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Bargaining Down That CT Scan Is Suddenly Possible
NY Times ^ | February 27, 2007 | MICHAEL MASON

Posted on 02/27/2007 12:11:04 AM PST by neverdem

Patrick Fontana twisted his left knee last spring while hitting a drive down the fairway on a golf course in Columbus, Ohio. But what really pained him was the $900 bill for diagnostic imaging ordered by his doctor.

Mr. Fontana, a 42-year-old salesman, has a high-deductible health plan coupled to a health savings account. Since he was nowhere near meeting his deductible, he was on the hook for the entire bill.

So he did something that insurance companies routinely do: he forwarded the bill to a claims adjuster, in this case My Medical Control, a Web-based company that reviews doctor and hospital bills for consumers.

After concluding that Mr. Fontana was not getting the best possible price, the company’s representatives called the imaging facility and demanded a lower one, promptly saving him $200 — minus a 35 percent collection fee.

“I asked before I went in to the clinic how much it would cost, and they just will not tell you,” he said later. “I didn’t know until I got the bill, and at that point I figured I had nothing to lose.”

The savings are possible for one reason: medical care is often priced with the same maddening, arbitrary opacity as airline seats and hotel rooms.

“The average provider — doctors or hospitals — has between 5 and 100 reimbursement rates for the exact same procedure,” said Timothy Cahill, president of My Medical Control (mymedicalcontrol.com). “A hospital chain with multiple locations may have 150 rates for the same procedure. Consumers don’t know this.”

The varying reimbursement schedules, negotiated between the nation’s 850,000 providers and more than 6,000 health plans, have been kept all but secret. Consumers almost never get information on prices before treatment. Even insurers do not know what other health plans are paying.

Despite the complexity, the Internet has...

(Excerpt) Read more at nytimes.com ...


TOPICS: Business/Economy; Culture/Society; Government; News/Current Events
KEYWORDS: healthcare; healthinsurance; healthsavingsaccount; hospitals; managedcare; medicare

1 posted on 02/27/2007 12:11:06 AM PST by neverdem
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To: neverdem

The NYT is (kinda, sorta) speaking favorably of smart shopping in medical care?

Unnh, my heart! Gasp! Gasp!


2 posted on 02/27/2007 12:14:45 AM PST by sinanju (s)
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To: sinanju
...speaking favorably of smart shopping in medical care?

Absoluetly not!

It's not good being forced to hire an advocate to check your billing. It's also pretty shady that diagnostic charges are so varied,,,,, but hitlery care would eliminate this. Oh Joy! :-)

3 posted on 02/27/2007 12:30:40 AM PST by JoeSixPack1
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To: sinanju
The NYT is (kinda, sorta) speaking favorably of smart shopping in medical care?

Not a bit of it. They are stumping for one price fits all, everywhere, everytime, and it was never any different.

4 posted on 02/27/2007 12:33:03 AM PST by dr_lew
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To: JoeSixPack1
It's not good being forced to hire an advocate to check your billing. It's also pretty shady that diagnostic charges are so varied,,,,, but hitlery care would eliminate this. Oh Joy! :-)

Some years ago I received a bill from a radiologist for reading an x ray. I was most upset as my primary pulmologist was the best man in town for my condition and I was paying him big bucks from my own pocket to tell me what the hell was wrong with me. I sent a short note to the radiologist that said, "if you do not think the best pulmonogist in Corpus Christi, Texas is not qualified to read my X-Ray I will be more than happy to pay the bill that you have sent me. I never heard from him again. The radiologist also owned the facility where I had the X-Ray!

5 posted on 02/27/2007 12:57:39 AM PST by cpdiii (Pharmacist, Pilot, Geologist, Oil Field Trash and proud of it.)
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To: El Gato; Ernest_at_the_Beach; Robert A. Cook, PE; lepton; LadyDoc; jb6; tiamat; PGalt; Dianna; ...
That should be a starting point for more haggling on prices, IMHO.

Ancient Islamic Penrose Tiles Some actual numbers and angles are here.

An Early Environmentalist, Embracing New ‘Heresies’

Practical Fusion, or Just a Bubble?

FReepmail me if you want on or off my health and science ping list.

6 posted on 02/27/2007 1:14:48 AM PST by neverdem (May you be in heaven a half hour before the devil knows that you're dead.)
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To: neverdem

You don't really need a "middle man." Most hospitals will negotiate a bill. Just walk in with cash in your pocket and that should do the trick.

I have a close friend who only carries catastrophic insurance and he's done this a number of times. His bill is usually reduced by 1/3 to 1/2 and at that rate, I think the hospital's still getting paid much better than an insurance company would pay them.

My husband had major surgery a few years ago and our insurance company paid the hospital 1/6 of the bill, which was evidently the price that had been pre-negotiated.


7 posted on 02/27/2007 3:26:21 AM PST by dawn53
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To: neverdem
I like the concept of the health savings account but found it completely unworkable compared to other options.

