From my understanding, there have been laws or orders put in place to make costs associated with drugs and medical care fairer and more transparent. Has Anyone in the healthcare/insurance industry seen these laws come to fruition? Could I go to a hospital and get a round about quote on an open heart surgery before the service is performed?

Not yet

Not at all.

Just had a baby. As much as my wife and I struggled to understand to bill, I'm not sure the doctors/hospital understood what to bill. It wasn't a matter of disputing services performed, just understanding what was and wasn't included with certain fees. You basically need a PhD in medical billing and coding to get it right.

Same as it ever was except our family now functions under a high deductible plan, which essentially translates into 100% our responsibility for everything not maintenance related in most years. Although, we are more aware of the costs associated with medical care, they are in no way shape or form transparent. I do not think it is a sustainable model.

It's a legally sanction mafia-style racket.

Go back and look at health care ETF performance the years following the passage of obamacare.

themissinglink said:

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...I'm not sure the doctors/hospital understood what to bill...

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employed doctors are just pawns in the system
they serve the multitude of layered administrators, who work for the hospital or large medical group

No. But there are places that are transparent. Where I live there is www.umedmarket.com

Cadet05 said:

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There will never be transparent pricing until all in network hospitals require all providers in the hospital to be in network. Nothing worse than going to an in network hospital and being treated by out of network providers when you don't have out of network coverage on your policy. It's not like you have a choiceOf who you are seen by once you get in the hospital. Better yet, put an end to the practice of back billiing!

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That's a good start, but doesn't fix the whole problem. I think the core issue is that the insurance companies are the hospital's real customers. Until that changes (and I have no good suggestions) I don't think durable improvement is possible.

topher06 said:

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Cadet05 said:

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There will never be transparent pricing until all in network hospitals require all providers in the hospital to be in network. Nothing worse than going to an in network hospital and being treated by out of network providers when you don't have out of network coverage on your policy. It's not like you have a choiceOf who you are seen by once you get in the hospital. Better yet, put an end to the practice of back billiing!

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Back billing is one of the most infuriating things doctors and hospitals do. Such bull**** they can lie to you up front on cost - after they say they've fully reviewed insurance - and then surprise it actually cost 200% of what we said.

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I had two major procedures last year. It was infuriating to just get a trickle of bills over the course of 3-4 months after each one that you had no idea what they were for or if legitimate. I was able to catch one duplicate bill and get it canned, but unless it was clearly duplicated there is no way to know what is legit or not.

Ulrich said:

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That's a good start, but doesn't fix the whole problem. I think the core issue is that the insurance companies are the hospital's real customers. Until that changes (and I have no good suggestions) I don't think durable improvement is possible.

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Think about what you just said. Every patient needs to remember this and use it to their advantage. Any time you have an issue with your provider, your first step needs to be making your insurance company mad. Hospitals listen to them.

Cadet05 said:

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There will never be transparent pricing until all in network hospitals require all providers in the hospital to be in network. Nothing worse than going to an in network hospital and being treated by out of network providers when you don't have out of network coverage on your policy. It's not like you have a choiceOf who you are seen by once you get in the hospital. Better yet, put an end to the practice of back billiing!

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Yep. Having a doctor order tests and then finding out that provider isn't in- network needs to be corrected in the law. Also finding out that the company they sent the test results to have it analyzed isn't in-network needs to be changed by law.

When you take the trouble to make sure the doctor is in-Network then you expect everything including tests and analysis to be in-Network. If a doctor wants you to go get a pet scan and blood work done then they need to make sure they give you in-Network providers or disclose to you in writing that those are out of network providers.

My brother had stage 4 cancer last spring and the doc sent his blood work to SanFran for gene level testing. Turns out they weren't in network and sent my SIL a $20k bill. To make this worse my brother died before they ran the tests. The good news is they dropped their bill and the insurance covered the vastly reduced amount since by brother had already paid his max out of pocket for this year. But this should never have happened, yet it happens to unsuspecting people everyday.

