<p>Yeah … Doctors and used car salesmen… I put them in the same category. </p>
<p>I was going to write a post on the similarities between doctors and used car salesmen, but now I don’t have to do that. </p>
<p>I apologize to the used car salesmen.</p>
<p>Nobody is negotiating TatinG. It is hard to negotiate when you dont know the offering price. </p>
<p>Do you usually buy the car and drive it around for a month before you are told the price?</p>
<p>My wife is a very good negotiator. I am getting soft as I get older. :)</p>
<p>It’s very hard to negotiate after the fact, when you have no leverage. </p>
<p>I’m on my bike. I crash and lose consciousness. I’m taken to the hospital. Luckily, both major hospitals near me are in network, so whichever one I’m taken to, I’m OK as far as hospital coverage. I’m treated by an out-of-network doctor. They bill me $10,000 for putting three stitches in my calf.</p>
<p>So, then, I’m supposed to negotiate? How? I say, “I don’t want to pay,” and they say, “If you don’t pay we’ll ruin your credit and set a collection agent on you.” And I say what? What’s my next move here?</p>
<p>It may well be, because I’m stubborn, that my next move might be, “I’m calling my lawyer. I find this tactic so despicable that I’ll pay a lawyer more than $10K just so you get nothing, you rotting piece of garbage.” But the piece of garbage ER doc is banking on most people not being as stubborn as I am.</p>
<p>NYU gouged my son. My wife and I paid for the bill. This is in 2013. A couple of xrays and a boot for a sprained ankle. In network… Supposedly. Cant remember the cost. It was ridiculous. My wife tried to negotiate. </p>
<p>NYU said no. We could have said get the money from my kid, the grad student. Good luck. </p>
<p>Maybe we should have but we paid. </p>
<p>CF doesn’t like doctors. I don’t much like doctors, either. In fact, I try very hard to never see one. But, I have negotiated and it was easy because when they know you don’t have that much they will take what they can get. I agree, it’s not acceptable.</p>
<p>I was able to negotiate to lower the amount.</p>
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<p>So it’s your position that the healthcare “market” was perfectly transparent before the new law? LOL</p>
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<p>This exactly happened to my D. She ended up stuck with a bill, because the doctor’s office gave her inaccurate information. </p>
<p>I feel like there should be some recourse for patients in this situation. My D did precisely what she was supposed to do. She got insurance, and she asked the doctor if they accepted it. What else was she supposed to do? But insurance companies can’t manage the apparently impossible task of posting accurate providers lists. Doctors can’t manage the apparently impossible task of knowing what insurance they accept. I don’t see how that’s the patient’s fault. If the insurance company and/or the doctor had to eat those costs, I bet they’d figure out how to do their jobs in a hurry.</p>
<p>alwaysamom has hit on the solution to this and many many other problems with our healthcare system.</p>
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<p>When businesses take advantage of people in a disaster situation – e.g., [charging</a> $500 for a hotel room after Sandy](<a href=“Is Price Gouging Reverse Looting?”>Is Price Gouging Reverse Looting?) – it’s called “price gouging.” I fail to see the difference between that and what goes on in American emergency rooms. Charge whatever you want to; your “customers” have little choice.</p>
<p>Tatin, I can’t believe this has to be spelled out, but surgery is not a used car.</p>
<p>[Five</a> Reasons Free Markets Don’t Work in Health Care](<a href=“HuffPost - Breaking News, U.S. and World News | HuffPost”>Five Reasons Free Markets Don't Work in Health Care | HuffPost Latest News)</p>
<p>“When businesses take advantage of people in a disaster situation – e.g., charging $500 for a hotel room after Sandy – it’s called “price gouging.” I fail to see the difference between that and what goes on in American emergency rooms. Charge whatever you want to; your “customers” have little choice.” </p>
<p>Hospitals are required to give away free hotel rooms to anyone who can’t pay, though. So, it’s a little more complicated.</p>
<p>LaMas:
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<p>Please go back and re-read my post carefully. I said
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<p>Yes, it was a mess before, so…IF we are going to allow the Feds to regulate this industry on a MORE invasive and detailed level than BEFORE the ACA…then do the things that make a big difference to the somewhat educated and already purchasing consumer. Do the transparency thingy, make a NPC part of the 3000 page bill, MANDATE that consumers know the price beforehand and can comparison shop.</p>
<p>As for the dilemma faced by your daughter described in 15547, if this is the first time visit to a new practice/doc I would advise your D to call not once, not twice but at least three times. And call not just the docs office but also the insurance company. That is your D’s responsibility given the system we have. See if you get a consensus. Is it a PITA, yes…but hey…she has coverage right! It was the same responsibility she would have had pre-ACA. So, see…no improvement… </p>
<p>As I’ve said before, she was uninsurable before ACA, so it’s a big big improvement in our view. </p>
<p>But I take your point about triple checking. We do that now. I still think, though, that the patient shouldn’t be penalized if given incorrect information by people who should know the answers to simple questions.</p>
