Healthcare Providers and Fees

[MissStepcut]

Does anyone else find it really difficult to pin down healthcare providers about the costs? I've had doctors say things like, "Gosh, I don't even know, you'll have to talk to my assistant about that," or otherwise seem just totally disconnected from the business side. For me, pursuing one treatment or another is both a financial and a health decision, but I find it so difficult to get them to have a transparent conversation with me about it! It's one thing when you're visiting a huge hospital, but I have the same issues with solo practitioners.

 

[sonnyjane]

I had to LOL when I read this because I just got off the phone four seconds ago with my doctor's office, and before that I was on the phone with my insurance, and before that I was on the phone with my doctor's office...and before THAT I was on the phone with my insurance! I have been calling them back and forth all day because I'm trying to get a straight answer about something. My doctor ordered some tests, and they are covered by my insurance, but they have to be done at an in-network facility, and the place my doctor referred me to was not in-network, so I have been on the phone and scouring the internet trying to find one and I finally had luck, but now I have to get my doctor to change my referral to that location and blah blah blah blah blah this is driving me batty! I'm going to need to see a mental health specialist due to the stress of my healthcare provider!

 

[marchesa6989]

i think you'll find the reason why doctors say something like that is so that they don't provide you with any misleading information. in the US, the healthcare system is quite complex and costs payable depend on socioeconomic status, health insurance etc. that is the exact reason why there are administrative staff in most clinics/hospitals, whether small or large. wouldn't you prefer we spend our time continuing professional development and improving our clinical skills and knowledge rather than learning the nitpicky details of medical accounting? i don't think it's the practitioner trying to be vague or to cover things up - more like they see a myriad of patients with different conditions everyday, perform different procedures, and can't remember which ones cost what, let alone how would they know how much out of pocket you will have and what coverage (if any) each patient is entitled to. that being said they should be able to say something like "there are a few options - some costlier than others" and give you an indication of which ones are more complex/cost more. but it's unrealistic to expect them to provide exact costs. don't forget if you're needing a surgery or something which involves other medical staff there are the fees involved to hire them, cost involved with different tests and scans, to get anesthesia, book into pre and post-surgical clinic etc. our goal is not to be a business or sell a product - we are there to look after your health.

in other countries such as Australia, the system is a little more transparent due to a medicare system that provides global healthcare for all citizens and a lower level of care to visitors. there are fixed costs, clearer insurance policies etc. the complexities of insurance, indemnity and lawsuits in the US is a plain headache for everyone involved.

 

[MissStepcut]

Marchesa I hear what you're saying but I don't agree with:

"wouldn't you prefer we spend our time continuing professional development and improving our clinical skills and knowledge rather than learning the nitpicky details of medical accounting?"

I think small business owners (which is exactly what small partnerships and solos are) should be able to talk about costs and how they're getting paid. For their own sake, and for mine.

 

[sonnyjane]

Marchesa I hear what you're saying but I don't agree with:

"wouldn't you prefer we spend our time continuing professional development and improving our clinical skills and knowledge rather than learning the nitpicky details of medical accounting?"

I think small business owners (which is exactly what small partnerships and solos are) should be able to talk about costs and how they're getting paid. For their own sake, and for mine.

On a more serious note than my general rant above lol, when I was working with paramedics, they told me that they were not allowed to disclose the costs of specific services if asked because it may affect the patient's medical decisions. In other words, if a patient needed a life-saving procedure, they were instructed that they could not mention how much it costs, because the patient might then refuse the treatment. That was almost 8 years ago though, so I'm not sure if that's changed. It's seems kind of wrong to me, since certain medical procedures can bankrupt someone, but that was what we were told. Now, those were also paramedics, not doctors. They were asked things like "how much is an ambulance ride" or "how much is it that IV going to cost?" They wouldn't say, would just explain why the medication or procedure was necessary. I'm not sure if doctors have different guidelines.

 

[Skippy123]

Does anyone else find it really difficult to pin down healthcare providers about the costs? I've had doctors say things like, "Gosh, I don't even know, you'll have to talk to my assistant about that," or otherwise seem just totally disconnected from the business side. For me, pursuing one treatment or another is both a financial and a health decision, but I find it so difficult to get them to have a transparent conversation with me about it! It's one thing when you're visiting a huge hospital, but I have the same issues with solo practitioners.

