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Hospitals looking for cash upfront
The Chicago Tribune ^ | Nov 17, 2013 | Peter Frost, Chicago Tribune reporter

Posted on 11/17/2013 5:57:44 AM PST by M. Dodge Thomas

Before undergoing an MRI, a CT scan or a surgery to clean up that wobbly knee, consumers had better become accustomed to hearing: "How do you intend to pay for that?"...

The shift comes as more consumers enroll in so-called high-deductible health plans, which require consumers to pay more out of pocket in exchange for lower monthly premiums. As a result, health care providers must collect a larger portion of patient bills from consumers themselves, rather than their insurance companies.

It's a delicate balance for hospitals, which have certain legal and ethical obligations to care for people who arrive with critical health conditions regardless of their ability to pay. At the same time, hospitals believe they must become more insistent and methodical about screening patients' ability to pay, particularly people with scheduled procedures or elective surgeries.

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


TOPICS: Business/Economy; News/Current Events
KEYWORDS: 0carenightmare; aca; deductibles; hospital; insurance; obamacare; obamacaredeductible; obamacaredeductibles; obamacarehospitals
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"At the same time, hospitals believe they must become more insistent and methodical about screening patients' ability to pay..."
1 posted on 11/17/2013 5:57:44 AM PST by M. Dodge Thomas
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To: M. Dodge Thomas

I think that people who have large deductibles and out-of-pocket expenses who have to do business with a hospital had better first get in touch with the billing/finance administrator and work out some haggling, myself. Cash up front can cut costs I believe.


2 posted on 11/17/2013 5:59:52 AM PST by Gaffer
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To: Gaffer
I found a private MRI in the Pittsburgh area that charged me $350 for my knee that confirmed I needed arthroscopic for a torn Miniscus.

Within "the system" an MRI averages $2,000.00

it was a sacrifice, but I came up with the 350 ... no WAY could I swing 2 grand.

3 posted on 11/17/2013 6:07:20 AM PST by knarf (I say things that are true .. I have no proof .. but they're true.)
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To: M. Dodge Thomas

I loved how the surgeon had me sign a financial responsibility form when I was laying face down with an open backed gown just before getting anesthesia for a colonoscopy.


4 posted on 11/17/2013 6:11:03 AM PST by glorgau
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To: M. Dodge Thomas

Take my wife for a MRI,Please!


5 posted on 11/17/2013 6:13:17 AM PST by Dr. Ursus
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To: Gaffer

Just one nites’ stay is un-Affordable...


6 posted on 11/17/2013 6:13:25 AM PST by Son House (Democrats want you to use 'Great Recession' instead of 'Jobless Recovery', recession ended June 2009)
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To: knarf

My GP is an Indian doctor that I’ve gone to for almost 30 years. He is a wizard at finding low-cost facilities for tests like MRIs in the price ranges you cited. I honestly don’t know what I would do for a doctor when he retires.


7 posted on 11/17/2013 6:14:29 AM PST by Gaffer
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To: Gaffer

Yup. But before we can “shop” our medical purchases, the hospitals have to be willing to disclose their prices - which is anathema to a system that *depends* on non-transparent pricing.

Same, as regards benefits, for the insurance companies -I know some pretty smart people who are *shocked* to discover to discover what their “inexpensive” insurance did not cover, especially as regards yearly caps.


8 posted on 11/17/2013 6:18:18 AM PST by M. Dodge Thomas
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To: Gaffer

Here is the deal.

You have a MRI and the hospitalization pays the bill.

Look at that bill its says the cost of the MRI $2,315 dollars, Under that it says Hospitalization paid $435 dollars, the hospital accepted that and you owe nothing.

You go in there with a $3,000 dollars deductible and you will pay $2315 dollars right off the top.Not the $435.

Obamacare screwed you again.
Happy friggin Birthday.

We need to tar and feather every SOB who voted for this crap.


9 posted on 11/17/2013 6:20:44 AM PST by Venturer (Keep Obama and you aint seen nothing yet.)
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To: Gaffer

Cash up front only cuts costs when one is self-insured. The reason for this is the hospital doesn’t have to file paperwork with anyone else.

Cash upfront to assure the hospital you can meet your insurance deductible is not the same thing.


