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pnwmom

(110,331 posts)

30. Why? If one hospital facility in a city charges $2000 for a colonoscopy

Sun May 18, 2014, 06:57 PM

May 2014

and another charges $8,000 for the same uncomplicated procedure, why should the insurers be bound to pay 80% of either charge?

http://www.nytimes.com/2013/06/09/opinion/sunday/the-weird-world-of-colonoscopy-costs.html

Colonoscopies are one of three standard ways to screen for colorectal cancer. So it is disturbing to learn that the cost of this routine procedure, performed on more than 10 million Americans each year, differs radically from state to state and even within the same metropolitan area.

As Elisabeth Rosenthal reported last week in The Times, the amount paid by a patient and the patient’s insurance plan for a routine colonoscopy can be as high as $8,500 in the New York area, compared with a high of $1,900 in Baltimore. The low price in New York was $740, less than a tenth of the highest price.

Variations like these are not limited to colonoscopies. Big price differentials occur in a wide range of procedures and services, including hospital stays, M.R.I. scans and artificial hips, among others. Bringing the highest prices down to more reasonable levels will be an essential ingredient in holding the nation’s health care costs to sustainable levels.

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Obama administration quietly approves new Obamacare loophole benefiting insurance companies. [View all] woo me with science May 2014 OP

sad NJCher May 2014 #1

It's often extremely depressing, with corporate-purchased government, woo me with science May 2014 #2

Obama Betrays Us Again billhicks76 May 2014 #51

Nice to see the GOP still getting its way, all these years later. blkmusclmachine May 2014 #96

So True billhicks76 May 2014 #110

But we don't have single payer right now. We have a system under which the hospitals pnwmom May 2014 #3

The pressure won't fall on the hospitals to cut costs as much as it will on individuals to pay up Fumesucker May 2014 #6

Exactly. truedelphi May 2014 #17

They are supposed to send the tests to contracted labs lark May 2014 #23

yes, my provider sucked up the cost when some of my hopemountain May 2014 #129

Single payer is the answer lark May 2014 #186

But this says it opens the door for insurance companies to set prices. cui bono May 2014 #11

Why? If one hospital facility in a city charges $2000 for a colonoscopy pnwmom May 2014 #30

re: colonoscopy cost LiberalElite May 2014 #34

That is obscene. Hope your insurance company negotiated a more reasonable japple May 2014 #42

I paid a couple hundred for the biopsy LiberalElite May 2014 #45

Typically those are cheaper than hospitals - Ms. Toad May 2014 #58

Wow. You've just demonstrated the problem. I don't know if reference pricing pnwmom May 2014 #68

For one thing, all colonoscopies are not equal. Ms. Toad May 2014 #54

I'm talking about the price a hospital will charge for a standard screening colonoscopy. pnwmom May 2014 #69

Hers isn't labeled (or charged) any differently than a standard screening colonoscopy Ms. Toad May 2014 #73

Would it be possible to develop a system that assigned patients like your daughter pnwmom May 2014 #74

This system right now is that we have selected a doctor Ms. Toad May 2014 #76

And why should getting medical care be like shopping for a used car? Doctor_J May 2014 #62

It already is. I don't see how this would make it worse. pnwmom May 2014 #72

I agree! burrowowl May 2014 #107

+10000000. Note the blatantly false implications being offered in defense of this assault: woo me with science May 2014 #84

You do understand what is being said here? davekriss May 2014 #86

I think it would depend on how insurers are allowed to set the reference price. pnwmom May 2014 #90

ACA was supposed to be something new--and more, well, affordable, not less. merrily May 2014 #121

But we DON'T know how bad this is going to be, because, as I said, pnwmom May 2014 #123

All DUers are not progressives; and neither all DUers nor all progressives always assume the worst. merrily May 2014 #124

The OP story is written by one writer with his or her point of view. pnwmom May 2014 #125

Again, if no one understand the ramifications of this, why take any position at all? merrily May 2014 #126

I'm not saying that it's impossible to understand. I'm saying that this one Common Dreams pnwmom May 2014 #127

