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Subscribe to RSSMassachusetts is launching a sweeping plan to hold down health care costs. A new law is partly designed to get patients to help drive down prices by shopping for medical care.
So when I had a series of migraines over the summer, I decided this was an opportunity to be an engaged, savvy patient.
First decision: whether to even get the doctor-recommended MRI. It’s a very expensive test, and I thought maybe the headaches would just disappear.
But I followed my doctor's advice, called Newton-Wellesley Hospital and asked for the price of the test. My doctor didn’t know, I got transferred to radiology, I got transferred to billing. Billing said they would call me back. They didn't. I couldn't even get a ballpark estimate.
Now, I have insurance with no deductible, so wherever I went was only going to cost me a $25 copayment. (Apologies to all of you with high-deductible or tiered plans out there.)
When I couldn’t get through to Newton-Wellesley, I tried Mass General, which is what we usually hear is the most expensive and best hospital in the country to go to. They were charging $5,315. That’s for an uninsured patient. For one MRI.
But they couldn’t tell me what my rate was going to be as an insured patient. They said they didn’t have that information. So I hit another wall with another hospital.
Then I tried an independent lab called Shields. It’s a chain that specializes in MRIs and other radiology tests. Shields said it would have charged between $2,000 and $3,600 for this test (the higher cost is for an MRI with an injectable dye to show contrast). But that's not what they would bill my HMO Blue Cross plan for my MRI: $600 for the MRI without the contrast dye, and $1,200 for the MRI with the dye is its negotiated rate with my health plan.
Eventually, I got the test at Newton-Wellesley. I thought the price would be somewhere between Mass General and Shields, and I thought there was some value in following my doctor's recommendation. When I got the bill from Newton-Wellesley I was stunned. It was for $7,468. It turns out this is the price Newton-Wellesley charges someone who is uninsured. If you include the charge for reading the test, the total is almost $8,000, even higher than Mass General. I thought that since Newton-Wellsley knows I’m a Blue Cross member, they’d send me the Blue Cross rate — what Blue Cross was going to pay for the test. They didn't.
Newton-Wellesley also didn’t tell me that I’d had two MRIs while lying there in the cave wearing headphones that are supposed to ease the earthquake rumble effects of the test. I found this out months later when I got the "Explanation of Benefits" (EOB) from my insurance company. I still don’t know why the hospital ran two tests. My doctor says he only ordered one. So the $7,468 doesn’t sound as bad if it’s the price of two tests. This is all incredibly confusing and about as far from the transparent process that is supposed to help us “shop” for care as you can get.
Tips For Price-Conscious Consumers
If you want to try to shop around, here are few things you should know, if you don’t already:
1) Insurance companies negotiate different rates with different hospitals. I’ve had a hard time getting doctors or hospitals to give me the negotiated rate, but Blue Cross will tell me, if I’m willing to wait on hold and have the exact code for the exact procedure I need.
2) Get the code for the test of procedure you need. In some cases there will be several billing codes. For example, my MRI codes were 70551 without the dye, 70552 with the dye. I used those numbers in so many different conversations I don’t think I’ll ever forget them. And in the end, since I had another test I didn’t know about, an MRA, I wasn’t using all the right codes. This process really could drive you crazy.
3) Sometimes your insurance company will send you the EOB that lists the price they actually pay the hospital, but good luck trying to decipher all this paperwork.
4) The physician’s charge is often a separate bill, or rather two bills: what the doc charges and what the insurance company pays. You have to ask a lot of questions
Why the huge disparity between what a hospital charges for an MRI and what a stand-alone clinic such as Shields charges? Newton-Wellesley said that it costs a lot to keep a hospital open 24 hours a day. Hospitals lose a lot of money on some services and make it up other other services. MRIs or other tests are a way to make up for money lost on services such as mental health.
And hospitals say they lose money taking care of patients with Medicare — that’s mostly for the elderly — or Medicaid government insurance mostly for the poor. So private insurance payers like me end up paying more for these tests so that the hospitals can have everything balance in the end.
While Shields lab doesn't have the overhead of a hospital, Tom Shields, the company’s president, says charging more for an MRI to make up for losing money on other services is just a sign that health care finances are really broken. "You’re reimbursing for diagnostic imaging at a very high rate to justify the underpayment for other lines of health care. It’s sort of like justifying the $500 Ace bandage. The logic isn’t there."
I wasn't ever able to find out how much of the charge for an MRI is based on "real" costs - like cost of the machine or the salaries of the technician or doctor.
These real costs vary, but in many cases, not much. We know that hospitals with a strong brand name use that brand to boost their charges. Rick Siegrist, who teaches health care management at the Harvard School of Public Health, says hospitals, much like computer giant Apple, can set their charges as they see fit: "A lot of times, people think they’re just going to look at what their cost is and put a little markup on that and that’s what the charge will be. That’s not the way it’s done, just like it’s not the way it’s done in private industry."
We have the health care industry telling us to shop around, to be smart consumers, to make wise choices, and yet it’s really difficult to do that, because we don’t understand how hospitals set prices, and it can take hours to find a price. The whole pricing system seems very arbitrary. And we’re left trying to make choices based on incomplete or wrong information.
There may be some hope, according to Dr. Gene Lindsey who runs Atrius, the state’s largest physicians group. He said while it's a long way way off, "Atrius Health will, in a very, very focused way, begin the work that’s necessary to try to deliver what the bill asks for in terms of cost transparency.”
Atrius and a few other physicians groups have started putting some price information in the record that doctors can see when they are speaking to a patient. It'll be a tough task to say, "You're going in for an appendectomy and here’s what it’s going to cost," because there are so many variables when you go into a hospital for a procedure. But Atrius is shopping for software that will pull all the information, like my health insurance data, together so that they can say, "OK, you’re an HMO patient, here’s what you’ll pay" or, "You have a high deductible, here’s what you’ll pay."
Two months after I had the tests, I got an Explanation of Benefits from my insurer. Blue Cross paid $1,650 for both. Actually, Blue Cross paid $1,360 for the tests and $290 in physician fees. I never saw a bill for the physician fees. I had to call to get that number. Again, a remarkable lack of transparency.
Then the broader advice is: If you really have to pay attention to price because you have a high-deductible or a tiered coverage plan, then do a lot of deep breathing. Be ready for a long journey that will take some patience.