10 posted on 11/17/2013 6:23:46 AM PST by EBH ( The Day of the Patriot has arrived.)
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To: knarf

I don’t understand.

Is the $2000 billed to you or to the insurance company? And can you choose to pay by yourself even when you have insurance?


11 posted on 11/17/2013 6:24:00 AM PST by James C. Bennett (An Australian.)
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To: Venturer

I don’t think this is about Obama Care high deductible plans, which are both expensive and have high deductibles. I think this is talking about high deduct plans (with or without HSAs) that have been around for a while.

We have one. It has a 10K deductible BUT…BUT...It is about 10 thousand dollars less expensive than a low deductible plan per year in premium…..it’s simpler, less paperwork and so on. I think most people who are on such a pln understand it. But again, we don’t have all the Obamacare strings attached to it.

It’s like the old major medical stuff…WHICH WORKED!


12 posted on 11/17/2013 6:25:47 AM PST by C. Edmund Wright (Tokyo Rove is more than a name, it's a GREAT WEBSITE)
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To: James C. Bennett; knarf

I think what he was saying is this: when these clinics have to put up with all the billing and papwerork bullsh-t - it cost 2 grand. OR….if you can just plunk down the cash, 350, done deal.

Which is, in a way, a very teachable moment about what is wrong with our system now,….AND how to solve it.


13 posted on 11/17/2013 6:27:20 AM PST by C. Edmund Wright (Tokyo Rove is more than a name, it's a GREAT WEBSITE)
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To: James C. Bennett

The 2g was from inquiries ... the ones giving that answer had no idea what an MRI costs ... they could only tell me what they charged the ins. co.


14 posted on 11/17/2013 6:27:45 AM PST by knarf (I say things that are true .. I have no proof .. but they're true.)
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To: EBH

I understand that. But there is no reason you have to tell the hospital you have insurance is there?


15 posted on 11/17/2013 6:27:48 AM PST by Gaffer
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To: M. Dodge Thomas

“But before we can “shop” our medical purchases, the hospitals have to be willing to disclose their prices - which is anathema to a system that *depends* on non-transparent pricing.”

And before it is over, this will bring about some form of price fixing, just like they have in other parts of the world.


16 posted on 11/17/2013 6:27:49 AM PST by DonaldC (A nation cannot stand in the absence of religious principle.)
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To: Gaffer

How negotiable are hospital / medical procedure costs in the US?

I have a high deductible insurance covering me whenever I am in the US (which is, quite often), and have wondered about just this.


17 posted on 11/17/2013 6:29:57 AM PST by James C. Bennett (An Australian.)
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To: M. Dodge Thomas

as I predicted.

I believe his plan is a lot more nefarious.

Healthcare is a major part of the American economy, this many people without insurance will cause a collapse of the industry, it will rob many of their savings plans as they have to pay out of pocket for care, Hospitals and doctors won’t get paid and will default on their businesses plans causing a total collapse of the healthcare system in the USA. .


18 posted on 11/17/2013 6:32:02 AM PST by jyro (French-like Democrats wave the white flag of surrender while we are winning)
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To: knarf

I think that’s the mess that the entire insurance industry / medical industry here is vilified for.

Same procedure gets charged $2000 to the insurer vs. $350 if upfront?

That’s so wrong, it’s amazing riots haven’t started over such theft.


19 posted on 11/17/2013 6:34:28 AM PST by James C. Bennett (An Australian.)
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To: knarf

I would guess that there is “dead” time on MRI machines in the middle of the night. Waiting for an open, unused otherwise time slot should be priced lower.


20 posted on 11/17/2013 6:34:52 AM PST by Paladin2
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To: Venturer

My experience has been the opposite. I get the contract price, but have to pay it myself. The typical price for the MRI is $2500 list, $900 negotiated. I pay the $900.


21 posted on 11/17/2013 6:35:31 AM PST by proxy_user
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To: Gaffer

I believe you’d have to check with your insurance policy regarding that question and how it applies towards your high-end deductible, as there maybe a hidden contractual conflict in there. Plus I do believe under 0bamacare most hospitals will be asking for your insurance and if you claim none I am sure some helpful social worker will come visit you to sign you up. LOL...


