Healthcare is broken

[nucular]

I had an MRI done on my shoulder not too long ago and the healthcare provider billed $2500 for it. The insurance company negotiated it down to $300. They didn't pay the other $2200, they just only pay $300 and because the provider is in-network, they have to accept that and I get to pay $300. That original charge was an 800% markup from what they are willing to accept for that service. If I walked in off the street, I would have had to pay that $2500 unless I did some sort of cash negotiation with them. I am just venting but this system is freaking broken.

 

[OneBadV8]

I had an MRI done on my shoulder not too long ago and the healthcare provider billed $2500 for it. The insurance company negotiated it down to $300. They didn't pay the other $2200, they just only pay $300 and because the provider is in-network, they have to accept that and I get to pay $300. That original charge was an 800% markup from what they are willing to accept for that service. If I walked in off the street, I would have had to pay that $2500 unless I did some sort of cash negotiation with them. I am just venting but this system is freaking broken.

it's the insurance and negotiated rates though.

Independent place down the street from me will do an MRI for $400 Cash price.

If I went through insurance, the co-pay is $500 with the total cost being in the thousands.

 

[Creedmoor]

I had an MRI done on my shoulder not too long ago and the healthcare provider billed $2500 for it. The insurance company negotiated it down to $300. They didn't pay the other $2200, they just only pay $300 and because the provider is in-network, they have to accept that and I get to pay $300. That original charge was an 800% markup from what they are willing to accept for that service. If I walked in off the street, I would have had to pay that $2500 unless I did some sort of cash negotiation with them. I am just venting but this system is freaking broken.

I find some of it interesting myself, in the last few years I have gone to the clinic on Andersons bypass ( Community? )for the flu and lung infection. The bill was around $175.00 and since I was paying that day it ended up at $60 or $65.00.
It makes one go, Hummmmm

 

[bwframe]

A lot of these crazy high bills are due to the government involvement in our healthcare.

You all remember, back when we let them pass government healthcare, right?

A lot of smart people said at that time, "Just wait, healthcare will never be more expensive then when it becomes "free healthcare."

 

[Cameramonkey]

it's the insurance and negotiated rates though.

Independent place down the street from me will do an MRI for $400 Cash price.

If I went through insurance, the co-pay is $500 with the total cost being in the thousands.

THIS.

I had one done at Methodist Sports Med for $400 cash. Methodist hospital and St Vincent hospital both wanted $2500 for the same procedure when I was shopping around.

The only difference was mine was done in a strip mall, and the other would have been in an actual hospital. But same exact results.

Oh, and no parking garage cost either. LOL

 

[Ark]

I had an MRI done on my shoulder not too long ago and the healthcare provider billed $2500 for it. The insurance company negotiated it down to $300. They didn't pay the other $2200, they just only pay $300 and because the provider is in-network, they have to accept that and I get to pay $300. That original charge was an 800% markup from what they are willing to accept for that service. If I walked in off the street, I would have had to pay that $2500 unless I did some sort of cash negotiation with them. I am just venting but this system is freaking broken.

This repricing is the real service you're paying an insurer for. They are the check against providers simply charging whatever they want because you can't say no.

You probably could have paid something like $500 cash in the end, after a long process of unnecessary argument and petitioning. Sticker price in healthcare is basically meaningless, everything is negotiated by payers and networks.

If it weren't for piles of needless health regulation, we could have Joe Bob's MRI and Gun Shop running MRIs for $50 cash and paying nothing but payments on the machine, the space to keep it in, and one employee.

 

[pute62]

It is broke and nobody wants to fix it. I'm on MDwise which is the Happy Pappy insurance plan and can't believe how money is wasted. The hospice company I'm with is even worse.

 

[BJHay]

Healthcare was broken before Obamacare. Back in the day, we took my son to St. Vincent's ER for a broken arm. The nurse on duty was an acquaintance of my wife and said we were probably the only people there who would pay their bill. It was busy and filled with people who needed healthcare but couldn't get it and knew the ER couldn't turn them away. In Crawfordsville, at the time, there were no doctors, none, that were accepting new Medicaid patients, and I think darn few in Indy were either.

The weird system that developed over decades (from bad government policy) causing healthcare to come from your employer was broken for anyone who didn't have employer-sponsored healthcare.

That was a queue for the Republicans to step in (when they had a majority) and replace the employer-based system with a free market solution. Instead, they ignored the problem allowing the Democrats to do what they did.

Now, I'm starting to wonder if what we have isn't turning into the worst of both worlds. A free market solution would be ideal but perhaps going full into a single-payer system would be an improvement over the current mess.

Start watching for doctor visits to be increasingly replaced by Physician Assistants and Nurse practitioners. Mid-level providers are great for some basic things but the HHS is going to further loosen their oversight requirements and they're going to do more. They're cheaper than doctors and will become more so as the trend of doctor burnout increases.

OK, there is my 2 cents on the matter.

 

[spencer rifle]

As I've mentioned here before:
SWMBO needed a shoulder x-ray. She thought she would call around to get an idea of prices rather than just take the order to the specified place (a hospital). She called 9 places. Prices ranged from $2500 to $60 (plus a "reading fee"). But the most common answer was "We don't know." What, have they never done an x-ray before? Imagine going to a car dealership, asking the price, and being told that.