Oh, and I don’t have a brain tumor or anything serious. My doctor sent me a note. My MRI and MRA showed “white matter with a propensity for migraine.” White matter is just brain tissue, by the way, not little bits of white junk floating around in my brain. I’m fine; I just need to get more sleep.
Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy research and communication organization not affiliated with Kaiser Permanente.
Related stories:
- US health care: It's officially a mess
- More employers send workers to find own insurance
- Obamacare prevails in November election
Leave a Comment:
I had a knee MRI a few months ago at a freestanding imaging center -- $415. I work in a family practice office and all the freestanding centers around here are more than willing to give you cash prices for any test they do. I can get a digital mammogram AND bone density for under $200. You need to get out of Mass.
We Americans pay more for medical care than any other country, yet we get less for our money than any other country as well. Guess this is our capitalist system at work. Side note, the same applies to our wireless phone costs, less service for higher costs, capitalism is great if your top dog.
Our health care system is first about making profit and than trying to provide good health care for the patient.
The problem with a doctor or facility telling you what the procedure costs when you have insurance is based on several levels of complexity, mostly due to the insurance company.
1. I sign an agreement with the insurance company to not disclose their fee schedule. The insurance company may say they reimburse $XX but then they pay me a discounted rate from that. If I disclose that I can be sued for breech of contract.
2. Insurance companies are notorious for stating a certain rate but then reimbursing something different. They say they'll pay $100 but when the check comes they pay $90 and tell me I can appeal it if I want but that will take hours worth of paperwork.
3. Different procedures get paid at different rates depending on the outcomes/what is discovered during a procedure or the complexity of the procedure. So procedures or tx's take 30 min and some 75 min depending on the patient's particular issues.
4. Many places don't provide quotes because if they are seen as giving too many people a discount then they have to provide the insurance company a discount that is XX% below the avg discount they give others. Many ins agreements will state they pay the provider XX% below whatever lowest rate the provider charges on average.
5. Even providers who are open with rates risk being sued by an insurance company or prosecuted because that could be construed as racketeering and rate setting in an area.
6. etc etc etc
If you want something to change the end the insurance monopolies and make ALL fees straight forward and up front. Sadly, Obama care did nothing to change things, as the ins and pharma donated millions of $$ to politicians from both parties. I have a set rate for cash paying patients and don't have a problem with disclosing it to any patients who ask.
I have not joined some major insurance carriers because they demand I reduce my charges to the carrier by 10-50% below my avg discounted rate. I provide a lot of services to the poor and elderly so that would mean certain major ins companies would pay me less than minimum wage. I lose patients that way but maintain my values of helping the poor. That may change with the Medicare reductions of 20-37% approved for 2013. Irregardless of values, the bills must be paid or the doors must close.
You guys are getting only half the story. The other half of the problem. according to the article, is that those of us that have the money to pay cash, or have insurance are also paying for all the other people the medical establishment treats that either can't pay, or are on medicare or medicaid.
It's the fact that there is socialism mixed in with capitalism that is causing prices to spiral up. The government is taking your tax dollars to provide medical care to the old and poor, then forcing the medical industry to treat them at a loss, causing your medical insurance rates to go up to pay for it.
As usual, the middle class gets screwed at both ends.
Prices continue to rise, making health insurance un-affordable to more people, who then drop their insurance only get treated when their situation becomes critical (and expensive), but they can't pay for it, causing the hospitals to raise prices on the insured, and premiums go up.
This is standard operating procedure for ALL our health care providers. The only way is to give some semblence of rationality is thru ONE PAYOR SYSTEM aka the government. Look at how they do it in other countries. We are so hung up on how well the private sector does it we turn a blind eye to the way we are getting the shaft when it comes to cost. Well, guess what, the only ones that are telling us how good the US system is, IS THE ONES THAT ARE CONTROLLING THE SYSTEM. You poor suckers that think privatizing everything is the way to go are all so very, very sad. Look at your electric bills, your phone bill, your airline ticket price, anytime you create a for profit monoply the consumer suffers. There is no way on earth that the average Joe can shop for medical care given the way charges are bundled, discounted or described any more than he can figure out quantum entanglement...In fact, I think that the Ins/Medical providers/hospitals use quantum entanglement to obfuscate their charges.
yeah let me tell you about moving to a different state,,that DOESNT WORK!! I had to have an MRI on my back for pain and the test that I had done took approx 12minutes and I was charged $1500 of which my insurance *and I have GOOD insurance* only paid $800 of it,,,oh yeah im an RN,trust me they rack you UP with charges,,I spent 4 hours in the ER one night and got the bill and it was $3500 and luckily all I had to pay was my copay of $300,,its stupid the amounts that we are charged
It cost me $50 to get an MRI for my neck injury.
BTW, I live in Japan.
Oh, and Japan is ranked #10 according to the W.H.O., whereas America is ranked #38.
This is a must read. Sorry it is so long but it's important for you now or in the future. This is a true story and I have yet to find some way of changing it although my insurance company did tell me I need to fill a grievance with them and my pharmacy. I think the Medicare Fraud Division in our government is a better organization than the insurance company that is letting it continue would be better.
Again sorry for the length.
