The Great Rip Off

[AM64]

I just googled MRI cash pay. Depending on what you're doing and where you are, there are some portals that will help you shop pricing.

Many years ago a colleague was getting their gall bladder removed and he showed me a Georgia portal that would shop most every Ga hospital. One place was 1/2 the price of the other. Even though he was insured, he still had to pay 20%, so he was paying 20% of a much smaller number.

I also have a prescription that is $180/mo. It goes toward my deductible but again, my deductible is $6k. So I pay cash using a GoodRx coupon and it's $35/mo.

If for some reason I had a big expense like a surgery and hit my deductible, then I'd start filing my prescription and it would pay 100%.

It's like a huge racket. I'd encourage everyone, no matter your insurance situation to take as much control of your medical situation as you can.

Then there's the Catch 22 stuff. Several years ago I needed to go to an ENT for hearing loss. We had TriCare since my wife was military. The doctor's office asked about insurance, and I said TriCare - sorry we don't take TriCare. OK then what kind of cost am I looking at for a visit without insurance. By law we have to file with your insuror, but since we don't accept TriCare, we can't accept you as a patient. There were no ENTs in Chattanooga who were in the TriCare network - had to go elsewhere.

 

[McDad]

Hence the reason they don't care if health care costs go up.... they make a 20% margin whether they save you or your employer.... infaacat they make more when the costs go up.

In fact they have a vested interest in costs rising. 20% of 1,000 is better than 20% of 500.

 

[AM64]

In fact they have a vested interest in costs rising. 20% of 1,000 is better than 20% of 500.

I keep trying to impress my wife with that fact when we discuss selling this house. She watches all the home improvement shows and is convinced that we need to spend a bundle - new kitchen cabinets, etc, etc. I keep telling her to see who sponsors those shows. Realtors and lenders always want the home to sell for top dollar - they just don't care about how much you recover to sell at top dollar. Wives never listen. I'd much rather buy a house and do improvements I want, than buy one where someone has slapped on cheap paint and put down cheap carpet, etc. The key is figure out who has the most to gain when it's your money on the line.

 

[CABVOL]

I called local hospital about an MRI they said $2400 if we bill insurance, $1200 if you pay cash. Sounds like insurance fraud to simple minded people like me.

Since my deductible is $6000 I drove an hour to a cash only place and paid $399.

I have a client that's a Dr and in his practice he is him, 1 PA and "3 ladies that work all day on trying to get us paid."


I think it was Forbes that did a deep dive about 10 years ago that said the "process" was the biggest problem in the medical system. Not Doctors, ambulance chasing lawyers, etc but the arduous process of dealing with Medicare, Medicaid and insurance companies. They showed many elective procedures that had gotten much cheaper over the years (vision correction, cosmetic, etc) yet gall bladder surgery, that is now outpatient, is 5x more than it was back when they cut you from backbone to breastbone and kept you hospitalized for a week.

Speaking from a hospital standpoint, hospital’s have WAY more overhead than a stand alone imaging center or a “cash only” place. Hospitals are forced by insurance companies to negotiate a contract, which normally means the hospital automatically has to accept 50-60% of the billed amount from the insurance company. Then you’d hv your deductible portion to pay. That’s why they offer a much lower cash price.

In a hospital, X-ray, lab, surgery, pharmacy are the only real money makers. Every other department that it takes to operate a hospital is a liability.

I’m not saying it’s right, just explaining the difference.

Edit: Medicare/Medicaid payments for that same MRI is probably around $300, which is probably how the cash only place came up with their pricing. My hospital sees roughly 70% Medicare/Medicaid patients. Kind of hard to survive without commercial insurance for hospitals. Just how it is under the current system.

Also on this note, I was on vacation one year and one of my machines went down. GE came in to repair it. When I got back, I was going over a $13k bill for the repair. One part on the invoice for $10k. I researched to learn this part was for a battery back-up for the machine. The same battery back up I could buy on CDW for $900. Long story short, after convos with GE corporate, I didn’t pay that and they thanked me for “bringing it to their attention”. BS. They tried to say it was “medical grade”. More BS.

Another company tried to up our pricing 35% on tv’s for patient rooms after they found out it was for a hospital.

 

[McDad]

Speaking from a hospital standpoint, hospital’s have WAY more overhead than a stand alone imaging center or a “cash only” place. Hospitals are forced by insurance companies to negotiate a contract, which normally means the hospital automatically has to accept 50-60% of the billed amount from the insurance company. Then you’d hv your deductible portion to pay. That’s why they offer a much lower cash price.

In a hospital, X-ray, lab, surgery, pharmacy are the only real money makers. Every other department that it takes to operate a hospital is a liability.

I’m not saying it’s right, just explaining the difference.

The administrative burden, overhead, and expense of hospitals is unsustainable. Took off with the growth of managed care and has not stopped growing.

