The only people paying full price are the uninsured (at least that's the theory). Medicare and the insurance carriers negotiate provider discounts that are usually half of the price the hospitals charge the uninsured. They take a patient age, sex, procedure, and diagnosis code to group them together into a Diagnosis related group code. This is what payers use to negotiate standard payments with the hospitals and providers. When the uninsured can't pay their bills, the cost are passed on to the rest of us.

Medicare payments are so low that many providers don't want to do business with medicare patients.

when I had to look up through my insurance company website, the cost of a c-section, the cost was between 8,000 and 15,000 between 12 hospitals....i thought it was crazy that the price was almost double at one compared to the other. the price of health care is out of control

Before people flip over the $182,000 bill the review looked at TOTAL charges for the stay, not just the surgery. The patient with the $182,000 say likely had other medical issues that elevated the bill. For example, the pt may be on dialysis or be paralyzed, thus requiring extra care while they were in the hospital that made their bill more expensive.

and you wonder why our insurance cost is so high in this country? I remember once taking my daughter to children hospital when she was a baby. one of the visit by the doc while she was in there cost me $400 for a 1 min check. and he visited her twice in less than 1 hour. So $800 for 2 min visit. Now you tell me is it the doc's fault or the hospital? and who is worth so much of their time that it cost $400/min/visit? Gosh, I guess I'm in the wrong business. I'd be a doc if I knew that I'll be making that kind of money. :-)

Until we standardized the real cost on how much hospital/doc can charge, we'll never going to resolve our high insurance premium problem. Also take that word "for profit" for insurance and hospital. Such a conflict of interest.. Having to pay the premium for the patience yet still have to worry about paying dividend to the stock holder. It's beyond oxymoron to me..

The first new rule says you HAVE to have insurance. Both my husband and I have pre-existing conditions, and although the new bill says we can't be denied coverage because of it. So far, the cheapest health insurance we've been able to find is called "Penny Health" search for it online if you are pre-existing conditions.

That's one of the main problems with our greed based health care system - you're required to accept care when you have no idea what the cost will be whether you have insurance or not, then you're considered a derelict when you can't pay or when you dispute the charges. With every other service or good we purchase, we're allowed to know the price going in and we can make a decision as to how to pay for it or whether or not we can afford it. With medical care, we have to just go in blindly and HOPE we can foot the bill if the insurance company decides to screw us and deny coverage.

I used to work for a medical billing company. Four people with the same type of broken arm can walk into the same ER at the same hospital on the same day and all four of them will be charged different amounts. The Medicare patient will be charged the least. The guy who got hurt at work will be charged more, but not a lot more than the Medicare patient, because most states have restrictions on how much hospitals can charge worker's comp patients. The guy with private insurance will probably pay more than the first two, but not much more, since his insurance company has negotiated a competitive rate with the hospital. And then there's the guy with no insurance, who pays the most--like the "rack rate" on a hotel room. Of course, he's also the guy who's least likely (and least able) to pay anything, so the first three guys end up paying his bill through add-ons and fees while Mr. No Insurance dodges collection calls or declares bankruptcy (over half of all personal bankruptcies are caused by medical bills in the United States).

But we don't need health care reform or anything. This system's just fine with everybody. Even Mr. No Insurance jumps up and down and screams when you suggest requiring him to buy insurance because, well, he "just can't afford it."

I had a 24 hour stay in a hospital for neck fusion and my insurance sent me notification of payments of 12 thousand dollars for miscellaneous room charges. 12K for peeing 10 times and for water, I know they measured my goes ins and goes outs by looking at the vessel I peed in. They use insurance money to help defray the cost of the uninsured admitted in turn the insurance companies bill anybody with insurance to cover the charges received by the hospitals.

I am one of those uninsured who has recently had to use the hospital system. I negotiated pricing for a mammogram and ultrasound. I asked several times if the price quoted was the total and was told each time yes, this is the cost to uninsured patients. I paid upfront as that is the requirement to receive a 20% discount. Since the procedure I have received several bills from the hospital. A couple from the radiologist who read my results and one from the hospital asking for more money than negotiated and agreed upon. Each time I have had to call and spend time speaking to billing clerks who tell me things like, "Oh, the cost you negotiated is for the procedure, not the doctor," or "we miscalculated and you owe more." Each time I have pitched a fit and asked how is it that I can negotiate a total yet they feel it is OK to come back and ask for more. I have so far been able to get them to cancel these extra bills as I did not agree to them when I made the arrangement with the hospital. It is a pain in the behind to have to spend so much time defending the agreement, but at least I have been successful. I wonder how many people just go ahead and pay without holding the hospital to the agreed upon cost? I wonder how many people negotiate with their providers for reasonable cost? I'm lucky that I am not sick and having to deal with this. I don't know if I would have the energy or wherewithall to fight for what I have negotiated. I personally am looking forward to the provisions requiring insurance companies to accept pre-existing without raping the patient are instituted in the AHCA. Currently insurance would cost me and my spouse in excess of $1300/mth with at least a $5000 deductible and a co-pay. That is criminal. When I had insurance I hardly used it as I am relatively healthy. Single payer healthcare is the solution, too bad so many are so greedy they cannot see it.

