Posted on 03/07/2017 7:18:50 PM PST by Wisconsinlady
Sometimes called direct pay, and closely related to concierge care, this sort of business model was once seen as the perquisite of rich folks and medical tourists from foreign lands. But nowadays many of the people seeking cash-based care are middle-class Americans with high-deductible insurance plans. For a patient with an $11,000 family deductible, for example, it might make more sense to seek out a cash-based center like the Premier Medical Imaging facility in Minneapolis, which offers a basic MRI for $499, than to cough up the several thousand dollars that the same procedure generally costs at a traditional hospital. Cash payments don't count toward a patient's deductible, but for some it's worth the gamble.
(Excerpt) Read more at time.com ...
Almost all insurance companies have agreements ahead of time with MRI places where they can’t charge more than 500.
I’ve never seen a bill higher than that.
They can charge 10k, but insurance will allow 500.
Bad example.
then the hospital bills the patient for the unpaid balance the insurance does not pay...Ive seen that plenty of times too.
Catastrophic insurance, along with direct payment is becoming popular because its cheaper often. I have used a direct pay outfit for xrays and saved hundreds of dollars instead of using my ####cross.
Agreed. The primary benefit of most insurance plans these days is the negotiated rate.
And sometimes the doctor has an agreement with the insurance company for a fixed amount and you don’t pay the difference.
Medical treatment is the only industry in the whole world where there are almost no market forces available to the consumer.
The provider will almost never tell you in advance what a service is going to cost.
The doctor says you need some service that he provides, he provides the service, and then sends you a bill for whatever he wants to charge you afterwards.
The whole step about “well, how much is this going to cost me and is there anything cheaper I can do instead?” does not exist as a meaningful part of the process in any way.
This has got to change. Completely. All medical services must have defined costs which are prominently displayed at the doctor’s office.
“Almost all insurance companies have agreements ahead of time with MRI places where they can’t charge more than 500.
I’ve never seen a bill higher than that.
They can charge 10k, but insurance will allow 500.
“
Not even remotely true.
I just did a hernia operation at St. George Surgery Center. $3050 cash on the barrel head, zip zip done and out in three hours, great people.
I was getting quotes like “well, somewhere between $5,500 and $12,000” from the idiots in Vegas. Like buying a car whose price is between $5k and $12k.
From what I have seen, the hospital/facility bills the insurance company. The agreement with the insurance company/hospital sets the agreed upon reimbursement. If the patient has not met their deductible for the year, the hospital/facility bills the patient for THAT amount - not whatever their original billing amount was. That has always been the reason to stay within your plan’s network of physicians/hospitals/facilities. They agree the accept the insurance amount, whichever one of you pays it.
The world of medicine will return to healing as best as humanly possible. And the loved ones of those who cannot be healed will realize that it often has little to do with what the doctor did or didn't do, said or didn't say, not everything or everyone can be fixed. Instead of looking for a big payday from some insurance company.
No, the real question here is "What happens when the doctors all quit?" And I don't mean anything like this "Day Without Bimbos" or "Day Without Illegals" things sponsored by Snowflakes, Inc. I'm talking about an Atlas Shrugged/everyone to the mountains/screw society style quit.
will an XRay place go for that?
I agree. Where else do we get stuff that we don’t know the cost. My son gets regular treatments for a chronic condition. We just about choked when we found out weeks later they cost $11,000 a crack. Every 8 weeks. Insurance covers it but wow.
Bright students will not apply to medical, dental, optometry, podiatry, and other professionals schools that must depend on the system for their livelihood.
And....It is already happening. When there are more women in the medical school classes than men then the profession has already flipped.
I pay cash for Dr appointments.
I get in right away, they have less paperwork.
Everyone is happy.
If you do the math on group insurance through an employer it works out as follows:
$300 a month $3,600 per year.
Deductible is $5,000 per year.
You are now $8,600 in the hole before your medical necessity kicks in.
You then have procedures, items and drugs that are not covered, putting you even further in the hole.
Then what is covered is done at a percentage.
In this instance well say 70%.
That means for every $1,000 of your medical necessity you owe $300 above the $8,600 you are already obligated to spend.
So, for $12,000 you are actually on the hook for $9,700.
So, if you spend $8,600 over ten years and then have the medical necissity above you will have drained your finances of some $37,100 dollars!!!
Makes sense right?
Time-Lies-Warner thinks it is “wrong” for private citizens to get the same negotiated prices that the insurance companies pay.
Marxists want the shortfall to come from the private sector. Redistribute that wealth.
[I agree. Where else do we get stuff that we don’t know the cost. My son gets regular treatments for a chronic condition. We just about choked when we found out weeks later they cost $11,000 a crack. Every 8 weeks. Insurance covers it but wow.]
Sounds like Remicade infusions.
And just think if you could’ve set aside that $300/month into a medical savings account and built up those savings from year to year.
But Dead Red Ted Kennedy considered that to be a tax dodge and prohibited it. As if Mr. Ted Kennedy ever paid all of the taxes that he imposed on the rest of us. His family’s estate was shielded from confiscatory inheritance taxes by calling it a “foundation” who’d properties were to be used by members of the cult, I mean Kennedy Klan.
All you need to understand about healthcare costs as *paid* for under insurance you can learn by looking at a typical Medicare bill.
In the final years of her life I saw these kinds of bills come in for my Mom. (She didn’t have to pay them, I am just commenting on the numbers)
Billed: $1382.19 Insurance reinbursement: $72.44
Billed: $719.22 insurance reimbursement: $49.65
It is complete ridiculousness. The providers know that they will be typically reimbursed no better than 1/5th of their bill and that’s the exception, often the ins reimbursement is 1/12th, 1/15th. Thus there is an absolute compulsion for the provider to grossly overbill with an eye to what will be reimbursed. This drives up the “book” rate for procedures bigly.
The entire pricing structure of HC delivery is warped to the moon based upon the pitiful ins reimb rates. This is where you get the proverbial $50 aspirin. It is a complete scam and the primary beneficiary of most of HC spending in the US is the insurance industry.
I am lucky to be in good health so my visits to the doc are few. But I routinely get 30-35% discounts for paying in cash.
Medical care these days seems to all come from third world immigrants. Came from abroad to study and stayed for the wages.
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