 

[walkenvol]

The administrative burden, overhead, and expense of hospitals is unsustainable. Took off with the growth of managed care and has not stopped growing.

If true, why does it appear so many hospitals are still constructing more buildings?

Also, what exactly is managed care?

 

[walkenvol]

I just googled MRI cash pay. Depending on what you're doing and where you are, there are some portals that will help you shop pricing.

Many years ago a colleague was getting their gall bladder removed and he showed me a Georgia portal that would shop most every Ga hospital. One place was 1/2 the price of the other. Even though he was insured, he still had to pay 20%, so he was paying 20% of a much smaller number.

I also have a prescription that is $180/mo. It goes toward my deductible but again, my deductible is $6k. So I pay cash using a GoodRx coupon and it's $35/mo.

If for some reason I had a big expense like a surgery and hit my deductible, then I'd start filing my prescription and it would pay 100%.

It's like a huge racket. I'd encourage everyone, no matter your insurance situation to take as much control of your medical situation as you can.

Might be a dumb question but what is a “portal”?

 

[MurphyVol]

Might be a dumb question but what is a “portal”?

Sorry, portal was poor description. It was a website that you can plug a procedure into and it will search multiple hospitals/providers for you.

 

[Zues1]

Thank you for sharing this. I take a single prescription that I’ve been having filled at the Publix pharmacy for several years and will need it for life. It’s price changes every time it seems for a 90 day supply ranging from $30 - $42 if memory serves. Checked it on the app and my local Walmart has the same for $10 so I called them & moved my prescription there. Who says it’s a waste of time reading VN? You paid it forward today!

We use Good RX as well. Usually cheaper than our insurance coverage.
There are other programs/app that work like Good RX so do your research.

 

[Juanita]

Also, what exactly is managed care?

Managed care came about in the 70s with the creation of health maintenance organizations (HMOs). The intent was to "equalize" the rising costs of health care. Part of this was due to the good ole boy system. Doctors did not police their own. I saw this happen with an orthopedic surgeon. He would routinely perform an arthroscopy even though he knew he was going to open the knee. He was paid for two procedures. Pretty slick, huh? Insurance companies got ticked. They designated primary care physicians as the "gatekeepers" to patients' health care plans. PCPs were/are reimbursed a percentage of their charges for voluntarily participating in plans. This produced an upward spiral in service charges as docs/hospitals attempted to compensate and/or write off their losses. Also, it produced a rise in patients' premiums/deductibles/copays/co-insurance payments. Additionally, PCPs may only refer to specialty docs that participate in the plan, "in network" physicians . It's not their problem if you are referred to a neurologist who doesn't participate in your insurance plan. On their behalf, how in the world can they be expected to keep up with the changes of plans/participation? Out of network equals out of pocket for consumers. If you don't have insurance, ask if financial aid is available. The paperwork is a pain, but it doesn't hurt to ask. If you do have insurance, thoroughly investigate your plan options and requirements...referrals/authorizations/certifications. In the end, we are responsible for our health care and are our own best advocates.

 

[Zues1]

We use Good RX as well. Usually cheaper than our insurance coverage.
There are other programs/app that work like Good RX so do your research.

Here's a screen shot from Good RX with listed rates at various locations. How can there be such a large discrepancy for the same prescription. It's nuts.

 

[GAVol]

Hence the reason they don't care if health care costs go up.... they make a 20% margin whether they save you or your employer.... infaacat they make more when the costs go up.

The top companies have a margin of about 5-6%.

 

[walkenvol]

Here's a screen shot from Good RX with listed rates at various locations. How can there be such a large discrepancy for the same prescription. It's nuts.

That’s crazy - it’s obviously set up to fool the uninformed. BTW, I recommend Kroger!

 

[Zues1]

That’s crazy - it’s obviously set up to fool the uninformed. BTW, I recommend Kroger!

We've found Kroger normally has the best price.

 

[walkenvol]

GoodRX should expand their app to cost compare medical procedures in one’s area!

Sorry, portal was poor description. It was a website that you can plug a procedure into and it will search multiple hospitals/providers for you.

any recollection of the web site name?

 

[MurphyVol]

GoodRX should expand their app to cost compare medical procedures in one’s area!

any recollection of the web site name?

Sorry no, but I bet a little digging can find one. I have also just called around directly to hospitals for cash pricing. Just get it quoted in an email before you have the procedure

 

[volkyries]

If you think insurance companies don't have a hand in this I don't know what to tell you. Everywhere I've been in the world where insurance is catastrophic-only and is highly limited healthcare costs have been reasonable while still preserving enough profits for clinics and hospitals to incentivize them to stay open.

