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<p>Not meaning to derail the thread, but I just have to say how refreshing it is to see someone use the acronym correctly! (I get so annoyed when people type it the other way - I’m not going to do it here, because we all know which error I’m talking about and it drives me nuts to see it the other way - while pretending to be experts on the policy itself)</p>
<p>I just have to comment on how difficult it is to get a price. I wanted to compare urgent care clinic fees when S had to go in for a minor illness (he had just recently aged out for his pediatrician & didn’t have a new doc yet). No clinic would quote me a price … all said “it depends.” Made me mad! My coworker tried to get a price on a test her doc ordered, and she couldn’t get a straight answer from any place she contacted. She never got the test.</p>
<p>Asking for “the price” of a medical procedure is not asking a question that has an answer. The price is different, depending on the insurer. It’s like asking “the price” of an airline ticket for some flight: there isn’t one.</p>
<p>Providers (like doctors) and insurers negotiate prices. The price of a procedure is going to be different depending on which insurer you have, because providers negotiate separately with each insurer.</p>
<p>And think about how these negotiations work. The insurer wants to pay zero dollars, $0. The doctor wants to get a big fee, $BIG. Eventually, they agree to some price between $0 and $BIG. </p>
<p>But notice what the price is going to be for uninsured people-- it’s going to be $BIG, the doctor’s starting point for the negotiations. That is necessarily bigger than the doctor thinks that any insurer would pay, because it’s the number the doctor is planning to negotiate down from. The quoted price for uninsured people HAS to be bigger than the price any insurer pays.</p>
<p>Doctors could give a price list for all their procedures, for uninsured people. But that’s not very useful for people with insurance. The uninsured prices are necessarily going to be much bigger than the price the insured person or their insurer will pay.</p>
<p>United Healthcare has a price estimator that has given me very accurate information this year on what charges for certain procedures/visits would be would specific doctors – usually within just a a couple of dollars of the actual cost on the final explanation of benefits. I found this incredibly helpful when I needed xrays and then an MRI earlier this year – the charges varied hugely at different “in-network” facilities. I drove twenty minutes down the road and got the imaging done at a tremendous discount. </p>
<p>In my area, United HealthCare is my favorite third party payer. Very reasonable reimbursements with minimal hassle. </p>
<p>CF, asking the price-- I ask the basic charge for what’s being ordered. Eg, the lab told me that test could run 270, usually does, unless there is some twist. Then she said, we don’t know today what your insurer will pay, though, and then charge you, per your policy. Fine, I know my policy, deductible and co-insurance. And my insurer lists every transaction, with detail, on my online page, so I can watch. (Pretty much an online EOB.) I called the imaging center for a cost on the CT with contrast, got a bracket number. What I didn’t realize, as a layman (though savvy enough about this stuff,) is it was “dual contrast.” So the bill came in a little higher. Arabrab, same here with BCBS, by doctor is available. It’s a challenge though, for, say, imaging, where you don’t know which doc will read scans- and there is obvious great variation in their listed costs. In the end, it was in spitting distance of Healthcare Blue Book. </p>
<p>What does “basic charge” mean? Who is charged the “basic charge” price?</p>
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<p>The employer may do research on aggregate information. For example, does the employer’s offering of a free stop-smoking or other wellness program make the employees overall healthier, resulting in lower medical insurance costs? Is there a high rate of physician visits for repetitive strain or other possibly-work-related injuries that ergonomic modifications in the workplace can reduce?</p>
<p>Of course, publicly mentioning something where individual employees can be identified is not a good idea. In terms of public statements, a company would be wise to make only the most general of statements (no mention of specific types of medical services used, etc.) if it wanted to say anything at all about medical insurance costs. But then they may privately know a lot more than what they are saying publicly.</p>
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<p>True, but one can always find out the exact price one would pay for a ticket on a particular flight, right now, and one never has to take the flight without knowing the cost of the ticket.</p>
<p>@arabrab, thanks for mentioning the United Healthcare price estimator. This caused me to go check Anthem’s website and hey, they have one too! I hadn’t realized this feature had come along since I last had reason to want to check the cost of a medical procedure. There’s one I’ve been putting off because I have some choices and was feeling stymied about cost. According to the estimator, one of my choices (actually the better facility, I would have thought) is predicted to be about $400 cheaper than the other. All right, then. I can call and get this thing lined up.</p>
<p>Woo-hoo weatherga – glad you found an estimator for your insurance. I really, really like UHC’s.</p>
<p>Now if they’d only fix their doctor/facility search function. A less competent search capacity would be hard to imagine. I particularly despair at the way they handle facilities like PT – they list contracted physical therapists name by name, with no associated name of the PT practice. And, huge numbers of their contracted providers don’t even show up in the search, but the office says they are contracted and the bills go through just fine. </p>
<p>ucb, some employers may want aggregate data only for the most benign purposes – to improve their quit-smoking program, or to re-design workplaces to reduce repetitive stress injuries. Others, like AOL, may use aggregate data as an excuse to cut retirement benefits. We simply can’t assume that employers will always use this information in a way that’s beneficial to employees (though it’s a safe bet they will always use it in a way that’s beneficial to themselves). </p>
<p>Some employers are requiring blood tests and waist measurements as a way of monitoring their employees’ health and “incentivizing” them to get healthier (read: incentivizing them to cut the employer’s costs). Note that this isn’t health claim information, which is purportedly anonymous to the employer. This data is collected and retained by the employer themselves, completely personally identifiable. Regardless of your waist size, do you really want it to be part of your personnel file?</p>
<p>And quite obviously, we cannot assume that all employers will be discrete about not using health claim information in a personally identifiable way.</p>
<p>Well, if you don’t want this can of worms, then you should advocate moving away from employer paid medical care. But the alternatives may not escape similar issues:</p>
<ul>
<li>Single payer (government): then the government would have similar interests in getting you to adopt healthier habits.</li>
<li>Self-pay with insurance: then the insurance company would have similar interests in getting you to adopt healthier habits.</li>
<li>Self-pay without insurance: no one else should care, since you would be paying for your own healthy or unhealthy habits. But you need lots of savings to self-insure the various possible expensive medical costs you may encounter.</li>
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<p>Ucb, I absolutely do advocate de-linking insurance from employment. My choice would be single payer, which isn’t perfect, but works a far sight better in every country which uses it than our system works in ours. </p>
<p>Oh, the insurance saga… If TurboTax can simplify mounds of paper and endless chapters of out tax code for me, one would think that it would be just as simple to decipher how much one should owe after the specific insurance payout for a specific procedure, using a specific doc etc. This is NOT rocket science!</p>
<p>A side note. What really irritates me is that when a provider sends their first bill to me with a “PAST DUE” stamp on it - even though it is the very first bill I see! Then, there is a vague clause, “10% off if paid within 7 days” 7 days within WHAT?! </p>
<p>This problem with out-of-network costs and balance billing is only going to get worse now that we are moving to narrow networks under Obamacare. The law has done nothing to enhance transparency and has made it much more difficult to find care that is in-network. </p>
<p>I hope people on this thread, who are complaining about the costs of procedures not covered by their insurance, will not forget that this new law is only going to make the situation much worse. In the other thread, I have been warning that this outcome was inevitable and people with Obamacare policies will be dealing with these issues far more often in the future.</p>
<p>Yes, no one ever had any problems with insurance before Obamacare.</p>
<p>^^^^^
Non-sequitur - Making the problem far worse is not an acceptable solution in fixing an imperfect system</p>
<p>No one said it was an issue of narrower networks. That’s your presumption. For your own reasons. Read the original posts. </p>