Health care costs

[CO. Hoosier]

How are the lab results communicated to you?

I have a similar experience as far as blood draws are concerned. Been that way since 2010 when I had a narrow PE escape. Used to be I never knew the results until my physician's office called them to me. Now, after I moved, I see a large medical conglomerate for care and everything is posted to a web site. This includes lab work, hospital records, my history, and notes of Dr. visits. The web site is a two way street, it is used to communicate with me and I can communicate with the Dr. with it. Pretty slick. But . . . . there is that NSA thing. I assume Obama knows all about my colonoscopy.

 

[Noodle]

Re: In most hospitals the

I went to a new eye doctor last year for an ordinary exam. I have vision coverage and gave them my insurance card. For some reason, however, they tried to submit it to the health insurance company under my regular health insurance plan rather than the vision plan--despite the fact that both account numbers were on the card I gave them. Of course it was rejected and I got a bill from the eye doctor. I called them and they said oops, our bad we'll take care of it. Got another bill, called them again, and they said the same thing. A month or two later, the eye doctor turned it over to collections. At that point I was irate.

It finally got resolved, but I will not be going back to that eye doctor ever. (Didn't really care for him to begin with, so no great loss for me, I suppose)

 

[Marvin the Martian]

Doesn't some shopping happen now?

It is just done by someone else. To be a part of the insurance I have, a doctor must agree to a certain price. The largest physician's group (at the time) in Bloomington was dropped by the insurance carrier because they would not agree to the rates the insurance company demanded. Eventually they caved and rejoined. For a while, there were no specialists in Bloomington for certain procedures for the same reason. One had to travel to Indianapolis to be "in network".

So there is still some price shopping going on as I imagine almost every insurance plan is that way now. Back in the day, the 60's through 80's, it seemed that most plans were open. Go see any doctor. So things have changed and there is some shopping happening, it is just at a macro level.

Now it is true that one might save money by medical tourism. If I'm willing to travel 500 miles, I might save money. I'm not sure if I want to fly back (or worse, come back via car) a day or two after having been released from a hip replacement surgery so one has to take that into account. One might have to stay a week or so in this other town away from friends and family. Depending on your friends and family, that may be a good or bad thing.

I was trying to find out information about colonoscopies a couple months ago. It is difficult. Not about the procedure, but about the costs and issues. One thing I learned that was interesting, Europeans are far more likely to have a colonoscopy without anesthesia. In Europe about 50% are done without anesthesia. What is interesting, both Americans and Europeans tend to get this free. Yet in Europeans with more socialized medicine are willing to save the money that they really don't save? What's that all about? Had I saved hundreds, I may have gone that route. But it really isn't much of an option in America. A lot of doctors won't even entertain the thought.

Slowly there is getting to be some disclosure in the medical industry. One of the issues we have had is that there is a ton of information available to buy a car. My last used car purchase involved searching a ton of information on the specific make/model/year I wanted for the price I was willing to pay. Granted, I still may have a lemon, but I made the best statistical choice I felt I could make (for example, the 4 cylinder version had a very low rating, and the 4 wheel drive version had real mechanical problems, but the 6-cylinder FWD version had excellent ratings from several sources).


That hasn't been the case in medicine. Even today there are sites I can go look at patient reviews of doctors. When I use them, there are 1, maybe as many as 3 reviews. That isn't much of a statistical sample. So it is harder to make an informed decision for a physician than, well, just about anything else. I can compare medicines that are used to treat a condition, I can compare cars, breakfast cereals, and just about ANYTHING sold (via Amazon*). But physicians, that seems still to be something that isn't very easy to do. Your average college professor (ratemyprofessor.com) has a FAR larger sample size.

So yes, one can make a choice based solely on price but I'm not sure that is enough to base on. A couple years ago I thought I might need a procedure done and there was only one physician in Bloomington that did it. My GP at the time looked at me and said that he wasn't supposed to speak poorly of another physician but that he personally would travel to Indy long before allowing that person to do the procedure. That's probably as close to an honest review as I've ever seen on a doctor.