Ummm YEAH, have you ever seen how the different insurance companies negotiate things? There are so many variables that go into the insurance game. Ask for the Medical billing code and then call up your insurance company and have them look that up and see what they might pay??? It is all negotiated. How do I know?? I had 2 preemies that cost over a million dollars in medical expenses and I tracked down every expense and I can tell you it is a nightmare! I am still tracking everything down because I don't want to have to pay more than I have to! eta: oh and they do make mistakes, the ins co & med billing dept!!!

 

[joflier]

In many (or most) instances, the providers themselves and their staff can't give an exact $ amount, because, as others have mentioned, it varies soooo greatly depending on your insurance coverage. If I remember correctly, there is a law in place that says that costs of procedures need to be given upon request, but I believe these are the pre-discounted numbers. So, if you were to request the price of a chest xray - they can tell you the price will be $200. That may or may not include getting a radiologist to read the xrays. And your insurance might pay for $100 of it. Or you may only have a deductible fee, or........you get the idea. Its just not something that can be pinned down, unfortunately. You can get a base price, but that's about it. I know with our clinic system, if you direct your call to the billing department, you can usually a get a quicker answer, instead of contacting the dr, nurse, or other staff.

 

[MissStepcut]

In many (or most) instances, the providers themselves and their staff can't give an exact $ amount, because, as others have mentioned, it varies soooo greatly depending on your insurance coverage. If I remember correctly, there is a law in place that says that costs of procedures need to be given upon request, but I believe these are the pre-discounted numbers. So, if you were to request the price of a chest xray - they can tell you the price will be $200. That may or may not include getting a radiologist to read the xrays. And your insurance might pay for $100 of it. Or you may only have a deductible fee, or........you get the idea. Its just not something that can be pinned down, unfortunately. You can get a base price, but that's about it. I know with our clinic system, if you direct your call to the billing department, you can usually a get a quicker answer, instead of contacting the dr, nurse, or other staff.

It's one thing to not guarantee a certain amount and another to be totally ignorant about what your charges will be. You're right of course that other providers (like a radiologist) will charge more on top of it, but you should know what your own fees are if you're a small business owner.

 

[swingirl]

My husband's cardiologist actually told us he doesn't want to know the cost of his procedures because he doesn't want it to affect his decision about treatment.

 

[MissStepcut]

My husband's cardiologist actually told us he doesn't want to know the cost of his procedures because he doesn't want it to affect his decision about treatment.

But it affects my decision about treatment. I guess I find it a bit condescending. It's my cost:benefit analysis, not his or hers.

 

[swingirl]

My husband's cardiologist actually told us he doesn't want to know the cost of his procedures because he doesn't want it to affect his decision about treatment.

But it affects my decision about treatment. I guess I find it a bit condescending. It's my cost:benefit analysis, not his or hers.

I agree. The doctor's billers/coders and the insurance company should be able to estimate the cost of various procedures and treatments. They are being lazy because those figures are all spelled out IF the doctor has mapped out a plan.

 

[packrat]

I doubt the Dr I work for and the two ARNP's that work there could tell you "Your pap will cost X and if you have a complete blood panel it will be X but if you just do Lipids it will be X, and then if your deductible is X then you'll pay X out of pocket" When we're asked what things will cost, we ask about deductible and copay and get "But I have Blue Cross" Yes, and BCBS has many different polices, so we could tell you *roughly* what it *may* cost if you were to pay privately but we can't tell you what you'll pay after insurance. And we can say it costs X for the visit, X for the drawing fee, X for this test, X for that injection, and X for that injection fee, but sometimes there are tests we don't run in the office and blood is sent out-we don't know the labs billing, so you may get a bill from an outside lab. And not all insurances/policies pay for every test/injection. A lot of times we've had to tell people to check w/their insurance company to see if they'll pay for X-and we're expected to know what every insurance company will pay in every policy for every circumstance and that's just not going to happen. I don't do the billing/coding in the office but I spend a lot of time going thru things w/patients every week.

 

[MissStepcut]

I doubt the Dr I work for and the two ARNP's that work there could tell you "Your pap will cost X and if you have a complete blood panel it will be X but if you just do Lipids it will be X, and then if your deductible is X then you'll pay X out of pocket" When we're asked what things will cost, we ask about deductible and copay and get "But I have Blue Cross" Yes, and BCBS has many different polices, so we could tell you *roughly* what it *may* cost if you were to pay privately but we can't tell you what you'll pay after insurance. And we can say it costs X for the visit, X for the drawing fee, X for this test, X for that injection, and X for that injection fee, but sometimes there are tests we don't run in the office and blood is sent out-we don't know the labs billing, so you may get a bill from an outside lab. And not all insurances/policies pay for every test/injection. A lot of times we've had to tell people to check w/their insurance company to see if they'll pay for X-and we're expected to know what every insurance company will pay in every policy for every circumstance and that's just not going to happen. I don't do the billing/coding in the office but I spend a lot of time going thru things w/patients every week.

packrat, many of the instances I can think of, I was uninsured or I knew what I was getting wasn't covered (like dental stuff) but even then it can be hard to get someone to talk to me about ranges, alternatives, consequences...

