topic Re: How often do you do something without knowing the price? in Community Chat

How often do you do something without knowing the price?

Abrowneyegirl — Fri, 22 Jul 2016 14:13:41 GMT

My blood is boiling!!!

When will there be transparency in medical pricing and costs?

When my doctor suggested that I should have a ultrasound of my heart to establish a baseline for my medical records I said fine.

When I went to the front office to schedule, I asked about the $$ (it is done in the office). I am on private insurance and need to plan for deductible, co-insurance, FHSA, etc.

You would think I asked them the gross national product of Venezuela! Several people started to scurry around trying to figure this out. One women had the nerve to ask me why I wanted to know. I asked her when was the last time she bought something for thousands of dollars, that can not be returned without knowing the price?

I had to leave without the price because no knew and was given so numbers to call. I have know talked to 7, yes SEVEN people- going up to the manager in attempts to find the price of one test at one practice. So far prices they quoted ranges by over $2500.

I went through this earlier in the year at an imaging center. They were able to tell my their would be additional costs that would have to be applied to my deductible so they needed me to sign form that was I willing to pay "those costs and fees" and I resisted my natural urge to say 'yes' and sign, but then I though NO and asked 'how much is the scan?'

Again, mass confusion- there was NOBODY that could answer that question??!?!! I know that price varies significantly depending on who you are and what insurance you have.

Finally I said just give the price you charge a person who has no insurance - no answer.

I expressed my annoyance that an imaging center can not tell me the cost of an image. I was not asking the price I re-attaching my leg= a complex surgery.

I was told I would have to leave and wait for someone to call me, then set up another appointment to come back. :-/ Again this took weeks of calls.

I wish more patients would ask more questions then perhaps practices would be better prepared.

In this day and age this is unacceptable.

Re: How often do you do something without knowing the price?

catwhisperer — Fri, 22 Jul 2016 14:19:35 GMT

I recently went through a similar situation. Very frustrating. No one wants to give a straight answer regarding costs.

Re: How often do you do something without knowing the price?

jackthebear — Fri, 22 Jul 2016 14:21:56 GMT

agree and it is annoying.

but every insurance company has a different deal

did you call your insurance company for the cost to you?

but NOONE wants to go with a single payer. (don't answer it will be political)

Re: How often do you do something without knowing the price?

silkyk — Fri, 22 Jul 2016 14:24:12 GMT

I'm begining to think they make it up as they go along. Ridiculous!

Re: How often do you do something without knowing the price?

Mustang Shar — Fri, 22 Jul 2016 14:27:27 GMT

I agree, unfortunately almost all offices have separate billing departments. They go by the procedure code, some tests have multiple different codes depending on the exact procedure requested by your ordering physician. Sometimes your Physician doesn't know the code either, LOL. Plus if you're in a PPO, there are contracted prices that only screen the exact cost once the claim goes through the network. So IF a diagnostic test is $2500.00, it may actually be PPO priced at say $1275.00.

if you want to pursue, contact the billing department shown on your statements. Request they find the procedure code and the charge. They will need to pull your record, so let them research it.

Hope this helps. Yes, you're upset but perhaps understanding what exactly is involved will help you know why most don't have access to the information you need.

Re: How often do you do something without knowing the price?

StylishLady — Fri, 22 Jul 2016 14:28:07 GMT

My 2¢ on this. I'm afraid a lot of this testing has to do with malpractice lawsuits. Doctors may be worried that if they don't have to undergo certain tests that it may come back at them later. Another factor in causing the rise in health care costs.

Re: How often do you do something without knowing the price?

millieshops — Fri, 22 Jul 2016 14:30:15 GMT

They should be able to tell you what they will bill you, but I haven't had experience with any offices that will tell you the cost after that bill is submitted to your insurance.

I'm on Medicare and the offices do seem to know whether something is Medicare covered or not. That's a start. But they don't know what it might cost me - they don't know if I'd already paid my annual deductible, they don't know whether my other insurance is going to kick in, etc.

Sometimes they try, but I've learned not to go with what they tell me without checking in with my own insurance people. I'd have to call them anyway because I have no idea whether that's a covered procedure when it's for a baseline instead of for a perceived problem and I wouldn't trust the billers to know!

Scary and frustrating.

Re: How often do you do something without knowing the price?

NativeJax — Fri, 22 Jul 2016 14:32:50 GMT

You should call your insurance company and find out what they pay towards the procedure, then you will know the cost the doctors office will charge. They find out what insurance will pay and the. They will usually charge more than that.

I know, I think it's all a racket.

Re: How often do you do something without knowing the price?

Abrowneyegirl — Fri, 22 Jul 2016 14:33:30 GMT

@jackthebear Yes I did call the insurance company. I thought that would help, they most they could tell me was the 'customary charge'

I would have to contact the practice to find out what they were going to charge, because anything beyond the customary charge was paid 100% by me, in addition to deductible and co-insurance........

Re: How often do you do something without knowing the price?

Snowpuppy — Fri, 22 Jul 2016 14:35:41 GMT

The "price" for a procedure is usually what an insurer will pay.

You'll find many doctors fees are far less when you tell them it's not covered or you have to use an HSA.

Re: How often do you do something without knowing the price?

Abrowneyegirl — Fri, 22 Jul 2016 14:40:02 GMT

@millieshops wrote:
They should be able to tell you what they will bill you, but I haven't had experience with any offices that will tell you the cost after that bill is submitted to your insurance.

I do not expect them to know how it is going to cost me out of pocket they have no way of knowing that.

I am ONLY asking what they are going to bill me/my insurance company.

