News, Biggest medical mystery: The bill.

[emilybh]

Originally Posted by John1960

NEW YORK (CNNMoney.com) -- Ask most Americans how much it costs to visit a doctor and they probably do not know.

Ask doctors what their fees are and they're not likely to know that either.

Health care prices need more price transparency - Apr. 22, 2009

Nowadays, with the help of the telephone, yellow pages and internet, it is easy enough to find out about prices if you really WANT to.

The American Hospital Directory website lists the five different price points that ever hospital in the country seems to have for each service they offer. The website features the most popular services. The highest of the price points is used on the most naiive customers/patients who can most easily be intimidated/manipulated into paying that rediculous price.

NOBODY should think for a second that they are liable for whatever "the bill" might be in this environment. You can ALWAYS negotiate. Knowledge is power. Do your research. Note the CPT code of the service and call other providers and ask what they charge for the same CPT code.

Next, if you need to have an MRI done or some other diagnostics. Get on the computer and search for "low cost MRIs". If you have a Health Savings Account plan (HSA) with a high deductible, it is especially worthwhile to do this if the expense will be going towards your deductible. DON'T for a SECOND think that the network negotiated price will be the lowest. OFTEN you can find better rates than what the insurance company negotiated.

I found this out doing some research for some clients who got health insurance through me. Their insurer reimbursment rate , the"low negotiated discounted rate" that would be applied to the deductible if they used a PPO network provider was $1350 for a specific MRI. Doing some research for "low cost MRI's" on line I found at least three stand alone MRI centers that performed MRIs for between $250 and $600!

There is no excuse for not knowing what a doctors visit costs. If you want to find out, get on the phone and call different doctors and ask. Also ask how much of a discount they give if you pay CASH relieving them of having to fill out any insurance claim forms.

More and more primary care doctors are doing business on a cash basis which is better for the consumer. They've lowered their prices for the full cost of the visit as compared to those that will bill the insurance company.

Last but not least. IF YOU HAVE A CHOICE, NEVER CHOOSE A CO-PAY PLAN over a Health Savings Account Plan or an old fashioned non co-pay plan with just a deductible and coinsurance as both of these eventually pay 100% of your expenses for the rest of the year after you have reached your out of pocket maximum responsibility INCLUDING covering 100 percent of your prescriptions.

Co-pay plans on the other hand in addition to having a higher monthly premium only cost you more the sicker you get. Just being on 10 prescriptions with $75 co-pays each would cost you $750 per month or $9000 per year --JUST FOR those RX CO-PAYS! The moral of the story is NEVER choose a health plan that won't pay 100% of EVERYTHING once you pay X amount out of pocket. This means AVOID CO-PAY plans like the PLAGUE!

With the 100% BETTER VALUE NON-CO-PAY PLANS YOU KNOW IN A WORST CASE SCENARIO YOU WILL never HAVE TO PAY any more than your premiums plus your deductible (minus tax savings if you have an HSA plan)

Sadly most small business owners have been brainwashed into thinking these are the "best" plans but in actuallity they are the WORST value and the WORST protection for the money.

People need to take the emotion out of choosing a health plan and look at it as a finanancial decision which is what it is. Don't pay thousands of dollars more for a silly overpriced co-pay plan because it includes a $100 value check up after a $20 co-pay. Instead get the less expensve NON co-pay plan, pay the $100 for the visit out of the thousands of dollars of premium savings you will realize! You'll have had the check-up and will be thousands of dollars ahead of where you would have been had you picked the stupid co-pay plan.

[davidt1]

Treatment overseas has become increasing popular and necessary for people unable to pay the obscenely expensive US health care system. They call it "medical tourism"

Medical tourism: Have illness, will travel - CNN.com

Medical Tourism: Everybody's Guide to Affordable World-Class Medical Travel - US News and World Report

Medical Tourism: The Insurance Debate - BusinessWeek

An American with aorta aneurysm was told by a local hospital that it would cost him $450,000 for the surgery. He went to India to have the operation for $9,000. This kind of competition will slow down the practice of ripping off patients and tax payers by the greedy US health care industry.

[subsound]

Medical Tourism is not really the great cure people like to tout in medical costs. Sure it's cheaper, the docs are usually well trained, and if it goes right it's great...the problem is if something goes wrong, as in the patient is hurt or dies on the table you are pretty well SOL. Not only is there no one to sue, but it's unlikely that any subsequent care would be covered by any insurer for anything related to what happened out of the country.

[Flamingo13]

Does anybody know if you can get an itemized bill from the hospital (I remember they used to do that) - now they just bill insurance and we can an Explanation of Benefits from the insurance company. I find it hard to believe what the hospital charged and I'd like to know each specific cost.

Might sound like no biggie to some, but since most insurers cap your lifetime benefit, I certainly think it's worth investigating.

[Ultrarunner]

Originally Posted by davidt1

Treatment overseas has become increasing popular and necessary for people unable to pay the obscenely expensive US health care system. They call it "medical tourism"

Medical tourism: Have illness, will travel - CNN.com

Medical Tourism: Everybody's Guide to Affordable World-Class Medical Travel - US News and World Report

Medical Tourism: The Insurance Debate - BusinessWeek

An American with aorta aneurysm was told by a local hospital that it would cost him $450,000 for the surgery. He went to India to have the operation for $9,000. This kind of competition will slow down the practice of ripping off patients and tax payers by the greedy US health care industry.

Gotta Love a Free Market in Action

[Ultrarunner]

Originally Posted by Flamingo13

Does anybody know if you can get an itemized bill from the hospital (I remember they used to do that) - now they just bill insurance and we can an Explanation of Benefits from the insurance company. I find it hard to believe what the hospital charged and I'd like to know each specific cost.

Might sound like no biggie to some, but since most insurers cap your lifetime benefit, I certainly think it's worth investigating.

Good question to ask prior to signing the consent forms... even put it in writing...

Lots of people don't even read what they are signing today... they just sign... hope for the best and argue like heck if there's a problem later...

[subsound]

Originally Posted by Flamingo13

Does anybody know if you can get an itemized bill from the hospital (I remember they used to do that) - now they just bill insurance and we can an Explanation of Benefits from the insurance company. I find it hard to believe what the hospital charged and I'd like to know each specific cost.

EOB's aren't really correct if you look at the straight charges. There are very rare exceptions, but no contracted insurance payor will pay more then 70% of charge...the average is around 55-65%. Medicare will pay on average 45% of charge, and Medicaid less then 40% (depending on the state). RBRVS and APC rates are even lower. The only agencies that do pay near full charge are auto insurance and other liability based commercial payors.