 

[packrat]

Well hell then there's no reason they can't give you some sort of idea. That's just ridiculous. Our dentist has some sort of estimating tool for insurance, so you know roundabout what it will cost..tho we ran into an issue last year-they estimated something to cost under 300 and it ran over 900 and boooooy was I maaaaaaad and they said "Oh, sorry". For something that is private pay the billers should have some sort of idea tho, you're right and it would tick me off if they didn't.

 

[that_someone_special]

Yeah! And they nickel and dime! You know I was in the hospital a few months back and they charged me like $10 for those grey footy socks.

ugh.

 

[ksinger]

Health care in the US is a front-and-center example of how The Great And Glorious Hand of The Free Market is an illusion. It is a totally failed market.

We are propagandized by politicians that healthcare should be a consumer good, like a washer or a TV. But it's not, and we all know it. Healthcare does not respond to market forces for a number of reasons, first and foremost because, as mentioned, you can't know how much the "item" is going to cost before you consent to purchase it. Being able to make an informed choice is crucial to markets working as we are told they are supposed to.

You are also not generally in possession of enough information to decide for or against purchase of said item. You are told you will die without it (not much of a choice there huh? Not like being able to say I'll hold off on that new dishwasher until the price goes down.), and then aren't told the cost. In fact, as noted above, you can apparently be deliberately kept in the dark as to the cost. And when you ARE finally billed for the item, the price stated and the price paid are generally in completely different universes. You have no way of telling what is reasonable or customary.

Healthcare in the US is a right mess, that's for sure....

 

[packrat]

It's about half scary/funny to ask for a detailed line item bill. I remember being a kid and my mom on the phone yelling b/c she was billed like, $6 for one tongue depressor. That was probably 25 years ago-can you imagine what it would be now?

Need to check your EOB's from the insurance company too..after we had London, I just was perusing the ones that came in for our stay at the hospital b/c I thought it was interesting, the costs for anesthesia etc..and I saw "circumcision" and thought whaaa???? Obviously I knew they'd done no such thing. When I the office I asked why they billed for it, she said "We only bill for the procedures performed" and I asked if they'd like to hear from a lawyer b/c that meant they performed female circumcision on my daughter. Idiots had her as LANdon, male, not LONdon, female. And duh, why would you assume anyway that it was done and just automatically bill it for a male? Now I work there and the one who did it is my office manager.

 

[Skippy123]

My husband's cardiologist actually told us he doesn't want to know the cost of his procedures because he doesn't want it to affect his decision about treatment.

But it affects my decision about treatment. I guess I find it a bit condescending. It's my cost:benefit analysis, not his or hers.

Oh my gosh, I don't want the doctors to think about costs when doing procedures or even have to worry about that!!! I think it is awesome if they care to help change things (grass roots movements, etc) but their minds need to be used for what they got their degrees in. I don't find it condescending at all; MissStepcut, please go out with an accounting firm and do an audit on the billing. You would be mind boggled and billing contracts change year to year so I soooo don't want my doctor to be preoccupied with something like that. Yes, I do think we need more affordable healthcare for all but no way, to having doctors figure it out.

 

[Sparklelu]

I have been having some urology issues and needed to see a Urologist. Long story short I have Bcbs HMO and my Dr "was" a participating provider until her practice consolidated with another and no one notified BCBS, my Dr refferred her so off I went. In pain and on A Friday at 4:30 they tell me" we don't accept your insurance you have to self pay and we can bill as a courtesy. So I pay $587.00 for a 20 minute visit. When i mentioned to said Dr that she does not accept my insurance she said I dont?
Fast forward past 6 or so communications w BCBS and dr office. They accepted pmt from BCBS and wanted to refund me the 112.00 they got from BCBS & keep the $475. I gave them,.
When I asked to see a line by line statement I see $175.00 for urological training? Huh? When we finally figured it outit was this:
PA enters room
Says hi, do you know what kegel exercises are
Me: yes
PA: good do them several times a day
Me: ok

PA: leaves room !
I learned more from Cosmo magazine when I was 17 than I did from this gal and the Cosmo cost waaaay less!
They finally refunded my money but not without a fight!

