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Old 06-17-2012, 10:44 AM   #29
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I do believe regulations are a major factor in health care. The second issues is lack of adequate price transparency. All you have to do to understand this is ask around on pricing. Typically what the hospital charges insurance is at least ~50% more than what they'd charge you direct...all because of paperwork and regulations. I know this for a fact because we are on high deductable plan and pay almost everything out of pocket and I always shops around on price.

As an example I had a small operation this winter which cost me $1500 cash price, paid upfront. The price if it had gone through insurance it would have been over $5000. This is not at all unusual. Every single doctor I go to has a different price for cash versus insurance. Every single one! Often you get extra discounts for paying upfront.

Regarding lack of price transparency (which goes hand in hand with lack of competition), the same procedure can have vastly different costs at different locations. Even things like basic bloodwork! When I lived in Asia you could get basic costs for just about any procedure simply by clicking on a hospital website. Here getting costs is like pulling teeth. This winter I needed costs for a simple scan and called 10 different hospitals. The price for the exact same scan varied from $200 to $1200 cash price. Same procedure, just different prices.

We need less paperwork and more price transparency. At least that's my take.
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Old 06-17-2012, 10:46 AM   #30
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Originally Posted by Steve N Sal View Post
The cost of health care is getting way out of hand. Insurances are going to raise prices when they are having to pay into bills that are being tallied by hospitals and doctors. My wife had back surgery and in the hospital for two days including the day of the surgery. Hospital bill not including the doctors fees $128,000 in round numbers. The doctors charges another $13,000 and a bone growth generator she has to ware another $6800.00. In my opinion you can't blame costs on any one president as these costs have been escalating for years now. Who knows where it will all stop. JMHO
I'm this "senior" Canadian reading all these posts and THANK YOU Steve N Sal for being openminded!
Sometimes I want to YELL at americans Gosh people this president hasn't been here that long! AND look at what he inherited..!
So good for you people who have an open mind!
God Bless America !
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Old 06-17-2012, 12:09 PM   #31
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Originally Posted by Steve N Sal View Post
The cost of health care is getting way out of hand. Insurances are going to raise prices when they are having to pay into bills that are being tallied by hospitals and doctors. My wife had back surgery and in the hospital for two days including the day of the surgery. Hospital bill not including the doctors fees $128,000 in round numbers. The doctors charges another $13,000 and a bone growth generator she has to ware another $6800.00. In my opinion you can't blame costs on any one president as these costs have been escalating for years now. Who knows where it will all stop. JMHO
Did you see what your insurance actually paid? My back surgery totaled over $240,000 when all said. Insurance paid just over $66,000 TOTAL, and accepted in settlement from the other insurance $40,000..

DO NOT ASSUME that the bill you see is what insurance pays. Ask for the Explanation of Benefits (EoB) next time. You will be VERY surprised at how little is actually paid.
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Old 06-17-2012, 12:16 PM   #32
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Our system was set up during a time of relative youth, high wages, and much greater participation paying in. Now, we're all older, wages are stagnant, and many employers have axed health benefits for the middle-class. So there are far fewer healthy workers paying in, and many more older, poorer, Americans drawing from the system. Costs have escalated due to litigation, regulation, and a host of other reasons, yet many good doctors are going bankrupt. Simple economics, spending more than we're making.
Is Obamacare the answer? I doubt it. Is returning back to the way things have been trending for the past 30 years? Absolutley not!
What I would like to hear from all those bashing Obamacare is an alternative, what is the answer? And if the answer was known 5-10 years ago, why wasn't it implemented?
Dont have the answers but participation is in the 95% and MORE employers today provide coverage, not less, again depending on who you believe, there are only some 12-15 million without some type of coverage. Thats outta almost, what, 311 million.

Again, insurance companies dont pay NEARLY what they would have you believe, and until Exxon got lucky, insurances where the most profitable companies in the US.
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Old 06-17-2012, 12:33 PM   #33
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Obamacare is allowing young people who are in college to stay on their parents insurance. That can be good, many just have no healthcare and if they have issues they are tied down with medical debt for many a year. I see this as a good thing.

Also it starts closing the donut hole and drops the costs of drugs 50% in that period, how is that bad? There ware other issues such as the previous administration giving universal drug coverage with no provisions made to pay for it. We all want this stuff but none of us want to pay for it.

Also people with pre existing conditions cannot be denied health insurance.

I don't know a lot of the rest but those 3 have gone into effect and I don't see anything bad about those new regulations. We as taxpayers are paying for it one way or another anyway.

Also if you read the stats the majority of our medicare money is spent on us seniors in our final year of life. I really think that needs to be looked at. I know I'm getting to that age too, but we all have to face reality. I don't want to die either but its going to happen no matter what we spend. Perhaps we need to have an evalutation to determine if its feasible to keep us alive and what will that qulaity of life be. Of course this gets into ethics and everything but its real and needs to be looked at or if that is what we really want need to make sure money is there to pay for it.

