An MRI Costs $1,145 in America and $138 in Switzerland. But Medicare Could Change That.
- Thread starter Justin Bilyj
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- #32
Something more to think about when it comes to transparency, this just in:
President Obama's Affordable Care Act stands to benefit from a major new player emerging in the diagnostic's industry. DRG codes have fundamentally changed the structure of hospital reimbursement. Instead of paying hospitals for how many goods and services are used per patient, diagnostic related groupings set reimbursement at a predetermined amount of money based on the average cost for someone dealing with a particular ailment. In other words, hospitals make more by spending less. This system, originally used by Medicare has now been adopted more broadly by private payers. This is part of a larger movement to hopefully improve quality and cost of care in the new legislation. The Centers for Medicare and Medicaid's Actuarial Office is on the record stating that reducing hospital acquired conditions could save $3.2 billion over the next ten years.
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President Obama's Affordable Care Act stands to benefit from a major new player emerging in the diagnostic's industry. DRG codes have fundamentally changed the structure of hospital reimbursement. Instead of paying hospitals for how many goods and services are used per patient, diagnostic related groupings set reimbursement at a predetermined amount of money based on the average cost for someone dealing with a particular ailment. In other words, hospitals make more by spending less. This system, originally used by Medicare has now been adopted more broadly by private payers. This is part of a larger movement to hopefully improve quality and cost of care in the new legislation. The Centers for Medicare and Medicaid's Actuarial Office is on the record stating that reducing hospital acquired conditions could save $3.2 billion over the next ten years.
Obamacare's New Gold Standard: T2 Biosystems - T2 Biosystems (NASDAQ:TTOO) | Seeking Alpha
Carriers (and I believe Medicare as well) commonly use flat per diems for some medical conditions vs "pay for services rendered". This prospective payment system report is right out of BHO's playbook of fairness.
These bungled (bundled) payment systems have some merit but also a downside. If a provider is paid a flat fee prospectively for treating a condition it would not be unusual for the provider to selectively choose patients that should require minimal care and therefore maximize the profit potential.
Anytime DC thinks they can outsmart the public with a change in the way things are covered or taxed they fail to consider the logical counter-move designed to offset the new provision or tax.
These bungled (bundled) payment systems have some merit but also a downside. If a provider is paid a flat fee prospectively for treating a condition it would not be unusual for the provider to selectively choose patients that should require minimal care and therefore maximize the profit potential.
Anytime DC thinks they can outsmart the public with a change in the way things are covered or taxed they fail to consider the logical counter-move designed to offset the new provision or tax.
Why would anyone with "health insurance" shop for price may I ask? The only thing someone might shop for is quality, not price since price is irrelevant to a covered person.
I'm self employed and shop for "insurance", which really isn't insurance after all because it covers things like annual check ups. What loss is being insured for when I go see a doc so he can check my weight, BP and heart beat?
- 514
I had asked a question about the repricing negotiation services mainly for somebody uninsured or maybe they have a high deductible. Or sometimes somebody wants to get something done out of network... they could have test/procedure and still submit claim to their insurance company and the insurance company would apply to the deductible. The insurance might apply something to the deductible minus a penalty (if any)
High ded claims are still repriced when filed with the carrier.
If they consciously go out of network the time to negotiate is up front, not after the fact. Some claim review services will check your EOB for errors for a flat fee, usually a few hundred dollars. Some will also attempt to negotiate a discount in exchange for cash payment and take a % of the discount.
Seems kind of silly to pay someone to negotiate a cash discount when you can do that yourself. Make a reasonable offer. Either the provider will accept your offer or tell you to pound sand.
Uninsured people typically don't pay anything so I doubt they would pay someone to negotiate pricing.
Look what I just got from BCBSTX
The Blue Cross and Blue Shield Association today released a new report that analyzed the cost variance of knee and hip surgery using claims data in 64 Blue markets.
The report points to recent research that indicates consumers may pay as much as 683 percent more for the same medical procedures, in the same town, depending on the facility they choose. The Association analyzed claims data from 64 markets, which included Blue Cross and Blue Shield of Texas (BCBSTX), and found that prices for identical hip and knee procedures can quadruple in cost depending on which hospital a patient chooses within a market.
The report corroborates our work in helping our members better understand their health care options and costs. By having access to tools that explain their choices, they can play a bigger part in finding providers that offer the best possible care, at the right time resulting in the best possible outcomes, while still keeping cost in mind.
To help our members better understand their health care costs, we have the following tools available that have helped our members save real money, without sacrificing quality:
BCBSTX's Provider Finder®, an online health care transparency tool, enables our members to search for providers and estimate costs and quality metrics for more than 400 common medical procedures, including hip and knee replacement surgeries.
We analyzed the use of Provider Finder for approximately 800,000 members and found that members who acted on a Provider Finder recommendation saved on average $900 per procedure.
Benefit Value Advisor (BVA) is a program offered to many of our members. With BVA, a specially trained customer service advocate provides members various health care options and explains what they mean for the member. An analysis of approximately 1.2 million Blue Cross and Blue Shield members in Illinois, New Mexico, Oklahoma and Texas who used a BVA found that:
Members who acted on opting for an alternative saw an average savings of approximately $2,000 per claim.
BVA usage resulted in $6.7 million in realized cost savings.
The Blue Cross and Blue Shield Association today released a new report that analyzed the cost variance of knee and hip surgery using claims data in 64 Blue markets.
The report points to recent research that indicates consumers may pay as much as 683 percent more for the same medical procedures, in the same town, depending on the facility they choose. The Association analyzed claims data from 64 markets, which included Blue Cross and Blue Shield of Texas (BCBSTX), and found that prices for identical hip and knee procedures can quadruple in cost depending on which hospital a patient chooses within a market.
The report corroborates our work in helping our members better understand their health care options and costs. By having access to tools that explain their choices, they can play a bigger part in finding providers that offer the best possible care, at the right time resulting in the best possible outcomes, while still keeping cost in mind.
To help our members better understand their health care costs, we have the following tools available that have helped our members save real money, without sacrificing quality:
BCBSTX's Provider Finder®, an online health care transparency tool, enables our members to search for providers and estimate costs and quality metrics for more than 400 common medical procedures, including hip and knee replacement surgeries.
We analyzed the use of Provider Finder for approximately 800,000 members and found that members who acted on a Provider Finder recommendation saved on average $900 per procedure.
Benefit Value Advisor (BVA) is a program offered to many of our members. With BVA, a specially trained customer service advocate provides members various health care options and explains what they mean for the member. An analysis of approximately 1.2 million Blue Cross and Blue Shield members in Illinois, New Mexico, Oklahoma and Texas who used a BVA found that:
Members who acted on opting for an alternative saw an average savings of approximately $2,000 per claim.
BVA usage resulted in $6.7 million in realized cost savings.
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I just found this...looks kind of useful
And gives cpt codes and avg charges per zip code
http://fairhealthconsumer.org/medical_cost.php
What it is
http://fairhealthconsumer.org/faq.php
And gives cpt codes and avg charges per zip code
http://fairhealthconsumer.org/medical_cost.php
What it is
http://fairhealthconsumer.org/faq.php
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Health care Bluebook is a similar site but no match for using carrier tools.
Can't believe BXTX doesn't have a cost estimator. That's a real bummer
Can't believe BXTX doesn't have a cost estimator. That's a real bummer