The likely real reason behind the evasive answer is "Depends on who's paying."

 

[Twangbanger]

The people who don't pay their bill don't think it's broken.

$500 is the price if they know the payer will actually pay.

$2500 is likely the pre-negotiation price for "Brother's Keeper" patients who may or may not pay. They have to price-in the negotiation losses, is my guess.

 

[femurphy77]

When I retire from the industry, I'll have stories to tell. . . .

 

[WebSnyper]

As I've mentioned here before:
SWMBO needed a shoulder x-ray. She thought she would call around to get an idea of prices rather than just take the order to the specified place (a hospital). She called 9 places. Prices ranged from $2500 to $60 (plus a "reading fee"). But the most common answer was "We don't know." What, have they never done an x-ray before? Imagine going to a car dealership, asking the price, and being told that.

The likely real reason behind the evasive answer is "Depends on who's paying."

And theoretically, there are laws in place requiring that transparency in pricing and providers are not complying.

 

[Ingomike]

I find some of it interesting myself, in the last few years I have gone to the clinic on Andersons bypass ( Community? )for the flu and lung infection. The bill was around $175.00 and since I was paying that day it ended up at $60 or $65.00.
It makes one go, Hummmmm

The extra hundred is for the cost of staff to get the $65 from the insurance company that you offer at the window…

Had a podiatrist that I would tell in the appointment I was paying cash and he made a cash price, if I had met deductibles he billed it differently…

 

[WebSnyper]

Healthcare was broken before Obamacare. Back in the day, we took my son to St. Vincent's ER for a broken arm. The nurse on duty was an acquaintance of my wife and said we were probably the only people there who would pay their bill. It was busy and filled with people who needed healthcare but couldn't get it and knew the ER couldn't turn them away. In Crawfordsville, at the time, there were no doctors, none, that were accepting new Medicaid patients, and I think darn few in Indy were either.

The weird system that developed over decades (from bad government policy) causing healthcare to come from your employer was broken for anyone who didn't have employer-sponsored healthcare.

That was a queue for the Republicans to step in (when they had a majority) and replace the employer-based system with a free market solution. Instead, they ignored the problem allowing the Democrats to do what they did.

Now, I'm starting to wonder if what we have isn't turning into the worst of both worlds. A free market solution would be ideal but perhaps going full into a single-payer system would be an improvement over the current mess.

Start watching for doctor visits to be increasingly replaced by Physician Assistants and Nurse practitioners. Mid-level providers are great for some basic things but the HHS is going to further loosen their oversight requirements and they're going to do more. They're cheaper than doctors and will become more so as the trend of doctor burnout increases.

OK, there is my 2 cents on the matter.

You had me up until the single payer aspect.

The market should be more open and decouple it from solely being an employer based benefit. I'm not against it being available as an employer benefit (I myself considered it heavily each time I have moved jobs, and even took a little less $$ at start due to great healthcare benefits), as that can help companies attract employees, but decoupling it and allowing reasonable, competitive options outside of employment as well would be a great thing, and free up labor to move even more freely between jobs.

I'm not interested at all in a single payer system. Lack of competition has seldom if ever produced something better.

I'm not looking forward at all to enrolling in medicare as I believe it will be a significant step down from what I have today.

 

[yeti rider]

When I retire from the industry, I'll have stories to tell. . . .

Please keep those to yourself. All it will do is confirm how messed up the system is. That'll raise my blood pressure and cause anxiety, then i'll have to go to the hospital and pay over-inflated bills.

 

[blain]

Having a third party in the middle of any transaction will always drive up the costs.

 

[Cameramonkey]

You had me up until the single payer aspect.

The market should be more open and decouple it from solely being an employer based benefit. I'm not against it being available as an employer benefit (I myself considered it heavily each time I have moved jobs, and even took a little less $$ at start due to great healthcare benefits), as that can help companies attract employees, but decoupling it and allowing reasonable, competitive options outside of employment as well would be a great thing, and free up labor to move even more freely between jobs.

I'm not interested at all in a single payer system. Lack of competition has seldom if ever produced something better.

I'm not looking forward at all to enrolling in medicare as I believe it will be a significant step down from what I have today.

And there is no good reason I shouldnt be able to buy insurance from providers in other states. I remembered learning about that when I worked for a tech company that was elbows deep in the healthcare insurance industry.

 

[bwframe]

And there is no good reason I shouldnt be able to buy insurance from providers in other states. I remembered learning about that when I worked for a tech company that was elbows deep in the healthcare insurance industry.

Exactly. Walmart and Amazon should be in competition for our healthcare business. On top of that, their involvement might shake out a lot of monopolys the healthcare industry has built in.

 

[WebSnyper]

And there is no good reason I shouldnt be able to buy insurance from providers in other states. I remembered learning about that when I worked for a tech company that was elbows deep in the healthcare insurance industry.

Agreed.

 

[WebSnyper]

Exactly. Walmart and Amazon should be in competition for our healthcare business. On top of that, their involvement might shake out a lot of monopolys the healthcare industry has built in.

Amazon is already in health care in some aspects. They have opened a pharmacy and I think I've seen something about clinics.