Hospital costs now public

[jerseygirl]

Last year Trump administration passed final rule that hospitals must make their costs public starting Jan 2021 (first link)
Well now the wild differences in costs are showing up.
Rather than just trying to get everyone insured, this hopefully will lead to lower costs (see bottom 2 links and hopefully lower insurance costs)

www.google.com/amp/s/www.policymed.com/amp/2019/11/trump-administration-releases-hospital-price-transparency-final-rule.html

www.google.com/amp/s/www.wsj.com/amp/articles/how-to-find-the-cost-of-hospital-medical-procedures-11613048778

www.google.com/amp/s/www.wsj.com/amp/articles/how-much-does-a-c-section-cost-at-one-hospital-anywhere-from-6-241-to-60-584-11613051137

[pulmonarymd]

Not a prayer this works. Patients do not shop based on costs, and many areas of the country have little competition due to consolidation of healthcare facilities. Medicare and Medicaid already determine what they pay hospitals, so no negotiation happens there, and big health plans already negotiate their prices. Another feel good order that will have no effect and kick the can down the road with dealing with our healthcare cost crisis

[minnesotapaintlady]

I wish they'd be more like the vet and give you a rough estimate as you go. $400 to stick a tweezers in my kids ear and pull a piece of rubber out?  I'll pass and take him home to do it myself.

[Lizard Queen]

Oh, I think it's going to help a bit. A lot of people have little choice where to go, though, but more transperency is a good thing. People will start asking questions.

[pulmonarymd]

If you have no choice as to where to go, how does knowing what something costs help? You can either get the test done or not. If you have private insurance, we are not allowed to negotiate, and if you get charged less than Medicare rates without a good reason, Medicare does not like it.

[justme]

I think it would be way more helpful if it was for non-hospital places. Besides those that have to use the ER as a regular doctor because they have no insurance (and likely aren't actually paying much anyways) when you go to a hospital it's almost always because you need to and you're not going to quibble about which is cheapest. If you even have a choice - I have technically at least 5 hospitals within 30 mins of me but they're all part of 2 chains so not that much competition and all hospitals of the same chain are likely same price.

Whereas with other stuff if you know the choice before you go  you might pick one or the other. I think my insurance is doing that a little bit if you bother to log in and look at estimated costs. 

[giramomma]

I think it depends. Some things you cannot be provided estimates...like for maternity care. I actually tried to get an estimated price tag for #4, and my insurance said "sorry, we can't. We don't know what you'll need for treatment and what you won't."

And we only have two hospitals that you can deliver at in a city of 250K. So, I ended up in a situation like pulimonaryMD..either I had the tests, or I decline them. Not based on money of course, but if it made sense.

There are very few urgent care/walk in type places too in my city. We have 3 urgent care places for 250K people.

So my city really isn't set up for comparison shopping. It's you go where they will take your, or you go to the clinic that only takes the uninsured.

[myrrh]

It would be nice to know the various options though, along with the percentage of patients who get them. Something like below, with an estimated dollar amount for each. I know there's stuff I am missing or don't know, but you get the idea.

C-section 
vaginal birth 
epidural 
spinal
IV
pitocin/induction
UV treatment (for jaundice)
bed/meals (per night)

[jerseygirl]

Actually you could shop for a hip or knee replacement, also L&D , cataract surgery, etc. Many docs can give you a choice of hospital or a surgicenter
Not ER and if you’re in a rural area with only one hospital you’re limited

But I do think more information will bring some costs down
Eye laser surgery certainly decreased in price cause it’s not covered by insurance and prices are publicized.

[NomoreDramaQ1015]

I think it would be nice to have some things upfront.   CHI here decided that if you don't come in to see your doctor every six months then anytime you go in  you are charged a $250 new patient fee.

Nowhere was this listed, there was no mention of it made when DH would go in for his physical. .. nothing.  All of a sudden I'd get a $250 office visit when according to our insurance physicals should be covered 100%.  

So I did some digging.  I was told that they do it that way because "they want you to build a relationship with your doctor and once a year isn't enough".  Why the hell would I be going more than once a year if I am healthy?   

Nope.  We switched to Methodist.  I imagine once people figured it out a lot of people switched.  There is zero reason they could not be upfront about that except they knew it would piss people off.

Shit like that should be 100% transparent.   My insurance did not cover the $250 because that was outside their limit and not a part of the actual physical services.   That's a lot of money for some people.  All because you don't come to say hi to your doctor twice a year instead of one?

