Shop your medical care!

[TexasHusker]

A few months ago, my wife's doctor ordered 3 MRIs. We have a high deductible (Medi-share), so I did some shopping. The cash price at the local hospitals here ranged from $2400 to $3100 per MRI, plus the reading fee.

I found an independently owned MRI center about 120 miles from me and they quoted my $300 cash for each MRI, including the reading fee. So for $900 and 3.5 hours of driving and some Chick-Fil-a, we got three MRIs for a fraction of the cost of the local hospitals.

Fast forward to a month ago, my doctor ordered me a sleep study because he thought I had sleep apnea. So I called around again - he referred me to the hospital that he worked for, and they offered me a cash price of $2100. Plus, it would be about 5 weeks before they could work me in.

So...I did some calling around and found a home sleep study provider that quoted me $100 cash. They would come to my home before bed time, hook it all up, and then I would deliver it to their office the next day. But when could they do it? How about TOMORROW NIGHT?

So I had the sleep study done, and sure enough, they told me about 10 minutes after I dropped the equipment off at their office that I had sleep apnea, and printed me a full report.

What next? Either I could go back to my doctor and pay him a $100 office visit to prescribe me a CPAP machine, or the home sleep folks had a P.A. that would write the script for $10. I did that.

Then the home sleep folks tried to sell me a Fisher and Paykel CPAP machine for around $1000. But I went online at respshop.com and bought the same machine delivered for $450.

I could give a lot of other examples of shopping around for health care. If your doctor orders up a bunch of profitable lab tests, just tell him you'll take the order to AnyLabTestNow and pay them cash. It will cost you about 80 percent less. He won't like that, but your wallet will!

Folks, there's the traditional medical care world where the price has zero relationship to the service/product received, that coordinates with pricey insurance...or there's the growing cash medical care world that allows you to shop for your medical care like you shop for Cheerios. I opted out of the former and have embraced the latter. It's still expensive, but it won't bankrupt you.

People are flocking to this particular hospital due to its transparent and straightforward, all-inclusive pricing. See the CEO's blog on this website - it is simply amazing:

https://surgerycenterok.com/

I have high hopes that this concept is going to take our country by storm, and these greedy hospitals and insurance companies can take a hike.

[disneysteve]

Everything you said is true, but only applies to people paying for their own care. Most people have insurance. That's a big part of the problem. Patients don't care what something costs because they aren't the ones paying for it. It doesn't matter if a test is $100, $1,000, or $5,000. They pay their $50 copay and that's it. When you eliminate the connection between the consumer and the price, the system goes haywire.

[TexasHusker]

Everything you said is true, but only applies to people paying for their own care. Most people have insurance. That's a big part of the problem. Patients don't care what something costs because they aren't the ones paying for it. It doesn't matter if a test is $100, $1,000, or $5,000. They pay their $50 copay and that's it. When you eliminate the connection between the consumer and the price, the system goes haywire.

Right on. Really started with Medicare.

I'm OK with there being a system of insurance for people that want the copays, etc. But some of us are good with taking on much of it, leaving insurance for the surgeries and cancer treatments.

I don't expect a copay every time a window pane breaks at my house - I just need insurance in case my roof falls in or a tornado blows it away.

[krystal098]

It's better not to use insurance for small things. I have seen many using insurance for small damages as they don't bother because they are not paying for it.
I used to keep it aside for emergency situation.

[LivingAlmostLarge]

Sounds good in principal but would it really work? Let's decouple insurance to employment. Then I would guess MANY people might buy catastrophic insurance. But let's see how that goes for 10 years (I bet within 5 years) we'd have socialized medicine because people would be pissed to be told they have to pay $X until deductible hits. They'd also hate to be told they have to die because the insurance company won't cover X, Y, Z. And not be able to afford care.

Truth be told the US is the most expensive in the world and way more than any other single payer system and the most inefficient. If we want to go free market we have to do it and put our money where our mouths are.

Decouple insurance and employment. Military and federal workers too. And see how it plays out. Let's go true free market. I believe healthcare can never be free market. But I'm willing to gamble because I have money and enough savvy to navigate the market. But I need them to guarantee pre-exisiting conditions.

But the majority of american's can't and won't afford it nor will they like it. You thought Obamacare had death panels? Wait until free market hits. It'll become apparent who can and can't afford healthcare.

[TexasHusker]

Sounds good in principal but would it really work? Let's decouple insurance to employment. Then I would guess MANY people might buy catastrophic insurance. But let's see how that goes for 10 years (I bet within 5 years) we'd have socialized medicine because people would be pissed to be told they have to pay $X until deductible hits. They'd also hate to be told they have to die because the insurance company won't cover X, Y, Z. And not be able to afford care.

Truth be told the US is the most expensive in the world and way more than any other single payer system and the most inefficient. If we want to go free market we have to do it and put our money where our mouths are.