22 posted on 11/17/2013 6:35:45 AM PST by EBH ( The Day of the Patriot has arrived.)
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To: EBH

I’m okay with them ‘helping’ me sign up. I just won’t be able to give them any information that is worth a damn.


23 posted on 11/17/2013 6:39:06 AM PST by Gaffer
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To: James C. Bennett
Medical industry cost-shifting is at the heart of the affordability problems, and despite the public chaos the industry has no intention of giving up this kind of excessive billing. It will take a repeal of all the anti-trust exemptions they have bought themselves over the years through their hired legislators before any real systemic fix can be put in place. Which is the major stupidity of both ObamaCare and single-payer- attacking the insurers (the symptom) instead of the problem.

A healthy blast of genuine free-market medical services competition would solve the problem - fast.

24 posted on 11/17/2013 6:42:30 AM PST by Mr. Jeeves (CTRL-GALT-DELETE)
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To: proxy_user

$2500 for the equivalent of running a document scanner on a book for a few minutes? Ridiculous.

Why hasn’t an industry of MRI scanning facilities cropped up to allow capitalism to lower costs to saner levels?

Oh, that’s because of regulatory capture, where it’s near improbable cost- and certification-wise to start such a facility unless you’re Big Business with all the necessary political ties.

It’s crap like this that swings a functional country from being Free Market-based to fully Socialist, with democratic support aiding the change.


25 posted on 11/17/2013 6:43:17 AM PST by James C. Bennett (An Australian.)
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To: Gaffer
My GP is an Indian doctor that I’ve gone to for almost 30 years. He is a wizard at finding low-cost facilities for tests like MRIs in the price ranges you cited.

My doctor just opened his own MRI and CT Scan lab right next door to his office instead. Not sure how it's paying for itself although he does take in alot of referrals from other doctors for MRI's and CT Scans and his machines are always busy.

After my brother passed away from a massive brain aneurysm in August of 2011, my doctor made me get a very specific type of MRI on my brain & brain stem to look for aneurysm's as it turned out the type my brother passed away from was genetic.

Total cost to me was $450. Cash. If I had run it through my high deductible insurance the cost would've been over $2k with me fronting $750 out of pocket.

I think we're going to see alot more "concierge" type medicine with doctors refusing insurance and taking cash instead. Think about it: If they eliminate all the back office workers required to deal with the insurance claims and switch to cash instead, the costs for things like MRI's, CT Scans and regular office visits are going to become alot cheaper. Sounds like a win-win for the Doctors and the Patients IMO...

26 posted on 11/17/2013 6:46:10 AM PST by usconservative (When The Ballot Box No Longer Counts, The Ammunition Box Does. (What's In Your Ammo Box?))
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To: EBH

I love the idea of paying upfront for routine medical treatments. When I was in The Bahama’s, I broke my shoulder. I went to the hospital and had to pay 45 dollars for registration (cost for everyone regardless of care) and then 97.10 for X-rays. I paid 80 bucks for sling and medicine. That is it. That is how the American system works. Insurance should only be for major medical problems. If people had to pay out of pocket for most routine medical issues, people would not be going to the doctor for a splinter in the finger and a runny nose.


27 posted on 11/17/2013 6:46:27 AM PST by napscoordinator ( Santorum-Bachmann 2016 for the future of the country!)
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To: James C. Bennett
Why hasn’t an industry of MRI scanning facilities cropped up to allow capitalism to lower costs to saner levels?

Not sure where you live, here in N.E. Illinois where I'm at there are at least 5 such facilities within 10 minutes drive of my home. (One of which is at my own Doctor's office.)

28 posted on 11/17/2013 6:47:36 AM PST by usconservative (When The Ballot Box No Longer Counts, The Ammunition Box Does. (What's In Your Ammo Box?))
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To: James C. Bennett

My understanding is that the contracts between medical providers and insurers prohibit the providers from negotiating their list prices. If the uninsured were to negotiate lower payments then the providers would eventually have to raise the amount they charge the insurance companies, who are currently being subsidized by the uninsured, by the negotiating power of their size.


29 posted on 11/17/2013 6:49:27 AM PST by Glenmore
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To: usconservative

So would those facilities be charging about $350 per MRI (which still seems high for a non-invasive scanning procedure) instead of the $2500 that hospitals charge for the same?