So other than wanting the cheapest procedure, I'm not sure there are many ways of making a rational decision. As more and more people are on the high deductible accounts, there is more and more incentive to do as you say. Except even that gets blocked some. When I had cataract surgery I had a friend recommend his lasix place as being so much cheaper than anyone else several years ago. I called them, their first question was what was my insurance. They then quoted me the "approved" amount. So there are even limits to high deductible plans. But if it took me 10 hours to find a car out of the fairly limited choices, I can imagine how long it would take to create a spreadsheet of every doctor who might do a procedure with their cost, their strengths and weaknesses. And once one says "I'll only look at the ones within 30 miles", the market goes out of the equation somewhat. Let's face it, Amazon has put tremendous price pressure on all retailers because of their reach.

* Amazon's rating system sucks. At least from the standpoint of just looking at the number of stars. For example, one looks through the ratings and might see a high number of one stars. That should indicate something, but I've seen one star ratings because the product was slow to ship (not the fault of the product) or the person didn't like the packaging (not an indication of how the product will perform. Also, "it arrived broken" is a little informative, but every product is going to have some of that happen, as long as I can return it for another I'm not overly concerned about that one. Or people will give it one start because it only comes in green and they want red. The rating system is a clever idea, and I like reading the comments before an expensive purchase just to make sure that overall a product seems to do what I want it to do. But the numerical system is close to useless. Heck, I've seen 5 *s of people saying "it just arrived and I can't wait to try it". But as a source of data for making decisions, I think Amazon has created this huge database that is virtually priceless even if I buy the product elsewhere. We need that for physicians. Somehow there needs to be a metric to determine success and failure for procedures and that metric should be common knowledge. Heck, PRICING should be common knowledge and listed on websites, etc. I shouldn't have to call 30 offices and wait God knows how long just to find out something that simple. Granted, some procedures may vary, but a simple "colonoscopy average price is $###" would go a long way). I know some people love the thought of calling every doctor from Louisville to Chicago to find out prices, but I think for the market to really work they are going to have to be more visible. Castlight is a start on that but it isn't complete. For example over half the people that perform colonoscopies in my area have no estimated price.

 

[DougS]

Website

Next time will be the first time I use it

This post was edited on 10/29 11:21 AM by DougS

 

[Noodle]

Conpare that to my experience


Whenever our kids have lab work done (e.g., strep throat swab, blood work, etc.), the doctor's office says they will call us with the results. But, 9 times out of 10 we have to call them to find out.

Worst one was when our son had a strep swab (which kids hate almost as bad as a blood draw or shot). We called the next day to get results, only to find out that they somehow lost the sample. So, poor kid had to get another swab. But to make matters worse, they billed us for BOTH tests, expecting us to pay our co-pay twice! On top of that, when we called to complain the person we talked to couldn't quite comprehend why we thought we should not have to pay for both when they actually took a throat swab twice!

In the end, they credited our account for the second co-pay--meaning that the insurance company paid their share of both tests, even though we notified them of what happened. It wasn't a huge amount for them or us, but still. I guess it arguably makes some sense for the insurance co. to just pay for both in that it could cost them more time and effort to deal with it than it was worth, and there was no reason to think that there was some type of ongoing fraud.

We still go to the same doctor (a large practice group) for the simple reason that they have great doctors whom we trust immensely when it comes to our kids. But we do carefully review their billings.

 

[DougS]

We had a similar experience

with regard to lost results for an EKG that they did on my wife. The difference was that they did not charge for the redo.

 

[NPT]

I have website

access to my family doctor and my urologist. My family doctor is not one to want you to come back just to tell you that everything is okay. However, he does order blood work AFTER my yearly visit rather than before like my previous doctor. I don't know if it has to do with Medicare or not.

