Health Care Freedom Myth

[somarco]

Are we really free to determine our level of health care or is it rationed by governance?

Three ingredients that impact access to care include . . . increased demand for care (especially by those who pay little or nothing for care) . . . . medical bureaucracy (medical staff spends too much time filling out forms for reimbursement) . . . . almost half the cost of care in the US is allocated to regulations, compliance and oversight.

[EXTERNAL LINK] - In Health Care, Freedom Is The Biggest Shortage

 

[rmhaire]

Are we really free to determine our level of health care or is it rationed by governance?

Thanks. Good article. I'm keeping that one.

 

[sman]

medical bureaucracy (medical staff spends too much time filling out forms for reimbursement)

I have gotten to where I ask what their self-pay price is when it's something more than a routine doctor visit since we have a high deductible. It all started a couple of years ago when my wife had to have a CT scan. They billed a little better than $3k and the negotiated rate was a little over $2,300. When I saw the EOB, I called OPI and asked them what their cash/self-pay price was for the CT scan. They said $325. I spoke to the office manager and explained I had a high deductible and asked if they would honor the cash/self-pay price. Thankfully she did.

Wife is having an MRI next week. When OPI called to schedule it we asked for the self-pay price. Open MRI (not the enclosed narrow tube) will be $530 instead of an outrageous insurance negotiated rate of $2k+. Granted, unless I file the claim myself this won't count towards my deductible, but I'm good with it since it saves me a couple of grand.

Wife had a doctor visit two weeks ago with a new specialist (it's what prompted the MRI), asked the question of them (regarding self-pay) and they couldn't give us a straight answer so we let them file it. They told us it would be $575 and were asking that we pay 25% up front. Great, no problem. Not sure why they couldn't just tell us what the negotiated rate was versus the self-pay. Just saw the EOB online. They billed $317 and not $575. Negotiated rate was $101. Now they owe us money. We do have a follow up so I guess we'll have a credit until the next visit is filed.

My biggest gripe with the healthcare system at this point is the different pricing depending on how a person is paying. Just have a flat rate regardless of that persons insurance status. I understand there are thousands of codes and various negotiated rates, but we are at a place with technology where the pricing should be a few clicks of a mouse away.

 

[Truce]

Not sure why they couldn't just tell us what the negotiated rate was versus the self-pay.

Because integrated (primary care up to hospital) providers have built their model around being paid by insurance companies, not patients. A cash payer at the primary care level is going to ask $$$ questions all the way up the chain, while a good patient just buys the most expensive insurance plan and remains blissfully ignorant about costs as the care gets more complicated.

And please do file those claims yourself and have them applied to the deductible. Fight the good fight.

 

[sman]

Because integrated (primary care up to hospital) providers have built their model around being paid by insurance companies, not patients. A cash payer at the primary care level is going to ask $$$ questions all the way up the chain, while a good patient just buys the most expensive insurance plan and remains blissfully ignorant about costs as the care gets more complicated.

And please do file those claims yourself and have them applied to the deductible. Fight the good fight.

I understand the system. I just don't understand why we can't get simple pricing given the technology we have. And I definitely will file the claims myself. Although I will wait until later in the year if I see we may reach our deductible. Not going to do that work if it isn't needed this year.

 

[Truce]

Is simple pricing a technology issue the providers would want to fix? I'm saying that they would, and have, actively worked to suppress any pricing transparency. Simple pricing encourages consumers to price shop. That's the last thing providers/insurers want to make easy for you.

A tech issue that the market could solve? I guess it would be nice to get an aggregator to list cash prices across all providers for all services, but they aren't posted and I don't know if providers would honor them.

Any limit to how long you can submit a your claim for reimbursement or application to your deductible? I agree on not wasting time unless you come close to meeting it.

 

[goillini52]

I have gotten to where I ask what their self-pay price is when it's something more than a routine doctor visit since we have a high deductible. It all started a couple of years ago when my wife had to have a CT scan. They billed a little better than $3k and the negotiated rate was a little over $2,300. When I saw the EOB, I called OPI and asked them what their cash/self-pay price was for the CT scan. They said $325. I spoke to the office manager and explained I had a high deductible and asked if they would honor the cash/self-pay price. Thankfully she did.

Wife is having an MRI next week. When OPI called to schedule it we asked for the self-pay price. Open MRI (not the enclosed narrow tube) will be $530 instead of an outrageous insurance negotiated rate of $2k+. Granted, unless I file the claim myself this won't count towards my deductible, but I'm good with it since it saves me a couple of grand.

Wife had a doctor visit two weeks ago with a new specialist (it's what prompted the MRI), asked the question of them (regarding self-pay) and they couldn't give us a straight answer so we let them file it. They told us it would be $575 and were asking that we pay 25% up front. Great, no problem. Not sure why they couldn't just tell us what the negotiated rate was versus the self-pay. Just saw the EOB online. They billed $317 and not $575. Negotiated rate was $101. Now they owe us money. We do have a follow up so I guess we'll have a credit until the next visit is filed.

My biggest gripe with the healthcare system at this point is the different pricing depending on how a person is paying. Just have a flat rate regardless of that persons insurance status. I understand there are thousands of codes and various negotiated rates, but we are at a place with technology where the pricing should be a few clicks of a mouse away.

Similar to as when you take your car to the body shop, they ask if this is being covered by insurance.....because if it is there'll be an inflated price.

 

[somarco]

They billed a little better than $3k and the negotiated rate was a little over $2,300. When I saw the EOB, I called OPI and asked them what their cash/self-pay price was for the CT scan. They said $325.

It has been a while since I had clients as young as you and your wife, so I probably have forgotten a few things.

Seems like provider/MCO contracts had a clause that prohibited a provider from charging less than the contractual, negotiated rate. If discovered the provider was charging less their contract was pulled.

This article seems to indicate that a par provider who charges a lower rate for cash may indeed be in trouble with the MCO.

https://drjarodcarter.com/partial-cash-practice-pricing-legalities/


Glad you saved a few bucks, even after the fact.

 

[sman]

It has been a while since I had clients as young as you and your wife, so I probably have forgotten a few things.

Seems like provider/MCO contracts had a clause that prohibited a provider from charging less than the contractual, negotiated rate. If discovered the provider was charging less their contract was pulled.

This article seems to indicate that a par provider who charges a lower rate for cash may indeed be in trouble with the MCO.

https://drjarodcarter.com/partial-cash-practice-pricing-legalities/


Glad you saved a few bucks, even after the fact.

Not my problem. If they are willing to let me pay a much lower cash price than what my negotiated rate would be, I'm willing to do that all day long if it's a substantial savings. In the two examples I gave on the imaging procedures, the savings is substantial. To be fair, on this latest one, the MRI, I had my wife just tell them we were self-pay since I already had experience with them and the pricing of the prior scan. As far as they are concerned, we have no insurance.