Related to health insurance question - Why can't we comparison shop for medical care?

[Anonymous]

You have absolutely no idea how much any treatment will cost.

Basically you go in blind, open your wallet, and say bill me whatever the heck you want.

And people wonder why things cost so much.

Forget medicare/medicaid/insurance. None of them let you find out whether this doctor/facility is charging you a proper price. Did you need 3-4 blood tests? Do I need a CT scan? How much is it?

Anybody a doctor/health care professional? Can you tell me why?

[Anonymous]

Because (perhaps naively) I go in believing that 8 years of medical training put my doctor in the position to know better than me whether I need those tests. I will give you that they probably shouldn't cost as much as they do. That's mostly due to liability insurance.

[Anonymous]

In MD the hospital rates are set by the state.

Regardless, there isn't even consistent pricing with a single provider. Which prices do you want to compare? Insurance A contracted prices? Insurance B? Retail? Cash on;y discount? Medicare?

[Anonymous]

The billing costs have been pre-negotiated by your insurance. That allows your MD to practice and request tests for you at his/her discretion.

Whether we could do comparison shopping at a new job? You could, but the company has selected the plan(s) its willing to pay for, others you would have to pay out of your own pocket.

[Anonymous]

Anonymous wrote:In MD the hospital rates are set by the state.

Regardless, there isn't even consistent pricing with a single provider. Which prices do you want to compare? Insurance A contracted prices? Insurance B? Retail? Cash on;y discount? Medicare?

And correct me if I'm wrong, but I don't think that MDs even know what things cost. I mean they might know in the ballpark or weather is covered by the insurance, but that kind of stuff is left for the billing folk.

[Anonymous]

Also people who don't have insurance and don't qualify for medicare, do have the right to comparison shop.

For example, a woman can ask OBs for quotes on price for pre-birth and birth costs as well as midwives. Then she can decide which doctor or midwife she wants to go to based on quality and price. Many people don't care about costs when it comes to getting the best quality.

[Anonymous]

Anonymous wrote:

Anonymous wrote:In MD the hospital rates are set by the state.

Regardless, there isn't even consistent pricing with a single provider. Which prices do you want to compare? Insurance A contracted prices? Insurance B? Retail? Cash on;y discount? Medicare?

And correct me if I'm wrong, but I don't think that MDs even know what things cost. I mean they might know in the ballpark or weather is covered by the insurance, but that kind of stuff is left for the billing folk.

^This is why many have pushed for business school like training for MDs. Running a practice is no different than running a large business. You need to know how to balance a budget and provide good care while minimizing the risks.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:In MD the hospital rates are set by the state.

Regardless, there isn't even consistent pricing with a single provider. Which prices do you want to compare? Insurance A contracted prices? Insurance B? Retail? Cash on;y discount? Medicare?

And correct me if I'm wrong, but I don't think that MDs even know what things cost. I mean they might know in the ballpark or weather is covered by the insurance, but that kind of stuff is left for the billing folk.

^This is why many have pushed for business school like training for MDs. Running a practice is no different than running a large business. You need to know how to balance a budget and provide good care while minimizing the risks.

I think that's why they hire office managers and have accountants. I disagree that they need to be jacks of all trade. They need to practice medicine.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:In MD the hospital rates are set by the state.

Regardless, there isn't even consistent pricing with a single provider. Which prices do you want to compare? Insurance A contracted prices? Insurance B? Retail? Cash on;y discount? Medicare?

And correct me if I'm wrong, but I don't think that MDs even know what things cost. I mean they might know in the ballpark or weather is covered by the insurance, but that kind of stuff is left for the billing folk.

^This is why many have pushed for business school like training for MDs. Running a practice is no different than running a large business. You need to know how to balance a budget and provide good care while minimizing the risks.

I think that's why they hire office managers and have accountants. I disagree that they need to be jacks of all trade. They need to practice medicine.

For large practices that is true. For a single primary care provider with a nurse or two it may not be financially feasible to hire an office manager.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:In MD the hospital rates are set by the state.

Regardless, there isn't even consistent pricing with a single provider. Which prices do you want to compare? Insurance A contracted prices? Insurance B? Retail? Cash on;y discount? Medicare?

