Getting a simple price quote for medical procedure...NOT EASY!

[Blaze]

So I ended up needing surgery for my bicep tendon where it attaches up my the shoulder area. The orthopedic surgeon requires a ultrasound guided injection or cortisone shot to make sure this is the right area if it kills the pain.

I haven't used any deductible this yr so I was curious what the $$ damages were for this injection. So I called the hospital where the injection is getting done. On the phone for most of the day waiting for call backs etc.

Finally get this billing code for the procedure after most of the day waiting. That wasn't enough. They also wanted the exact name of the procedure besides the billing code. So another hour of two trying to get find someone that knew the procedure name.

So now I finally have both the billing code and exact name of the procedure and get through to billing to get a price...not happening!

They first asked me if this is cash or insurance and then go on to say this will take several days to work up an estimate and we can e-mail that to you, grrrrr.

 

[MrMoody]

The medical industry has gotten away with secret & selective pricing for far too long. We all know where this is headed.

Your insurance company will probably be more help because the prices are determined by the hospital's contract with them, unless the hospital dings you for uncovered charges, which they are not supposed to do.

 

[Hall]

Your situation is what is wrong with the $$$ side of healthcare in the US.

To be perfectly clear, that is not a political statement or comment.

 

[JohnnyJohnson]

They need to stop this and they need to require 1 year full warranties from these people.

 

[Propflux01]

Originally Posted by Blaze
They first asked me if this is cash or insurance and then go on to say this will take several days to work up an estimate and we can e-mail that to you, grrrrr.


Cash pays more.

 

[Alfred_B]

They first have to figure out what is going to be involved in the surgery. Every surgery is different and no surgery goes as planned. So they have to figure out what kind of supplies the surgeon will use, what kind of anesthesia he will demand and how long it's going to take.


They have to call your insurance company and see what they cover and how much, and what they don't cover.

Also, remember that the surgeon will bill for his time as well.

 

[Alfred_B]

Originally Posted by Propflux01
Originally Posted by Blaze
They first asked me if this is cash or insurance and then go on to say this will take several days to work up an estimate and we can e-mail that to you, grrrrr.


Cash pays more.


They have to give a discount for cash patients that is equal to the going discount the insurance companies have negotiated.

 

[PimTac]

Originally Posted by Alfred_B
Originally Posted by Propflux01
Originally Posted by Blaze
They first asked me if this is cash or insurance and then go on to say this will take several days to work up an estimate and we can e-mail that to you, grrrrr.


Cash pays more.


They have to give a discount for cash patients that is equal to the going discount the insurance companies have negotiated.





This.


Also, this sounds like a typical pain injection procedure instead of a surgery. They should be able to give you a general range. As mentioned above, every procedure can differ between patients. The doctor performing the procedure will bill you separately.

Some of these are done at clinics outside of hospitals. Would that be a option?

 

[JHZR2]

Originally Posted by hallstevenson
Your situation is what is wrong with the $$$ side of healthcare in the US.

To be perfectly clear, that is not a political statement or comment.


Agree. I have an HDHP with HSA. So it's MY money that's paying for stuff, at least until a deductible is met. So darn right I want to know what stuff costs. And good luck getting it with most stuff.

The only "help" one gets is using in network providers and notionally getting the correct insurance rate.

How posted prices isn't a thing is beyond me. How stabilized billing rates isn't a thing is also beyond me.

 

[JHZR2]

Originally Posted by Alfred_B
Originally Posted by Propflux01
Originally Posted by Blaze
They first asked me if this is cash or insurance and then go on to say this will take several days to work up an estimate and we can e-mail that to you, grrrrr.


Cash pays more.


They have to give a discount for cash patients that is equal to the going discount the insurance companies have negotiated.


Says what law? Per my post above, genuinely interested.

 

[ZZman]

Part of our high cost system. You should be able to shop for the best package price and if you chose a lower cost one get a break on deductibles and copays.

 

[Wolf359]

Originally Posted by MrMoody
Your insurance company will probably be more help because the prices are determined by the hospital's contract with them, unless the hospital dings you for uncovered charges, which they are not supposed to do.


How do you know what the hospital is supposed to do? They negotiate individual contracts with each insurance company. You'd have to know what's in the contract to say this. Some smaller insurance contracts don't cover all the doctors in a hospital so sometimes you can easily get a big bill from a doctor who is out of network and they will charge their full price, not the discounted one. Then it all depends on the contract between the insurance company, the hospital and you to determine how much you end up paying. Never assume anything.

