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Where to get affordable healthcare when you don't have insurance

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    #46
    Originally posted by Smallsteps View Post
    Part of the issue we have in healthcare was created when we took the prices off the menu, I ASK for the costs for each treatment plan when being seen.
    People do not know what things cost and so if their plan pays 80% and they are responsible for 20% it sounds ok. Even 20% adds up quickly in an expensive situation.
    It creates a situation where "free" is not really true. If you and/or employer PAY premiums and they pay for the flu shot for example. People will tell you " i got a FREE shot" when in fact it was paid for when you paid the premiums.
    When i hear the term " Surprise medical bills" i would like to see a breakdown of how many were because the patient disconnect.
    Lets say people added up items thinking they had their deductible covered only to find "insurance math" is not easy to follow. Or perhaps they simply did not watch the bills add up and their % goes right up too.
    I worked for years in the health insurance industry and have ZERO faith in most companies involved. The wasted dollars and cost of the administration is taking a huge chunk of money.

    With that said I have read how bloated administration the system in the UK and other countries have as well. The more middle people the more cost............ with paying them and their benefits etc.
    Agree this is a huge issue. Switching from a traditional to a high deductible plan definitely changed my mindset and got me asking how much things cost. Most of the time providers couldn't tell me, and if I pressed and finally got an answer, it was often wrong. I've spent too many hours to count fighting between doctors offices and insurance about charges related to my annual checkup (which should be covered at 100%) and somehow I end up being charged every year. Docs office says its insurance company's fault, insurance says it's doc office's fault... always such a mess

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      #47
      Originally posted by Smallsteps View Post
      The one fee to cover most.... is simply cost shifting... so someone who needs very little services is partially covering someone who uses more then average time/ services?

      Just see how that works at a buffet... people are often trying to get their moneys worth.
      The reality is probably that people like simplicity. They like all-inclusive deals. They like going to buffets knowing when they walk in the door exactly how much dinner will be for their family regardless of what everyone gets to eat. They like going on cruises and knowing their meals are already paid for whether they get a hamburger or filet mignon.

      In an Urgent Care setting, when you price everything a la carte, you run the risk of people saying, "I want to be seen by the doctor but I don't want any testing done." It also creates the perception that the provider might be ordering tests just to run up the charges. "Do I really need the throat swab done? Can't you just prescribe an antibiotic just in case it's strep?" That approach creates all kinds of problems. I, for one, am much happier that they went to flat pricing for the visits. Patients seem to like it much better, too.

      Just like experts advise people to look over detailed hospital charges to see if they were over charged for items/ treatment you did not receive but as you said people say "it does not matter insurance covers most" etc.... many people simply do not look any deeper.
      That's a little different but I agree that most people don't bother to review the bill. However, that's a mistake. Most hospital bills contain errors and finding those errors can save you money. If you have a deductible or copay, those errors are coming out of your pocket. When my wife had an operation years ago, I got an itemized bill and found a $1,000 error. She had been double-billed for something. I brought it to the hospital's attention and they took that charge off, saving me $1,000. Insurance had already paid their share so I got 100% of that savings.

      What other service do people IGNORE the details like this? Without transparency and people wonder why there is fraud and room for so much abuse.

      if a person had their car fixed and bill had a set of new tires or wipers and you never received those you would say something. not just" oh well it is on insurance"
      In some ways, health insurance ought to be more like auto insurance. You car insurance doesn't cover routine maintenance, oil changes, tires, or wipers, but your health insurance covers nearly everything.

      The problem is that to a large extent, people take better care of their cars than they do of their bodies. Few people would risk driving around on bald tires or with worn out wiper blades because they see the danger in doing so. However, lots of people walk around with uncontrolled high blood pressure or diabetes because the consequences aren't as immediate or visible.
      Steve

      * Despite the high cost of living, it remains very popular.
      * Why should I pay for my daughter's education when she already knows everything?
      * There are no shortcuts to anywhere worth going.

      Comment


        #48
        Originally posted by amastewa93 View Post

        This is interesting because I never received a price beforehand when I was insured under my father's coverage. Probably because I never thought to ask. However, when I hit urgent care for my allergic reaction last week they said it was $155 for the visit. Before they administered any breathing treatment or shots they informed me of how much it would be (since I was paying cash). Steroid shots and one shot of Benadryl was $40. The breathing treatment was another $25. I was pleasantly surprised to find the pricing was so upfront.
        When you had insurance, there's no reason they would have given you the price when you walked in. Plus, the price would partly depend on your particular insurance coverage and what fees the clinic had negotiated with that company.

        As a cash-paying patient, though, you should absolutely be able to get the cost information upfront. However, as I said above, it sometimes puts the providers in a difficult situation. You could have said, "I'll take the steroid but do I really need the Benadryl? Can't I just go across the street to CVS and get some pills?"
        Steve

        * Despite the high cost of living, it remains very popular.
        * Why should I pay for my daughter's education when she already knows everything?
        * There are no shortcuts to anywhere worth going.