[pulmonarymd]

Feb 12, 2021 15:30:20 GMT -5 jerseygirl said:

Actually you could shop for a hip or knee replacement, also L& , cataract surgery, etc. Many docs can give you a choice of hospital or a surgicenter
Not ER and if you’re in a rural area with only one hospital you’re limited

But I do think more information will bring some costs down
Eye laser surgery certainly decreased in price cause it’s not covered by insurance and prices are publicized.

Unless you have an HSA or old time insurance, this doesn't work either. A PPO or HMO will require you to be in network, and they have already negotiated your discount. And as I said, you cannot pay less than Medicare. Medicare finds out, and they go to the healthcare provider and ask for all their money that they paid over whatever you did. Nobody will get a better deal. And how many people can pay cash for a joint replacement?

[bookkeeper]

I used to visit a chiropractic office that had the charges for services on the wall.  Went back after a year and a half and the poster has been removed.  I use a dentist that explains all the work he wants to perform and brings you a list of charges which you can then accept or take home to think about.  Nobody likes to be surprised with a healthcare bill. Seems pretty customer friendly to be upfront about money.

I took our son to the clinic when he was 10 or so.  He had burnt his leg on a minibike muffler.  No biggie, we saw the P.A. and they applied ointment and then a dressing and tape.  The dressing fell off in the parking lot of the clinic.  When the bill came for $600 for in office surgery I lost it.  This was literally an office visit.  When I called to complain the billing department refused to back down the charges without the P.A. approving it.  I said put him on the phone.  He was unwilling to back down from his charges until I explained that I had a very big mouth and would be telling the entire community about how he charges $600 to put ointment on a kid and a bandage that falls off in the parking lot.  This Catholic clinic was notorious for overcharging people with top tier health insurance.  The charges were reduced to an office call as I requested but not before it was pointed out to me that my insurance would pay for the higher cost anyway.

Healthcare in America can be difficult.

[Deleted]

High-deductible policies were sold to us with the pitch that we could be "informed consumers". Very hard to do in the absence of information. Before I was on Medicare I had a HDHP and needed a colonoscopy. Since they'd found an adenoma in the previous one it would not be preventative but diagnostic so I'd be on the hook for the costs. I liked the doc I'd used before but he used hospital facilities. His office could tell me wheat HE would charge but not the hospital. I didn't even try to find out what the hospital would charge- I figured I'd end up in voice menu hell with no way to get a good answer. I went with a doc who operated out of a free-standing facility where they could quote me a total cost.

And then insurance paid it anyway.

More information is better, although it may not help with the many other issues such as billing from out-of-network providers (ER Docs, anaesthesiologists not employees of the in-network hospital) and lab bills that trickle in later.

I don't order in restaurants without looking at the prices on the menu and I sure don't tell the sommelier to bring whatever wine he/she thinks would go best with the meal and not determine the price. The stakes are even higher when you've got a $6K deductible on your medical insurance.

[jerseygirl]

Feb 12, 2021 16:13:52 GMT -5 @athena53 said:

High-deductible policies were sold to us with the pitch that we could be "informed consumers". Very hard to do in the absence of information. Before I was on Medicare I had a HDHP and needed a colonoscopy. Since they'd found an adenoma in the previous one it would not be preventative but diagnostic so I'd be on the hook for the costs. I liked the doc I'd used before but he used hospital facilities. His office could tell me wheat HE would charge but not the hospital. I didn't even try to find out what the hospital would charge- I figured I'd end up in voice menu hell with no way to get a good answer. I went with a doc who operated out of a free-standing facility where they could quote me a total cost.

And then insurance paid it anyway.

More information is better, although it may not help with the many other issues such as billing from out-of-network providers (ER Docs, anaesthesiologists not employees of the in-network hospital) and lab bills that trickle in later.

I don't order in restaurants without looking at the prices on the menu and I sure don't tell the sommelier to bring whatever wine he/she thinks would go best with the meal and not determine the price. The stakes are even higher when you've got a $6K deductible on your medical insurance.

Actually another Trump program - in the ER if your insurance covers then you will get NO out of plan bills from out/of- network docs- no SURPRISE! bills. Signed end of year. Another way to decrease medical bills and hopefully also decrease health insurance

www.google.com/amp/s/www.marketplace.org/2020/12/30/no-more-surprise-medical-bills-what-will-that-mean-for-insurance-premiums/amp

www.google.com/amp/s/www.vox.com/platform/amp/2019/5/9/18551274/trump-surprise-medical-bills-congress

[pulmonarymd]

So the ED physicians have to take the network rates. They cannot decide if they want to participate or not. Maybe that should be the case for the Orthopedic surgeons.