Healthcare down here in Peru, where insurance is basically only used for things like pregnancies, cancer, massive traumas, etc., and where I can get all kinds of stuff OTC, costs next to nothing. Examples: I got two chipped teeth repaired and my wife and I both got cleanings for a total of $70; my wife had a preventative operation here (that insurance would not approve in the US) for less than $7K including all tests, hospital stay, follow-ups with various clinicians (this same operation would have been well over $20K at home, with worse doctors); I had a foot injury and got it treated for a total of $50 in three days (insurance would have required me to get a referral from a GP, plus the specialist doctor visit, plus the treatment if they actually would have covered it; estimated cost over $2K if they hadn't).

The bureaucracy that insurance companies pile on in the interest of their own margins is hugely problematic. Government insurance programs and regulations don't help, but they're not the main problem.

I am not saying insurance doesn't drive up costs, but according to google, doctors in Peru make on average $53,100 USD per year US while American doctors make over 4 times more at $228,000 USD. I dislike insurance as well, but the comparison is not apples to apples if costs are 4 times different to start with.

 

[Rasputin_Vol]

I am not saying insurance doesn't drive up costs, but according to google, doctors in Peru make on average $53,100 USD per year US while American doctors make over 4 times more at $228,000 USD. I dislike insurance as well, but the comparison is not apples to apples if costs are 4 times different to start with.

I'm sure that the cost of living may not be 4 times cheaper or 25% of the cost here in America, but I would assume that the cost of living in Peru would be significantly less than here to maybe help close that gap a little bit.

 

[Rasputin_Vol]

I am not saying insurance doesn't drive up costs, but according to google, doctors in Peru make on average $53,100 USD per year US while American doctors make over 4 times more at $228,000 USD. I dislike insurance as well, but the comparison is not apples to apples if costs are 4 times different to start with.

Oh, and it appears that you are suggesting that the salaries of doctors is a driver of costs? Is that what you are suggesting?

 

[Smokey X]

If you really want to get pizzed off, dig in to specialty drugs where there is no generic available. And complicate that by retiring and being forced into the Medicare system and the "donut hole".
Oh, and those retirement plans you had.....may have to modify those. When it is all said and done over the course of a year, if my wife has to stay on the current cocktail of medicines she takes, it will average out to approximately $1000 per month out of our bank accounts into the pockets of who knows who just for medicines. Infuriating.

 

[walkenvol]

I am not saying insurance doesn't drive up costs, but according to google, doctors in Peru make on average $53,100 USD per year US while American doctors make over 4 times more at $228,000 USD. I dislike insurance as well, but the comparison is not apples to apples if costs are 4 times different to start with.

American doctors are under paid if that’s accurate. What other job do you need 4 years of college at a cost of ?, 4 more of med school at a cost of +/- $200K, then a 3 year residency at apx $51K before you can start making $228K? Then out of the $228K a huge payment for liability insurance along with student loan payments. Relative to many other professions Doctors are underpaid at $228K

 

[Rasputin_Vol]

American doctors are under paid if that’s accurate. What other job do you need 4 years of college at a cost of ?, 4 more of med school at a cost of +/- $200K, then a 3 year residency at apx $51K before you can start making $228K? Then out of the $228K a huge payment for liability insurance along with student loan payments. Relative to many other professions Doctors are underpaid at $228K

That is actually something else I meant to factor in earlier. The upfront costs and time they have to go through also can justify their salary. I would assume that in Peru, the costs are not nearly the same for doctors. Again, I'm assuming...

 

[VolStrom]

My current doctor and a former next door neighbor doctor both got their medical degrees paid for by the federal government by spending 6 years (I think) in the military after medical school. So after the military requirement, they had no debt and were free to go practice wherever they wanted. That is the route I would choose today if I aspired to become a physician.

 

[walkenvol]

My current doctor and a former next door neighbor doctor both got their medical degrees paid for by the federal government by spending 6 years (I think) in the military after medical school. So after the military requirement, they had no debt and were free to go practice wherever they wanted. That is the route I would choose today if I aspired to become a physician.

Do the math before you make that decision. You get paid under $100K in the military. If your getting the average of $228K that’s in the range of $700-800K more you would be earning in the private sector to offset the cost of med school. Then there’s the fact that you will work geographically wherever Uncle Sam needs you instead of your picking where you prefer in this country. It’s not nearly as simple the equation as you present it to be.

 

[Wireless1]

Do the math before you make that decision. You get paid under $100K in the military. If your getting the average of $228K that’s in the range of $700-800K more you would be earning in the private sector to offset the cost of med school. Then there’s the fact that you will work geographically wherever Uncle Sam needs you instead of your picking where you prefer in this country. It’s not nearly as simple the equation as you present it to be.

Does the 6 years start during or after intern/residency? I want to think that a radiologist I knew went military and really only served a year or two. He signed up in undergrad and the military helped him get into med school.