What annoys me is seeing someone with the same HMO able to cover a family of five for half what it will cost me for a month's direct coverage cost payment. His wife couldn't hope to get insurance with her prior conditions but since it's a benefit of a public employee job, there's no screening or limits whatsoever. My premiums probably jump 20% per year. Co-pays aren't cheap.

I think if everyone had to weigh the cost of a $100 or $200 co-pay they might not go to the ER for a hang-nail.

IMHO, there should be punitive measures for those who are injured engaging in risky recreational behavior (e.g. idiot climbers in the dead of winter) or monopolize the doctors time trying to get antibiotics uselessly for a common cold. Folks need to learn when to go to the doctor and when to wait or do self care. We have a range of OTC products and pharmacists to help us out.

8 posted on 02/27/2007 3:59:10 AM PST by newzjunkey (HUNTER in '08.)
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To: neverdem
The average provider — doctors or hospitals — has between 5 and 100 reimbursement rates for the exact same procedure

The great Austrian economist Ludwig von Mises said the reason that socialist command economies didn't work, and would ultimately fail of their own weight, was that without a market economy, resources were bound to be inefficiently allocated. Well, here in the USA we have a situation with medicine where no one knows what anything costs.

When I was a kid, the Jewish moms would say you should be or marry a doctor, lawyer, or dentist, in that order. The lawyers must have been jealous, because now, many years later, its clear the lawyers have won. Why would anyone choose to be a family practitioner these days?

9 posted on 02/27/2007 4:04:03 AM PST by Pearls Before Swine (Is /sarc really needed?)
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To: newzjunkey
IMHO, there should be punitive measures for those who are injured engaging in risky recreational behavior (e.g. idiot climbers in the dead of winter) or monopolize the doctors time trying to get antibiotics uselessly for a common cold. Folks need to learn when to go to the doctor and when to wait or do self care. We have a range of OTC products and pharmacists to help us out.

While I agree with you think of what you are asking. The elderly have always had, in their previous professions, good health care with little or no deductable. They are used to getting good care cheap.

The uneducated that don't work or have very low paying jobs don't care who pays the bill as long as they don't.

The average person has been convinced that doctors are gods and can do no wrong so they blindly follow what the doctor tells them.

Medicine has been marketed for so long that and Americans have been used to the "best" that they are too scared to question what they are told by a doctor.

An example: My wife took our four year old to a dentist. The kid has perfect teeth. The dentist told my wife that he has two cavities in his back molars. Not by decay but naturally occuring cavities. He wants $340 to fill them and then seal the teath. On baby teeth!

My wife still wants to do it only because that's what the dentist said. I had a tooth filled last year. I asked the dentist how much it would be. He said about $90. I just got the bill. He billed the insuranc company $160 and I am expected to pay the remaining $72. I don't know yet what I am going to do.

10 posted on 02/27/2007 4:12:45 AM PST by raybbr (You think it's bad now - wait till the anchor babies start to vote.)
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To: newzjunkey

Only go to a medical doctor for trauma or a very severe acute illness but never for chronic disease. They will only make you worse. Go to curezone.com. This saves a ton of money.


11 posted on 02/27/2007 4:42:38 AM PST by Conservativegreatgrandma
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To: cpdiii

Radiologists send reports to pulmonologists. Not all physicians are qualified to interpret radiological procedure results. The bill was standard practice for all procedures. You were not expected to pay it if you had insurance. FYI.


12 posted on 02/27/2007 4:50:37 AM PST by x_plus_one (As long as we pretend to not be fighting Iran in Iraq, we can't pretend to win the war.)
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To: neverdem
One time I worked in a small hospital as an anesthesiologist. The hospital was trying to build up its plastic surgery department.

At that time, they would pitch a plastic surgeon by telling him that they would offer his patients a room overnight with nursing care, for say, a face-lift. The price quoted: $300 dollars. This was 12 years ago. Maybe inflation adjusted it would be $350 today.

At that time, Medicare or the insurers would pay $3000 for an overnight stay for a tonsillectomy, no questions asked. They will pay even more today. This is for an identical room, identical level of care in both cases.

The public would get the churchman's rate if they would bargain for it, as MSA encourage them to do.

The reason medical costs of all kinds are so high now is because the triumvirate (government, hospitals, and insurers) all play keep-away from the consumer. To wit:

The government will pay any overpriced bill because it has unlimited money and because it knows that the more ridiculous the price, the more the taxpayers and nontaxpaying citizens will clamor for socialized medicine.

The insurers will pay any claim no matter how ridiculous (except for doctors' bills whom they are trying to subjugate and make into drones to administer the new StateCare system) because they get a percentage of all hospital bills. The higher the bill, the greater their cut.

The hospitals encourage large bills because it increases their gross and their margin.

All three parties pay lip service to cost-containment, but, they all win big if the ridiculous prices stay ridiculous.

