WatchI propose two rules for medical billing in America:
1. Everyone must be charged the same price for the same service from the same provider in each calendar month.
So a hospital would not be able to bill someone with insurance only ten cents for an aspirin, and then turn around and bill someone without insurance $10 for the same aspirin. Price changes would be allowed only on the first of each month, and the new price would again apply equally to everyone using that service from that provider.
2. Everyone must be told the exact cost of everything the doctor or hospital is going to do before it's done, except in life-threatening emergency cases, or where the patient is incapacitated and has no legal representative on hand.
At least then you would know enough to refuse the $10 aspirin, and to walk down the street to a pharmacy for it.
Can we get these two simple and fair proposals made into law?
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I'm all for it.
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46 male
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OK, I need a catchy name for this proposal.
"Fair Medical Billing"
"No Surprises"
Not catchy enough...
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Piggyback on the "Fair Trade" phenomenon?
Fair Trade Healthcare
Fair Trade Clinic
Fair Trade Doctor
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Beverly Hills, CA
The Medicinal Price Gouging Initiative
The Fairness in Medical Costs Act
The Kelly Blue Book for the Human Body
Equal Opportunity Act of Medicine
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Equal Opportunity In Medical Price Gouging
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Mammoth Lakes, CA
My doctor offers me a significant cash discount (25%). Under your proposal, I would have to pay full price.
Also, I have never had a problem discovering medical costs in advance. I'll sometimes ask my doc the cost for various office visits and procedures. His staff have provided me written estimates each time I have asked. Same for the hospital lab. I have used a different lab on occasion, for some of the more expensive lab tests. And that lab also provided me with the cost for each test.
There are ways to make the healthcare system better. My doc rails against the widespread practice of ordering unnecessary tests and imaging studies. He says a a lot of docs order MRIs that aren't necessary, sometimes due to "cover your ass" and other times due to a deficiency in clinical skills (e.g., elbow hurts, dunno why, order an MRI). Tort reform is opposed by the American Bar Association, or course. And I don't know how you fix retarded docs who lack the clinical skills to make diagnoses without resorting to unnecessary tests.
I suspect that health care costs will continue to increase, and quality healthcare will increasingly be only available to a small, wealthy percentage of our population. Indeed, Medicare is circling the drain, as this article, published today, points out:
http://www.cbsnews.com/stories/2011/05/13/politics/main20062642.shtml
Bleaker outlook for Social Security, Medicare
Government report says bad economy means Medicare, Social Security trust funds will be exhausted sooner than expected
(AP)
The government said Friday that a bad economy has shortened the life of the trust funds that support Social Security and Medicare, the nation's two biggest benefit programs.
The annual checkup said that the Medicare hospital insurance fund will now be exhausted in 2024, five years earlier than last year's estimate. The new report says that the Social Security trust fund will be exhausted in 2036, one year earlier than before.
The trustees for the trust funds said in their annual report that the worsening financial picture emphasized the need for Congress to make changes to avoid disruptive consequences in the future for millions of people who depend on health and pension benefits...
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Sean7593 says
No problem, as long as they are required to offer everyone the same discount for cash. So there would still be a published list price that applies to everyone and everyone gets the opportunity to pay cash for the same discount. They could even apply the same late fees to everyone.
The point is to make the same billing terms apply to everyone.
Sean7593 says
Failed miserably for me. The people treating me just have no clue what it costs.
Sean7593 says
I agree with your doc, but that's a slightly different issue.
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Patrick says
If the provider does not know, ask the biller/billing department. Simple and no new law required.
I vaguely remember hearing somewhere that it's not legal to bill different amounts for the same service. I think the difference you see in cost is in *reimbursement*. So, a hospital bills $10 for an aspirin, but is reimbursed anywhere from $0 to $10, depending upon any contractual agreement between the provider/insurer, etc. The higher paying contracts effectively subsidize the lower (or non) paying insurance (Medicaid, etc.).
My 2 cents, fwiw.
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Sean7593 says
What a joke. So it is illegal to ASK for different amounts for the same service, but it is NOT illegal to accept different amounts as payment in full, depending on what credentials the customer might have as a member or not of a certain class or group of customers.
Sounds like pure deception and sophistry to me.
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44 male
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You have to wonder how it's legal to charge different prices to different people in the first place. If they charged you $10,000 for an operation if your black and $4,000 for the same operation if your white, the civil liberties people be all over that. But some how it's OK to do the exact same thing if you have, do not have or have certain insurance. I believe if someone fought this in court, the hospital would lose hands down.
