I asked the pharmacist I’m married to. He says the only way the pharmacy knows what to charge you is by billing your insurance. So until you’re actually on the new plan, the pharmacy can tell you the cash price and the price for your current insurance, but not the price on the new insurance. He does say that many people use GoodRx, pay cash, and then submit a claim to their insurance to get the cost applied to the deductible.
Some of the barriers against shopping for health care are:
A. Some health care is in emergency or urgent situations, where there is no time to shop around.
B. The patient may not know enough to be suspicious that a provider may be overcharging or overprescribing.
C. The patient may not know enough to have an idea of what kinds of care are high value or low value.
D. Because most health care costs are still run through insurance, there is less price transparency until one actually purchases the health care item (runs it through the billing system), almost like not being able to have any idea of what a college’s financial aid was like until April (in the days before net price calculators).
E. Relating to D above, published list prices tend to be inflated ones used as starting points to negotiate with insurance companies, so cash buyers may not necessarily know the true price before walking in an negotiating.
I.e. basically a benefits cut. Seems like the employer believes that employee reaction will not be as large as it would be if they cut pay by an amount equivalent to the employer’s reduction in benefit spending.
My mom was without prescription coverage for a month when they were between employer coverage and medicare. Found out the cost of her prescriptions without coverage was LESS than what she had been paying with coverage. So, ask the pharmacist, ask more than one pharmacy and check out lists from Walmart, Sams and Costco for their $4 and $10 drugs.
@ucbalumnus Exactly. We also lost Christmas bonus, annual gain-sharing check, couple holidays and a day of pto, and full employer funded pension and 401k. We only have 4% match for 401k now.
“the hospital told the insurance company what billing codes they’d be submitting and got the cost estimate for me up front.”
Ime, depending, the facility doesn’t really know until the doctor submits the codes. I did this exploring (with both the practice and the hospital) for a procedure and learned some in-process adds can affect final billing. Eg, 15 extra minutes to check a bit further or for 2nd spot biopsied, etc. What I did get, however, was ballpark. Roughly 2k, not 4k or 8k. That was helpful.
I feel for people who don’t have the skill to ask.
And for all of you dealing with big $ Rx. I’ve got one biggie. Even with 90% off, expensive. Luckily, it lasts a good while.
You would think that offering a health care price transparency tool to employees would enable them to save money on health care costs. Unfortunately, at least in this very big study, it did not:
It’s a lot of work to immerse in the details, even comprehend the variables, then decide with confidence. A new era.
In my case, my total billing would have been less at an outpatient place, but the wait weeks longer. Same learning and decision making affects Rx options, too. The alt for my expensive med is 2x the cost. I know many agree it can be exhausting to do the due diligence.
All of these except A, emergency/urgent care, can be dealt with. And most health care is non-emergency/urgent. Most people don’t know the first thing about cars, houses, appliances, insert product here. They still go out and do the research to make good decisions.
We have been conditioned over 40+ years that health care only “costs” $30. People are slow and resistant to change, especially with healthcare. It will take some time.
@uwalummom sounds like you had some pretty “rich” benefits. Welcome to us common folks. 
@yourmomma It was a really great company…
Lots of people make poor or suboptimal decisions. In cars, people get bad deals because their only understanding of how loans or leases work is from the salesperson, they buy overpriced extended warranties, or they buy used cars with hidden damage or deceptions like odometer rollback. Or they buy a car unsuitable for their use and have to buy a different one shortly thereafter. Of course, car maintenance and repair can have overpriced or oversold stuff, just like health care.
Given how poorly many people buy cars and other car related stuff, it is not surprising that health care, with greater complexity and less transparency, functions even less well in an economic market sense. The sectors that function best in an economic market sense are those which are mainly optional and preplannable, like cosmetic stuff.
Also, in some areas, there are local monopolies for many medical services. So even if there were a well-functioning economic market otherwise, it would be an unfavorable situation for those patients facing a monopoly in their local area, and who do not have the money and logistical capability (e.g. time off work, family constraints) to engage in medical tourism (even domestic).
https://fivethirtyeight.com/features/how-catholic-bishops-are-shaping-health-care-in-rural-america/ is about situations where a local monopoly is a religiously-controlled hospital, resulting in religious restrictions on health care there. But it can easily be generalized to other limitations (not necessarily religious) or higher costs that one can face if the local hospital or health care provider for something is a monopoly.
I think the shock comes from the high costs on top of the very high monthly charges for insurance. When you are already paying many thousands of dollars per year for your family, you don’t expect to pay $350 for an epipen.
There are also hidden monopolies which prevent people from shopping for their own healthcare. last year I had a bout of common pink eye. My doctor prescribed drops that cost close to $100. I know there are many very low cost options and I called the doctor and begged her to prescribe me something else. She said that was the “best” and she would not bend. My only choice would have been to see another doctor which would have cost more than the drug just for the appointment. Its frustrating.
It’s far from the majority of people who make poor decisions. It’s far from the majority of dealers that take advantage of people. Don’t let the exceptions make the rules. Just because a small percentage don’t make good decisions, doesn’t mean you should mess it up for everyone else.
Many of those monopolies are granted by the government. Ever try to build a hospital? They did in my area and it was a political, back room, deal. They froze our all the other potential competitors.
If only “a small percentage” make poor financial decisions, then why would so many people have difficulty paying for a $400 emergency with cash or its functional equivalent (rather than going into debt or selling something to pay for it)?
https://www.usatoday.com/story/money/personalfinance/2017/10/06/why-half-of-americans-cant-come-up-with-400-in-an-emergency/106216294/
https://www.federalreserve.gov/2015-report-economic-well-being-us-households-201605.pdf
Yeah, the crap is expensive. We have a similar plan to the OP. Non-ACA, High deductible, HSA plan. It took some getting used to. But in the end, for most people, it is the better plan. We are able to cover the employee premium, instead of having them pick up a percentage of a higher premium. They can save in their HSA to help cover deductible expenses. If you’re healthy, once you build up a little balance you’re good to go. It works well, even for those with chronic conditions and higher than average medical expenses.
But you definitely need good providers that understand your plans. Your Doctor is a jerk for not offering something cheaper to you. For us, cost is always part of the conversation. Our doctors start out with the cheapest options first, unless there is a compelling reason to recommend something else. And you really need to shop around when possible. For example, we need to get an annual MRI. Dr. can do it for $2,500. We get a special deal thru an insurance preferred provider at $500 (nicer place too).
Many occurred because one bought out the others. Unless you think that the government should actively prevent monopoly formation this way by blocking such acquisitions, then it is something that is not “granted by the government”.
Be aware what’s state government. Not just the catch all, “government.” Voice your concerns in your area.