<p>And I couldn’t agree more that price transparency is critical. It might be hard to achieve, though. EG, in the emergency room, when they’re checking you in, they aren’t going to know what procedures are going to be done, if any. Not sure how to solve that one. Perhaps just a blanket fee? IDK. When I went to ER, I had a $100 copay, that was it. Some bloodwork was done, a minute with the doctor, and they handed me a prescription which I filled at CVS. It never occurred to me to ask if all providers were in network. I made the assumption which Fang refers to – reasonably, I think – that since the hospital is in network, any possible thing they might do to me there would be covered.</p>
<p>This is an insane system. Universal Care is the better way to go. There are too many moving pieces in this system and the people who really need help are sick! Sick people negotiating this Kafkaesque maze is nuts. I can’t even figure out how we came up with this new system. It’s senseless and in many cases really inhumane.</p>
<p>poetgrl, it’s totally insane because there was never any plan. It’s just been cobbled together, piece by piece, over the last 70 or 80 years, with no plan or vision about what the whole thing should look like. The one obvious solution is just completely out of the question, unfortunately.</p>
<p>Slight side step to the original question of insurance premiums: I’m joining late, and not sure where this thread has gone because I can’t read 1037 pages! But, I thought I’d add my recent experience of cost comparisons. I lost my health insurance recently due to a job change. Prior to that position, we paid for our own health insurance approx. $480 for our entire family 2.5 years ago. Now, my individual premium for similar coverage is approx. $600 per month (for me alone – not a family plan)! I knew that insurance has been rising, but was not expecting this huge difference. There has been no change in my health status, thankfully, but it was explained to me that because now that current health is no longer a factor in purchasing insurance, the expenses must be borne by the healthy.I was also warned it is likely to increase considerably more, once I reach the years before medicare.</p>
<p>I don’t like the increase at all. At the same time, I am relieved to know that should my health condition change, my coverage can’t be dropped either. However, something has to be done, because at least for me, my health premiums & max. OP cost are nearly 1/3 my income which is unsustainable.</p>
<p>You’re not eligible for a subsidy?</p>
<p>If the premium and max out-of-payment are 1/3 of your income, you should be eligible for a substantial subsidy via the exchange. Or is the problem for you that you live in a non-Medicaid expansion state and your income is too low? </p>
<p>I’d add that if you were paying $480 for family coverage with an employer policy two years ago, your premiums were being subsidized by your employer. That is, the real cost to your employer was probably at least triple that amount. Or, if that is the amount you were paying for private market insurance – that coverage was probably deficient in some way - for example, it might have had a low maximum annual or lifetime payout. I know that when I was helping my son with insurance shopping after he got laid off a few years back that there were policies that looked inexpensive on the surface, but they had benefit caps of around $20K /year – fine as long as he was healthy, but an amount that would be inadequate to pay for even a few day of hospitalization. </p>
<p>But again – it sounds like you are subsidy eligible. The ACA did very little to control the upward trend in insurance premiums, but it does provide a strong scheme to help most low and moderate income families pay for their insurance. Bottom line, the insurance companies can still charge high premiums, but in your case I think that the government will pay the bulk of your premium. (That is the legislative compromise that resulted because it wasn’t possible to pass universal single payer, taxpayer funded coverage – so its kind of a back way around to achieve a similar result. In countries that do have single payer, government funded systems-- everyone gets health care for free or at a very low cost, but there is a higher tax burden on the citizenry, which of course tends to extract more money from citizens with higher incomes). </p>
<p>I’ll tell you what I’d be inclined to do if the doc said they accepted my plan (ie, insurer negotiated rates) and the insurer said the doc does not: get it in writing from the doc. Of course this applies to a planned procedure, not ER. But as patsmon and I said, our plans state that when the facility is covered, the pay the players in-net rates. </p>
<p>As for the excessive charges for stitches for the kid who had a concussion and a cut, I sure hope some of the charges were to explore the concussion.</p>
<p>Also, keep in mind that not all doctors “balance bill.” A PPO will pay out-of-network providers the UCR (“usually, customary and reasonable” rate) My former doctor’s staff was not able to tell me whether they were on or off network until March – but the insurance did specify an allowed UCR rate and applied it toward my deductible – and the rest was waived by the doctor without my having to ask. </p>
<p>Some clarifications: $480 was self-pay(not through employment). One year later, it raised to about $520 (for a family of 3). To the best of my knowledge, there was no lifetime max. However, our family has been VERY healthy (thank goodness), and at that time, your health history significantly influenced the cost. That former self-pay family plan was closer to silver level coverage, and comparable plans now cost around $600/mo… I actually chose the bronze plan so premiums are slightly less . Premiums plus maximum OP are about 1/3 of my salary – not premiums alone. If I continue to win the health lottery, I can keep the cost down.</p>
<p>I’m not eligible for a subsidy, because the amount dh and I make together are over the limit. He is covered now through employment, but his firm does not cover family or spouses. I am self-employed. </p>