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elliemae's website
Billed charges are normally figured according to what Medicare pays for an ICD-9 code. It's up to the practitioner to figure out what they'll accept. I'm not so sure this would change even with a fair billing act.
Kind of like automotive repair charges - most shops operate according to the manual that estimates the amount of work that it takes to perform a task. I had a motor mount replaced on my old car; I was waiting for a ride and timed the job. From the moment they started until they completed the job was one employee, one hour. They charged me 5.0 hours because according to their billing bible it should have taken longer. I've since found a different shop, they bill what's fair, not what they can gouge you. The first shop is now out of business, btw. I doubt it was because of billing practices.
If they billed for medical costs according to what they actually receive, we would all save money. And they often do order tests that they don't need - but the people who needed the test & didn't get it wouldn't care if the rest of the world gets it or not. complicated issue.
Name for the Act: Fair & Unbiased Compensation Key for Medical Equality...
Anyone?
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It'll never happen.
You can propose something sensible.
It can go to a Congressional committee.
Then the lobbyists show up in the Congressmen's office with 5 year old boys, bricks of hashish and trunks of cash.
Doctors will be using patients' cold, stiff bodies for ashtrays before any meaningful change will happen to health care in the states.
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elliemae says
I can completely understand different Doctors charging different rates for the exact same procedure. A younger, less experienced doctor might give you a break on the price cause they haven't done the procedure too many times and your good practice, then say a top of there field doctor that has loads of experience. My issue is the same doctors charging different people different rates for the same operation. The price may be $6,000 for the young doctor and $15,000 for the experienced doctor. But wait, you don't have insurance, the price jumps to $30,000 and $75,000. And it's not a little adjustment, I might be able to swallow a few thousand dollar difference, but usually it 5 times more the price.
I also understand the whole medicare thing, they government pays doctors/hospitals barely enough to cover there expenses, but they take them anyway cause it helps to keep the lights on. They make there real profits with the people who have medical coverage, but to charge 5 times more for people who do not have medical coverage or medicare, it's just an insult to injury.
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I don't think (1) would work out well. Because different insurance carriers negotiate different pricing. And ironically it's the provider networks that put pressure to keep these rates hidden.
This makes insurance companies be the front man for all the costs this way. When insurance sends someone a bill for 2000 that individual gets upset at insurance. They don't see the hospital billing $60,000 from insurance on the back end. So if you are paying out of pocket to the hospital you "may sometimes" end up paying a lot less than insurance.
What would be great if all prices were completely transparent to the public so one would know what they are paying for and how much.
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Sean7593 says
I have been given the run around, by both insurance companies and the hospital when trying to determine the price of a procedure.
The response from both was that the price I would be charged was "confidential".
When that was countered with, "Well... won't I find out your 'confidential' price when I get the bill?"
The response was, "Yes, but we can not give you the price now."
Needless to say I was flabbergasted.
I like both proposals, and think that transparency in pricing would be a huge improvement. The problem remains that you are still stuck with a provider, once locked in with a provider it is not like you can not shop prices around.
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Patrick says
Unfortunately, not everyone in the hospital that needs the $10 (I got a bill @$36 per acedomedaphyn) over the counter medication can pull themselves out of bed to go get it themselves.
And, it would not surprise me if hospitals forbid the use of "outside medication".
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An excellent example of how medical care is not a free market.
You are not free to choose when you can't even walk away.
Unlimited private profit at the expense of the sick is just evil and wrong.
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You are free to die. No one is stopping you. America is about freedom. If you don't like it, you hate America. Case closed.
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APOCALYPSEFUCK says
OMG, the perfect summary of the Republican platform!
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APOCALYPSEFUCK says
He forgot to add: ...then the terrorists win.
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I'm hurt that no one "got" the acronym for "Fair & Unbiased Compensation Key for Medical Equality."
sigh
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We got it. There is just that there is so much innuendo on Facebook these days that we have become blase' :).
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Mammoth Lakes, CA
Interesting study that suggests utilization goes down when providers are informed about the costs for lab tests.
more at link:
http://online.wsj.com/article/SB10001424052748704281504576327463166456754.html?mod=googlenews_wsj
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justme says
I wouldn't go that far. It's all negiotiable, AFAIK. Your doc could be a provider with Blue Cross, and therefore have to accept, by contract, a certain reimbursement if you were a BC member. For example, she bills $100 for an annual physical, but would be contractually obligated, as a provider, to accept $75 as a Blue Cross provider.
