Transparency in pricing for surgery

[RJ]

Transparency in pricing for surgery

Yes I think it would be helpful to have transparent prices and/or known prices for general services.

My health insurance is limited to in-state providers, so if I was to travel out of state for any health service I would be paying out of pocket entirely for everything. Nonetheless, this is a scenario I consider as I’m sure many others have too. For something like surgery, performed by an expert, services are expected to be fairly expensive.

What would be really great would be a variety of package prices to make the entire experience easier for travelers: total fees for consult, fees for surgery (maybe even repair types), pre-arranged hotels that are near the site of services, pickups from airport, etc. almost like a package vacation, except surgery.

Slightly off topic, the country of Singapore publishes their costs online per hospital and service, for hernia repair that can range from $900 to $22,000 (USD), depending on the choice of hospital, service, complexity of case, etc. Sure that’s a big range, but at least you know what to expect. Here’s the Singapore government website, kind of interesting if you like data:

https://www.moh.gov.sg/content/moh_web/home/costs_and_financing/HospitalBillSize/hernia_repair.html

It would be great if the USA had something similar for US providers and hospitals, but we’re obviously a much larger country than Singapore.

From looking online at actual patient bills, I’ve found laparoscopic hernia repair bills from a general US hospital to range around $10,000 – $35,000, thus after insurance the patient is usually left with a $1000 to $7000 bill depending on their insurance policy and co-insurance. I would imagine open hernia repair with mesh to be a bit cheaper than that but that may be an incorrect assumption.

[groundfaller]

Transparency in pricing for surgery

From a patient point of view, I have been saying for a long time that pricing transparency is a must. Of course pricing becomes more complicated as the difficulty of the procedure increases. This is true for any fee for service transaction such as when you take your car in for work or when a plumber or electrician works on your house. Let’s bring some reality to the situation though. If a plumber is called in to snake a drain, they pretty much can quote you a cost. Sure it might lead to a new, unknown problem but you address that as it arises, including the new cost. To me, that is akin to having your blood drawn. The cost should be known up front and if it leads to something more, then you address that as it arises.

In terms of something more complex like surgery, it would seem that there are parts to the procedure that are largely fixed in price. Then there are the parts that probably follow a fairly predictable average for the procedure. Then there might be a couple more difficult to calculate variables but they still have a max or a min and the surgeon assessment would determine that, right? Hospitals and insurance providers hire tons of number crunchers already to calculate similar things. Other industries have to stick their necks out all the time to anticipate costs and live by what they calculate. Call me callous but I feel like the lack of transparency and the ridiculous compexity of the bill paying process is just a clever way to hide how the health care consumer is being financially gouged.

I find the wild variation in facility costs (from one place to the next) to be strange and frankly alarming. I am suspect of this difference. Sure, some places have newer or different services/equipment that can account for it to some degree, but should it really vary that much, especially if my method of payment is the only variable that is different? Things such as this can explain a lot of the reason why people are becoming more and more skeptical of going to the doctor. It becomes a real shame and very real social problem if people avoid getting needed medical help because they dont trust the billing/insurance process and as a result they ascribe those feelings to the doctors and services provided.

Transparency….it seems pretty important to me.

[WasInTN]

Transparency in pricing for surgery

Dr Towfigh
The following thing I am posting has some bias, a LOT of frustration and anger caused by people in the medical field. Here you go.

When a patient comes to your office, hospital or anywhere (s)he expects a uniform rate of charge. But what happens in these situations is that t if the patient has insurance, he pays co-pay, dr bills insurance exhorbitant amount ($450 to $700 for office visit) and he may get paid 75% of the billed amount. If the patient has no insurance then charge is $200 or so. Why is this difference? The general talk is that, “insurance is paying, why you worry?” I tell you why we worry. When insurance pays a lot, you get a lot and all looks dandy, right? The answer is NO because next year the insurance rates are up and the employee pays more. Q for you in medical community – why cannot you charge the same amount in both cases? The general public thinking is that, the medical community charges differently due to two reasons 1) fear of lawyers 2) greed to get more money. Period. I know for a fact that my dental office charges both my ins companies and even asks me to pay co-pay. When they got more money once due to double billing, I asked them and they refused to return the money to insurance. I plan to report them to these companies sooner or later.

Now coming back to exhorbitant prices – an MRI costs about $3K to $4K and insurance really pays 90% of this amount. Why is an MRI so expensive? I know for a fact that MRI in any other country costs less than $250, even with a contrast. The hospitals bill exhorbitantly for drugs too. For example tylenolr tablet is $20 when given in the after surgery waiting room for a patient. Ridiculous, isn’t it? Same for anesthesia medicines, his price and hospital even bills for disposables – gauze pieces, needles and so on. Many of the patients do not even have an idea that they have to request an itemized bill. Why do they do it? GREED, to answer in short. I was on phone with a famous hospital when my son was born and was requesting, begging them to give a disount and do you want to know their answer? “Even if you die, we do not care, we must be paid.”

When you are healthy, have money and feel good you always talk from high horse and feel invincible. Huh? One day all these health administrators, physicians who are so greedy get cancer and die like roadside dogs too. What they forget is the pain of the patient. Why does this happen? Why is there no single price for everything? We can discuss this till the end of the world, why rules cause problems, state laws, federal laws etc etc. but the bottom line is, there is no rule. Medical community can bill a physical appointment as any other visit and bill differently or bill an injection administration as surgery and get more money from patient. These things have happened to me and both insurance and medical community just wank to milk the common man.

Unformatunately the wealthy have no problems, the poor have no options. It is the middle class like us who get the whip! Great.

Sorry for the bad language but you asked and I gave you a frank answer.

[bob P]

Transparency in pricing for surgery

One can only quote surgical fee,or packages for straight forward operations.Any complex procedures in patients with multiple comorbidities cannot have a fixed package.

[sngoldstein]

Transparency in pricing for surgery

I think all of medicine should have transparent pricing. My issue with publishing rates is that the insurance rules essentially prohibit it by forcing us to keep our rates artificially high. Also, the hospital where I work is unable to give me pricing for a cash patient, and when they do it seems to be different every time for the same procedure.