And correct me if I'm wrong, but I don't think that MDs even know what things cost. I mean they might know in the ballpark or weather is covered by the insurance, but that kind of stuff is left for the billing folk.

^This is why many have pushed for business school like training for MDs. Running a practice is no different than running a large business. You need to know how to balance a budget and provide good care while minimizing the risks.

I think that's why they hire office managers and have accountants. I disagree that they need to be jacks of all trade. They need to practice medicine.

For large practices that is true. For a single primary care provider with a nurse or two it may not be financially feasible to hire an office manager.

In that case billing shouldn't be all the complicated. And I still think it's prudent to hire an accountant.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:In MD the hospital rates are set by the state.

Regardless, there isn't even consistent pricing with a single provider. Which prices do you want to compare? Insurance A contracted prices? Insurance B? Retail? Cash on;y discount? Medicare?

And correct me if I'm wrong, but I don't think that MDs even know what things cost. I mean they might know in the ballpark or weather is covered by the insurance, but that kind of stuff is left for the billing folk.

^This is why many have pushed for business school like training for MDs. Running a practice is no different than running a large business. You need to know how to balance a budget and provide good care while minimizing the risks.

I think that's why they hire office managers and have accountants. I disagree that they need to be jacks of all trade. They need to practice medicine.

For large practices that is true. For a single primary care provider with a nurse or two it may not be financially feasible to hire an office manager.

In that case billing shouldn't be all the complicated. And I still think it's prudent to hire an accountant.

Accountants are always good, but trust me medical billing is so complicated its actually a profession. Each insurance company has its own codes, procedures, etc. So not only do you need to know how it works, but you'd also need to know how each insurance company needs bills and paperwork prepared. It's extremely time consuming and one reason several doctors have moved away from private practice. They'd rather have a parent group (e.g. Johns Hopkins, Kaiser) handle their medical billing.

[Anonymous]

"So not only do you need to know how it works, but you'd also need to know how each insurance company needs bills and paperwork prepared."

You you need to know more than that. With BCBS, you need to know what zip code the provider is in in order to figure how what the allowable reimbursement rate is for a particular code. Frankly, I think it is a just a shell game insurers use to keep the upper hand.

[Anonymous]

Anonymous wrote:"So not only do you need to know how it works, but you'd also need to know how each insurance company needs bills and paperwork prepared."

You you need to know more than that. With BCBS, you need to know what zip code the provider is in in order to figure how what the allowable reimbursement rate is for a particular code. Frankly, I think it is a just a shell game insurers use to keep the upper hand.

Exactly. You don't know what you're gonna finally pay, and even when you do, insurance tries to weasel out of it by finding any technicality (or just delay paying by requesting more documents, "losing" papers, etc.)

And they send you gazillion different billing for every test, visit, and procedure.

Annual physical? Co-pay. 4wks later? Adjusted visit fee. 6wks later? Bloodwork fee #1 and EKG reading fee, 7wks later Bloodwork fee#2 and urinalysis fee. 8wks later, lab fee for bloodwork. Arrrrrrrgh!

[Anonymous]

I am a health economist who recently went though IVF, which is a market that should (and does) have more price transparency than the overall health care market (due to less insurance coverage, the fact that treatments are not an "emergency" so unlike a heart attach you can shop around, etc) and I found it was still hard/impossible to determine he total cost going in. For example, you could need higher doses of drugs than the doctor expected, which would increase the cost or your embryo could unexpectedly need a special procedure that costs extra. Overall, the experience made me feel that getting rid of insurance (even if people could afford to pay their full medical costs when sick, which they can't) would not make health care a perfectly functioning market. At best, it will be like the market to get your car repaired, where the mechanic knows more than you and you can get screwed over even if you get a second opinion (or pay a lot when it was necessary and just wonder if you got screwed over).

[Anonymous]

I thought this Washington Post article is interesting, and somewhat related:

http://www.washingtonpost.com/national/health-science/cash-rewards-for-thrifty-health-consumers/2012/03/08/gIQAvoHgcS_story.html