I thought Republicans wanted less regulation in health Care

[The Walk of the Penguin Mich]

Feb 12, 2021 15:30:20 GMT -5 jerseygirl said:

Actually you could shop for a hip or knee replacement, also L& , cataract surgery, etc. Many docs can give you a choice of hospital or a surgicenter
Not ER and if you’re in a rural area with only one hospital you’re limited

But I do think more information will bring some costs down
Eye laser surgery certainly decreased in price cause it’s not covered by insurance and prices are publicized.

What difference does it make?  My insurance is going to dictate my surgeon, and the doctor’s operating privileges are going to dictate where he can do surgery.  My insurance is also going to dictate how long I can stay in the hospital, and what drugs are covered.  

[Miss Tequila]

Feb 12, 2021 15:46:24 GMT -5 pulmonarymd said:

Feb 12, 2021 15:30:20 GMT -5 jerseygirl said:

Actually you could shop for a hip or knee replacement, also L& , cataract surgery, etc. Many docs can give you a choice of hospital or a surgicenter
Not ER and if you’re in a rural area with only one hospital you’re limited

But I do think more information will bring some costs down
Eye laser surgery certainly decreased in price cause it’s not covered by insurance and prices are publicized.

Unless you have an HSA or old time insurance, this doesn't work either. A PPO or HMO will require you to be in network, and they have already negotiated your discount. And as I said, you cannot pay less than Medicare. Medicare finds out, and they go to the healthcare provider and ask for all their money that they paid over whatever you did. Nobody will get a better deal. And how many people can pay cash for a joint replacement?

But there are still differences in rates paid in network. I worked with our insurance company to not only negotiate rates but to try to get our employees more involved with reigning in the costs of healthcare. One of the things I discussed with our insurance company was getting easy access for employees to see the difference is costs. I’m not taking about heart surgery. Obviously I’m going with the best, cost be damned. But something as simple as an MRI would have different prices at different in-network providers. I left just a few months after that discussion so I am guessing it got dropped. But the biggest take away for me was that insurance companies negotiate different prices for the same procedure. We should be aware of those costs and choose wisely. My suggestion was to rebate the employee 10% or 20% (or some %) of the cost savings by choosing a lower priced test. We were 80% experience rated so that savings truly impacted our premiuma

[Miss Tequila]

Feb 12, 2021 17:45:45 GMT -5 The Walk of the Penguin Mich said:

Feb 12, 2021 15:30:20 GMT -5 jerseygirl said:

Actually you could shop for a hip or knee replacement, also L& , cataract surgery, etc. Many docs can give you a choice of hospital or a surgicenter
Not ER and if you’re in a rural area with only one hospital you’re limited

But I do think more information will bring some costs down
Eye laser surgery certainly decreased in price cause it’s not covered by insurance and prices are publicized.

What difference does it make?  My insurance is going to dictate my surgeon, and the doctor’s operating privileges are going to dictate where he can do surgery.  My insurance is also going to dictate how long I can stay in the hospital, and what drugs are covered.  

I have a PPO and I can select my surgeon. I did that when I had my last surgery. When I was admitted for Covid, I chose the hospital that I wanted to go to. I had several options that were all in-network.

[pulmonarymd]

Feb 12, 2021 18:55:37 GMT -5 Miss Tequila said:

Feb 12, 2021 15:46:24 GMT -5 pulmonarymd said:

Unless you have an HSA or old time insurance, this doesn't work either. A PPO or HMO will require you to be in network, and they have already negotiated your discount. And as I said, you cannot pay less than Medicare. Medicare finds out, and they go to the healthcare provider and ask for all their money that they paid over whatever you did. Nobody will get a better deal. And how many people can pay cash for a joint replacement?

