejournal.com]

Understood. But they can't (or won't) tell me "your insurance company pays us X dollars" for a pelvic ultrasound, or "if you came in off the street, you'd pay Y dollars it," OR "if you had one today and were on a deductible plan with your insurance company, we'd send you a bill for Z dollars."

I was on a deductible plan from 2004-2005; I can look up some of the lab costs from then and adjust them for price increases. But I didn't have any ultrasounds, dammit.

And my insurance company won't tell me, either.

Yet one of the ways I make my living is designing and laying out wellness newsletters that constantly promote and stress the importance of Health Care Consumerism. It's the latest magic pill that's supposed to solve all of our problems and bring prices down.

So I'm left with over 100 health plans to choose from, and insufficent data with which to evaulate what my actual total health care costs (including insurance) are likely to be under any of them. Well, except for the premium plans that have no deductibles. 'Cause co-pay amounts are reasonably clear. Not perfectly so -- about once a year, I get a refunt check in the mail for a copay they charged me that I didn't actually owe, but I'm not looking for that level of precision. I'm trying to ensure that changing to a plan with a lower premium that I can pretend to afford won't actually end up costing me more than the plan getting hit with the $148/month premium increase.

Much as I personally like the leafy green, "I say it's spinach, and I say to Hell with it!"

[sethb.livejournal.com]

It probably won't help in time this year, but I'd suggest getting hold of some of your elected representatives and asking them (1) to get the data for you (they might), and (2) to pass a law requiring that the prices be made easily available so that consumers can make informed choices.

The companies will fight it, of course, but at least you'll have the fun of watching their purchased politicians attempting to weasel.

[gerisullivan.livejournal.com]

Good suggestion! Thanks.

[voidampersand.livejournal.com]

People worry about global warming, but what about the rising levels of irony? We're being inundated. Enough already.

I'm afraid the only real fix for this mess is going to be political. I say afraid, because political solutions are slow, and in the meantime you need to take care of yourself and stay healthy. I've been white-hot angry about this for years, what with my sister's problems with recurring cancer, and my cousin's death from an easily preventable heart attack. Search for "murder by spreadsheet" and what blogger nyceve is writing about health care, it expresses a lot of what I feel.

Good luck. Maybe you can lightly sauté the spinach with some garlic in a bit of olive oil.

often, I'm gonna guess

[(Anonymous)]

It's a negotiated price to the insurance plan. Bigger plans can get better prices. makes a lotta sense, doesn't it.

[apostle-of-eris.livejournal.com]

My own bad news is that I just (a week or two ago) got the anesthesiologist's bill for my operation last November. First I've heard of it.
OTOH, yesterday I got a bill for something last August, which I have no idea about, but the amount sounds like a bill I got a couple of months ago which I never could figure out what it was for. This one has more clues, so when I have the time & am in the mood, I'll play phone tag.

People who can't understand that single-payer is the only sensible answer either have so much money it doesn't matter to them, haven't been sick, o/r/ a/r/e/ t/o/o/ d/u/m/b/ t/o/ l/i/v/e/.

For a small egoboo point: Years ago I was talking about the revolution in American medicine. Only historians remember the ferocious fight near the end of the Nineteenth Century over who would get to define medicine. Effectively, the AMA won, and they got to decide if something was medicine or not. Today, the operational definition of medicine is what insurance covers. So, for instance, "alternative" practitioners lobby the insurance industry to be reimbursable, and ignore the medical establishment.

[minnehaha.livejournal.com]

I had no idea. How craptastic.

K.

[fmsv.livejournal.com]

This may or may not be helpful, but at least it's a link. The government does publish the Medicare reimbursements for procedures, which might at least give you some information for your location. (This might also lead you down a twisty maze of websites, all confusing.) At any rate, the link that starts up the whole set of Medicare stuff is here. (BTW, (and I hope this isn't telling you something you already know) the person you really want to find is the one who does the coding of procedures for billing, since how a procedure is coded determines what the reimbursement will be for it.)

[mjlayman.livejournal.com]

Ah, I was going to suggest she find someone who has Medicare who's had those labs. When I do stuff outside Kaiser, I get copies of the bill that shows me what the hospital charged, what Medicare paid, and what Kaiser paid (and they never pay anything near what the charge is).