Decouple insurance and employment. Military and federal workers too. And see how it plays out. Let's go true free market. I believe healthcare can never be free market. But I'm willing to gamble because I have money and enough savvy to navigate the market. But I need them to guarantee pre-exisiting conditions.

But the majority of american's can't and won't afford it nor will they like it. You thought Obamacare had death panels? Wait until free market hits. It'll become apparent who can and can't afford healthcare.

Should we have nationalized home and car insurance too, with $25 copays?

[Mjenn]

Interesting article in the NYtimes this week on coding and why billing is so hard to predict in health care. Made me think of this thread.

https://www.nytimes.com/2017/03/29/magazine/those-indecipherable-medical-bills-theyre-one-reason-health-care-costs-so-much.html?action=click&contentCollection=magazine&region=rank&module=package&version=highlights&contentPlacement=3&pgtype=sectionfront&_r=0

[TexasHusker]

NEEDING A COLONOSCOPY?

Well, I hit the magic 50 (actually 51 now), and the doc says I need the ol' colonoscopy. So I called around town and found out some cash prices:

Hospital 1 = $3100 plus anesthesia and gastroenterologist fees

Hospital 2 = $3400 "" ""

Endoscopy center owned by Hospital 1 = $2800 plus anesthesia and doctor fees

Endoscopy center owned by two physicians = $800 all inclusive


Guess where I'm getting my colonoscopy done?


Shop your medical care!

[disneysteve]

TH, what type of insurance do you have? Many people have a plan that has a preferred network of providers so you generally need to stay in-network to get the lowest out of pocket cost.

If you have a big deductible, though, shopping around can certainly stretch your dollar a lot farther.

[TexasHusker]

TH, what type of insurance do you have? Many people have a plan that has a preferred network of providers so you generally need to stay in-network to get the lowest out of pocket cost.

If you have a big deductible, though, shopping around can certainly stretch your dollar a lot farther.

I have what is called Medi-Share. My network is PHCS. But both hospitals assured me this was their best price. Better than PHCS. Such b.s. I wasn't born yesterday. You can't tell me that charging $3K for someone to lay on a table for 45 minutes with a bit of anesthesia has any relationship at all with the real cost of this.

Hospitals are raping and pillaging and have been for years. For 24 years, I was a part of it!

Steve BTW, the "networks" are a joke. They generally offer 25% to 50% off of some price that's 10X too high to begin with. I have an intimate knowledge of this area.

[disneysteve]

Steve BTW, the "networks" are a joke. They generally offer 25% to 50% off of some price that's 10X too high to begin with. I have an intimate knowledge of this area.

I understand. I just meant that if you don't have a high deductible, staying in your network is likely going to result in the lowest out of pocket cost. Shopping around only makes sense when you are paying cash for the care, which most insured people aren't.

In your example, hospital #2 might be charging cash patients $3,400 but if that's the in-network place for my plan, I might only pay a $100 copay for the exact same procedure. Going to the place that quoted you $800 might cost me $250 since it's out of my network, or might not be covered at all and cost me the entire $800.

Not only do you need to shop around for things you're paying for, but also you need to be sure you understand all of the terms of your insurance plan. Make sure you're choosing preferred providers, facilities, and pharmacies. Something as simple as going to Walgreen's instead of CVS could cost you a bundle if CVS is the preferred chain for your plan.

[Thrif-t]

We're lucky, there is a hospital in my DH's plan that covers ANYTHING 100% if we get any surgeries, procedures, MRI's, x-rays, done there. He works an hour away from home so the hospital is an hour away but anything we can plan to get done we make the drive. No co-pay's, no co-insurance, no deductibles, nada.

My colonoscopy was free. I'd heard if they found any polyps and had to remove them it was no longer routine but diagnostic and you'd get all kinds of charges. I made the drive so I didn't have to worry about that.

[disneysteve]

TH, you should doublecheck. Routine screening colonoscopy should be covered 100%. It shouldn't cost you anything and definitely not $800 or more.

[TexasHusker]

TH, you should doublecheck. Routine screening colonoscopy should be covered 100%. It shouldn't cost you anything and definitely not $800 or more.

Actually my plan does not cover routine screenings etc. But it saves us about $1500 a month over an Obamacare plan. In most situations it is a superior plan - my wife had a neck fusion surgery and it paid for the whole thing.

Instead of deductibles, we have what is called an annual household portion of $5000. Again, routine stuff doesn't count. But once you exceed $5000, the plan pays 100%.

[disneysteve]

Actually my plan does not cover routine screenings etc.

You must have one of the grandfathered plans.

Coverage of colorectal cancer screening tests is required by the Affordable Care Act (ACA), but the ACA doesn’t apply to health plans that were in place before it was passed (called “grandfathered plans”). You can find out your insurance plan’s grandfathered status by contacting your health insurance company or your employer’s human resources department. If your plan started on or after September 23, 2010, it must cover colonoscopies and other colorectal cancer screening tests. If a plan started before September 23, 2010, it may still have coverage requirements from state laws, which vary, and other federal laws.