Don't think so. We have been cash pay for a couple years and we always ask what is the price up front for an Office visit. Then at checkout we state we are cash pay and want to pay everything for the visit now that may have happened on top of office visit, given thy have no insurance to process and have the chart right in front of them that states everything done. We pay that price and then still get a bill later for other stuff, which I have begun wholesale ignoring After calling and telling them we asked to pay for everything up front and paid that price, which of course they never respond to, and so then have to ignore the collections agencies they eventually wind up at.

Hanrahan said:

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Don't think so. We have been cash pay for a couple years and we always ask what is the price up front for an Office visit. Then at checkout we state we are cash pay and want to pay everything for the visit now that may have happened on top of office visit, given thy have no insurance to process and have the chart right in front of them that states everything done. We pay that price and then still get a bill later for other stuff, which I have begun wholesale ignoring After calling and telling them we asked to pay for everything up front and paid that price, which of course they never respond to, and so then have to ignore the collections agencies they eventually wind up at.

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Balance billing should be illegal. Hospitals are thieves and doctors are willing accomplices.

topher06 said:

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Hanrahan said:

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Don't think so. We have been cash pay for a couple years and we always ask what is the price up front for an Office visit. Then at checkout we state we are cash pay and want to pay everything for the visit now that may have happened on top of office visit, given thy have no insurance to process and have the chart right in front of them that states everything done. We pay that price and then still get a bill later for other stuff, which I have begun wholesale ignoring After calling and telling them we asked to pay for everything up front and paid that price, which of course they never respond to, and so then have to ignore the collections agencies they eventually wind up at.

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Balance billing should be illegal. Hospitals are thieves and doctors are willing accomplices.

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Balance billing is illegal in Texas. Hospital's are at the mercy of the contracts they have with insurance companies who often times are considerably larger and have more bargaining power. If you want healthcare fixed you have to start with insurance, including Medicare and Medicaid who pay less than 10% of total charges.

Bert315 said:

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topher06 said:

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Hanrahan said:

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Don't think so. We have been cash pay for a couple years and we always ask what is the price up front for an Office visit. Then at checkout we state we are cash pay and want to pay everything for the visit now that may have happened on top of office visit, given thy have no insurance to process and have the chart right in front of them that states everything done. We pay that price and then still get a bill later for other stuff, which I have begun wholesale ignoring After calling and telling them we asked to pay for everything up front and paid that price, which of course they never respond to, and so then have to ignore the collections agencies they eventually wind up at.

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Balance billing should be illegal. Hospitals are thieves and doctors are willing accomplices.

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Balance billing is illegal in Texas. Hospital's are at the mercy of the contracts they have with insurance companies who often times are considerably larger and have more bargaining power. If you want healthcare fixed you have to start with insurance, including Medicare and Medicaid who pay less than 10% of total charges.

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Can you source that law for me because I need to report places like Kelsey seybold 10 times? Thank god I haven't yet had any major emergencies (did superglue my hand last weekend to avoid going to urgent care) with real bills that would ruin my life like many others deal with.

Edit: Did some research. Applies to 20% of Texans and only in emergencies or when no options are available. Back to the original claim, hospitals are thieves and doctors are willing accomplices.

topher06 said:

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BoydCrowder13 said:

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As someone that had a kid with a prolonged NICU stay, I'm intimately familiar with the hospital billing system. It is awful. No different than bartering in some third world market. Sometimes the hospital will try to overcharge you and send you multiple bills for the same service. Other times, you can call and offer them 50% and they will take it.

In theory, I'm not for universal healthcare. But it is starting to get to the point that I'd be willing to try it. The current system is terrible and purposely set up against the consumer.

Imagine going to a restaurant and asking how much the steak is. "Sir, I really have no idea. But we will bill you afterwards." Then they charge you $500 for your steak. What kind of business model is that?

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That isn't how it works at all. The waiter would tell you it costs $50.23 and then you would be mailed a bill a month later for $612.12 with a detail that they invoices your food insurance $1000 but insurance only paid $7.45. You'll be reported to a credit agency if you don't pay the restaurant at their full rate.

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Haha fair enough that is probably closer.

Hanrahan said:

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Don't think so. We have been cash pay for a couple years and we always ask what is the price up front for an Office visit. Then at checkout we state we are cash pay and want to pay everything for the visit now that may have happened on top of office visit, given thy have no insurance to process and have the chart right in front of them that states everything done. We pay that price and then still get a bill later for other stuff, which I have begun wholesale ignoring After calling and telling them we asked to pay for everything up front and paid that price, which of course they never respond to, and so then have to ignore the collections agencies they eventually wind up at.