        Comment


          #49
          Originally posted by disneysteve View Post

          I work in Urgent Care. For the longest time, I could not get anybody to give me a price list for the services we provide. Most of our patients have insurance so it doesn't matter for them but we do have cash patients, too, and they would ask, "How much is this chest x-ray going to cost?" and I couldn't tell them. I asked my manager, our lead physician, our medical director, and a few other people and nobody could tell me. I finally gave up trying to get the info.

          Now they changed our billing system and made a global fee for a visit that includes anything we do onsite like a strep throat test, a flu test, an x-ray, stitches, etc. That way a price list is no longer needed. Patients pay a flat fee to be seen and they're done.

          I just never understood why nobody could give me an answer to my question. They were going to send the patient a bill but nobody could tell me how much that bill was going to be for. It was beyond frustrating.
          I believe this is what the Wal-Mart model is trying to do, bring transpatency into healthcare by showing prices, and hopefully bring about change in the insurance industry by customer demand. At least that is how I understood it, I could be wrong.

          Comment


            #50
            Originally posted by Thrif-t View Post

            I believe this is what the Wal-Mart model is trying to do, bring transpatency into healthcare by showing prices, and hopefully bring about change in the insurance industry by customer demand. At least that is how I understood it, I could be wrong.
            I think you're right. They are trying to advance transparency, and pull in business, of course. As I said, CVS, Walgreens, and others have been doing the same thing for years. The more the better. And Wal-Mart certainly has the muscle to compete with them.

            I don't know how much impact that will have on the insurance industry because you're still laregely talking about insured vs. uninsured patients primarily. If I have insurance and my PCP copay is $25, I'm much more likely to go there for a visit rather than pay Wal-Mart $40 even if my PCP is actually collecting more than that from the insurance company unless the convenience factor is worth $15 to me.
            Steve

            * Despite the high cost of living, it remains very popular.
            * Why should I pay for my daughter's education when she already knows everything?
            * There are no shortcuts to anywhere worth going.

            Comment


              #51
              Originally posted by riverwed070707 View Post

              Agree this is a huge issue. Switching from a traditional to a high deductible plan definitely changed my mindset and got me asking how much things cost. Most of the time providers couldn't tell me, and if I pressed and finally got an answer, it was often wrong. I've spent too many hours to count fighting between doctors offices and insurance about charges related to my annual checkup (which should be covered at 100%) and somehow I end up being charged every year. Docs office says its insurance company's fault, insurance says it's doc office's fault... always such a mess
              I would almost be certain it was the insurance.
              Like I said, I did work for a LARGE player and the basic incompetence was staggering and they simply DID NOT care that this is more then an oops.... this ends up as a BILL for someone.
              They count on those who will NOT fight it as well. ....I can tell you many instances where they tried to pull these kinds of stunts on me. I am a fighter i stayed on the case until fixed but i knew many whom simply thought they needed to pay it and PERHAPS that accounts for some of what is referred to as "surprise bills".

              Like Disneysteve responded to me saying patients want simplicity... etc. If you are NOT an advocate for yourself you will get taken.

              "SIMPLICITY" is part of the problem in MANY problems .... people want no responsibility to plan for retirement / to have an emergency fund / to UNDERSTAND how their insurance or other things work.
              They assume that the other players in the game are playing fairly. Often they are NOT and the best part is when caught they say "OOPS, it was a mistake" ..... I saw plenty of examples where it was NO mistake.


              I had a particularly nasty fight with a billing service trying to charge me for the discounted amount ( that was part of the contract between the Dr. and insurance that is illegal). Ended up with a BBB complaint ( F rating for them) and involved 2 insurance commissions in 2 states. My insurance finally stepped up and said "drop this group for billing or we will instruct our insured not to use your facility".

              The DR's billing group said ALOUD in a conference call " there are enough people who just pay that it was worth it even when one pain in the A$$ wins it is no big deal"



              Comment


                #52
                Originally posted by riverwed070707 View Post
                Switching from a traditional to a high deductible plan definitely changed my mindset and got me asking how much things cost. Most of the time providers couldn't tell me, and if I pressed and finally got an answer, it was often wrong.
                I missed this post earlier.

                Yes, most of the time the doctor does not know how much something is going to cost. They aren't being difficult. They honestly don't have that information. They need to submit the bill to the insurance company and wait for a response to see how much, if anything, the plan covers and what balance, if any, remains.

                There are thousands of insurance plans. At my office, we probably accepted at least a couple hundred. We couldn't possibly keep track of what each one covered and didn't cover and how much they each paid for every single test and procedure. And that information is fluid, ever-changing. You and I might both have Aetna but our plans could be entirely different, different deductible, different fee schedule, different carve outs in what they do and don't cover, different copays, etc.

