posted on Mar, 20 2018 @ 10:44 AM
For those of you who have had to have medical tests and have had to pay out of pocket either for part of the test or the entire thing, you will know
that the price can vary greatly from business to business and the price could be drastically different by driving 20-30 miles to a different location.
Now I want to say that in this example the tests provided are of the same quality and or test for the same things using the same procedures - such as
a blood test, drug test, MRI, CT scan, ultrasound, etc.
So if you are told that you need a blood test and the office you are at offers them, with the price of $150 for what you need, but other businesses
across town offers the same thing for $60 - 100 depending upon where you go. Now the doctor you are at tells you to "go next door and get blood
drawn" and many people would do just that. But if you are paying yourself, you may be worried about price, or if you have an insurance cap of say
$4,000 per year and you know you are going to hit that amount this year for whatever reason, you may want to shop around for price. Now can the
doctor demand that you go next door?
What if this is a comprehensive drug test/screen which can be very expensive in some situations some being $1,200 when testing for a mass of
substances (some are 30+ different compounds), and they offer it "in house" where they take a sample, send it out and get the results. Across town
the big lab where most employers send people for testing offers the same thing for $400 - 800 depending upon area. Do you have the right to go to the
service that has the most competitive rates and or can the doctor demand the test be done "in office"?
Now there are some insurance plans that are much more liberal with amounts they pay for testing and don't have a cap that most people are likely to
hit in a given year, unless major medical issues arise. Now if an MRI is ordered and it is going to cost $3,000 for an extensive scan at the local
office, but another location in a large city (say 30-50 miles away) offers it for $1,200 - 1,600, then the person paying out of pocket would probably
drive to the lower priced office, but those with insurance might not care one way or another. I've seen this type of thinking a lot and I think this
is a reason that medical insurance is so high.
I've asked some people about this and I was told "well the insurance companies negotiate prices and they are pretty standard from place to place"
but when I look at the explanation of benefits, which says how much the company charges the insurance company, how much the insurance company pays, I
don't see a whole lot of negotiation in most cases and it may be slightly different than what the "cash" price is (in one case instead of $3,000 it
may be $2,875 but no where near the $1,200 - 1,600 of other places) and if the lower priced place has "negotiated prices" then their insurance rate
may be $1,095 - $1,485 (instead of the $1,200 - $1,600) - so I don't see a fixed $1,050 price at all locations or anything like that - at least I
haven't for the test's I've had.
So, if the insurance company is paying for this, is there any way that they can incentivize the member to find services that offer the most
competitive rate? With car insurance, I get 3 quotes for the car damage, and they often will pay the highest quote if I decide that is where I want
to go, as long as it is competitive and not 2x (or more) than the others - but I can also select the shops I go to - like dealer repair locations
instead of "Little Rickie's Dent Den", lol, (or some other low cost repair joint). Could something like this be done where rates are compared and
the member be rewarded for using the lower cost provider? The problem would come in when this is demanded instead of rewarded and I don't know how a
line could be drawn to differentiate the difference.
I just know that when I was shopping for cash prices for tests, there were some MAJOR cost differences when I looked at major metropolitan areas vs
more suburban or "rural" areas. Even going out of country if needing a lot of tests (and not having insurance) can save money, prices in Canada can
be much less and pricing in some Caribbean countries and SE Asia are MUCH less and even less expensive with air fare (if having a barrage of testing
for whatever reason).
I want to know what people think about the "rights" or options for the patient to choose where they get tests done as explained in the blood test or
the drug test (as above). Do they have the right to go to their provider of choice, or do they have to stay at the office that is asking for the
test. I know some offices tend to pressure the patient to get tests done in office and don't offer any alternative or even say it is an option (like
"do you want to do the test here?). I've asked what the pricing of the tests are and they haven't even been able to tell me until I get the bill
or the letter from insurance which says how much they pay for and how much is owed/covered. This seems almost illegal and underhanded. It seems that
the pricing should have to be clearly stated as well as the options of the patient. There are many industries where pricing, by law, has to be clear
and stated. Why is this not the case for medical procedures?