Originally Posted by JHZR2
Originally Posted by Alfred_B
They have to give a discount for cash patients that is equal to the going discount the insurance companies have negotiated.


Says what law? Per my post above, genuinely interested.


Again it depends on the contract between the hospital and the insurance company. Typically the cash price is what the insurance company discounts. You can always ask for a discount if paying cash, but they don't have to give it to you. Some of this may also depend on state law. So yeah, lots of assumptions being made.

 

[Hall]

Originally Posted by JHZR2
Says what law? Per my post above, genuinely interested.

They certainly do not have to give a discount and by the terms of their agreements with the insurance carriers, any discounts would be against the terms but many doctors will still do it. Our family doctor has "cash rates" that they are rather discrete about and then they have the standard insurance rates. To be clear, his cash rates are affordable. Of course that depends on each patient's situation as to what they consider affordable. To some, a gallon of milk may not be "affordable" but they can't give away milk nor medical services.

 

[bullwinkle]

Many doctors' offices give a cash discount because they don't have to deal with the insurance companies' coding & billing departments, nor have to wait to get paid. Hospitals are a different story, many of them get stiffed by patients with no insurance, so the people paying have to make up for it.

 

[Lyman]

Originally Posted by Propflux01
Originally Posted by Blaze
They first asked me if this is cash or insurance and then go on to say this will take several days to work up an estimate and we can e-mail that to you, grrrrr.


Cash pays more.

Im sorry but you are 100% wrong. I paid cash for the birth of two of my children. I paid 50% of what the Insurance Companies paid for the exact same thing. Even our Doctor gave a 50% discount.

 

[Hall]

Originally Posted by Blkstanger
Im sorry but you are 100% wrong. I paid cash for the birth of two of my children. I paid 50% of what the Insurance Companies paid for the exact same thing. Even our Doctor gave a 50% discount.

After our son was born, it was 2-3 months later and I told my wife "we still haven't gotten a bill from the hospital" so I actually called them. Our insurance covered 100% of everything that the hospital billed for. We did have to pay the OB/GYN a single co-pay for the "treatment" which started with the first office visit, covered all follow-ups, ultrasounds, and the delivery. I want to say the co-pay was $15 but maybe it was $25.

 

[Blaze]

Originally Posted by PimTac
Originally Posted by Alfred_B
Originally Posted by Propflux01
Originally Posted by Blaze
They first asked me if this is cash or insurance and then go on to say this will take several days to work up an estimate and we can e-mail that to you, grrrrr.


Cash pays more.


They have to give a discount for cash patients that is equal to the going discount the insurance companies have negotiated.





This.


Also, this sounds like a typical pain injection procedure instead of a surgery. They should be able to give you a general range. As mentioned above, every procedure can differ between patients. The doctor performing the procedure will bill you separately.

Some of these are done at clinics outside of hospitals. Would that be a option?



The only place they gave me was the hospital here in Colville, Wa. Its right next door to the orthopedic surgeon. The procedure is called an ultrasound guided aspiration injection. The needle guided with an ultrasound. The surgeon said they guide the needle into a specific area under the tendon sheath. He said this is going to be done prior to surgery to make sure they have the correct area.

If it kills the pain within hrs after the procedure then its the correct area. I have had severe tendinitis of the bicep tendon. The pain goes from my shoulder down my bicep, then to elbow and right done to my wrist. The only way to correct it at this point is pull the bicep tendon off and reattach it at a different point at the shoulder. The surgery procedure is called a bicep tenodesis but evidently they don't do it until this test injection is done first.

 

[mk378]

This could be done at any place that has a suitable ultrasound machine, and in a sane world such places would advertise the price to use their machine and compete with each other.

But the government regulates hospitals and clinics to limit the number of machines in an area, often to one. It has been bizarrely explained to us that that will help keep the price down.

 

[talest]

Originally Posted by mk378
This could be done at any place that has a suitable ultrasound machine, and in a sane world such places would advertise the price to use their machine and compete with each other.

But the government regulates hospitals and clinics to limit the number of machines in an area, often to one.


Inefficiency at its best.

 

[Old Mustang Guy]

Won't you end up paying your deductible anyway on the second procedure?