An MRI Costs $1,145 in America and $138 in Switzerland. But Medicare Could Change That.

[somarco]

The US won't go to single payer anytime soon, if ever. What we will see is Blue + one or two other carriers with Blue dominating (85%+) of the market in every state within 2 - 3 years.

For all the talk about transparency almost nobody is taking advantage of it now. Primary care through doc in a box is readily available yet not wildly popular especially among those with insurance. Every major carrier has pricing models available to consumers that would take the time to log in to their account. Over the weekend I checked par providers and pricing for an upcoming outpatient procedure. It took less than 5 minutes.

I can use the same portal to check Rx pricing.

The tools are there, consumers aren't using them.

 

[RayNY]

Somarco, to be fair, the people who are concerned about the billed cost of health care are the ones without insurance.

Huge bills, huge prices, a big stressful back and forth, before the charge is finally just changed to be reasonable and a payment plan is established. Or, you ignore it, and they send it to collections for the full amount. You'd flip if you got gas, got a receipt for $1,145, and then had to call the billing department for weeks for it to finally just get changed to the $138 everyone else paid. You'd be pissed if you took home a TV with a $75 copay(deposit) and 3 weeks later get a bill in the mail for $13,000, only to get it knocked down to the $800 retail price after fighting with billing.

Why the heck can't they just bill the actual rate off the bat? I realize "it's a tool for negotiation" and "no one actually pays it", but why do it in the first place?

 

[somarco]

Somarco, to be fair, the people who are concerned about the billed cost of health care are the ones without insurance.

And those are the ones that statistically pay the least since most of the time they stiff the provider. Non-pays with high deductible insurance are right behind the uninsured.

Lee, if I recall correctly from a discussion we had a few years ago your firm caps reimbursement at 135% of actual charges, not what Medicare pays. I believe you said you use Chargemaster data.

This approach does not artificially dictate pricing (which I believe is illegal) but rather impacts how much is paid on each claim.

 

[kgmom219]

People with HSA's do tend to shop around. Or my clients do. Its not as easy to get the info as you think, but I think its also state specific. I know MA just passed a law that says you have to provide that information, but we don't have the ability in TX without calling providers. If I call 3 different MRI providers I am going to get 3 different contracted rates. Shockingly, the highest amount is always the one the doc referred to me. Which is usually owned by the doc.

Presby Hospital Dallas contracted rate is $5800 for a normal delivery.
Presby Hospital Allen (15 miles north) contracted rate is $2700 for a normal delivery.

Same Carrier. Same Procedure. Same parent company. That's ridiculous.

One reason the billed rate is higher than the contracted rate is because the providers can write off the difference in their taxes. (Or they used to be able to. I don't keep up with the tax code. And it wouldn't shock me if ACA had that in there to eliminate that deduction.)

Until the high cost of med school is fixed in the US (average debt of $170K) and the American public takes ownership for their healthcare costs (copays are stupid) we are going to be the highest worldwide.

 

[leevena]

And those are the ones that statistically pay the least since most of the time they stiff the provider. Non-pays with high deductible insurance are right behind the uninsured.

Lee, if I recall correctly from a discussion we had a few years ago your firm caps reimbursement at 135% of actual charges, not what Medicare pays. I believe you said you use Chargemaster data.

This approach does not artificially dictate pricing (which I believe is illegal) but rather impacts how much is paid on each claim.

It's not capped on actual charges, these are way too high. It is based off of Medicare costs, which are reported yearly to CMS. This is significantly lower than anything else out there. The payment is justified by ERISA fiduciary requirements.

 

[somarco]

It's not capped on actual charges, these are way too high. It is based off of Medicare costs, which are reported yearly to CMS. This is significantly lower than anything else out there. The payment is justified by ERISA fiduciary requirements.

My error, I meant 135% of actual COSTS, not charges. My fingers didn't follow my brain.

People with HSA's do tend to shop around. Or my clients do.

I have no trouble finding approximate negotiated pricing for par providers. If I wanted to go to the trouble of calling for a lower price through a non-par provider I could do so, using the par estimate as a starting point, but I have no desire to use non-par providers.

Perhaps people in TX do things differently.

 

[kgmom219]

My error, I meant 135% of actual COSTS, not charges. My fingers didn't follow my brain.

I have no trouble finding approximate negotiated pricing for par providers. If I wanted to go to the trouble of calling for a lower price through a non-par provider I could do so, using the par estimate as a starting point, but I have no desire to use non-par providers.

Perhaps people in TX do things differently.

They aren't going to publish it and make it easy on people til we pass a law. Its a huge PITA.

I will call on an MRI cost. Most people won't.

 

[RayNY]

They aren't going to publish it and make it easy on people til we pass a law. Its a huge PITA.

I will call on an MRI cost. Most people won't.

I've met a LOT of people that presume medical care is medical care, the same quality and cost no matter where they go. Sort of like how you get the same Big Mac at the same cost no matter which McDonalds you walk into.

Heck, they don't even realize there's a difference in cost between an Urgent Care center, their PCP, and the ER until the bill comes. It wouldn't even cross their mind that a different hospital might do the same thing for half the price.

 

[ATM]

Switzerland has about half as many MRI machines per person as the US. Canada about 30% as many per person. That means that access is much more limited, as it is for most other medical procedures in socialized medicine countries.

Also, no one should believe the BS "we pay more and have worse outcomes" line that is sold to us. We pay more and we get far better health care outcomes. The usual line used is that our life expectancy is lower here even though we pay more for health care.

If you adjust life expectancy for things that have zero to do with health care, such as traffic deaths (we drive much more than anywhere else) and murders, US life expectancy is the longest in the world even though we are the fattest and most sedentary. So go figure.

Also never believe the infant mortality figures spouted by such propaganda machines as the WHO. If you have a baby that needs medical attention their best chance is in the US by a wide margin. The numbers that WHO spout are not close to being apples to apples.

Things as simple as "live birth" are not. In the US we consider any baby born with a pulse live. Most other countries do not. They have a waiting period before the child is considered alive for reporting purposes.

The problem with our system is we have unlimited access to health care but no counteracting cost considerations. We don't have self interested consumers who have skin in the game when they consume health care because very few people actually pay for health care, they just demand health care.

With unlimited demand you get rocketing prices. I blame government for that problem because it was government mandate that forces employers to provide health "insurance" to employees as a free benefit. employees don't know what it costs, don't care what it costs and don't value it as something they pay for themselves. It's like the free company store for anything health related.

I want everything I deserve for free!

Health Insurance needs to be decoupled from employment. Ten you don't have issues with loss of coverage, you don't have people stuck in jobs because of insurance, you get a consumer back into the game that shops for price and you create that self limiter on upward price movement.

In my world everyone is simply self employed. If you work at ABC Corp you do so under a contract. You get paid for service but no benefits. You buy those yourself and then you have skin in the game and you take responsibility for yourself because you have to.

 

[Family Man]

I love this country, and it's the best...but the medical costs are out of control for the general population. Medical professionals as recently as 30 years ago, entered the field to provide a service to their communities. Now, many enter it to make six figure incomes. Hey, I want to make six figures, too...but if I start charging outrageous prices I won't make a single sale, or have so much business volume nobody cares about me or vice versa. The bottom line is, quality health care comes at a tremendous price. Maybe it's not intended to be for everyone after all--which really sucks for my income class. In reality, single payer system is inevitable considering climbing premium rates, but it will simply have BCBS as it's name (or UHC or whatever). Good luck getting quality healthcare from insurance carriers profiting billions and medical professionals getting paid under six figures. Maybe I should change my username to cynic man.