If you had no insurance, she would still bill the same $100, and you'd be liable for the entire amount.
But she might (as my doc does) offer a discount for uninsured/cash patients. I sign a payment agreement (contract) form to get that discount.
A universal system would certainly simplify things. Right now, good insurance seems to help balance crappy insurance from a doctor's perspective. And cash patients sometimes (if no discount is offered or negotiated) pay a lot more than insurance companies for the same service, when the doc is contracted with the insurance company.
It's not fair, and it's not fair that it's not fair. Being an informed consumer can help, though.
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I'm in Mammoth Lakes, CA, and just saw the above ad in "The Sheet" (local rag):
----------
Colonoscopy at Competitive Prices
Package Prices
*Wellness with out (sic) biopsy = $2750
*Wellness with biopsy = $3750
Our Board-Certified General Surgeon...has over 10 years experience performing laproscopic (sic) surgery and endoscopy and has performed over a thousand colonoscopies to date. Be proactive about your health and schedule your colonoscopy today.
---------
I'm too young to need a colonoscopy, I think, but would not go to a surgeon with an ad that contains spelling and grammatical errors.
At least the prices are listed, which should make some folks happy.
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elliemae's website
I would want my colonoscopy with a side of blopsy, thankyou.
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So, you go to the hospital with chest pain and they admit you for monitoring. You have asthma and allergies, as well as high blood pressure and a pain in your leg.
You will be assigned a Hospitalist to oversee your care. You will be seen daily by a cardiologist, an internist, an allergist, a pulmonologist, and get at least a consult with an ortho doc. They'll draw daily labs, and you'll surely get a CT, MRI and whatever other test is necessary to diagnose the pain in your leg. You'll also possibly receive IV's and other treatments, requiring additional labs.
That's how it works, folks. You go into the hospital and you'll be treated for pretty much everything if you have insurance... but if you don't you'll be treated and streeted - and turfed to an outside doc for follow up. It's up to you if you can't afford treatment to find a way to pay for it.
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elliemae says
The fear of death shames us all.
God bless you, ellimae.
And God bless the United States of America.
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I would postulate that the fear of living with pain & anguish is worse than the fear of death. I've seen a lot of suffering. That sucks.
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Zlxr says
No, but it's possible to have more fair pricing. There's always the unpredictable, even with mechanics. It's just that it's a life or death proposition with doctors - even when it's a minor procedure.
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Zlxr says
I believe that physicians and many other providers truly want to cure their patients. They couldn't go to work every day if they didn't. Drug companies - they seem to want to introduce new medications as quickly as possible to generate tons of revenue whether or not the product is safe and effective.
All those little plastic pieces cost tons because of overhead, from the property taxes and building maintenance funding to salaries to electronic costs to paying lobbyists and paying insurance, etc. They also figure in the losses of the non-funded ER patients so that they can make up for that. And they can't use any old plastic pieces, they have to be sterile and are replaced often, some times multiple times a day.
And then they add in the cost of administration, which is always a quagmire of the good ol' boys & girls who hire their friends and respond to the drama generated by family members.
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elliemae says
So how do drug reps go to work every day?
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Sean7593 says
In Beemers, or cute little (expensive) convertibles. ;)
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Zlxr says
It is true that we are not identical inside (BTW, a good book in the subject is "Biochemical Individuality"). We are not so different that when a doctor opens us up they will find a stomach that pumps blood, and lungs that digest food. Our insides are about as varied as our outsides. They can be placed and look very different, but we can all identify eyes, hands or nipples on other people.
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APOCALYPSEFUCK says
Usually, i think your statements are over the top. but I think you nailed it here.
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You're kind of ignoring the fact that insured patients have already paid into the system that supports a hospital/clinic before any treatment is delivered.
Charging them and the uninsured the same amount for services is penalizing people who work for/buy insurance.
Insured people are already subsidizing the uninsured too much. If only they realized this, maybe they'd support single-payer more avidly.
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Patrick,
We shouldn't make health care providers out to be the enemy, only insurance companies. Health care providers don't like insurance companies any more that we patients do. You can usually get a prompt pay discount of around 60% if you bypass the insurance paper work. If you are not opposed to being uncivil (e.g., "OK, come try and get my money if you dare."), you can get even steeper discounts for prompt pay. Of course they are businesses, and will try to make money like anyone else, but we need them on our side if we are ever going to have hope of getting a single payer.