[gerisullivan.livejournal.com]

Thanks. Yes, that is a twisty maze, all right!

What I find most annoying is that my providers *have* the records right there, showing what I've had done. If I were on a deductible plan right now, I'd have the EOB statements showing me what the clinic charges, what the insurance plan allowed, how much was written off, etc. etc. Similarly, my insurance company has the information.

My one saving grace is that I was on a deductible plan the first year I was here, and I save paperwork. So I can get at least something of a notion from those amounts. I didn't have any ultrasounds done then, so I'm up a creek there. And there's always the unknown future. I don't expect anyone to be able to tell me what that will cost, 'cause there's just no telling.

Yes, I understand about the coding. But I don't think I need the person who does the coding -- I just need someone who can (and will) look at my records, see the codes and the corresponding amounts charged/received/paid/whatever.

This whole system? It's screwed. It's so screwed.

Who, me, attitude? Well, yes, actually.

[drpaisley.livejournal.com]

Back when I had insurance (I'd been covered through Dragonet's work policies for almost 20 years when she got laid off in December), I had begun a relationship with a dentist a block from my workplace who took our insurance. When the "permanent" bridge serving as the upper left set of teeth fell out, they told me it needed to be replaced with a new bridge (including an extension to cover a tooth on the other side that had lost its filling) and it would be, after insurance, $6K or so. I had them cement the old one back in, which lasted several months, and did the same before the NASFiC and Worldcon, so as not to look like a refugee from the Bubbas of the Apocalypse series.

D/lta D/ntal then informed me that such cementing was considered a "once in a lifetime" expense, and that I owed the dentist some money. Before Rohanna could process the invoices, I told her to wait until we got a bill from the dentist. Said bill appeared, and they (as I had suspected) had written off most of the charges, leaving us with a bill under $20. But I still don't know what they would charge me to do it now.

I'm not a particularly violent person, but I would love to see everyone in the health insurance industry be stricken with random maladies and missing body parts and forced to go to public hospital emergency rooms for evaluation. After midnight. On a holiday weekend.

[kip-w.livejournal.com]

I'm wondering if there is a book on the subject, maybe from a consumer outfit. Kind of like my guide to fat and calories and stuff. Just a thought.

[gerisullivan.livejournal.com]

One of the clients I worked for last year had a software tool employees could use where they entered a ton of personal medical information for each member of their family. The worksheet showed average annual costs of treating each person -- annual wellness checks, allergy shots, diabetes treatment, etc. etc. After you made your way through the entire worksheet, up popped a page showing each of the health plan options, what each plan would have paid for, and what your out-of-pocket costs would be under each plan. It was all based on average costs and it only covered common things, but it was a damned sight better than anything I have available to me.

The amount of variance within any price/treatment structure is so profound that it would be hard to come up with a meaningful data set like you can with calories and such. My insurance company gave me some average amounts paid by other members of the plan, broken into low, medium, and high cost categories. Even with them shaving off the outliers at the top and bottom, the range still went from something like $31 to $302 for one of the ordinary lab tests that you wouldn't think could possibly vary so much in meaning or cost.

[smofbabe.livejournal.com]

Much to my amazement, my brother actually managed to negotiate some of the bills for his operation (like the hospital and the anesthesiologist) downward by pointing out that by paying cash, they didn't have to deal with any insurance company paperwork! I get the impression that the price of medical care is what the traffic will bear or negotiate, and not a fixed cost.

Best of luck!

[retooned.livejournal.com]

Not being able to get prices for procedures and lab work is outrageous.

[gerisullivan.livejournal.com]

Agreed!

[mjlayman.livejournal.com]

I don't know what kind of ultrasound you're looking for, but here's what I had outside in 2006. I don't have anything for 2005 or 2007.

2006:
MRI R Knee, $1981 for hospital, $360 for radiologist
PET scan abdomen, $5000 for hospital, $850 for radiologist
Ultrasound, abdomen, $761 for hospital, $118 for radiologist

My carotid dopplers and heart ultrasound were done inhouse, so I don't know what they cost.