I called the docs and med centers I had been referred to so I could find out if all of them were participating and preferred with my plan. With two of the med centers I was able to get confirmation. With the final med center, they could only confirm that a few of the providers were participating and preferred. In frustration and desperation, I called the scheduling concierge who said that because the center was participating and preferred, everyone there was participating and preferred, so no worries.
It shouldn’t be that tough to find out who is and is not participating and preferred and what estimated costs will be.
It’s impossible to be an informed consumer when you can’t get estimates of charges and costs. My charges at Stanford were MUCH higher than UCSF or National Jewish, tho I had much less done there than an the other two med centers and all were in 2016. Fortunately, my insurer had no issues with the bill and handled the balance of all my bills, but it makes me more reluctant to return to that med center.
I’m dubious about the value of transparency in reducing costs. Suppose I have some symptoms. I go to my doctor. She orders some tests. Knowing how much the tests cost isn’t of much value to me in deciding to have them, because, not being a doctor, I don’t know whether they are worth what they cost.
Someone might say, well, but you can find the cheapest provider of the tests and procedures that are recommended to you. But I also don’t know how to evaluate providers.
Of course, estimates depend in the codes the doc submits, not the alpha name, and those aren’t always known ahead of time. And then the negotiated rate. Then any facility costs.
I tend to check big procedures on Healthcare Blue Book. And there you can sometimes see the different pricing per facility.
I had an outpatient thing scheduled once and did get a good amount of info. But from the billing clerk, not the doc or desk gal. Eg, that an ambulatory here has lower rates (a base rate) but a longer wait to schedule. And that the hospital rate is per increment (per 15 minutes?). She was able to rough project for several codes. Got me into ballpark.
I just learned from getting the bills from each facility after I had received services and will base future treatment partly on that, as well as what my treating provider recommends. It’s very hard to be an informed healthcare consumer and even more to be able to compare costs in any intelligent way.
When I was trying to get the same test performed and my provider’s offices was calling medical centers to fit me in, one facility said they’d squeeze me in a month from the date the provider called. Another said they’d test me just before I saw a provider at their facility. The third testing facility was able to fit me in a week from the date the provider’s office was calling to schedule–we went with the soonest test so we could determine if further intervention was urgently needed.
We have a high deductible health plan. My wife needed to have a procedure performed per the doctor’s instructions. She called several places and we saved around two thousand dollars by going to a different provider. The doctor had no issue with the report from the other provider.
I know nothing about codes, only about some of the tests I have performed on a fairly regular basis at a variety of different facilities. I also know that I have seen a fair number of specialists at various different medical centers for basically the same issues (frequent respiratory infections), around the same time period. I have mostly seen MDs and they are all well-regarded and all participating and preferred with my insurer. The procedure is the same, wherever it is performed and however it is coded. Other testing is additional, depending on the ordering provider.
It is just that this year, I was having even more infections that usual, so I saw a LOT of providers in Feb-June at many different facilities–in HI, at Stanford, UCSF and National Jewish in Denver, CO. It was interesting to me to see the various bills list price and the EOB, as well as my out-of-pocket share.
However, there are situations where several courses of action may not yield one clearly superior to the others in medical results, but cost substantially different amounts. An example is colon cancer screening. All of the usual methods have similar outcomes in terms of lives saved over no screening*, but the expected costs are quite different.
Another social or economic distortion caused by the predominance of third party payment for medical care (with or without ACA) is that third parties (your employer or the government) are now much more interested in your health habits, since they are the ones paying for the increased or decreased medical costs that your health habits may lead to.
Most people probably are not comfortable handling the costs of their medical care themselves, but probably are also not comfortable with their employers or the government taking an interest in their health habits.
Inteeresting how small the number of ACA enrollees are. Most people are still covered by their emplyers. No wonder it is a bad deal unless you are very sick. The pool is too small to spread the cost of caring the very sick.
Thank you, @lookingforward It sounds like if you are covered by your employer, you shoudn’t pay anything to medicare since you pay a private provider for the supplement. For some reason, I am paying $3-400 to medicare through SS deduction although I am covered by the employer for Part B. Was I overpaying all this time?
my parents still work and are over 65 and on Medicare…they both pay monthly to the government for Medicare coverage. They also have Blue Cross for the gap. Igloo I suggest you talk to HR and or if you have an insurance agent you use not sure about income thresholds etc…
@Iglooo it sounds like you have both an employee sponsored plan AND Medicare. You then would oaynfor both…one is your primary, and one your secondary.
We pay more for my Medicare per month because we are considered “high earners”. Because you are still employed, I’m guessing you fall into the same boat. In addition to an additional Medicare charge, we also pay an addition charge for part d, RX coverage per month.
Igloo, I’d say start by asking the employer. High earners pay more for Part B, but Part A is dependent on having paid into Medicare ten years, at least. In that case, no Part A cost. Aiui.
It would be odd to pay a varying amount ($3-400.) SS sent me a summary in advance of the total to be deducted, based on present costs.
Last year, when we took our dog to the vet, we were presented with three options that were patiently and clearly explained to us. This is Level One Care, Level Two, and Level Three.
Each option had an estimated cost attached to it, and it also wasn’t a last chance offer, meaning, we could do Level One (which was essentially a pain prescription plus watch and wait) and come back for a higher level of care later, if needed.
I LIKE having some control over what I’m spending and WHY I’m spending it. Wouldn’t that be an economic incentive to drive down costs?
Re: screening and what is covered or not.
I’m also very uncomfortable with a large government agency being in charge of these recommendations. It seems so inefficient and slow to adapt to new information coming out of research.