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Your credit didn't take a hit? I had an $80 bill which went to collections from a pointless repeated blood test I felt I shouldn't had to pay. Never had a bill go to collection so I gave in.

YouBet said:

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O'Doyle Rules said:

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Private market has shown they can't fix their problems. Too much greed and lobbying. I'm 100% for single payer exactly for this reason.

They have had decades to fix it and refuse to do so.

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Uh, no. I would rather get mad at a few bill issues than have third world medicine.

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Most bankruptcies spawn from medical bills. The majority of those people have insurance too. Its ridiculous.

O'Doyle Rules said:

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YouBet said:

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O'Doyle Rules said:

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Private market has shown they can't fix their problems. Too much greed and lobbying. I'm 100% for single payer exactly for this reason.

They have had decades to fix it and refuse to do so.

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Uh, no. I would rather get mad at a few bill issues than have third world medicine.

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Most bankruptcies spawn from medical bills. The majority of those people have insurance too. Its ridiculous.

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I hear you, but there is a better way than UHC. That is not the answer.

500,000ags said:

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It's always classic when I meet some $150-175k per year healthcare administrator with a nursing degree from a D3 school and an MBA from an online program. It's freaking ludicrous and yet I meet these people like 2-3x a year it seems.

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Alot of times the private sector is just as good as the govt when it comes to red tape.

Ulrich said:

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YouBet said:

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Get rid of insurance and you probably fix this whole mess.

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Turn insurance into actual insurance instead of an intermediary in every transaction, no matter how insignificant.

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Yes. And give everyone a tax deferred health savings account that can be invested in relatively low risk investments. If you never get sick, it becomes part of your IRA. If you need to get something minor done, like wisdom teeth, or you get cut and needs stitches, then you've got something to pay with. If you get into a catastrophic accident or get cancer, then you've got insurance to back you up.

Another advantage of HSAs is that it's your money, so there's an incentive to not waste your money going to the ER (the most expensive form of healthcare) for frivolous things that can be taken care of by an urgent care or regular primary care family doc.

O'Doyle Rules said:

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Private market has shown they can't fix their problems. Too much greed and lobbying. I'm 100% for single payer exactly for this reason.

They have had decades to fix it and refuse to do so.

Oh but the wait times with single payer!! ...blah blah blah. Eat healthy and exercise. That fixes 98% of
Problems.

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I'm kind of with you. However here's the issue - single payer wouldn't really be single payer. It would be the same insurance companies we currently have, contracted with the government (similar to what you see with MediCare). I suppose the government would technically be the single payer at the top, but you're still going to see insane amounts of bureaucracy, artificially inflated prices, and all kinds of money games as insurance companies and hospitals fight among each other.

At the end of the day tax insurance companies and hospital executives will get rich off the tax payer, doctors will have to work more for less pay and patients will get less choice. I think most patients will still get adequate healthcare, and many will get far better care than they get now, but they will have less choice in the matter. Part of what Americans value a lot in health care is choice - hence why HMOs aren't as popular as PPOs.

Also, if anyone has been in the military, or been a military brat, you've been in a single payer socialized medicine system.

Ulrich said:

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I dont think our current healthcare system can really be described as private anymore. There's an insane amount of regulation and government presence in general.

I can't speak to all of it, but even in my lifetime it seems like every time the government tries to expand access and increase transparency they just make it more complicated and expensive, and increase the power of their captive intermediaries (the insurance companies).

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It's socialism by proxy. They regulations are so many that there is no longer a difference between government run and privately run. The private sector has to do what the government tells them. They can't actually be efficient because the government has so regulated how everything is allowed to be done.

The real problem is the insurance who is the middle man. They don't pay the doctors or hospitals for months, and they have more leverage and lawyers than the doctor practices and hospitals. I know a doctors office that went out of business because the insurance wouldn't pay the bills they sent them for months. The doctors had to close up and take work as doctors for a much larger more corporate group.

Individual doctors are being put out by mega insurance and healthcare corps.