And if each of us looks at the expense of a hospitalization and you are truly honest we don't pay in enough for even a few of our hospitilizations, if we could afford to pay why would we even bother with insurance?

And now employers are dropping insurance how are these folks going to pay? Something needs to be done on the cost side of medical care also. A lot of problems and this is only a brief touch on them. But to blame Obama is a bit less then sincere, this has been coming for many a year if not decades.
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Old 06-17-2012, 12:34 PM   #34
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Again, insurance companies dont pay NEARLY what they would have you believe, and until Exxon got lucky, insurances where the most profitable companies in the US.
It's true that insurances don't pay "wholesale" costs, but they still pay waaay more than cash prices. In my research over the past year (of alot of medical stuff) I've found there are 4 main prices for healthcare...in decreasing order:

1/ "wholesale" price (my terminology) - what hospitals would have you believe is the regular price..often grossly inflated, but this is the basis for many insurance negotiations and anything government-related (e.g. statistics)
2/ "insurance" price - what hospitals actually charge insurance companies and what the insurance companies payout. Payout depends alot on the insurance company. Medicare is one of the worst payers and some hospitals (e.g. Mayo Clinic) have started dropping them for that reason.
3/ "cash" price - what you'd pay in cash if you paid direct. Often >50% less than #2
4/ "pre-pay cash" price - a discount on #3

This is not just personal experience (I've been calling alot of hospitals this year), but it's documented by others too...for example:

Many hospitals, doctors offer cash discount for medical bills - latimes.com

Healthcare - Home


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Old 06-17-2012, 12:45 PM   #35
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Originally Posted by WheelingIt View Post
I do believe regulations are a major factor in health care. The second issues is lack of adequate price transparency. All you have to do to understand this is ask around on pricing. Typically what the hospital charges insurance is at least ~50% more than what they'd charge you direct...all because of paperwork and regulations. I know this for a fact because we are on high deductable plan and pay almost everything out of pocket and I always shops around on price.

As an example I had a small operation this winter which cost me $1500 cash price, paid upfront. The price if it had gone through insurance it would have been over $5000. This is not at all unusual. Every single doctor I go to has a different price for cash versus insurance. Every single one! Often you get extra discounts for paying upfront.

Regarding lack of price transparency (which goes hand in hand with lack of competition), the same procedure can have vastly different costs at different locations. Even things like basic bloodwork! When I lived in Asia you could get basic costs for just about any procedure simply by clicking on a hospital website. Here getting costs is like pulling teeth. This winter I needed costs for a simple scan and called 10 different hospitals. The price for the exact same scan varied from $200 to $1200 cash price. Same procedure, just different prices.

We need less paperwork and more price transparency. At least that's my take.
Again, not true. Insurances pay LESS. The person who pays the most is the one without healthcare insurance at all. THEY get charged the highest price. The price you were quoted and what you see on the bill is what they charge, knowing that most insurances have a contract price they will pay (and the docs know what this is, cause they are 'in contract' with them) and that Medicare/Medicaid/Tricare/etc will pay what is 'fair and reasonable' (and THAT is also published for all to see). Wanna know what 'fair and reasonable' is on an MRI? $1280 charged, $40 paid...

The reason some of you get slammed with a high bill is because the doctors office is trying to get the difference of the contract price and what they charged, from you. Depending on which insurance program you are in (ie some forms of Medicare and Medicaid, CampVA, etc) it is illegal for them to do this.
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Old 06-17-2012, 12:50 PM   #36
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Again, not true. Insurances pay LESS. The person who pays the most is the one without healthcare insurance at all. THEY get charged the highest price. The price you were quoted and what you see on the bill is what they charge, knowing that most insurances have a contract price they will pay (and the docs know what this is, cause they are 'in contract' with them) and that Medicare/Medicaid/Tricare/etc will pay what is 'fair and reasonable' (and THAT is also published for all to see). Wanna know what 'fair and reasonable' is on an MRI? $1280 charged, $40 paid...

The reason some of you get slammed with a high bill is because the doctors office is trying to get the difference of the contract price and what they charged, from you. Depending on which insurance program you are in (ie some forms of Medicare and Medicaid, CampVA, etc) it is illegal for them to do this.
Simply not true. I have actual examples of this and I have researched this to death. Cash pricing is simply speaking the cheapest thing you can do.

Another example...last year I had an emergency visit to a clinic in Astoria for a head injury. Not thinking straight at the time I gave them my insurance information. Three weeks later the insurance bill came in. Total bill (explanation of benefits) was $1,400. I called the hospital directly and asked if I could negotiate a cash price. Final price I paid was $800 and I convinced the hospital to cancel the claim with the insurance company.