At this time in my life I find myself in another of the governments screwed up policies and would like to ask someone interested in it also, a question, it has to do with Medicare and the Donut Hole. If you're not interested in it stop reading and move on. My question is simply did you know that your Donut Hole includes the amount of money you spend (your out of pocket expense)? What this means is your deductable for your medication is added to the cost your plan pays. For example I have paid out $600 dollars in out of pocket expenses this year and because it was added to the cost the insurance plan paid I reached my Donut Hole. This out of pocket or medication deductable varies on what type of medication you get, Tear 1, Tear 2, and Tear 3... All the way to Tear 5 which at that level you pay possible hundreds of dollars for a one month supply of medication. Being a Diabetic my insulin is considered a Tear 3 and I pay $45 deductable and I pay this directly to the pharmacy. This is called a Deductable for what reason? It is not deducted from your Donut Hole but added to it. One medication I used to get from Walgreens was actually less if I paid cash for a 90 day supply than if I used my insurance and received a 30 day supply. When I didn't have insurance I used Walgreens drug payment program which I paid $20 a year for a plan that allowed me to pay $8 for a 30 day and $12 for a ninety day supply. When I did get insurance I would tell the pharmacy that I did not want it on my insurance because my insurance plan would only pay for a 30 day supply and my deductable was $10 each month and that I would use my member prescription plan I had with them. After years of doing this I was told yesterday that because I have reached my Donut Hole my same medication would now cost me $112.64 rather than $12. When I ask what my insurance had to do with it I was informed that the Pharmacy had been billing my insurance even though I had been paying $20 a year to enroll in their prescription drug program. Remember when I started this program I had no insurance and paid cash for all my medication (Tear 1, 2, 3…). I called my insurance company today to ask what was going on they informed me that they in fact was being billed and not only that but the amount they where being billed was substantially more than the medication cost when I was paying cash. The insurance company verified this by calling the pharmacy and asking the cash price while pretending to be a person without insurance. I was advised to file a complaint with the insurance about what the Pharmacy was doing. The Pharmacy actually quoted him one price while telling me another and billing the insurance company yet another price for the same medication. He told me a medication I paid $107 cash for was now because of insurance costing them and I $266, that's more than double the cash price. The price he told me he was quoted was $309, which is almost 3 times the amount I paid cash for and $43 more than they charge the insurance company. Does anyone know how they justify this or do they just hope we won't find out the cash price? Does Medicare need to be reformed? Not in my opinion, what needs to happen is a set price for medication so everyone pays the same price even the insurance companies. The Pharmacies/ Pharmaceutical Companies shouldn't be able to adjust the price to the circumstances (age). The elderly should not be paying more to stay alive which from what I have found out may be the case! By the way no one other than the doctors, pharmacies and insurance companies have ever asked my age so I don't see how this might be a price indicator. You should also ask your Pharmacy if you shop at Walgreens and have no insurance if in fact they do charge an insurance company for your medication. I found Walgreens was billing an insurance company on my behalf that in return was billing Medicare even though (again) I had no insurance what so ever! They told me it was a simple mistake that my information was mixed up with someone else's or possible someone's was mixed with mine. That might explain the medication they had listed for me that I have never taken. This brings me back to this subject, sorry for the side tracking. IF WE ALL BECOME ONE, THINGS WILL CHANGE FOR THE BETTER. No one would vote to hurt the other, and those hurting us now would change or in some cases go back home to the country they came from. Making it a Right to Work state should not make it legal or harder to prove a person is illegal as it has in some states. Ohio is a Right to Work state and millions of illegals have flocked here to work. Where I live off of Highway 75 it is considered a drug corridor where drugs move freely between Atlanta GA and Detroit MI. This brings illegal's that once they deliver the drugs they want to stay and become American's setting up safe houses for more drugs and illegal's. Again I'm getting off subject and I apologize. I would like to end on this, Merry Christmas to all and to all Good Night.
Save Changes missed in Confussed-1578043 post 1.9
I originally wrote this earlier tonight for a different article so at the end of this post it goes back to the original post subject (Right to Work). I can't seem to get my insurance/government policies off my mind, Sorry. I will try in the future to limit my post to subject at hand.
There's another list Japan ranks highly on, highest national debt to GDP. It comes in at #1. Way to go, Japan.
What is absurd is that these health care providers will charge a cash patient as much as 5-10 times what they get from and insurance company for the same procedure. This should be illegal. Those who do not have insurance get nailed twice, first in that they have to pay for everything, and second in that they get hit with absurdly inflated prices because there is nothing they can do about it. I have seen this with medication as well as with actual procedures or tests. If you are paying cash for medication you may be paying as much as 3 times what the insurance companies pay the pharmacy for the same medication. This is criminal. A given service or medication from a given source should have the same price, regardless of who is paying for it. Could you imagine going into a store and having how much you pay for an item vary widely depending on what form of payment you are using. How many people would put up with this kind of nonsense, yet this is exactly what goes on in health care. This needs to be stopped. The proposed reductions in what Medicare will pay for various services is going to make it very difficult for those on Medicare to find doctors who are even willing to take them on as patients. The fallacy in Obamacare is that it is claiming to be revenue neutral by reducing what providers are paid by Medicare. These reductions are going to ed up creating a two tier health care system in this country. Those with private insurance or who can afford to pay cash will be able to go to the best doctors. Those with Medicare will be forced to go to second rate doctors and facilities because none of the good doctors will be willing to take Medicare any longer. This is already happening with more and more doctors opting out of taking Medicare patients. Obamacare is not what it is being sold as and is going to hurt, not help health care in this country. Those who rely on Medicare, and likely the insurance plans that will be available through the exchanges, will be relegated to second rate care from second rate doctors and facilities because these are the only ones who will accept the low payments that Medicare and these exchange insurance plans will pay. I have been told by my doctors that if Obamacare goes ahead as planned that I will need to find new doctors. They say they barely break even on Medicare patients now and would be losing money to see Medicare patients if things go forward as planned. This is not what Obamacare was sold as, but it the reality of this garbage legislation that was rammed down our throats by Obama and his cronies.
Insurance companies should be kicked the hell out of providing health care coverage all together.
Single payer coverage by the government should be applied for everyone, everywhere.
JS.. I've never charged a cash pay client 10X, I don't even charge double the avg ins rate of plans I accept. Yes many facilities will, but I know of no provider that charges that much. That said, there are some insurance companies that will reimburse almost nothing, 1/4 or 1/5 of what even Medicare will reimburse. I personally refuse to join those panels. Those are often the same carriers that have $3000 deductibles and allow less visits than the deductible so the person never meets it.
bicfi.. Would be happy to see insurance companies out of healthcare. They are like leeches and provide little added value.
Out here in Old Fart Land in central Texas, Scott & White has a virtual monopoly - they're pretty much the only game in town. I wanted to have a simple physical exam but since I'm not yet 62 I had to pay out of pocket. I could not find out in advance what any tests were going to cost. The physical itself was pretty superficial - not worth the $300 I paid ($150 for going through the doors and $150 for the doctor - the bood test was extra). I'm thinking of having a card made up and laminated that says "In case of accident, do not transport me to a Scott & White facility".
"those of us that have the money to pay cash, or have insurance are also paying for all the other people the medical establishment treats that either can't pay, or are on medicare or medicaid".
