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Sun Jun 12, 2016, 01:54 AM

LA Times: Even if you have health insurance, you may want to pay cash

http://www.latimes.com/business/lazarus/la-fi-lazarus-healthcare-pricing-20160610-snap-story.html

Even if you have health insurance, you may want to pay cash

June 10, 2016
by David Lazarus


Five blood tests were performed in March at Torrance Memorial Medical Center. The hospital charged the patient’s insurer, Blue Shield of California, $408. The patient was responsible for paying $269.42.

If that were all there was to this -- which it’s not -- you’d be justified in shaking your head and wondering how it could cost more than $80 apiece for blood tests. These weren’t exotic procedures. The tests were for fairly common things such as levels of vitamins D and B12 in the blood.

It‘s what happened next, though, that this makes this story particularly interesting.

The patient, who for privacy reasons requested that I use only her first name, Caroline, was curious about why she needed to pay almost $300 for a handful of routine tests. So she called the hospital.

“I was completely surprised,” Caroline told me. “The woman I spoke with in billing said that if I’d paid cash, the prices would have been much lower.”

How much lower? Try this on for size: Tests that were billed to Blue Shield at a rate of about $80 each carried a cash price of closer to $15 apiece.

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Reply LA Times: Even if you have health insurance, you may want to pay cash (Original post)
proverbialwisdom Jun 2016 OP
Hoyt Jun 2016 #1
bluesbassman Jun 2016 #2
Hoyt Jun 2016 #10
glowing Jun 2016 #12
Hoyt Jun 2016 #13
glowing Jun 2016 #16
Hoyt Jun 2016 #21
littlebit Jun 2016 #3
mrmpa Jun 2016 #4
Hortensis Jun 2016 #20
ReRe Jun 2016 #5
UCmeNdc Jun 2016 #6
bemildred Jun 2016 #7
ljm2002 Jun 2016 #17
bemildred Jun 2016 #19
PoliticAverse Jun 2016 #8
B Calm Jun 2016 #15
Sgent Jun 2016 #18
KG Jun 2016 #9
B Calm Jun 2016 #11
Fumesucker Jun 2016 #14
TheProgressive Jun 2016 #22

Response to proverbialwisdom (Original post)

Sun Jun 12, 2016, 02:22 AM

1. Odds are Blue Cross approved $10 or less. If hospital is in network, they'd write off the rest.

Assuming no emergency, if patient went to out of network hospital, they need to think next time. Yeah, I know, single payer would have avoided that. But, don't have single payer right now.

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Response to Hoyt (Reply #1)

Sun Jun 12, 2016, 02:35 AM

2. So the insurer pays $10 and the insured is on the hook for $269 on top of their monthly premium?

That's quite a profitable little scam the hospitals and insurers have going. Insurer make a huge profit on the front end with sky high premiums, and the hospital makes another on the back end inflated procedure costs.

No defense for this, in network, out of network, none of it. They're ripping off consumers coming and going.

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Response to bluesbassman (Reply #2)

Sun Jun 12, 2016, 07:22 AM

10. No. If it's an in network hospital, $269 is written off as a contractual adjustment.

Patient won't be billed for that. I agree there is no reason for this other than Congress and 40+% of people just don't want single payer and a lot of other people will balk when they hear the cost. I think they are stupid, but that's the way it is.

Read about how Vermont abandoned single payer when they figured out the cost, knowing that people would not understand it. Even under single payer, you'll have bills that are higher than the final adjusted bill.

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Response to Hoyt (Reply #10)

Sun Jun 12, 2016, 07:30 AM

12. It was abandoned primarily because the gov is an asshole....

 

But beyond that, they are a state that has 650,000 people. When half the facilities that patients will use for major medical care are going to happen out of state, it would make VT incredibly liable for a lot of costs. The state is just too small to handle single-payer on its own. NOW, what they should have done to stream-line "single-payer" would be to essentially use an insurance company like they were a large employer, and work out a model of payments per person, then figure out the tax base from that number. They are just too small to handle the "switch", but abandoning it completely is an asshat move in my book... My Mom likes that idea, and has been making it a conversation to see how other people feel about that type of delivery system. Who knows, it might actually happen if they work on it, maybe by 2018?

