Why are medical prices not up-front? Why always a mystery?

I just recently received a bill for a doctor's appointment and I find it absolutely ridiculous. Why is it that medical prices/charges are not upfront at the time of, or prior to the rendering of services? It is always a mystery to both the doctor/nurses and the insurance companies, or so they claim. As they always refuse to give pricing.

I just get tired of going to the doctor, paying my copay required by my insurance, only to have a bill sent to me weeks or months later. I just wish they could tell me what things would cost up-front, that is all.

It's not a "mystery", it just fluctuates based on what an insurance company feels like paying for a given service that week. Some weeks, they'll decide that a strep test I perform sis worth $20, some weeks they'll decide it's worth $15. Though it's only five dollars, it's also a 20% variation. Insurance companies (other than Medicare, who is typically pretty consistent in what they reimburse) get to decide how much they think every service, test, and operation SHOULD cost, and then they reimburse based on that rate, regardless of how much it cost the doctor or their office/hospital to provide those services.

That's why you get a bill. If your insurance company is one of those who likes to low-ball costs, the differences is passed on to you.

Hospital's and Insurance's are both crooked as a barrel of snakes. My family and I are covered by two health insurance policy's and we still end up having to pay every time.

Two weeks ago my daughter got something stuck in her ear. Instead of going to the emergency room and waiting eight hours to be seen, we went to an urgent care facility. We saw the doctor immediately and all he did was look in her ear and told us to take her to an ENT. Got a bill the next week for over $600. After fighting with both insurances to pay the bills, we are still stuck with over a $200 bill. $600 for literally 10 minutes of time which consisted only of looking in my daughters ear.

And on the statement we received, it states in large bold letters, "FAILURE TO MAKE PAYMENT IN FULL BY DUE DATE WILL RESULT IN YOUR ACCOUNT BEING TURNED OVER FOR COLLECTIONS". Basically pay what we want or we'll ruin your credit!

That is one reason I hate going to doctors. Everytime I go it is a mystery as to what it will cost. If you ask them they aren't able to tell you besides extremely rough estimates that have a broad price range. Health Insurance companies also have no idea and will tell you what the market rates are but will direct you to contact the doctor. The billing department in a hospital won't know until they file it. I mean it is absolutely ridiculous how someone can go in, with insurance, to get medical attention and leave with a $1,000+ bill even after your insurance pays out.

My parents have medical insurance, and my mother got sick last year. She went to the doctor, they ran a few tests, and it turned out she had some minor health issues that some meds solved. She made an appointment, went to her GP, and did not go to the emergency room. When they got the bill it was over $2,000 as "their share" of the cost. When they called to talk to hospital/billing/etc they were told that they would not negotiate on the cost and that either they pay or they will have their credit ruined. It is absolutely ridiculous.

We definitely need Health Care reform, but it seems that the bill that was passed has failed to address some of the most important issues. I honestly don't know anymore, as it is depressing to live in a country where one can only receive medical attention if they are willing to become financially ruined.

reply to post by DJM8507


the medical industry is intentionally very fragmented. not one group or part of the network gets to see the entire picture... so nobody can question anything.

it really is like a lot of other business/ government structures out there. nobody knows what is going on.. the pharmacist tells you what you owe for your prescription because that is what the insurance company tells him or her to tell you that you owe. who is telling the insurance company? that is probably the important question. everybody else though in the food chain is just a monkey doing what they think they are supposed to do, which is really what they are being told to do.

the only people who get to see the bigger picture are the people at the very top who control everything...

It's been encouraged and nurtured to be the scam that it is.

You go in and get what you need then a bunch of crooks and swindlers work out how to use your insurance to their benefit. They bill for what they can then spread it around among themselves.

What you are billed has absolutely nothing to do with the services rendered.

Which is why every time a cash clinic pops up in the US it's hugely successful in that it cuts costs dramatically for the patients and still turns a profit for the doctor.

Then the government rushes in to shut it down.

There was a story a couple of years ago about a doctor who set up a small clinic in a rural area and charged a membership fee like a co-op. If you had a membership you got all your care covered. The fee was a fraction of the typical insurance payment. The patients were happy and the doctor was turning a profit. The fed came in and shut him down. The gov and the insurance companies didnt like what he was doing. Stossel covered it before he left 20/20. I'll see if I can find the report.

People who pay cash always get the better price. People who use insurance just get hosed in a massive off-the-radar scam.