If you can afford it then stop whining about it and be thankful you can! Medicare isn't FREE by the way. Plus I have no control over what deal is made to pay for medical procedures. I also paid all my working life for Social Security benifits. It to isn't free. Bottom line should be saving ones life not making huge profits.
Many doctors refuse to order MRI scans on the first visit, even if you are a very good candidate, due to the cost factor (there is no risk to the patient, unlike CT scans). Interestingly, CT scans can cost more! And by the time you visit the primary care doctor and the specialist, you've spent more on the visits than the actual scan, not to mention missed work, pain and suffering, and your own time spent running around. Sometimes I just don't get it.
You can argue that the scan might show a benign condition, but our medical community should know how to interpret that, and the patient benefits with a baseline scan. Plus, if there were more ordered MRIs, maybe the price would drop.
Please note, I am not advocating for unnecessary scan, but I do know of quite a few people who had to fight for them, and unfortunately one who got the scan too late to help :(
Health care pricing has to be very confusing to everyone, that is the way any con works. How many people would go to a con man and ask for a slow and direct plan of what he is doing with back it up information. You won't get it and that is what makes a good con.
My flu shot was free to me but Walmart billed Medicare $50.00. I guess there uninsured rate would be around a $1,000.00
How many of you who complain about the price have 'strategically bankrupted' in order to not pay medical bills? It's not just the homeless and jobless who are causing these high prices. It's people with homes that are not subject to asset forfeiture who are strategically bankrupting after they go in for these procedures.
I'll have to look at this, strategically, of course. However at first glance I see doctors making a million a year, hospitals making hundreds of millions in profit, and medical suppliers - well they aren't relying on the homeless for their income.
Hospitals that accept Medicare and Medicaid must CHARGE the same price to all patients for the same services regardless of thier insurance status. This is MEDICARE regulations.
IE if an brain MRI costs 3500.00 then they have to charge 3500.00 to you if you have blue cross , medicare or no insurance.
The hospital may have a negotiated contract with Blue cross allowing them to reduce the charges to a set lower amount, lets say 1750.00 with the hospital writing off the difference. medicare may be allowed to reduce that charge to 250.00 (yes Medicare pays that little on things).
The actual cost to provide that MRI is usually MUCH higher than the Medicare rate as the cost includes the cost of the film or electronic media used for the test, the MRI machine, the electricity costs, the pay for the tech (who has to be there whether it 1pm or 1am), the heat, the person who has to check you in and the person who submits the bill to your insurance, the malpractice insurance, the cost of the MRI for the uninsured crash victim who was seen in the ER last night, the cleaning crew who keeps the areas clean and sterile, etc...
Oh and then if you are lucky your insurance will pay for the claim the first time instead of "losing" the claim or the prior authorization files or taking months to pay the claim.
As to hospital profits, check the profit margin of your local non profit hospital (the records are public record since they are non profit). Chances are its less than 3% and many are actually losing money.
The only ones making huge profits are a)the insurance company (check the "bonuses" paid to the CEO of Anthem over the last couple of years while they raise premiums 20% a year) b)drug and medical supply companies.
So you are saying that if people fall ill, they should lose their homes.
HEYA NBC.....where is the article on the Democrats wanting to DELAY the 2.3% TAX on medical devices in OBAMACARE they VOTED FOR ?
Comon....REPORT THE DAD GUM NEWS.
They must be placating republicans in order to get the fiscal cliff moved out 100 feet. You know those republicans and those pesky taxes.
The whole lot of them, hospitals, physicians, insurance companies are all a bunch of crooks. Would someone please tell me why a company would charge a individual twice as much for a MRI, when they would be paid in cash with no paper work to speak of and immediate payment. The medical system in America is nothing but a bunch of greedy scammers, especially the insurance companies. If the government were to outlaw medical insurance and pharmaceutical companies and put every person in America on medicare and receive all the money that people are presently paying out for these necessary evils into the medicare pool we would be better off. The government could set the cost of these services to these companies and Doctors and pharmacies just as thye do now, without telling them how to do their jobs but assign a special department to scrutinize these things for fraud and neglect, we would have a pretty good health care system and everyone would be covered. You choose your Doctors and hospitals. If you wanted to go to a private hospital or a physician who chooses not to participate in the program then all of the cost would be borne by you.
Jerry.. One reason is that many insurance companys require as part of their contract for a provider to bill them 10-50% less than their usual or avg minimal fee. The usual fee is often based on an average of cash paying patients. Most doctors dislike those types of contracts but major insurers push them or you lose the ability to cover a large group of people. With ins monopolies everyone loses and individuals are stuck with what their company offers so little hope for change.
Now you know why we need healthcare reform.
We absolutely do, but this is not why. Both Tricare and Medicare are also complex, and they are government-run, single-payer systems. Ask any spouse of a service member about Tricare, and they'll tell you what a bureaucratic nightmare it is.
But at least they have health insurance.
I'm not knocking single-payer, or health care reform either. It's just that most people either think the current system is totally awesome, or that national health insurance would be a quasi-socialist utopia. I just think they're both wrong.
Free-market lovers here in the U.S. are quick to point out any and all flaws in single-payer or government-run health care systems around the world, as though there could ever be a perfect system of distribution for a good that has potentially unlimited demand.
At the same time, single-payer advocates talk like they think everything under the sun, even a desperate costly experimental treatment to save a sick child, would be covered under a national system (highly dubious).
The truth is that there is no way to adequately do all the things a fantasy health care system is supposed to do, while keeping costs down despite escalating technology, and not be bureaucratically complex and "ration" care in some way. It's just that the system we have now for distributing (that is, "rationing") care fails to keep costs down and leaves millions without access.
Clearly this cannot continue, but don't expect the solution to be simple.
dc
good post.
DCogito, I agree and respectfully disagree in part also.
Your last paragraph is where we have to disagree. Your quote...
"The truth is that there is no way to adequately do all the things a fantasy health care system is supposed to do, while keeping costs down despite escalating technology..."
The real truth is, there IS a way but no one in health care WANTS to unify the prices. Each level of health care has their own level of greed built in (for whatever reason) and they have no desire to become a uniform price-even though they COULD if they so chose. There is no oversight at this point to mandate everyone going uniform because everyone would scream SOCIAL MEDICINE.