30 posted on 11/17/2013 6:52:33 AM PST by James C. Bennett (An Australian.)
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To: C. Edmund Wright

The people I know got burned in one of two ways:

1) They did not realize that there was a low yearly cap on the total insurance payout (”mini-med”) plans.

2) They had plan like the one you described, got really sick (cancer, etc.), and were dropped next plan cycle - and left with no insurance from their old carrier, and no chance of getting new insurance except through a state “high-risk” pool, which was closed to new applicants or had a long waiting line.

These are the people who spend down their assets to bankruptcy and then go on Medicaid - essentially, the rest of us are their “backup” insurers.

A lot of people do not like the ACA because it essentially bans the first type of policy, and prevents the sort of cancellations in the second case.

IMO, it’s not as easy a call as it first appears: we naturally want people to have freedom of individual choice about want type of insurance to purchase, but a lot of people end up making a choice that *guarantees* their costs will be shifted to *rest of us* if things go wrong.

Plus, you have the issue that a lot of the people who *want* to be responsible *can’t* afford better insurance.

The end result is that unless you put your head in the sand and ignore that fact that *someone* ends up paying for such care, when you try to come up with a system where everyone pays at least *something* for care they will receive, you come up with mandatory insurance + minimum coverage requirements + subsidies - in other words, something rather like the ACA.

From this perspective, one of the major things wrong with the ACA is that by subsidizing existing insurance practices - which *depend* on making it hard to discover in advance what service is being provided and what it will cost - it perpetrates a system designed to make “comparison shopping” difficult or impossible and continues insurance practices which make it difficult to discover which high-deductible plans makes sense to a given consumer.

So I would argue that as regards such disclosure the ACA(which tries to make apples-to-apples comparisons between standardized plans possible) does not go *far enough*”, and mostly, as part of a cozy deal to protect the current Byzantine pricing and insurance arrangements between providers and insurers.


31 posted on 11/17/2013 7:09:49 AM PST by M. Dodge Thomas
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To: James C. Bennett

I can only tell you what the facility that my personal doctor opened charged me, which was $450. My best guess is given the number of them around where I live, they have to be competing on price.


32 posted on 11/17/2013 7:14:00 AM PST by usconservative (When The Ballot Box No Longer Counts, The Ammunition Box Does. (What's In Your Ammo Box?))
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To: M. Dodge Thomas

I am not aware of item 2 in the free market….prior to Obamacare. A principle of insurance is that when you have a claim, the company insuring you on the date of that claim is on the hook for that claim forever….that’s the risk. This is the evil of Obamacare - it “unisured the insured”

Also, the mini plans are the wrong way to go. Cat only,wtih high deducts, but something that will pay ALL of the cat is the soundest way to insure. Such plans are very much cheaper than most plans. This is the way we used to do it. It worked back then.


33 posted on 11/17/2013 7:37:51 AM PST by C. Edmund Wright (Tokyo Rove is more than a name, it's a GREAT WEBSITE)
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To: Gaffer

Up bet cash up front cuts cost, at just about any business.


34 posted on 11/17/2013 7:45:34 AM PST by MCF
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To: Mr. Jeeves

Anti trust is not free market


35 posted on 11/17/2013 7:57:44 AM PST by Manta (Obama to issue executive order repealing laws of physics)
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To: M. Dodge Thomas

“He said, ‘Call the doctor, I think I’m gonna crash’
“’The doctor say he’s comin’ but you gotta pay him cash’…”


36 posted on 11/17/2013 8:10:05 AM PST by RichInOC (Palin 2016: The Perfect Storm.)
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To: M. Dodge Thomas

Before government intervention and insurance company ripoffs, doctors used to accept cash and the payment was affordable.

I knew a doctor that had practiced since 1936. He hated the fact that by 1960 things had already gotten out of control. Regulation kept him from accepting chickens for payment, which he had done many time before. The IRS got involved and screwed up accounting. He went on and on about all the various government agencies that got between him and his patients.


37 posted on 11/17/2013 8:15:23 AM PST by CodeToad (When ignorance rules a person's decision they are resorting to superstition.)
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To: James C. Bennett; knarf

While the provider may charge $2000 initially, what generally happens is the $2000 gets negotiated down by the insurer to something like reasonable, close to the $350. The guy who gets screwed is the man with no insurance (and thus no system to negotiate down the “full list price” rates) who has some assets, who gets socked for full price.