But there are still differences in rates paid in network. I worked with our insurance company to not only negotiate rates but to try to get our employees more involved with reigning in the costs of healthcare. One of the things I discussed with our insurance company was getting easy access for employees to see the difference is costs. I’m not taking about heart surgery. Obviously I’m going with the best, cost be damned. But something as simple as an MRI would have different prices at different in-network providers. I left just a few months after that discussion so I am guessing it got dropped. But the biggest take away for me was that insurance companies negotiate different prices for the same procedure. We should be aware of those costs and choose wisely. My suggestion was to rebate the employee 10% or 20% (or some %) of the cost savings by choosing a lower priced test. We were 80% experience rated so that savings truly impacted our premiuma

Sure, that’s what insurance companies do. But I am skeptical that people care about cost beyond what their out of pocket costs are. They really do not care about the cost to the insurance company. The people on this board are an exception to that, in that they do recognize what is driving insurance premiums.

Your point about quality is an important one too. Another reason why people do not price shop.

[jerseygirl]

Feb 12, 2021 17:45:45 GMT -5 The Walk of the Penguin Mich said:

Feb 12, 2021 15:30:20 GMT -5 jerseygirl said:

Actually you could shop for a hip or knee replacement, also L& , cataract surgery, etc. Many docs can give you a choice of hospital or a surgicenter
Not ER and if you’re in a rural area with only one hospital you’re limited

But I do think more information will bring some costs down
Eye laser surgery certainly decreased in price cause it’s not covered by insurance and prices are publicized.

What difference does it make?  My insurance is going to dictate my surgeon, and the doctor’s operating privileges are going to dictate where he can do surgery.  My insurance is also going to dictate how long I can stay in the hospital, and what drugs are covered.  

We don’t live in a rural area, our doctors have admitting privileges at least 2 hospitals and usually a surgicenter.
Your insurance dictates your surgeon! That’s terrible

[The Walk of the Penguin Mich]

Feb 12, 2021 19:08:33 GMT -5 jerseygirl said:

Feb 12, 2021 17:45:45 GMT -5 The Walk of the Penguin Mich said:

What difference does it make?  My insurance is going to dictate my surgeon, and the doctor’s operating privileges are going to dictate where he can do surgery.  My insurance is also going to dictate how long I can stay in the hospital, and what drugs are covered.  

We don’t live in a rural area, our doctors have admitting privileges at least 2 hospitals and usually a surgicenter.
Your insurance dictates your surgeon! That’s terrible

Most insurance was companies do unless you want to pay for the surgeon’s services.  My surgeon was not in my insurance plan because I needed his specialized services.  I chose to pay OOP for his expertise.  

Most people have a list of doctors they are allowed to use on their insurance, if you want your insurance to pay.

[The Walk of the Penguin Mich]

Feb 12, 2021 18:56:48 GMT -5 Miss Tequila said:

Feb 12, 2021 17:45:45 GMT -5 The Walk of the Penguin Mich said:

What difference does it make?  My insurance is going to dictate my surgeon, and the doctor’s operating privileges are going to dictate where he can do surgery.  My insurance is also going to dictate how long I can stay in the hospital, and what drugs are covered.  

I have a PPO and I can select my surgeon. I did that when I had my last surgery. When I was admitted for Covid, I chose the hospital that I wanted to go to. I had several options that were all in-network.

Not all surgeons take all insurances, even on a PPO.  My orthopedic surgeon did not.  However, as he was one of the few specialists in the US who could do what I needed (turn a PAO into a replacement), choices were limited.  

[thyme4change]

There was a theory out there, and it was pretty fleshed out with references and support, that posting costs may actually **increase** the overall cost of Healthcare.

The theory goes like this....

I value my health, and I have money and insurance, but I don't know much about how to evaluate what constitutes good care (based on many studies that nice doctors are sued less, even if they are objectively a bad doctor, and rude doctors are sued more). I may do some research and see some marketing, but at the end of the day, the most expensive doctor/facility must be the best one - even if their outcomes are the same as an average priced facility. So, I will go to the most expensive one, because I am worth it. Maybe the average priced facility raises their prices so they can get the accolades they deserve.

Now, let's talk about the other side. I still value my health, but maybe my resources are a little tighter. Although I am worth it, and I will sacrifice to get the care I deserve, I can't afford to go to the very best. What I do know is that I will NOT go to the cheapest facility. They must be terrible. I don't want a bargain basement hip replacement- this thing has to last me forever. So, the lowest cost hospitals lose business.

Plus, most of this is covered by insurance, so what do I care?

And uninsured poverty stricken people will continue to go to the closest place and not pay.

[thyme4change]

This is an industry group, so definitely slanted. But, some interesting points in what some unintended consequences could be.

www.healthaffairs.org/doi/10.1377/hblog20200304.157067

I am not against transparency- especially when it is out of pocket stuff. But, I am not sure there is an easy answer.