And the insurance companies know this and embrace it also. How else could you explain them being willing to sue you if you disclose what they pay to others?
Your post is a valid one and I think one that many people will tend to agree with. I just think there is a difference between not being able to change and not WANTING to.
I am retired and have used Tricare for many years with no problems at all. The only drawback under the standard plan is you pay a % of the "allowable charges" which you will not know until you get the bill later but the paperwork is very light.
DC - Nothing in health care reform is going to be simple, but that doesn't mean we can move toward reform. The only other option is to keep the nightmare we have.
The US Constitution provides for Patent protection. But it does NOT specify how long that Patent protection must last. Nor does it state that all the varying sorts of patents should have the same length of protection. In other words, a patent for a new health care drug does NOT necessarily need to have the same number of patent protected years that, for example, a new and improved steering wheel in a car might have.
Our local hospital in town is legally a 'non-profit' -- which means they have to burn up money at the end of tax season. So what did they do here in town? They paid for a baseball park with their name plastered all over it. Of course that park has absolutely nothing at all to do with providing health care to the community -- it was a tax writeoff. Rather than actually lower their prices, they WASTED money on a baseball park. It's disgusting. But that's not where it stops -- they waste money all across the board...for the same reason. They maximize revenue, and then maximize their expenditures to take care of the tax man. The patient and his/her care is lost in the process.
And sure, they also donate to charity. Those chairs that get banged up, or which don't match this year's color scheme decor, get donated -- not so much to help the poor, but again....to satisfy the need to lower taxes. Those pills that don't expire for another 6 months....they get 'donated' to the non-profit health clinics around the state (perhaps the country)...again, for the same reason...to lower that end-of-year tax.
The entire system is moribund. It needs to be rethought -- completely from scratch.
BS, tricare pays less then medicare rates which is less than raw costs for services. Great for you , sucks for providers.
Well,i cant even get health insurance because i have a "pre-existing" condition resulting from an injury i suffered through no fault of my own. Reading this article reinforces what i already knew, i have no hope of being able to afford medical care, 1500 dollars or more for a single scan is beyond ridiculous. Health insurance companies will cover me for 1500 dollars a month but wont cover any care i need for my health problem, again beyond ridiculous. Exactly how is someone making minimum wage supposed to be able to afford healthcare at all in this country? Why would i or anyone even try to pay that much knowing ahead of time i wont get the medical care i need? How has it changed to NOT getting a service one pays for?
My injury happened a decade ago and back then the standard cost of an MRI was 1500 dollars.
When Obamacare goes into full effect, no more pre-existing.
Morlack,Well it is said Obama-care will be focussing on people in your position.
You're not expected to pay for it. They want you to die. That's just the way things are in this land of Mammon.
Martha, I don't know what you're talking about.
If you have the codes that will be billed for the procedure (as you did) and the name of the facility where it will be performed, your insurance company will most likely tell you the allowed amount they pay for that service, and what they expect your out-of-pocket cost to be. (They will, however, not guarantee that price because, as you found out, there may be other codes that will appear on the claim, and the price is subject to change at any time.)
Yes, unless the doctor is the owner of the MRI machine, he/she is going to bill you separately for his/her time and expertise. Also, the doctor may not send you a bill - and your insurance may not send you an EOB - if there was no patient cost for you to worry about. Both would rather save a stamp.
Please understand that health insurance is complicated because your health is complicated. Those billing codes are also used to determine whether a procedure was appropriate to the diagnosis, and therefore payable under your benefits. This is your insurance company trying to keep costs under control, while still paying for medically necessary procedures. Again, that is a complicated task.
This system was never designed to help you "shop around" for the best price, because you are not the immediate customer, your employer is. They shop around for the best insurance carrier that meets their needs, and provides the greatest value. The insured members, like yourself, usually shop around for the most competent doctor or the best hospital, not the best price. The insurance company then tries to negotiate the best price with providers.
The bottom line is that most people are not worried about what the insurance company paid the hospital. People care about what will come out of their own pocket. It's the job of the insurance company (and your employer, who pays for most of the premiums) to bring costs down.
Rather than working against them, health-care reform should find ways to partner with insurance carriers and employers to increase competition and transparency, and enhance their ability to control costs.
P.S.: most of the nation's Blue Cross/Blue Shield carriers are non-profits.
What Martha is the post directed at, i mean i see no Martha here?
By Martha Bebinger, Kaiser Health News
Actually there are millions in this country forced to try to shop around for healthcare prices. It is almost impossible to do . I have tried for many many years. I was born with a pre existing condition. No insurance for me .
DC:
"P.S.: most of the nation's Blue Cross/Blue Shield carriers are non-profits.
Boy, have you a lot to learn about Creative Bookkeeping.
Aster in 2014 they will no longer be able to deny you coverage.
Interesting point!
Folks pride the US on having a 'Free Market,' but there is anything but that available in healthcare. You can't accurately price compare the same operation at different hospitals or with different doctors.
The most choice you have is insurers, and most folks have no choice but what their employers offer.
Healthcare choice? Not in America!
I'm fortunate enough to have served in the military, so I've got the VA to go to when I need it.
The kind of care you get from the VA is something that also varies by state. When I was in Michigan (where there are less patients) and needed several tests done, I basically skipped from office to office with barely a wait and got everything that I needed accomplished in a matter of hours. In California, it can take months to get a certain procedure done; one of the sleep study clinics is backed up for a year of appointments at one facility. I've heard the mental health ward has a six-month backlog of appointments. I know by personal experience that a minor surgical procedure can take four or five months to schedule.
But at least the help is there. You do a means test every year, and if you make a certain amount of money and/or have outside private insurance, you only pay a VERY minimal amount compared to the services you get.
Now, the real question is this. How much electricity is used during one MRI scan to generate the images? Once they have paid for the equipment, which could not take long at the prices they charge, the only cost is electricity, operators, and the doctor reading it. I was not allowed to get a MRI on a knee in the military because the Corpsman said they cost too much, at the Naval hospital, now I receive disability for the knee from the VA. I'll take the money. Over the rest of my life I will bet they pay me more than that MRI would have cost. It is a scam for the medical industry to make huge amounts of money for doing little or nothing. There is no reason for 90% of the huge fees in the medical industry.
you forgot upkeep, which is huge. Also for the techs and nurses it takes to run the machines and monitor the patients. Also huge
@eric - But there's the problem, we don't know how much the upkeep is. Nurses generally don't run MRIs because they are too expensive. For every machine blamed for high costs I can show you a dozen expensive employees. RN cost hospitals over $100,000 a year. Then you have all the therapists, CNAs, and on and on.
