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Whelp, I just got screwed again by the lack of price transparency in the American Healthcare System. feelsbad.man.jpg
Thankfully, it's not a huge dollar figure, but it's the sheer stupidity of clinging to price opacity, which inevitably finds some way to reach into my pocket and pull out more money, that annoys me.
It was not a situation where the provider didn't have the necessary information to understand why the price ended up being what it was. When I called them to ask WTH, it took all of three minutes for them to just go through the steps of verifying the process and then explaining it to me. But that's three minutes that they should have spent going through the steps in order to give me a price before they performed the service, rather than blindsiding me with a bill after the fact.
Yes, yes, I know, they don't want to spend three minutes per patient; that adds up! And of course they don't want to; it's not only their time being spent; it's not in any way in their favor to spend those three minutes. It's my pocket that it comes out of, after all.
Moreover, it was a situation where, had they spent the three minutes and we could have then had a conversation about the price, in hindsight, I am extremely confident about how I would have made a different choice as to the way that I arranged the services that I would have liked to acquire. I literally, actually, could have personally made a different choice if I had had price information, and it's a choice that I would have preferred in terms of my personal cost/benefit analysis.
Of course, it must be remarked on that had I had this information and had I made the choice that I would have preferred, the provider would have made slightly less money. I don't think they were doing this on purpose; it's just convenient for them to not spend three minutes and also probably make more money. They just have near zero incentive to even consider doing things in a way that may be in my own interest. The only danger that they run is that if folks like me eventually get pissed off enough at these shenanigans, we'll either search desperately for a different provider who will bother spending three minutes or simply get so fed up with the constant nonsense that we just eschew that sort of service altogether. Man, it's tempting to do that, because it's just... so... constant a problem. I'm already pretty cynical for how they're going to find a way to screw me over, and apparently even that was not enough cynicism.
The snafu did, in a minor way, relate to the way the insurance policy is written. I mention this only because I would like to hold open at least some amount of plausible blame for them (it's really kind of hard to in this particular situation, but I'll mention it anyway), but the provider legitimately had 100% of the information necessary to provide me an actual price and discuss tradeoffs/courses of action prior to services being rendered. They just didn't bother.
This feeling really makes me sympathize with all the people who are so outraged. I'm sure there are tons and tons of stories where the insurance company is more to blame, too, so I sympathize with those folks feeling gut anger at them, too. It's just monumentally infuriating to have them over and over again find endless ways to screw you over and see that it's not even malevolence. It's pure apathy toward your interests as a patient combined with an addiction to doing everything possible to remain price opaque.
Another interesting gotcha is that if you have an HDHP/HSA and have an in-network service, you are required to pay the full in-network cost of the service out of your pocket, no haggling allowed because the amount you pay is counted into your deductible and other factors. This leads to interesting cases where that amount is significantly higher than the uninsured self-pay rate, and having insurance (and being in-network) is actually making things much much worse. Though on the other hand it is a form of price discrimination in that the hospitals make more money from patients with insurance, and for patients without insurance but still some money, the hospital can get something instead of nothing.
In this case you unfortunately need to go to your insurance to find out the prices, as the clinics and doctors kind of have no say in the matter. Which is unfortunate because health insurance companies are a huge mess to deal with.
For anyone on HMO/PPO usually this isn't a concern because copays are generally predictable, and the most common cause of a surprise gigabill is due to a service being out of network but nobody checked or told you, or if a claim is denied. And in that case the bill certainly is negotiable and generally you'll have decent success negotiating it down.
But in my personal imo after paying fully out of pocket on HDHP, medical treatment outside of the hospital is actually quite affordable. After seeing multiple specialists and having tons of blood draws and labs, the yearly cost is only a few thousand dollars, far below the premiums of even a basic ACA plan. But the moment you set foot in a hospital the gigabills come out. Just the room in the ER for half an hour will set you back thousands, and that doesn't include the doctor or any of the treatments.
This is not true. It's a lie perpetuated by providers who want to remain price opaque.
Providers and insurance companies sign agreements, where they agree to a list of negotiated prices. They both sign this agreement. They both have a copy of this agreement that they signed. They both have a copy of the negotiated prices. Either party is perfectly capable of looking at their copy of the prices and telling you the number they've agreed to.
Imagine that this lie were actually true, and clinics/doctors truly had "no say in the matter". Well, then the insurance company could just magically decide that the price is $1, right? There's nothing the clinics/doctors could do about it, if they "have no say in the matter". But in reality, they do have a say in the matter, and it happens when they negotiate an agreement on a list of prices. If, prior to signing an agreement on a list of prices, the insurance company were to say, "If you sign this agreement, we'll pay you $1 for services," the provider simply won't sign the agreement; it's not worth it to them to be "in-network" if it only pays $1. If, on the other hand, after signing an agreement on a list of prices, the insurance company were to say, "Lol, whatevs about that whole 'price list' BS, we're gonna only pay you $1, because you have no say in the matter," then the provider will simply point to the agreement that they signed, in writing, with the threat of obviously winning lawsuits.
I've long assumed that either the insurance companies or the care providers (or both!) want to keep the list prices hidden. I assume for competitive reasons. I thought the first Trump administration passed rules requiring those to be published, but that doesn't seem to have done much in practice (published, behind a door marked "beware of the leopard"?).
My personal suggestion is that we should, as a condition of accepting Medicare patients/payments, require providers to charge no more than a multiple of the Medicare price list, even if that multiple is something like 2 or 3.
functionally speaking this is the current status quo - commercial prices are generally somewhere around 1.5-2.5 of the Medicare price for a given service.
The hospital transparency stuff is hidden behind massive massive JSON files and poor data quality. Numerous startups are working in the space to make it actually transparent - still a work in progress.
The insurers themselves are doing some of the work by using eg variable copays to drive utilization to cheaper contracted hospitals. Only works in urban cores though.
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Hospitals all post their list prices these days, but unfortunately those are the list price and literally everyone gets a discount of some sort.
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