Healthcare pricing insanity

[VeryHappy]

<p>As I’ve said on a few other threads, the system sucks. The incentives need to change.</p>

[TatinG]

<p>The employer mandate of the ACA is being deferred until after the midterm elections. Not the individual mandate, however. Breaking news today.</p>

[interesteddad]

<p>What makes it so frustrating is that you can’t make rational health care decisions without knowing the price. I mean… the official recommendations are that I should get a colonoscopy every three years. But, I know that in many areas (like diet, cholesterol screening, etc.) the recommendations are complete nonsense and not based on any sound science, whatsoever.</p>

<p>I also know that many factors (weight, exercise, lack of insulin resistance, no family history) would tilt me to a very low risk of colon cancer. So, do I go every three years? Every five years? How can I make that decision without knowing if it’s a $500 procedure or a $5000 procedure? The Anthem rep said not to worry because the most it would cost me would be my out of pocket max ($5950). Gee thanks, that really pins it down. Apparently, it is against AMA regulation for the doctor to tell me what his office bills the insurance company (my cost) under preferred-provider contracts.</p>

[ucbalumnus]

<p>

@interesteddad

I also know that many factors (weight, exercise, lack of insulin resistance, no family history) would tilt me to a very low risk of colon cancer. So, do I go every three years? Every five years?

</p>

<p>USPSTF screening recommendations for colon cancer are here:
[Screening</a> for Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement](<a href=“http://www.uspreventiveservicestaskforce.org/uspstf08/colocancer/colors.htm]Screening”>http://www.uspreventiveservicestaskforce.org/uspstf08/colocancer/colors.htm)</p>

<p>Screening is indicated for people age 50 to 75 in the general case. If colonoscopy is used, the recommended interval in the general case is 10 years. (Where are you hearing every 3 years?)</p>

<p>Hiding the price is beneficial for both the providers (since that discourages price-shopping by individual patients) and insurance companies (since that discourages individual patients from self-paying, meaning that they are encourage to use insurance).</p>

[mini]

<p>American Cancer Society says every 10 years. If the first one shows one or two small polyps, every five years; large polyp every three years.</p>

[jym626]

<p>Read this the other day. Its outrageous:

My husband needed a knee brace.( I could get it online for under 500$, I only learned later). But we got it through the ortho clinic/supplier. We got it without knowing cost and were told insurance pays most of it. The doctor had said it was about a 400$ brace when I asked.</p>

<p>The bill from XXXX was 1300 or 1600$ (for some reason my EOB did not match what BC/BS had or the medical supply company). Our share was 250$</p>

<p>I called the medical supply company and told them it seemed fraudulent they are marking the item up over 400%. And the person assured me it was not fraud because CMS sets the fees and and they only charge the medicare allowable.</p>

<p>I investigated. Sure enough…knee braces, back braces are CMS “allowable” 100%s above the actual fee/cost.</p>

<p>So doctors and therapists are paid a fraction of reasonable charges, and medical supply companies are making profits hand over fist since their “allowable” charge is many times the actual cost.</p>

<p>I feel powerless to change a system so fraught with waste and profits for some, while other sincere providers work very hard to be paid a fraction of what they can collect from self pay patients.</p>

<p>I found a federal report online saying back brace allowables are 400-800% of cost, suggesting the CMS allowable be changed. But it does not seem they are changes from the allowable rates I could find on CMS sites.</p>

<p>Were there some type of medical supply company lobbyists/bribes to get their rates set so high?</p>

<p>It seems unethical and fraudulent to me to charge so much more than cost. But, it seems it is “legal” since it is following the CMS guidelines.

</p>