 

[stepcutnut]

This is such a difficult/heated subject!

So complicated from the healthcare providers stand point and so frustrating from the patients point of view.

The trouble truly lies first hand with the insurance industry, it is what really messed up our healthcare system!!! They made healthcare a big business and is something that most individuals really don't have a good understanding of!

 

[MissStepcut]

I don't expect every provider to understand every insurer and stay up-to-date on every cost. I do, however, expect to be able to say, "I am paying for this out-of-pocket and I might not be able to accept some treatments if they're out of my budget" and not have doctors brush me off. Which has happened to me many times over the years. It just happened Friday when I found out I have to undergo some expensive dental work.

Not all treatments are life and death or even things with serious potential consequences. If we are going to expect people to be responsible for the cost of their own healthcare, we also should demand from the medical community that they empower consumer choices and not just assume every patient wants "the best possible treatment." I want the best possible treatment that I can afford and actually need.

 

[rubybeth]

I don't expect every provider to understand every insurer and stay up-to-date on every cost. I do, however, expect to be able to say, "I am paying for this out-of-pocket and I might not be able to accept some treatments if they're out of my budget" and not have doctors brush me off. Which has happened to me many times over the years. It just happened Friday when I found out I have to undergo some expensive dental work.

I don't think that the doctor/dentist is ever going to be able to know these things, but their front-line staff should be able to help you. My mom works for a dentist, and honestly, he has no idea what things cost! The receptionist and my mom handle all the billing and insurance issues, so they're the ones to ask. I would talk to the receptionist/billing office/nurse/assistant/whoever actually does the bills at your dentist/doctor before your appointment and let them know you need to know out of pocket costs for some procedures you may potentially need.

 

[MissStepcut]

I don't expect every provider to understand every insurer and stay up-to-date on every cost. I do, however, expect to be able to say, "I am paying for this out-of-pocket and I might not be able to accept some treatments if they're out of my budget" and not have doctors brush me off. Which has happened to me many times over the years. It just happened Friday when I found out I have to undergo some expensive dental work.

I don't think that the doctor/dentist is ever going to be able to know these things, but their front-line staff should be able to help you. My mom works for a dentist, and honestly, he has no idea what things cost! The receptionist and my mom handle all the billing and insurance issues, so they're the ones to ask. I would talk to the receptionist/billing office/nurse/assistant/whoever actually does the bills at your dentist/doctor before your appointment and let them know you need to know out of pocket costs for some procedures you may potentially need.

But the decisions about care are made with the MD. Maybe people who understand billing need to be consulted before care decisions are made, but that's not how the system is usually set up, because if I have to go back out front and decide one line of treatment is out of budget, I need the MD's attention again to discuss alternatives. The disconnect is both impractical and frustrating.

 

[packrat]

Doc will come out of the room and ask the billers about costs if there is concern, and she'll have the nurses call over to Radiology if there are questions about costs there etc. Then she'll go back in the room w/whatever info she's been given, or ask the pt to wait in the room, she'll see the next pt and then go back in w/rough estimates on costs. Sometimes she'll go over what she can and then call the pt back w/costs or the nurse will etc.

 

[smitcompton]

Hi,

I had out of pocket costs at the dermatolgist. He knew exactly what my insurance would cover and what I had to pay for. He even asked how I was going to make the payment.

My gyne oncologist prepares a bill with the usual and customary charges on it and I almost fall over. However my insurance(medicare) will be paid what has been contractually agreed upon. The usual and customary charges are used in negotiating with insurers.

My neurolgist knows what his office visits cost and he also checks with his staff on other charges.

I have never gone to any dentist that did not know charges for those without insurance. I get an estimate each time. Pretty exact.

Just read an article on how doctors are filing for bankruptcy, or have to take personal loans out to pay for staff salaries. Insurers have cut costs, medicare has cut drug costs and the article stated doctors do not run their practices as small businesses. The author blamed them for not understanding how their practice works. One doctor learned that he could not treat all ailments in the same visit. He had the patient come back for each ailment so he could bill for each visit. My GP makes me come in to see him or he will not prescribe my medications, which I have been on for 15 yrs. Nothing wrong with me, I just have to see him. Paid visit though.
Nurses are sometimes paid more than a Drs visit. Sometimes things seem backward.
I have mostly had wonderful doctors, but I think they should know more about the business side.

Annette