 

[i'vegotwinners]

anyone thinking "price shopping" is the cure to runaway costs, is just kidding themselves.

if all you're having is a single test, say an MRI, then one could price shop. but not for something like a hip replacement or heart surgery.

say you need a hip replacement, and even know the brand and model of hardware you want.

you could call around to different hospitals and docs for prices, but even if you had any luck getting quotes, (and good luck with that), they would be deceptive.

you might get a quote for $25,000 one place, and nothing under $30,000 anywhere else.

you go with the lowest quote, ($25,000), but when the final bill comes, it's for $37,500.

yes, the bill says $25,000 for this and that, but there's another $5000 for "operating prep", follow up work is not included in the initial quote, meds are priced separately, and you have item after item that's also on the bill, that wasn't included in the quote.

and all this "itemized" stuff will be priced differently at different places, so there is no way to just call around to compare prices.

you're never going to get accurate quotes that are all inclusive, and the more price shopping would get popular, the more deceptive the quotes would get.

then there is the matter that docs don't have privileges to practice at any hospital or clinic they wish, so you'd need a different doc for every different quote.

and a hip replacement is a far greater candidate for price shopping than many things, because there is no real emergency or time sensitivity aspect to it, yet even it would be very difficult to ever effectively price shop.



we get bombarded with hospital ads on tv all day every day, but you never hear one peep regarding cost or price in any of them.

nor will you anytime soon.

let me know the next time you see a tv ad for IU Health, were the message is, "We'll beat any of our competitors' price on any hip replacement or bypass surgery".

or, "If you see a lower advertised price for double mastectomies, we'll refund you the difference".




i've stated all along that price controls are the only way to curb costs, and that's the only way we will.

just ask the ins companies, if you don't believe me.

the reason insurance gets billed far less than the non insured, is PRICE CONTROLS by the ins companies.

the insurance companies have told the providers up front that they will only pay this much for this or that, and if the provider wants the business of the ins companies' insured, then they agree to those prices.

if there were only bargaining entity on the payer side, say the fed govt, that entity would have much more pricing power than any 1 of several ins companies can have.

 

[meridian]

I recently had a procedure...

Got scoped from above and below (I insisted on a fresh probe for the endoscopy). Everything was cool. I just saw the claim - the bill to my insurance company for this outpatient procedure was over $27,000. It was spread across about 10 different categories.

The nature of the hospitals contract with Aetna was such that they go zero dollars for all but 1 of those categories. The one they got money form was reduced from about $8,000 to just over $1400. Because I am past my deductible for the year and into my co-pay I was billed $330 - less a 10% discount for pre-paying.

The $1400 sounds about right for the work that was done. I do wonder how they came up with $27,000 in the first place, and who is the poor sap that ever has to pay that kind of a bill.

All that to find out that I have acid reflux, for the which I take a little pill that costs less than $2 for a one month supply.
But the pain is gone and it no longer hurts to swallow which - when you enjoy steak like I do is a good thing!

I posted this here a few years ago.

I fell on the gym floor, and tore tubercle. That was in the evening.
The gym called an ambulance service, who took me over to a hospital emergency room.
A doctor came in and stitched the parts.
I stayed overnight there.
Next morning, my wife came over and took me home.

That was it; as simple as it gets!

Total bill? I don't remember exactly but around $85,000. Yes, it was paid by the insurance, except for the deductible, which I don't remember how much.

I still have the scar on my ear.
That is our medical system, amigos!

 

[JamieDimonsBalls]

I posted this here a few years ago.

I fell on the gym floor, and tore tubercle. That was in the evening.
The gym called an ambulance service, who took me over to a hospital emergency room.
A doctor came in and stitched the parts.
I stayed overnight there.
Next morning, my wife came over and took me home.

That was it; as simple as it gets!

Total bill? I don't remember exactly but around $85,000. Yes, it was paid by the insurance, except for the deductible, which I don't remember how much.

I still have the scar on my ear.
That is our medical system, amigos!