THe link I had here has some more specific numbers in it:
http://www.latimes.com/business/la-f...049,full.story

Yes, insurances have negotiated prices and these are less than what they'd have you believe. But cash pricing is even cheaper.
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Old 06-17-2012, 12:50 PM   #37
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I'm this "senior" Canadian reading all these posts and THANK YOU Steve N Sal for being openminded!
Sometimes I want to YELL at americans Gosh people this president hasn't been here that long! AND look at what he inherited..!
So good for you people who have an open mind!
God Bless America !
Wow
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Old 06-17-2012, 12:54 PM   #38
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Simply not true. I have actual examples of this and I have researched this to death. Cash pricing is simply speaking the cheapest thing you can do.

Another example...last year I had an emergency visit to a clinic in Astoria for a head injury. Not thinking straight at the time I gave them my insurance information. Three weeks later the insurance bill came in. Total bill (explanation of benefits) was $1,400. I called the hospital directly and asked if I could negotiate a cash price. Final price I paid was $800 and I convinced the hospital to cancel the claim with the insurance company.
Ok.. so how many of the thousands (yes, thousands) of EoB's do I need to publish to prove this to you?

Wife right now is going through this thing where the docs will charge a part of the surgery to the insurance, but want the rest up front. Price up front? $1500 cash.. Price to ChampVA if I can get it pushed through? $410...

I'm sorry, but having cash upfront might be the best thing in your position, but it is not the best overall..
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Old 06-17-2012, 01:11 PM   #39
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Ok.. so how many of the thousands (yes, thousands) of EoB's do I need to publish to prove this to you?

Wife right now is going through this thing where the docs will charge a part of the surgery to the insurance, but want the rest up front. Price up front? $1500 cash.. Price to ChampVA if I can get it pushed through? $410...

I'm sorry, but having cash upfront might be the best thing in your position, but it is not the best overall..
From what I've seen VA & Medicare may be exceptions. They are some of the lowest payout insurances, and for that very reason (as I said above) some places are dropping them. The most notable example is Mayo Clinic dropping Medicare (my link above) for the very reason that negotiated prices were not working out for them.

Those of us without Medicare or VA pay higher pricing whether through insurance or cash. For these cases my experience (and the links I've linked to above) show cash pricing is significantly cheaper in every instance. I'm not saying this is a good option...in fact for someone in my position it's really the only option. Individual health insurance is simply too expensive! This is where price transparency would make a huge improvement for everyone.
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Old 06-17-2012, 01:20 PM   #40
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Govt regulation and larger govt is not the solution.

Hospital and doctors offices can charge what they want because we pay our co-pay with the HMOs and PPOs and all that crap most people including my self don't understand and could care less what the hospital/doctors are charging us or what the insurance company pays because all we have to pay is our preset co-pay.

If we were somehow forced to take more of an active role in shopping around for our medical services and search out the better deal, much like we do with other services and products, then the medical services would be forced to compete for our business.

For those of us still in the workforce, why does the employer choose the medical insurance company? They don't subsidize or choose my auto insurance. My employer should increase my salery by what ever they supsidize and let me choose my own medical insurance, forcing insurance companys to compete for my business.

I'm a simple working American, and this is just how I believe capitalizim is suppose to operate.
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Old 06-17-2012, 01:28 PM   #41
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Here's some more specific examples. I happened to shop around this particular issue over this winter for various reasons (not for me)

Vaginal Delivery
---------------

"Blue Book" value - this is the fair and agreed value that most insurance companies will pay out. You can find the blue book here:
Admission for Vaginal Delivery Pricing by Healthcare Blue Book
The bluebook value in this case, just for hospital delivery is ~$4,500
This is for San Diego area.

Shopping around the area hospitals there is a vast array of "cash" prices. Some come close to the blue book, but some are significantly cheaper
Scripps -> $,4700 paid up-front
Sharp Birch Medical Center -> $2,250 paid up-front
Both prices incl. 24 hour stay

Again, outside of VA and Medicare this has been my typical experience. I'd love for you to tell me I'm wrong since it might change how I handle medical bills in the future.
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Old 06-17-2012, 01:48 PM   #42
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Govt regulation and larger govt is not the solution.

Hospital and doctors offices can charge what they want because we pay our co-pay with the HMOs and PPOs and all that crap most people including my self don't understand and could care less what the hospital/doctors are charging us or what the insurance company pays because all we have to pay is our preset co-pay.

If we were somehow forced to take more of an active role in shopping around for our medical services and search out the better deal, much like we do with other services and products, then the medical services would be forced to compete for our business.
Totally agree. I feel lack of price transparancy and understanding is HUGE issue in today's US health care. Hospitals can charge & collect different prices (depending on the insurer). The exact same procedure can cost VASTLY different amounts in different places and no-one knows (or cares?) what $$ are actually going through the system. I truly believe it would help to have price transparency (and the market competition that comes with it). These past 3 years of fulltime RVing and shopping around for out-of-pocket healthcare has really opened my eyes to the HUGE variations out there and how difficult it is to actually figure out pricing.
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