reply to post by DJM8507


Here's the truth of the matter from an investment guy who also carries an insurance license. You are paying perhaps $200-500 dollars per month towards your employer sponsored group health insurance plan. Your employer is paying substantially more than that for your plan, picking up most of the cost. If you have a family of four, the total cost of this plan, depending on its' level of coverage, may be $1500 per month or so. THat's $18,000 per year.
Health insurance is a relatively new concept. 50 years ago, most people didn't carry health insurance. And for good reason. In the 60's the gummint began to meddle in insurance. This forced your provider to pay for just about anything under the sun. Up go premiums, and as insurance companies have deep pockets, up go lawsuits. Rediculous lawsuits. Lawsuits have created about half the cost of your insurance. Much of the rest of is the result of government meddling. For example, a gay man contracts aids from his "he bitch". This wasn't an accident, was completely preventable, and was the result of some foolish behavior where the "victim" knew the risk he was taking. Can't put a clause in there to prevent the insurance company from being on the hook because the gumming says so. It's a way our gummint takes money away from one party (insurance company) to buy the vote of another (gay people). Insurance companies make around a 4 percent profit. That's it. Often, they actually loose money.
But oftent the problem is with us. We somehow get it in our head that we have to buy insurance. If you're under 50, and reasonably fit, you're better off without it, or perhaps with just a catostrophic policy. You see, you can go to a doc-in-a box for about $50. He'll look at your throat, prescribe some pills, you go to target, and get a $4 generic perscription. If you get sick twice a year, that's $108. That's it. Lets say you have an accident and injure your knee, requiring a bit more care. They cart you to the ER, sew up your knee, put your arm in a cast and keep you overnight for observation.
With insurance, your looking at (typically) $100 for the er visit and 10-20 percent of the hospital bill. Lets say it's $5000. That's a total of $1100 out of pocket. Here's the trick. They charge the insured more than the uninsured. So for an uninsured guy, that's around $2800. They'll take a payment plan, so figure $235 per month for a year. That's about your cost or less for that plan, but it goes away in a year. In the meantime, suppose there were no insurance, freeing up another 15 grand per year your boss could pay you. Accident and all, your about 12 grand ahead. In fact, the whole country wins. Even without, your not going to get sent to the hospital every year. Trust me, you really don't need the insurance if your young and healthy. In the event you get cancer, a low cost catastrophic policy will do. Even with insurance, if a young single guy gets cancer, he'll probably go bankrupt either way. If you're young, take the money and put it away in a ROTH IRA or other investment class. You see, in the event an illness bankrupted you, they wouldn't be able to get ahold of your qualified account. Thanks me later.

reply to post by VneZonyDostupa


Practices have all sorts of different agreements with different insurers.

I worked optics for years as an optical assistant and we were subjected to all sorts of deals and obligations from different insurers.
This meant that at times some insurers would require us to charge their members less then the usual price policy due to policies they apply to members.

EG If a pair of spectacles was listed as $100 we usually deducted the insurable amount to reach the co payment amount.If an insurer offers $60 the patient pays $40.BUT some insurers say we will pay HALF your cost with a maximum payment of $80.For these customers we must charge $80 so they receive half the cost as per insurer policy.
If we refused the insurer we were either unable to serve their members which caused anger from patients who did not wish to travel to another practice and was detrimental to the small practices survival. OR add another $ 20 premium on their members bills, this was abandoned a it gave patients the impression they were being ripped off if they attended our practice.So the insurer was ripping medical practices off and also their members who were not given adequate choice of care providers due the unwillingness of many providers to discount their set prices to comply with the insurers business terms.



[edit on 5-8-2010 by mumma in pyjamas]

Originally posted by DJM8507
I just recently received a bill for a doctor's appointment and I find it absolutely ridiculous. Why is it that medical prices/charges are not upfront at the time of, or prior to the rendering of services? It is always a mystery to both the doctor/nurses and the insurance companies, or so they claim. As they always refuse to give pricing.

I just get tired of going to the doctor, paying my copay required by my insurance, only to have a bill sent to me weeks or months later. I just wish they could tell me what things would cost up-front, that is all.

What do you mean? I always pay doctors or hospital bills upfront, that's the system...very transparent. Not that I have to go much, but whenever I have, the price is given to you before seeing the doctor...and if you don't pay, no consultation. Same with scans, injections etc.

Here is a part i know is fact.

Many hospitals do a credit check and your bill is based on how much you are worth.
if you have a good bank account and god gredit you may be charged more.

If you have terminal disease and a large bank account they will try to get as much of that money as they can.

Insurance is just part of medical cost the hospital will charge what they want and the insurance company will pay there part .
any difference you will have to pay.

A friends wife had cancer and he went to the hospital to start treatment.
They wanted the full cost up front. and he ask how much.
They told him they would give him the cost the next day.

He had $10,500 in the bank.
guess what they wanted $10,500 for her treatment.
they had run a credit check and wanted every dime.

He ask what the money covered and they said every thing.
He ask what would happen if his wife died the day after her first cancer treatment and the hospital said it would still cost $10,500 no mater what happened.

Another friend a year later the doctors told him he had cancer.
he had over $200,000 in the bank.
Before he went to the cancer hospital he moved all but $10,000 to a business account he had.
The hospital then wanted $10,000 as when they did the credit check that was all they found.
We still believe they would have wanted a lot more if he had more in his account.

I am willing to bet that under Obama care the hospital will still find a way to bill for more then the insurance companies will pay.
Some thing like basic care for cancer that may or may not work(what the insurance will pay for.) And a premium care over that the insurance will pay but with more likelihood of survival.

Sh*t, I went into the ER last November, for what I thought was a poison ivy or poison oak rash.
Like, I had it for two months, tried just about every available OTC medicine, both oral and salves.
My dads girlfriend had it horribley a few months before, so she had some sort of steroid medical salve.
It actually removed the pigment from my skin, but beyond the point.

I went in to the ER.
Waited for about 2 hours.
Went in the back, they made me put on the damn cloth onesie.
I wait another hour, scratching the whole time.
The doctor finally slowly strolls in.
I tell him I think I have poison ivy, I explain the itchiness and where it was located.
He doesnt even take a look.
Walks outta the room.
Walks back in 20 minutes later with three sheets of paper.
One, giving information on poison ivy.
Two, care of a posion ivy rash.
Three, a prescription for the most complicated medicine Ive ever taken.

About...2 weeks later, I recieve the bill.
It was 650 dollars.
For ME, to tell the DOCTOR what I think I had.

Which, by and by, after I took that medicine, the "poison ivy", didnt clear up.
It took another month for it to clear upon its own accord.
And, a few months later, I got it again.
Turns out, its an allergy of some sort, and Ive been getting hives, not poison ivy.
Which would make sense, because Ive never been allergic to poison ivy.



To put it quite simply...and less offensive.
I was fornicated in the anus by the health system.