38 posted on 11/17/2013 8:39:49 AM PST by FreedomPoster (Islam delenda est)
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To: FreedomPoster

Hmm.

Why can’t there be a more open, market-based pricing for these procedures?


39 posted on 11/17/2013 8:56:23 AM PST by James C. Bennett (An Australian.)
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To: M. Dodge Thomas
Before undergoing an MRI, a CT scan or a surgery to clean up that wobbly knee, consumers had better become accustomed to hearing: "How do you intend to pay for that?"

certainly beats hearing "There is a 6 month waiting time for an MRI/CT Scan..."

40 posted on 11/17/2013 8:58:23 AM PST by GeronL (Extra Large Cheesy Over-Stuffed Hobbit)
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To: Venturer

We need to shame all Obama voters.


41 posted on 11/17/2013 9:09:28 AM PST by rcofdayton (.)
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To: James C. Bennett

I believe the best option is to pay a monthly fee to a hospital network directly, to have access to facilities, there can be different levels of service, based on the amount you wish to pay. There can be competing plans, so that will tend to keep prices low. The difference is, now the middle man, the insurance companies, are eliminated, and you are not limited to the plans your employer offers, in fact, it totally decouples health care concerns from employment.

And that can be supplemented with Catastrophic health insurance, that pays for more expensive care.


42 posted on 11/17/2013 9:17:48 AM PST by dfwgator (Fire Muschamp.)
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To: dfwgator

Sounds reasonable.

Entrenched interests and beaurocratic entanglements will ensure that nothing reasonable will happen.


43 posted on 11/17/2013 9:28:01 AM PST by James C. Bennett (An Australian.)
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To: James C. Bennett

Great question.

The real issue has its roots in WWII. Manufacturers needed employees, there were wage and price controls, but not benefits controls. So to attract workers, corporations offered employee health insurance. This was tax deductible to the corporation, a tax advantage an individual does not get.

This “stuck” after WWII and over time, paying for medical events became something that your insurance company did, an insurance company the individual didn’t even hire - the insurance came from the workplace. Thus, buying insurance and paying for medical events was something corporate HR did, thus creating a disconnect between the consumer of services and the payer for those services.

Until that key disconnect is removed, say by HSAs and high-deductible individual policies, we won’t be seeing much in the way of greater transparency and market-based pricing.


44 posted on 11/17/2013 9:29:28 AM PST by FreedomPoster (Islam delenda est)
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To: FreedomPoster

Thanks for the elaboration!

I agree with what you wrote.


45 posted on 11/17/2013 9:37:42 AM PST by James C. Bennett (An Australian.)
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To: James C. Bennett
So would those facilities be charging about $350 per MRI (which still seems high for a non-invasive scanning procedure) instead of the $2500 that hospitals charge for the same?

James, there is justification for the $350. The machines are quite expensive. The wages of the technician must be paid, as well as general overhead for the building, utilities, support services, taxes, yada, yada.

The $2500 is to support insurance company and goobermint bureaucracies, and let's not forget, for medical care for the indigent. Including the illegal alien parasites sucking our lifeblood so they can send remittances "home".

46 posted on 11/17/2013 10:55:33 AM PST by jimt (Fear is the darkroom where negatives are developed.)
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To: All

Seems like everyone in US should just stop buying health insurance. Deal in cash


47 posted on 11/17/2013 11:19:18 AM PST by ncpatriot
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To: rcofdayton

Obama voters have no shame.


48 posted on 11/17/2013 12:01:56 PM PST by Venturer (Keep Obama and you aint seen nothing yet.)
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To: M. Dodge Thomas

The patient is going to ask, “How much will that cost me”? The hospital will respond, “How much is your deductible”?


49 posted on 11/17/2013 12:03:05 PM PST by Mike Darancette (Do The Math)
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To: M. Dodge Thomas

The low information patients will be very surprised when they first learn about deductibles, co-payments and co-insurance.


50 posted on 11/17/2013 12:05:25 PM PST by Mike Darancette (Do The Math)
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