Where do the drug companies fit in? They likewise enjoy high prices, but, unlike the other parties, they probably deserve the money.

If you don't want to pay for the latest and most expensive drug, just buy a generic off-patent.The prices of many, many drugs are tumbling now as they go off-patent.

So now you can manage a lot of chronic diseases without spending quite so much for prescriptions.

Bottom line is: The more the market is allowed to enter in to the equation, the more the prices will become sane. My guess is one quarter of the current prices or less for everything.

The MSA is the first and best way that the consumers have to combat the oligopoly of medical care. That is why the liberals hate it so much and have been quiet to report its advantages.

Go to a 'boutique' (i.e., cash on the barrel) physician, get the best rate for outpatient care, get low-cost options from the physician, find low cost prescriptions for generics, and negotiate for everything with cash.

Use a high deductible policy for everything big ticket.

If enough people do the above, the prices of everything will fall, and the power will be restored to the consumer. If it happens with "consumer electronics" it can happen with "consumer medicine".

13 posted on 02/27/2007 5:26:32 AM PST by caddie
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To: JoeSixPack1

While I also fear my high deductible I would rue Hilarycare; "Don't worry about that,...it's all taken care of."


14 posted on 02/27/2007 5:29:57 AM PST by incredulous joe ("Our hearts are restless until they rest in Thee, O God" - St Augustine)
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To: cpdiii
Some years ago I received a bill from a radiologist for reading an x ray. I was most upset as my primary pulmologist was the best man in town for my condition and I was paying him big bucks from my own pocket to tell me what the hell was wrong with me. I sent a short note to the radiologist that said, "if you do not think the best pulmonogist in Corpus Christi, Texas is not qualified to read my X-Ray I will be more than happy to pay the bill that you have sent me. I never heard from him again.

This is the way things work, and for good reason. Most pulmonologists can indeed read chest X-rays well, as far as it pertains to the lung. However, if there were a bone tumor or something wrong with the heart or neck or upper abdomen, they might never see it.

A radiologist may read a hundred or more chest X-rays every day and gets very, very good at it. Pulmonologists look at a small fraction of this number, and don't necessarily have time to dictate a full written report on each one they see.

The radiologist also owned the facility where I had the X-Ray!

Which means he paid for the note and service contract on the machine that took your picture, the salaries and benefits for the techs and receptionist and file clerks and billing clerks and transcriptionists, the cost of the X-ray film, the chemicals and machines to develop the film, the rent for the roof over it all, taxes, and a dozen other expenses. What was left over he got to keep. In your case, he paid money out of his own pocket to help you.

You stiffed this guy and seem proud of it. I think you are a contemptible freeloader.

-ccm

15 posted on 02/27/2007 5:39:33 AM PST by ccmay (Too much Law; not enough Order.)
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To: newzjunkey
I think if everyone had to weigh the cost of a $100 or $200 co-pay they might not go to the ER for a hang-nail.

I totally agree. However, the downside is that there are people who then avoid the ER because of the high co-pay. I'm always amazed at the people who call our clinic with symptoms of a MI or stroke, and refuse to go to the ER. Some of my co-workers (nurses) will relent and give them an appointment in the office. I usually don't back down - bringing a potentially medically unstable patient into our clinic is not appropriate; it's up to the patient to decide whether they want to continue having their stroke in the hospital, or die at home....

16 posted on 02/27/2007 5:50:06 AM PST by Born Conservative (Chronic Positivity - http://jsher.livejournal.com/)
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To: neverdem

Thanks for the ping.


17 posted on 02/27/2007 7:36:59 AM PST by GOPJ (Perverse incentives incentivize people to do perverse things.--- Freeper gridlock)
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To: neverdem

If you have a high deductible, it pays to sign up with one of the doctors savings plans...not insurance just a group savings plan...kind of like shopping at a wholesale warehouse club. They have the same plans for dental as well.


18 posted on 02/27/2007 8:35:38 AM PST by Katya (Homo Nosce Te Ipsum)
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To: Katya

Where can I find info on doctors savings plans?


19 posted on 02/27/2007 2:36:29 PM PST by kmiller1k (remain calm)
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To: neverdem

Yup!
I just bargained down my PET Scan from $2500 to $995 today!


20 posted on 02/27/2007 2:39:02 PM PST by G Larry (Only strict constructionists on the Supreme Court!)
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To: kmiller1k

search the internet for discount health networks and check which providers are in their network. This is NOT health insurance, this is a group rate plan, where the prices are pre-negotiated at discounted rates. I would always advise if you are happy with a specific doctor to call their office and ask whether they accept the network discounts...physicians may drop out of these networks and still be listed.


21 posted on 02/27/2007 11:20:04 PM PST by Katya (Homo Nosce Te Ipsum)
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To: incredulous joe

Hillarycare is something to be avoided at all costs, pun intended.


22 posted on 02/27/2007 11:23:05 PM PST by darkangel82 (Socialism is NOT an American value.)
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