PSA: As of 2019, federal law requires all hospital & doctors to post prices in a machine-readable format.
The results are pretty striking, esp here in the Bay: eg UCSF ( https://www.ucsfhealth.org/about/pricing-transparency/ ) charges $2600 for 1-way and 2-way chest X-rays, but charges $220 (that’s two _hundred_) for 3-way chest X-ray. The difference? How many angles they take of your body -ie, a 3-way includes the 2 & 1-way; and, more notably, the 3-way was used as a chargemaster item used in pricing estimators. So eg when I went in for a routine chest x-ray, I've expected a $300-ish bill, and got charged with a $2600 one. Knowing these prices now allows me to ask specifically from my doctor to select the diagnosis&intervention with the highest benefit/cost ratio.
I’m really curious seeing consumer reactions to this, because current medical billing practices must die.
Every time I use my health insurance in the USA I peel back another layer of this onion of a scam. I've started doing most of my health care abroad even though I'm insured just so I don't have to deal with this industry. I doubt posting prices online will do much because it seems like a quick fix to a systemic issue.
1. Go for a 3 minute, 30 second ENT appointment about earwax. Think I'm just paying a co-pay. Receive an extra bill for "Charges in excess of negotiated amount"
2. Go for appointment and be told: "If you just pay us now and bypass your insurance it will be cheaper than your copays." This happened twice without any prompting.
3. Be told by another office that my insurance doesn't cover a service and that it would be better if I paid out of pocket. Learn later that that service should have been covered 100%. Struggle for months to get insurance to pay instead all the while being told by the office "we can't guarantee you won't end up paying more in the end, even if it does say 100%"
Are those the list prices, or the negotiated prices the providers pay insurers? From my understanding and in my limited experience there is virtually no relationship between the two, and, in reality, even the uninsured don't end up paying list.
List prices, like chargemaster. Yes, on one hand, insurance negotiates %x0 discount on it (but eg in the above case, my insurer, Anthem was -ostensibly- charged full price on it) . OTOH, see example above, whereby simple intervention of designating what specific service I will be taking upfront makes a 10x difference in prices. So, regardless of insurance, this transparency gives a serious lever for informed decision-making (whenever that's possible), and can be used additionally to price negotiation.
The results are pretty striking, esp here in the Bay: eg UCSF ( https://www.ucsfhealth.org/about/pricing-transparency/ ) charges $2600 for 1-way and 2-way chest X-rays, but charges $220 (that’s two _hundred_) for 3-way chest X-ray. The difference? How many angles they take of your body -ie, a 3-way includes the 2 & 1-way; and, more notably, the 3-way was used as a chargemaster item used in pricing estimators. So eg when I went in for a routine chest x-ray, I've expected a $300-ish bill, and got charged with a $2600 one. Knowing these prices now allows me to ask specifically from my doctor to select the diagnosis&intervention with the highest benefit/cost ratio.
I’m really curious seeing consumer reactions to this, because current medical billing practices must die.