                As long as we have a system with hundreds or thousands of individual plans that each set their own terms and rates, this will continue to occur. You can't get meaningful transparency when there are that many different sets of rules.
                Steve

                * Despite the high cost of living, it remains very popular.
                * Why should I pay for my daughter's education when she already knows everything?
                * There are no shortcuts to anywhere worth going.

                Comment


                  #53
                  Originally posted by amastewa93 View Post

                  This is another HUGE reason we've been looking into private coverage. We are planning to start trying to have a child in another two years and having those costs covered will be key. There's no doubt we need coverage - especially once we start expanding our family, and we wouldn't start to try for child until we have insurance. But, right now, it is so hard to pay that $1,200 a month and be strapped to pay for it.
                  Research how long you need to be covered before maternity benefits kick in.
                  And give some thought to how financially strapped you would be if you incurred major medical costs while uninsured (I'm sure you have or are).
                  HDHP/HSA is definitely one option I'd recommend looking into.
                  I am trying to express concern here.

                  Comment


                    #54
                    Originally posted by disneysteve View Post

                    I missed this post earlier.

                    Yes, most of the time the doctor does not know how much something is going to cost. They aren't being difficult. They honestly don't have that information. They need to submit the bill to the insurance company and wait for a response to see how much, if anything, the plan covers and what balance, if any, remains.

                    There are thousands of insurance plans. At my office, we probably accepted at least a couple hundred. We couldn't possibly keep track of what each one covered and didn't cover and how much they each paid for every single test and procedure. And that information is fluid, ever-changing. You and I might both have Aetna but our plans could be entirely different, different deductible, different fee schedule, different carve outs in what they do and don't cover, different copays, etc.

                    As long as we have a system with hundreds or thousands of individual plans that each set their own terms and rates, this will continue to occur. You can't get meaningful transparency when there are that many different sets of rules.
                    Sure I get that. I'm not asking the doctors office to tell me the portion of the charge I'm going to owe, I'm asking them to tell me the full amount that will be billed. There should be no variance in what one patient is billed vs another for the same test, procedure, etc. If my insurance happens to cover a portion of it or negotiate a discount great, but since I'm on a HD plan, I'm anticipating I'm paying the full cost and, unfortunately (and I'm sure you as a provider don't like to hear it), that sometimes plays into whether I'm going to have it done. I'm no longer blindly following a doctors recommendation - if you're going to recommend a test or a procedure for me that isn't covered as preventative health, the reason but also the cost is part of the deciding factor and I shouldn't have to wait weeks to find out what an MRI or a blood test or an x-ray are going to cost.

                    Comment


                      #55
                      Originally posted by riverwed070707 View Post

                      Sure I get that. I'm not asking the doctors office to tell me the portion of the charge I'm going to owe, I'm asking them to tell me the full amount that will be billed. There should be no variance in what one patient is billed vs another for the same test, procedure, etc. If my insurance happens to cover a portion of it or negotiate a discount great, but since I'm on a HD plan, I'm anticipating I'm paying the full cost and, unfortunately (and I'm sure you as a provider don't like to hear it), that sometimes plays into whether I'm going to have it done. I'm no longer blindly following a doctors recommendation - if you're going to recommend a test or a procedure for me that isn't covered as preventative health, the reason but also the cost is part of the deciding factor and I shouldn't have to wait weeks to find out what an MRI or a blood test or an x-ray are going to cost.
                      At least at the level of the doctor's office, when they order a test, they may not be the one billing for it so they don't have the pricing info. For example, if you came to my office for a blood test, we drew the blood but the lab did their own billing, not my office, so we couldn't tell you how much that test would be. The same if I sent you for an x-ray. The x-ray site itself did the billing so you would have needed to get that info from them.

                      The really sad part of your post is that patients have to decide whether or not to get recommended care based on the cost. That's the big downside of HDHP/HSA plans. Many patients will choose to skip testing and treatment due to the cost. That often results in delayed diagnosis and treatment and worsening of conditions which can ultimately end up costing a lot more.
                      Steve

                      * Despite the high cost of living, it remains very popular.
                      * Why should I pay for my daughter's education when she already knows everything?
                      * There are no shortcuts to anywhere worth going.

                      Comment


                        #56
                        Before maternity riders had 2 years before they kicked in. And the costs were astronomical for any woman to get coverage even if you weren't planning on having a kid. I would defintely not even consider having a baby without insurance in this country. It'd bankrupt most people. Sure it's great if it goes well. But there is a reason why so many Ob/Gyns go out of business asap and have the highest malpractice. Also a reason why they are so eager to c-section women because of malpractice. I can't fault them for being the this side of safe ASAP because they know what's on the line.
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