An MRI machine can cost $1.0 - $3.5 million. The more detailed the scan, the more expensive.
It's not just a matter of plugging the machine in. The super-conducting magnetic coils must be kept in liquid helium at a temperature of 4.2 degrees Kelvin (that's -451.84 Fahrenheit). Average annual cost of ownership is $750,000 to $1,000,000.
A trained (civilian) MRI technician can make over $50,000 a year in today's market.
The average life span of the machine itself is 7 -10 years.
So: a $2 million machine that costs $800K a year to operate and a tech who makes $60k, divided by 10 years equals $1,050,000 per year in budgeted costs. That doesn't count maintenance and repair.
No surprise they charge $5,000 for a scan, and military hospitals can't afford them. (They send patients to nearby civilian MRI centers only if absolutely necessary).
that is a problem. But its certainly more than the electric bill, which is what the original poster claims
They are required to be present during transport and often during the procedure because techs are not allowed to push meds.
Maybe. One would argue its worth it
Thank you DCogito, for giving out the info that Gunner was ignorant of. Don't forget the physicists who service the machine, the help desk to answer questions when it goes down, the MRI girl who schedules the appts, gets benefits (ins companies are transferring more of the costs to the patients), and precerts (harder and harder to get, btw), the guy who fills the helium, etc!!!
But, I'll gladly give you our contacted rates for any ins co, for any MRI. It is impossible, even for me, to get rates from the hospitals. My advice? Stay away from hospitals if you can-they average 2-3 times as much as a free standing clinic-for any thing, MRIs CTs, xrays, blood work, etc.
Newer short bore MRI machines which use high temperature superconductive magnets can be cooled with liquid nitrogen instead of liquid helium. This is a much cheaper technology. My doctor just bought one of these. He says its purchase cost is less, and its operating cost is approaching that of an X-ray machine.
So he bought a cheaper machine with cheaper upkeep, but he will be able to charge the same as the competition, thus maximizing his profit margin. I would be surprised to see him pass the savings on to the patient.
DC,
Lets double your estimate for costs (to include maintenance...and be REALLY generous) and assume hospitals will use that machine once per hour:
2,100,000 / (24 [uses/day] * 365 [days]) = $239.72 - operating cost per use
Even doubling the approximate operation costs, the hospital would have to use the machine less than two times a day to justify what they are charging. ( 2,100,000 / 365 [days] = $5753.43 [operating cost per day]
It just doesn't add up.
And hence, now we reach the next level that needs to be addressed when trying to combat health care costs - the cost of the machines. If the government is serious about combating rising health care costs, they cannot just go after doctors and hospitals. They need to go after the manufacturers of things like these MRI machines and get them to lower their profit margins (not to mention the liquid helium providers apparently)
Now add that the hospital has to have a tech there to run the MRI 24/7 even hoslidays and the hospital must maintain liability coverage 24/7 to the cost of that MRI and the person who cleans the exam room and the supplies used to admin the test (contrast material doesnt get in your veins through osmosis, it needs an IV and the various non re-usabled supplies that go with it).
Many of those costs arent applicable to a dr's office or stand along radiology center who can close on holidays and non busy hours (like 1am).
When I lived in France I had approximately 5 MRIs in the whole 15 years I was there. I was not charged out of pocket. An MRI costs approx 250$ in France. Why so much in the U.S.?
Why so much in the U.S.? It's simple. The moneyed class wants it that way. You're talking about a sizable portion of GDP going to health care, and there are lots of people trying to get rich in their particular niche market within the field.
I doubt if the MRI and/or CT scanning machines are even 'made in the USA' -- and if they are, they're probably made here only in the sense that the final screws are tightened here...with the majority of parts actually made elsewhere....offshore.
But remember -- we're a country that has been brainwashed into thinking 'Greed is Good'. It's not one of the seven deadly sins -- it's what fuels a successful marketplace... pffttt.
We worship Mammon in the USA while lying to ourselves telling ourselves that we're a so-called "Christian Nation". That's quite the joke...
You want fair billings and fair prices in your health care--travel to India. You won't get it in America with the crooks here. It's all nothing but a swindle for American hospitals which are corrupted even more than Congress.
I had one taken last year for my shoulder @ summit Orthopedics in MN, The initial bill was $1260.00. I saw the doc for 5 minutes, almost as if it was a manufacturing line. They kept billing me for the same procedure for about 6 months, adding small amount overtime. I agree with DCogito, there is no magic bullet. The one thing for sure, it is no longer about our health, i tis pure business.
Our medical system if your rich is great yet for a normal family this system can financially destroy everything they have. Personally I would only go to a hospital if I thought I was going to die, once those people have you its like quicksand, you can never get out.
No - it is like a black hole - and no matter how much you fight it - nor how long - you will eventually end up .... in the hole.
It is just like these healthy people say to a fat person to just exercise and lose weight. Health food is way more expensive than unhealthy. Exercise will cost you a minimum of a good pair of walking shoes let alone a membership somewhere if you go that route. If you are poor or legally in poverty, you will only buy what you can afford. I can't go for health screens which I need, cause (in Florida) an unemployment check of 275 a week is too much to qualify for Medicaid. FYI: For a family of 4, $303 is the maximum income for Medicaid. Pay rent, electric, phone, gas, insurance, and food on $303 dollars.
I do background work in movies and TV from time to time. While most everyone on a production will indulge in snack foods from Craft Services, and weighty foods like steak and pasta from Catering, my first grab is for the fruits (mostly berries) and fresh vegetables... for that very reason, because of the cost. It's a real sacrifice on a low income to pay for anything like strawberries, raspberries or blueberries, when you're coughing up $5 for what is the equivalent of two handfuls--and you don't live close enough to a "pick-your-own" farm. Most often, you have to rely on frozen foods to get anywhere close to a bargain on vegetables--which is fine, if you have a freezer.