Once I know how much they are going to bill. I can do the math.

The fact they do not know how much anything cost is alarming to me!

Re: How often do you do something without knowing the price?

Mrsq2022 — Fri, 22 Jul 2016 14:41:14 GMT

@jackthebear wrote:
agree and it is annoying.
but every insurance company has a different deal

did you call your insurance company for the cost to you?

but NOONE wants to go with a single payer. (don't answer it will be political)

Actually, this frustrating procedure pricing has been the same for years. Nothing new here. And I wholeheartedly agree with OP that is is ridiculous how much the price varies depending on whether or not you have a PPO, an HMO, an HSA, in-network versus out of network, etc....ridiculous!

Re: How often do you do something without knowing the price?

jackthebear — Fri, 22 Jul 2016 14:41:23 GMT

@Abrowneyegirl wrote:
@jackthebear Yes I did call the insurance company. I thought that would help, they most they could tell me was the 'customary charge'
I would have to contact the practice to find out what they were going to charge, because anything beyond the customary charge was paid 100% by me, in addition to deductible and co-insurance........

ugh

so annoying

hope you can work it out

Re: How often do you do something without knowing the price?

qualitygal — Fri, 22 Jul 2016 14:43:39 GMT

@Abrowneyegirl,

Here, here!! I agree, more questions before we say, yes, without checking the $$$costs. I had one doctor suggest something at the dentist's office, and I thought I'd think about it, since it was just a suggestion. Well, I came home and looked it up, and got my answer. I'm not doing this...but, I could have just said sure, and they'd have run with it. Think of a cliff and decide if you just want to walk off it blindfolded. About the same thing. Honestly, we must ask first!

Re: How often do you do something without knowing the price?

Abrowneyegirl — Fri, 22 Jul 2016 14:44:00 GMT

@Mustang Shar It was the billing office that I called when I spoke to 7 different people. When I told the manager that the $2500 variance was unacceptable she finally agreed and has offered to research it and get back to me. That was 8 days ago......

Re: How often do you do something without knowing the price?

wagirl — Fri, 22 Jul 2016 14:44:12 GMT

mememe---I have to commend you on your intestinal fortidude about all this. I, too, have done the same thing--just said yes without first finding out what the bottom line will be. And I think that calling your insurance company should be the first plan of attack. I have a great insurance plan---yes, I know, am I nuts ?---but I do and after going thru breast cancer 4 years ago and all the horrendous scans and tests and procedures, surgery and then the chemo and radiation; most of which I just let happen without thought of cost., I prob only had to pay $5000 total and my ins covered the rest of the $100,000 + bill. But my point is, now I call my insurance first and I have a great woman there, that I bounce all sorts of questions off of. She has saved me thousands of dollars I'm sure. So build a repore (sp?) with someone if you can and go to him/her first and let them do the work. The people who are the worker bees don't really have a clue about insurance. and they shouldn't; they need to do their jobs. You still need to be vigilant and always be on top of things. Bravo to you for that.

Re: How often do you do something without knowing the price?

Abrowneyegirl — Fri, 22 Jul 2016 14:50:03 GMT

@Snowpuppy wrote:
The "price" for a procedure is usually what an insurer will pay.

You'll find many doctors fees are far less when you tell them it's not covered or you have to use an HSA.

Oh, yes to this.

I thought I would make it easy (ha hah ha) at the imaging center- I said "just tell me the price this scan would cost if I had NO insurance, I will pay that right now, so I can have the scan done now and leave."

No one knew the price......... grrrrrr!

Re: How often do you do something without knowing the price?

CelticCrafter — Fri, 22 Jul 2016 14:52:38 GMT

If they can't tell you what they bill for the procedure and it's not an emergency for a life threatening issue then I wouldn't have it done.

Re: How often do you do something without knowing the price?

Adamlambert — Fri, 22 Jul 2016 15:08:26 GMT

I think they are trying to determine what your out of pocket cost would be w your ins. I processed claims for years. Go by the usual & customary

Personally, when a Dr tells me I need a test I ask why, get their reasoning. Then I google, research it all and then I determine if I want it. Not the Dr. If I'm paying, I want to eliminate all duplicate procedures and only have things done I feel are necessary. I was told I needed a body part removed years ago, went to get other options and waited ......issue resolved itself.

I've been to practices where they do additional tests just to get money. Saw it all the time when working for the insurance company.

Re: How often do you do something without knowing the price?

pitdakota — Fri, 22 Jul 2016 15:40:43 GMT

It is frustrating isn't it, @Abrowneyegirl!

Since the 1990s many physician groups turned over their practices to physician practice management groups. That business determined scheduling, charges, etc. Those groups ran into some fairly significant money problems and declared bankruptcy around 13-15 years ago. They are now making a come back to some degree though.

So hospitals started doing the same type of businesses to manage physician practices. The net result is that today a significant number of physician groups are either employees of a hospital, a hospital organization, or a physician practice management group.

Meaning people in the doctor's office itself have no idea what the charges might be in that situation. It is not the doctor's office that determines the charge, it is the group that manages the practice. So it sounds like that is what you encountered in your situation.

And unfortunately, charges for any type of procedure, tests, etc. is closely guarded. This practice is the same in the hospital. Many staff nurses have no idea what the charge for various equipment or supplies are in their hospital. And it can be quite difficult for them to get an answer when they inquire. Funny thing, hospitals want nurses to deliver more cost effective care....but then the nurses have no idea what the charge for commonly used items used in that area might be!

Good for you in asking though. Public pressure might make a difference in holding health care personnel accountable for knowing what their patients are being charged and being able to relay that information when asked.