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Molly K says
Well, kind of... but not really. If we paid for healthcare without the huge-ass profits of hospital corporations, healthcare providers such as gentiva, insurance companies, etc, it would be much cheaper.
The costs of the uninsured are negligible compared to the costs of supporting profits of huge corporations. Medical practitioners don't make all that much money. Many people believe that physicians make money hand over fist, but working in the healthcare field I can tell you that if you broke it down to every patient phone call, visit, interaction, etc they'd make very little. Especially after considering the cost of their education, their staff & overhead, etc.
Doctors graduate thinking that they'll be practicing medicine... but the truth is that they have to run their business or work for a corporation to figure out the best way to run a practice. They spend years on medical issues, but the business part can be a huge shock to them. It would be awesome if they were allowed to practice, make the money that fairly compensates them without the business crap, and actually help people without having to worry about how they'll get paid. That bottom line really gets in the way.
If people could go into nursing homes without having to worry about how it's paid for, life would be great. Many won't accept a patient without a long-term payment source in place - actually most won't. It's possible to need placement, have no money to pay for it, and not be eligible for medicaid for some obscure reason.
Healthcare should never be an option. People should be fairly compensated for the service they provide. Corporations that work to deny benefits because they want to make money should not exist.
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Hi Patrick
I'm a medical specialist in Australia.
We have point two of your proposal here in Australia already, but not point one.
Point two is called informed financial consent. Just as the patient has to give their informed consent to the procedure ie - yes, I understand I might die of a bowel perforation but I need my colonoscopy anyway because dad died of cancer - they also have to give their informed financial consent ie. - yes, I understand you charge a squillion bucks, and I want you to do it anyway. For elective procedures if there is no informed financial consent, the patient is within their rights not to pay.
It does break down in the case of emergencies and procedures that unexpectedly turn into something else. ie. it's hard to argue someone really gave a meaningful consent while screaming in pain, or if you started out to do an appendectomy and it ended up being an appendectomy plus removal of enormous unexpected tumor plus resuscitation from anaphylaxis plus prolonged ICU stay to deal with the complications then what?
Of course we do have a single payer public hospital system with universal coverage as a backstop, so that even those who start out in the private hospital can have their care moved into the pubic system if it becomes prolonged.
In general I'd say it works quite well, and the fact that it is routine for my secretary to inform patients both verbally and in writing of the fees and document the fact that she has done that makes it better for all concerned. There are few bad debts and I don't feel particularly nasty having bad debts chased as I know they were informed beforehand and had the option to go to the public system if they did not like the fees.
There is unfortunately also the issue of price as a signal, so you know you are driving a good car if you paid 100k for it even though it still gets you to the shop in the same time as a 10k car. Likewise many people prefer to go to the doctor who charges a lot, so there can be a race to the top with fees in some areas. So you need a brain tumour out and you no longer give a damn how much it costs you just want the best, but who's the best? All you know is you have read about the truly dodgy character who is now in jail, there is a guy who is famous for charging 40k and another guy who charges 5k. Which one will you choose? Most will go for 40k man.
I'm not sure about having to charge everybody the same. The obvious example is the mechanic who charges his brother, or his parts supplier a less than the man in the street. Of course he does - he likes his brother and he wants a good relationship with his supplier.
I don't charge colleagues any more than a nominal fee and I think that is a pretty normal thing to do. I do sometimes charge patients without health insurance a different amount to those with health insurance. The majority of my bad debts come from this quite small group. In this country it's a bit nutty though to go to a private hospital without insurance when we have a perfectly good public system unless you are really loaded with cash. They are more likely to not pay even when they have been informed in writing, so they pay 50 to 100 bucks more for being in what for me is a high risk group. That way overall I get paid the same. The thought of charging them five times as much is mad and they would just go elsewhere.
I have also occasionally not charged at all - the most recent was a woman who broke down and said her husband had just left her and she had three kids and was about to loose her house. I though f--- I don't even have a house, but I felt sorry for her and reduced the bill down below what the insurer paid. Legislating to force doctors to charge everyone the same would stop them from being able to offer a lower price in special circumstances. It's difficult isn't it.
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I wish we had Australia's medical system.