As far as the walking shoes go? It's a minor sacrifice and, yes, you could pick up a pair cheaply at a thrift store, but in our body-obsessed society, walking just isn't good enough. You've GOT to have a gym membership to be socially-acceptable and deemed "in shape" by total strangers, particularly in Hollywood where anyone over a Size 8 is considered obese (tall, muscular women in the larger sizes feel this stigma in particular).
You do qualify for food stamps, or should.
Qualifying for food stamps does not, by any means, guarantee that you will get a decent amount. I went into this elsewhere in debth, and I have an Amazon.com short story up about it, but I applied two years ago for EBT/food stamps and was "granted" $22/month... with a 22-hour work requirement, in trade ($1/hour trade in order to keep the benefits--and if you miss a work day that they assign to you, then your benefits are suspended for a month). I dropped out before taking a single penny because after letting them fingerprint me and take my financial records in order to apply, that $22 for the month did not constitute reasonable "help."
In our area we have several hospitals offering MRIs as well as several orthopedic groups. About a year ago I had a MRI of my knee done - about one hour of testing and the cost was about $625. We have insurance, high deductible with office fees and co-fees. I can't remember exactly the total I spent. I also had three visits with the orthopedic surgeon and had a few X-rays done. Fortunately I did not require surgery. The MRI definitely showed knee damage vs the X-ray that just showed some mild arthritis that certainly was not causing my extreme pain.
Before hospitals had to accept all emergency patients, their bills were a lot smaller and a lot more defined. Now, the government forces them to overcharge every paying patient to meet their mandated expenses. With Obamacare, I I wonder if hospitals will be forced to lower their billing.
I doubt they will. It will be just like the Part D, the drug program of Medicare. The insurance company were to negotiate lower domestic prices for prescription drugs but why would they do that. The government repays the drug companies anything they charge. So our drug costs in the US are 3 time that of Canadians for the same stuff. It will be the same way with hospital care.
I experienced the same thing Martha did with my late wife's cat scan. The hospital was going to charge me $1400 under my insurance plan, so I shopped around and could have saved about $300. When I went back to the hospital to ask their cash price, they said I had to use my insurance and couldn't pay cash. This is ridiculous, and of course, none of this has been addressed by Obama-care which is mostly insurance reform and not health care reform. So to address this ... my rant is ... we need to open health care up to the market and we cannot do this without full transparency and published pricing for medical procedures as well as pharmaceuticals and medical devices (but not price control), we need to require the price to everyone to be the same for the same service or products as it is with other services and products - then reduced by whatever deal the insurance company or the individual can negotiate (which should be explained to the individual before the service is rendered whenever possible), we need individuals to take more responsibility for shopping the price and then getting reimbursed or arranging direct pay (which can occur immediately once the shopper locates what they want - not that unlike a food stamp debit card), we need to be able to buy health insurance across state lines just like we can life insurance on-line e.g. SelectQuote, etc. and carry it with us from employer to employer ... and pay the full cost of this. And we need to address the supply side of health care as we are about to add another 30m people under coverage but already face a serious shortage of doctors and nurses. This combined with reductions in medicare reimbursement are going to drive medical professionals out of the market, and only make rationing based on even higher prices worse for everyone (this is the hidden tax on the middle class that no one is talking about). Finally, while I think most Americans would be happy to pay extra to help those who get sick or hurt through no fault or their own and cannot afford to pay, we need to have a serious discussion about subsidizing (and how much if we should) those people who willing and intentionally live unhealthy lives (risky behavior, excessive alcohol, drugs, smokers, lack of exercise, obesity, etc.) By the way, this is quite a few of us - perhaps >50% of the non-senior population in one study that I read. Promising one-size fits all coverage to everyone is one thing ... receiving the actual service is quite another. And as ADAM-2385860 said it is all about business, so we must attack the problem like a business would. In our current closed and gamed system, business has figured out a way to make money ... at our considerable expense ... and they can do it in an open market too with government left to set standards, make and enforce regulations (and there are many more needed).
You exclude 'price controls' -- yet for no good reason. We need single-payer like most in the civilized world have. And if we need to help subsidize it, we can look at Sweden's model -- a surcharge on all fast-food. They have a "MOMS" tax over there which not only supports the elderly, but also provides education for university. It's 40% tax on everything fast-food. And while that might seem steep -- would you rather pay that, or your student loan each month? Would you rather pay that, or go bankrupt with these charlatans in white lab jackets?
There's no reason to not have single-payer. It will push prices down to a set level for every procedure.
I had an MRI a few years ago. I think the negotiated insurance cost was about $3500.00. I have no insurance now so I don't go to the hospital for anything or doctors. Hit the gym, run, eat veggies, got rid of the Harley, don't climb on the roof anymore, try to live like something well happen to my health. Health care costs are ridiculous. And if I do end up in the emergency room then I'll say to the hospital to stand in line an take a number on the bill. Sorry....I didn't create this problem.
And that's all fine and good, living as well as you can. Watching out for your health and doing what you can to look after yourself...
But at any time, any day, you can drop down from a massive coronary or a stroke. You could find a lump, or only see the doctor because you feel a little unwell, and learn that you have cancer spreading through your system.
At any time, some drunk driver can slam into your car or even your house; I know a man whose little daughter died while sitting on a sofa, when a drunk neighbor (whose friends had just driven him back from a party) got in his vehicle, lost control of his car on a hill and crashed through their living room.
You could be injured and require long-term care from a nursing service. You might need rehabilitation several times a week. You could suffer severe burns and require repeated skin grafts. You could develop something like high blood pressure due to stress, no matter how fit you are, and require daily medications.
Nobody created the health care problem we're in except for the health care industry and pharmaceuticals--private businesses out to get as much money as they can, as unfairly as they can.
And that's precisely the problem with American health care, it's motto is
"Nothing personal, it's just business."
Hospitals are expert at hiding what they actually charge for services. I worked for a guy who was in hospital administration for many years. He said every hospital hides charges and bills whatever the market will allow, which helps the bottom line, as well as bonuses for administration managers. I know he made too much money because he paid cash for a hardware store and still refers to customers as patients -- as well as lamenting that hardware does not bring in the kind of cash that ICU patient hours does. Hospitals are in it for the money. Don't fool yourself that they aren't.