You said we can't understand it without more info. Whose fault is it that we don't have more info? merrily May 2014 #128

Your fault, pnwmom May 2014 #131

Heroic try, but no, it's not my fault that the Admin did not inform Americans. merrily May 2014 #133

This is a work in progress and the government depends on feedback pnwmom May 2014 #135

Again that was not my question, but since you moved the goalpost to the future-- merrily May 2014 #136

The Obama administration couldn't force Congress to pass the public option. pnwmom May 2014 #140

Highly untrue. The cake was baked before it ever got to Congress. merrily May 2014 #143

The Democrats did not have enough votes to overcome the filibuster. pnwmom May 2014 #147

Did they seek our feedback before deciding? Do you, even now, have merrily May 2014 #137

This isn't a decision written in stone. It's a preliminary decision in an ongoing situation pnwmom May 2014 #139

this is why I have proposed that any and all Agony May 2014 #145

"why should the insurers be bound to pay 80% of either charge?" Heywood J May 2014 #175

What do you mean by "oppens the door?" They have been setting prices all along nt kelliekat44 May 2014 #138

I didn't write the phrase, it was in the OP. n/t cui bono May 2014 #221

No, we don't have single payer, but what does that have to do with the waiver publicized in the OP merrily May 2014 #116

I think the waiver might possibly have been intended to let companies selling to individuals pnwmom May 2014 #117

First, so? ACA changed what large group insurers have always been doing and that is exactly merrily May 2014 #118

"We have a system in which hospitals can charge anything they want ..." is laughably wrong. Scuba May 2014 #149

Some hospitals charge ten times as much as others for a colonoscopy in the same city. pnwmom May 2014 #154

It doesn't matter what they charge - at least to Medicare, Medicaid and insurance companies... Scuba May 2014 #155

If that is already the case, then why the uproar here over the "new" regulation? n/t pnwmom May 2014 #189

Which uproar? What "new" regulation? Scuba May 2014 #190

Slowly, one by one, the modest benefits of the ACA Maedhros May 2014 #4

Corporatist president run amok. Ed Suspicious May 2014 #18

The ACA had two goals: Maedhros May 2014 #71

Well said, except that I would qualify #2. woo me with science May 2014 #93

It was also to help medical providers, especially hospitals, and maybe merrily May 2014 #120

& give big crapsurance enough $$$ to lobby away any real reform in the ACA. grahamhgreen May 2014 #223

Ding ding ding! Exactly! They'll take their mandated trillions and 'lobby' away any good reforms. grahamhgreen May 2014 #112

Not really Shivering Jemmy May 2014 #156

Well, your superbly crafted argument has certainly quelled all of MY concerns. [n/t] Maedhros May 2014 #188

The way it was intended too be. SammyWinstonJack May 2014 #163

he really got me with that hope and change crap leftyohiolib May 2014 #5

He probably would have got me but I was paying attention during the FISA vote Fumesucker May 2014 #8

The more things "Change," the more THEY STAY THE SAME !!! blkmusclmachine May 2014 #99

Or get much worse. woo me with science May 2014 #104

One nation, under Wall Street... Octafish May 2014 #7

What a boost for GOTV efforts! 1000words May 2014 #9

See posts 63 and 81. woo me with science May 2014 #87

Good cop/Bad cop 1000words May 2014 #89

I'm not so sure the DC DEMS want to win in Nov. More DEMS could make "bi-partisanship" a harder sell blkmusclmachine May 2014 #100

I'm not sure this is bad if one is interested in reducing cost. Canada has used it Hoyt May 2014 #10

Consumer choice in medical care is a myth. An illusion. Try to find the price of an MRI from your Ed Suspicious May 2014 #20

It is really so much simpler than that. You guys are really making this more difficult than it is. Hoyt May 2014 #43

+1 IronLionZion May 2014 #146

I see absolutely zero reason why anyone should spend their precious hours Heywood J May 2014 #181

Well said. The mocking defense of this assault just shows woo me with science May 2014 #195

You don't have to shop around, your insurance company will tell you closest hospital that meets Hoyt May 2014 #203