True issues about insurance have not even been remotely addressed. Medical procedures are the one service in life you contract for but don't get an itemized estimate of charges before you sign. Before our Nation goes all crazy with health care reform, look at where the true reforms need to be. There is absolutely no reason that a procedure should cost one amount for someone in Texas and another amount for someone in Colorado. An appendix is an appendix. Mine shouldn't be more expensive to remove than my cousin's in another state unless I am some uniquely strange individual that requires a different type or level of anesthesia. There will be no solution to our health care costs just by ensuring that all people purchase the so called product. There's an issue with how insurance is actually administered and rates approved by insurance companies and the actual billable coded costs the providers charge and submit. I can assure you the idea that if all people buy a plan from a non participating stock company insurance company NO decrease it pricing and costs will occur. What we really need is foreign doctors to come over, set up participating mutal service plans and wipe out the high price US insurance service sector, or at least keep them around only for the people out there that want to pay unjustifiable costs for their procedures. I have heard that the medical care in Costa Rica is top notch, at a near fraction of the cost for the same procedure state side. Why? A totally different system and mentality regarding pricing and payment to doctors and hospitals. We have not even remotely delved into the true problems and issues with our coding and billing procedures in our medical care sector. Sure we have great technology and medical devices here in many areas. Not so great in other areas depending I guess where you live. But whether you get great care or not doesn't matter. The price is still determined by a billable "code"

The cost of a medical degree in the U.S. can be around $225,000 and the cost of Malpractice Insurance can be between $10,000 to $25,000 a year for doctors figure in lawyers and accountants for hospitals. Gee I can't understand why medicine costs so much.

For all the people against any form of universal health care or national health plan, I challenge you to think beyond your political party! If you have insurance you pay for the uninsured...it's called cost shifting. A hospital or physician cannot set reasonable and consistent rates across diagnoses because not everyone has money or insurance so the rates have to be high enough to cover all those people who come into the hospital who can't pay while still capturing enough from the discounts that insurers demand (up to 75% of set rates or the insurer won't let you see their captive audience patients) to pay for the non-pay patients. It is also law that a hospital cannot turn away a patient who presents at the Emergency Department regardless of ability to pay, so people who say you don't need insurance because you can always go to the ED are factually correct. The issue is that this is an unfair burden on everyone who does have the ability to pay so it is a hidden healthcare tax. Acuity, or how sick the patient is at the beginning of treatment, varies...a patient who is young and healthy with appendicitis should require less expensive care than a senior who presents with appendicitis that turns out to be colon cancer.

If you happen to go to a teaching hospital with higher labor costs while training the doctors you complain about and who often have a disproportionate share of indigent patients, expect to pay more. I could go on forever attempting to justify why it costs so much to be in a hospital, but I also don't want to negate the fact that there are issues at the hospital with billing accuracy, high labor costs based on region of the country, equipment and supply costs necessary to conduct business with pricing set by for-profit vendors and a myriad of other factors. Rather than focus on one or two issues that are problems, it is critical to begin a tough discussion. The only ones who are actively making money in health care today are the insurers. When the CEO of one insurer made $100M one year and inner city hospitals and rural hospitals are closing and families are being bankrupted by medical costs, it should make you think.

And, if you think that having insurance is the answer to every problem in healthcare, think about the patient with a $150,000 bill that you and your insurance are responsible for and a 20% co-pay for the patient...that's $30,000 out of pocket assuming your deductible is met. That can almost be a year's salary in many parts of the country!

Our country is facing a crossroad in health care...we need people who are at least willing to try to work things out...when Hillary Clinton tried to reform healthcare years ago, we should have listened...when President Obama tried to address these issues he's been vilified. If access to healthcare is not a right as Ron Paul professes, where does that leave us? We are already a country with poorer maternal child outcomes, less longevity and poor disease outcomes than many other developed countries with a national health plan of some sort...should make you think. Sorry if I ran on too long...but as you can see from my login I'm passionate that everyone should have access to health care.

The hospitals and doctors should list the price first for any service or surgery to patient, and if the patient doesn't like it, then he/she has right to go somewhere else for the procedures for lesser price.