[Lizard Queen]

Just thinking that it might be good if more people are questioning why they are charged $10 for one pill of Tylenol at the hospital.

[countrygirl2]

I have no complaints with medicare and my supplement and hubs had good insurance for a long time. I have plan F, it may get to expensive eventually but for now it covers all my deductibles and everything. Had no problems here with getting doctors. We have 3 hospitals and another south of us we may eventually use. Distance is the same. Just our primary comes to this town and makes it convenient. We also have a great Emergency Care clinic I can take DD too. It's owned by a couple of physicians and she has been going there long enough they have a good record for her.  My complaint is drug costs, thankfully though all I'm taking right now are older ones and the deductibles are low only one premarin that I pay a lot for.

Hubs has medicare and Plan G, means he picks up deductibles, he changed it because he said he isn't sick much, I tried to tell him, but its ok, we can deal with it. Again the problem is drug costs, he has to pay out of pocket more then me.

After we took medicare, DD then became eligible for medicare and medicaid, so she is good on everything. I appreciate this medical care help for her.

Our premiums are going up but no matter how high they get we will pay them, for us not being insured is not an option. We would just do without something else to have insurance.

[formerroomate99]

I’ve spent the last 20 years working for private companies in small cities in the middle of the country. The insurance plan changed every year or two. In every case, I could choose from many doctors, all of whom had privileges at several hospitals.

The pulmonary makes a good point. If the insurance company reimburses different doctors or hospitals at different rates, and you can’t get that information from the billing department or the insurance company, knowing how much different doctors/hospitals charge is not as useful.

[jerseygirl]

This year hospitals must publish costs
Next year insurance companies must publish costs

Sure insurance pays your bills so maybe you don’t care about these costs. But most insurance plans have deductibles and co- pays which can add up to large amounts. So knowing costs might make it possible for someone to choose less expensive. Plus publicizing costs may bring competition into the mix potentially lowering costs

www.npr.org/sections/health-shots/2021/01/05/953340571/hospitals-forced-to-be-more-transparent-about-pricing-will-that-save-you-money

[pulmonarymd]

Unless you have an HSA, copays for most private insurance does not change if you are in network. Medicare copays are the same. You are talking about a small percentage of people with private insurance being affected by this, and even fewer who pay attention

With all the consolidation that has occurred in healthcare and insurance, many major metropolitan areas have limited competition where these issues will make a difference

[The Walk of the Penguin Mich]

Feb 15, 2021 14:13:50 GMT -5 jerseygirl said:

This year hospitals must publish costs
Next year insurance companies must publish costs

Sure insurance pays your bills so maybe you don’t care about these costs. But most insurance plans have deductibles and co- pays which can add up to large amounts. So knowing costs might make it possible for someone to choose less expensive. Plus publicizing costs may bring competition into the mix potentially lowering costs

www.npr.org/sections/health-shots/2021/01/05/953340571/hospitals-forced-to-be-more-transparent-about-pricing-will-that-save-you-money

This still makes absolutely no sense.  My insurance company negotiates a rate for a particular service, and I pay my deductible.  If the negotiated service price encompasses my full deductible, then I pay my full deductible (assuming that I've not yet met this year's deductible).  It doesn't matter if my medical service is a $40K surgery or a $400K surgery, if the surgeon and the hospital is covered by my insurance, I pay my deductible.  Choosing someone less expensive doesn't mean my insurance company has negotiated the same rate with them.  So I would not only have to know the price of the service, but what proportion my insurance company would pay.  Half of that data is not on the table, so this is impossible to determine.  

Considering that insurance companies set their deductibles and copays, I know exactly how much I am on the hook for if I need to use my insurance to the max.  When I got sick, my OOP costs were $13K.  It was very easy to figure out where the costs came from.  My infection ran pretty much my full, IRS fiscal year but my insurance plan fiscal year split the year in half as it was July to June).  So I got to pay 2 x $1500 as in network deductibles.  I paid 2 x $4500 as out of network deductibles.  That is $12K.  I had $13K in expenses, the balance was copays for drugs and PT.  

Publicizing the cost of the 4 surgeries, the 6 weeks in the hospital, the month in rehab wouldn't change a bit what I ultimately paid, and I'd posit that in many cases patients are going to look for the best person to do the job - not the cheapest.