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Response to glowing (Reply #12)

Sun Jun 12, 2016, 07:39 AM

13. It'll happen nationally with a Public Option faster and with less fight.

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Response to Hoyt (Reply #13)

Sun Jun 12, 2016, 07:59 AM

16. Yes, and its needed now more than ever since the insurance companies are anything but affordable

 

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Response to glowing (Reply #16)

Sun Jun 12, 2016, 11:07 AM

21. I agree with that. But, even with public option or single payer, it won't be cheap.

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Response to proverbialwisdom (Original post)

Sun Jun 12, 2016, 03:05 AM

3. My primary doc

does the same thing. If I pay cash for an office visit it is $47. If they bill my insurance it is $95.

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Response to proverbialwisdom (Original post)

Sun Jun 12, 2016, 04:29 AM

4. Same with drug pricing............

if my 86 year old mother uses her insurance a generic is $8 a month, not using her insurance $10 for a 3 month supply. Name brand for one drug it's $15 a month with her insurance, without it's $28 for a 3 month supply.

I don't allow her to use her pharmacy insurance.

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Response to mrmpa (Reply #4)

Sun Jun 12, 2016, 10:20 AM

20. Exactly. We have few medication and doctor bills so

far, but we learned some time ago to tell the radiology office or whomever that we would pay the total up front if the price was low enough. The discounts are usually huge, and then we put in a claim for what we paid. After all, 20% coinsurance is far less on a $400 bill than on a $1500 one.

We also take strong exception both to doctors prescribing anything but generics unless they have a good reason and those prescribing very high-price drugs without discussing with us whether a presumably inferior but far less expensive option is available.

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Response to proverbialwisdom (Original post)

Sun Jun 12, 2016, 04:54 AM

5. Healthcare should be...

... universal in this country. Is there anything that Capitalism doesn't eff up? Any business that touches our health should never have been privatized. Will HRC pass single payer if she gets a Democratic House and Senate?

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Response to proverbialwisdom (Original post)

Sun Jun 12, 2016, 05:15 AM

6. The real question is why does Blue shield tolerate such over pricing practices?

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Response to UCmeNdc (Reply #6)

Sun Jun 12, 2016, 05:35 AM

7. It causes people to defer care.

Blue Shield then gets to keep the insurance money AND reject the patient in the future for pre-existing conditions.

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Response to bemildred (Reply #7)

Sun Jun 12, 2016, 09:35 AM

17. I think you are wrong about that last thing...

...to the best of my understanding, insurance companies can no longer reject people for pre-existing conditions, thanks to the ACA.

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Response to ljm2002 (Reply #17)

Sun Jun 12, 2016, 10:17 AM

19. I think you are right, but they would if they could.

Because: profit.

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Response to proverbialwisdom (Original post)

Sun Jun 12, 2016, 06:27 AM

8. I wonder what Medicare or Medicaid would pay for the same test. n/t

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Response to PoliticAverse (Reply #8)

Sun Jun 12, 2016, 07:56 AM

15. I'm on Medicare, it paid 100%!

 

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Response to B Calm (Reply #15)

Sun Jun 12, 2016, 10:05 AM

18. 100% of the allowable

the allowable for a B-12 is probably in $4-8

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Response to proverbialwisdom (Original post)

Sun Jun 12, 2016, 06:33 AM

9. insurers don't want customers to use thier insurances, so

lets force everybody to participate in the scam!

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Response to proverbialwisdom (Original post)

Sun Jun 12, 2016, 07:29 AM

11. It's a damn shame we were not allowed a public option on the ACA!

 

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Response to proverbialwisdom (Original post)

Sun Jun 12, 2016, 07:41 AM

14. Not to worry, the presumptive nominee is gonna fix all this with some pragmatic centrism

Her stronger supporters are so sure of this they are not even bothering to post in the thread.

Twain described it as the serene confidence of Christian with four aces.

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Response to proverbialwisdom (Original post)

Sun Jun 12, 2016, 12:01 PM

22. This is why Clinton doesn't want single payer...

 

Its all about grabbing the last penny from the middleclass.

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