This almost reminds me of a menu in a restaurant that shows items like lobster, no price, just quoted at "market value". The price of healthcare has no set pricing established and as mentioned earlier, some facilities can and do charge up to 4 or 10 
times more than other facilities. Confusing, yes!
There was a bill that was downed in the legislature that would have included physicians to include their pricing too. The only real defense a consumer has today, is to be sure and ask up front it appears, as prices vary a lot. BD
The consultation went like this: We chatted for a few minutes, then he held me at awkward angles several times and promptly diagnosed me with benign positional vertigo -- a tendency to get dizzy if my head is in a certain position.
This took 20 minutes. The doctor performed no fancy tests or procedures. He prescribed no medication.
So, was the treatment I received worth nearly $1,000, as the doctor apparently believed, or just a quarter of that amount, as Blue Cross had concluded? How can the provider and the insurer be so far apart in pricing a fairly routine medical service?
The upshot is that providers are overcharging insured patients because they have no other way of meeting total expenses, while insurers are paying significantly less than the billed amount because they know they're being hit up for unrelated costs.
The problem with pricing goes back to the insurance companies. For example, in the hospital I have a pill that costs $1. It would be reasonable to charge $1.50 for the tablet. However, one insurance company will pay $1.10 another $1.75, $3.50, $4, etc. If I only charge $1.50 then the companies will only pay me $1.50. However, if I charge $5.00 then the companies will pay the max that they allow for the tablet. Thus, I can maximize the payment by overcharging. The real kicker is the cash patient that get the bill for the $5.00. They are the ones getting hurt.
ReplyDeleteI see your point exactly and somewhat the same stuff that goes on in the doctor's office too, if he charges 100 and depending on the contract with the insurance company, he might see $50.00, but if he charges $50.00 he would only see $25.00 or less.
ReplyDeleteSame thing too with the cash patient they get stuck here too, but many will offer cash patients discounts which is good, but in the pill business you would have one big nightmare to track and create this type of pricing.
Insurance companies with their current systems have everything so very complicated today in every direction you turn in healthcare.