The problem of medical cost right now is that nobody say anything about the cost until after a procedure or surgery is done and people cannot choose a service for less cost, which is the major reason of medical cost of this country. If it's truly market driven medicine, then they should run medical market like retails, let people shop for the best price or lesser cost services.

Government should play a role in medical field by requiring hospitals and doctors to reveal the cost first to a patient first before patient agrees to a procedure/service.

I don't have insurance and had to go to the local med center twice for strep throat. The med center charged me more the exact same treatment the second time because I was now considered an "established patient". Really??? It is insane that the medical industry is the only establishment that is not required by law to post up-front costs, tacks on additional fees and costs at will beyond the original quote without consent, expects the patient to pay each vendor (services) separately that were administered at the hospital, and treats cash-customers as pariahs. Medical services are not run like a business but more like a drug cartel that will protect its cash cow at all costs.

When we take a car to a reputable mechanic, we have rights to a written quote, must give consent to have work done, must be told if additional work is needed and how much, get discounts for being repeat customers (sometimes), and aren't treated like children if we ask questions about what such-n-such means if we don't understand something. If they need to outsource work, they work that cost into the original quote; the customer isn't hit with the additional costs from the outside vendor at a later date, on a separate bill.

I needed a hernia repair just a month or so after beginning a job. I went in at 0700 and was out by noon, more or less. I had insurance, so wasn't concerned to discuss price; I just needed confirmation the procedure was covered. I was told it would be covered if 'medically necessary'. They wouldn't commit to just telling me if they'd cover a hernia repair. I had to wait, have the surgery and then hope. Where does anyone do business like this?

I had the surgery and wound up taking another position overseas. A half year or so later, living now in Germany, I get a bill for $48,000 for the surgery. They said my insurance refused to pay, so I'm off to collections. Now I am a working person, and even have the money, but 48K for a half day at the hospital is a crippling expense. The bill was an outrage.

I checked in to why insurance failed to pay and was able to get that set straight. I was only out of pocket a few thousand instead of tens of thousands of dollars. I went on to the website when I wanted to confirm the payment went through and found out the insurance company paid 18,000 dollars as payment in full. But they were about to charge me $48,000.

I used to be a chiropractor, and when managed care came on the scene in the late 80's (where I was) I learned, through the State Chiropractic Association, that it was a crime to charge your patients a different fee than the insurance company. Chiropractors I know would give cash payors a break; the costs to collect were less and payment was immediate, so a cash discount offered a person without insurance a break, to let them get care. But we were made aware that such a discount was considered a fraud, inflating the price you'd charge the insurance company. Previously there were professional standards, UCRB's (usual, customary and reasonable billing) that governed how much a chiropractor could charge. But now it didn't matter what you'd charge the insurance company; if you gave a discount to a cash customer you're commiting fraud.

Now fast forward to the present day when insurance company's are giving discounts- not to individuals, so they can access care, but to insurance companies. But the laws they established previously they are guilty of defrauding the public every day. There are no recrimiinations about this 'two tiered' billing system when it's a product of the insurance company punishing the public for not buying insurance, but God forbid a doctor tries to give a cash discount to a patient.

This is a sick, sick country.

We need to push Congress/government to require hospitals/doctors to give patient an estimated cost before any service/procedure is done, and let patient choose!

Price for removal, 1,500.00 up to 182K. And to think that the RETARDS at the Department of Justice are busy investigating the PRICE RIGGING of E BOOKS. Our entire US Govt is loaded with RETARDS. From the WH to the OUT HOUSE. I am sure glad that the AFFORDABLE health care BILL took care of these PRICE SPIKES.

Lets all agree to NOT Pay any more then the prices that the FRENCH Pay. For any proceedure PERIOD.

This is a fundamental issue with health care in the USA.

Can anyone name another product (any product) where the buyer (and often the seller) does not know the cost until after they've made a non-refundable purchase?

The health care system in this country is like The Price is Right!

This is just for your information: My mother spent 10 days in the Tarzana, CA medical center in 2010. Her bill came to $750,000. I asked for an itemized bill. The printed bill was almost 100 pages long and was totally incomprehensible. My mother's cost was $750.

OBAMA, this is why your healthcare reform bill stinks and is not getting the job done. Universal healthcare should mean that the cost of healthcare should be the same and have a standard price like most services oriented businesses. Fix how healthcare is delivered and priced and you will be on the right track in stabilizing the cost of healthcare in America. Its not about insurance companies and those not insured, its how the price for healthcare vary so differently, how hospital abuses pricing, $100 for an aspirin, and there is no clear prices for consumers to shop around.