I was in a clinical trial at Cedars-Sinai a few years ago, when I learned (the hard way) that I might have an allergy to steroids, after I was injected and passed out for about a minute. Although I was on the property and a mere two-minute walk from the E.R., the county ambulance took 20 minutes to get there, secure me into the vehicle, and drive me to the E.R. The bill: $1,400, for a one-block drive.
And even though the office holding the clinical trial paid for everything in the end, I still spent months fielding the ambulance bill AND the one from the E.R.--this, despite the fact that I had the clinical trials doctor with me in the room for most of the time, explaining the situation over and over again to Registration, and providing all the information needed to bill their particular department within the system itself! And I STILL ended up receiving phone calls from C-S to pay the E.R. bill! It took a good eight months to finally settle the ambulance bill through them.
Another private hospital that I went to (due to an unconfirmed attack of angina, it's a four-generational family thing so *I* know what it was), kept trying to bill me for x-ray services for about nine months afterwards. This, even though I was working under a Workers' Comp situation and owed nothing. In the end, when the communications between the Workers' Comp insurance agency broke down, and to pay the remaining balance of the bill... the hospital learned that I am a veteran and basically stole $149 from the government, because I'm a V.A. patient.
I am terrified to think what will happen when/if I have a genuine, severe medical crisis and am being hounded for years on end to pay bills that I do not owe. It only takes one company to hastily report an unpaid bill to throw your life in to chaos.
Ah, the joy of our American for-profit health system. I lived in Australia, Canada, Japan and Italy, and never had trouble getting quality health care for free or next to nothing in those countries. It CAN be done, my friends, if we have the political will to do so.
We would rather spend a trillion per year on the perpetual war machine for the benefit of defense contractors. I can't wait to see the deal to avert the fiscal cliff that cuts hundreds of billions from medicare and 0 from defense.
"I wasn't ever able to find out how much of the charge for an MRI is based on "real" costs - like cost of the machine or the salaries of the technician or doctor."
In most hospitals they make enough on MRI's to pay off on the machine in 18 months or less. Tech Salaries for an MRI are less than $100. The rest is all gravy, or theft, actually.
Not all hospital's own thier MRI machine. If the state doesnt okay the purchase they can only RENT it.
It shouldn't matter if you're insured or uninsured, hospitals should still give you the cost for tests if you ask for it. Is it acceptable if we walk into a shop to get our car serviced and they can't give us a price, is that acceptable? Heck no!! So, why should this be any different? Get the hospitals to show lot their prices!!!
Thousands of dollars for an MRI?! This is utter nonsense. We need government price controls.
I just had a CT scan done of my upper abdomen. Not my entire abdomen -- just the upper portion, mind ya... The cost... $4997.95. I had to laugh at that 95 cents at the end. That was with contrast... I had to drink this foul-tasting liquid, and have the burning dye injected into my system seconds prior to the scan. But still -- it took all of 5 minutes to actually scan me. That's $1k per minute!!
I'm in the same boat as a lot of people. If I need to go to a doctor, I don't. It's just that simple. I have to be incredibly sick to go see one. They are nice and smiley and then you get the bill and POOF there goes your next few month's wages. It's ridiculous and something definitely needs to be done. Have a couple friends from Canada, and they really do laugh at our system. The ones that say their system is worse are just the ones who are afraid if we went to that system, they wouldn't make their killing.
The Canadian system actually triages you according to the severity of your illness/injury. So if you have a life-threatening illness/injury, you get put into the MRI or CT scanner ahead of the person who isn't facing a life-threatening illness/injury. In some cases, this can add significant waiting time -- depending, of course, on your location and the congestion in that location.
Those Canadians who do complain about their system are typically rich and want to be seen immediately even though they aren't facing a life-threatening condition. And they come here to the USA and pay substantially more to do so.
All the health care providers scream because they aren't getting paid enough by insurers and medicare. But they sure keep building new facilities like crazy. You think they might not be telling us the truth?
I think the current stream of worker ants are being gouged to pay for the retiring stream of 'baby boomer' worker ants. And the retiring stream of worker ants never insisted on a 'lock box' for their social security and other payments to Uncle Sam -- so Uncle Sam used that money to blow things up around the world with super-expensive things that go BOOM!
And yes, they are building new facilities like crazy -- but that's due to the fact that they're being inundated by new boomer patients. That will eventually end as the boomers die off. And then we'll have lots of facilities that refuse to close until absolutely necessary, even though they hardly see anyone anymore.
If our government actually was forced to hold on to that Medicaid/Medicare and Social Security money until the person who paid it actually is in a position to USE it, we'd be in a much different situation. Instead, we find ourselves in our current position -- where each generation's bills are paid by the up-and-coming generation. And Generation X and Y are now getting hit hard because they're expected to pay to support the entire Baby Boomer generation's retirement.
Remember the Olympic Games Opening Night show, when they had the salute to National Health Care?! Hundreds of stretchers pushed out on the stadium field, by ACTUAL doctors and nurses, who danced, sang, and enjoyed themselves. The crowd cheered and applauded; they LOVE their National Health Care!
Now, imagine the same sort of spectacle here in the US of A; first out would be the CEO's in their Bentley's and Mercedes, the Surgeon General of the US Public Health Service, the Insurance Companies CFO's. Doctors would follow in Cadillac's, Nurse CEO's and Managers would be in Lincolns, and finally, handcuffed to long chains would come the actual "workers" of American Health Care; a long chain of Nurses, a long chain of Lab Techs, a long chain of Radiologists...while the crowd boos and gives the "thumbs down".
You didn't mention the capitalists who fronted the 'fiat' money and expected the compounded interest payments...
It has been estimated that 30% to 40% of all prices are now due entirely to interest on loans -- loans made by the producer and seller, not the loans of the actual consumer...which is yet another problem. Usury is definitely a part of the problem.
I have not had any health insurance for a decade; I need to have surgery to correct a chronic condition. A few years ago I called the local hospital to get an 'estimate', as I was thinking of taking a 2nd mortgage out to pay for the surgery. You would have thought i'd asked these people for top secret government intelligence...and I NEVER got a straight answer. Our system sucks beyond belief- totally broken.
Hospitals should be torn down and replaced with prisons. Same result.