Hmm, this sounds a whole lot like the old "reasonable and customary" crap. lark May 2014 #26

No, it's different because you'll have the tools to avoid paying extra out-of-pocket if you take Hoyt May 2014 #50

Actually - it sounds like worse. Ms. Toad May 2014 #60

As usual, those who can afford it the LEAST... bvar22 May 2014 #12

Yes, we need Single Payer and corporate money out. How are YOU going to make that happen? RBInMaine May 2014 #13

Yes. salib May 2014 #19

This was an Obama admin. on the sly/back room deal with Big Insurance Divernan May 2014 #44

.... Phlem May 2014 #185

Here is what Obama's nominee for HHS thinks about single payer. pa28 May 2014 #208

I expected nothing more Demeter May 2014 #14

It's more likely the employer in short run, and society in long run, will benefit. Hoyt May 2014 #27

Canada and Europe did not make middleman part of the system by law Doctor_J May 2014 #98

I would suggest you look up drug coverage in Canada and how private insurance Hoyt May 2014 #114

"ObamaCare" was originally a Republican-hatched WET DREAM out of the Heritage Foundation, circa blkmusclmachine May 2014 #102

This country should be ashamed of itself for not having universal healthcare. EEO May 2014 #15

This country should be ashamed of itself for a great many things. nt Javaman May 2014 #38

And for a great long time. Some seem to think the shame all starts with this President. n/t Whisp May 2014 #206

Nice user name. AAO May 2014 #85

This could really hurt my family salib May 2014 #16

A lot of us here tried to put up a good fight for people in truedelphi May 2014 #21

I see your point. However, I have really never heard may say "Medicaid for All". salib May 2014 #29

This does not change your out of pocket max krawhitham May 2014 #24

From what I read in the DOL reference from the Article, I STILL HAVE TO PAY salib May 2014 #32

Q2, Q3, & Q4 are all listed under Limitations on Cost-Sharing under the Affordable Care Act krawhitham May 2014 #41

I really wish that your conclusions were true salib May 2014 #47

CalPERS has been using reference pricing for several years. Emergencies don't fall under RPricing. Hoyt May 2014 #56

I feel your pain. It's a disgusting system designed to confuse. The consumer was never meant to Ed Suspicious May 2014 #25

"It is bullshit. You know it is." woo me with science May 2014 #106

It sounds like this goes above/beyond deductibles and annual OOP limits? Cal Carpenter May 2014 #22

All the good stuff is quietly approved. zeemike May 2014 #28

Note the absurd attempts to spin this already. woo me with science May 2014 #31

Yes, absurd. salib May 2014 #33

And when you go far enough down the road you get to the crossroad zeemike May 2014 #35

Once everything good has finally been taken out of ObamaCare, all that'll be left is the TAX. blkmusclmachine May 2014 #103

the absudity comes for the many ASSumptions Sheepshank May 2014 #216

Still pissed smallcat88 May 2014 #36

How come the Obama can never do wrong crowd are always absent from these threads oneofthe99 May 2014 #37

Michelle does look beautiful. McCamy Taylor May 2014 #40

Michelle Obama is an intelligent caring woman who is the First Lady of the United States Cha May 2014 #92

Actually, like most of these Obama-is-out-to-screw-us-threads, those in the "know" come along later. Hoyt May 2014 #59

LMAO Jeeze. L0oniX May 2014 #199

Have you researched this issue, or are you just going along with the he's-screwed-us-again-crowd? Hoyt May 2014 #202

Perhaps you stopped reading too soon? Read on, oh wise one, read on! Tarheel_Dem May 2014 #65

So this is where the Obama Can Do No Right crowd is? No wonder the other thread Number23 May 2014 #79

"Obamacare saved consumers billions, new report finds" which doesn't interest those Cha May 2014 #97

Well, they've rallied up the Truthiness Crew and the recs are a'pouring in now! Number23 May 2014 #119

I think they're pissed cuz the rally was a big fail! Tarheel_Dem May 2014 #178

Administration sock-puppets to explain how down is up in 3 - 2 - 1 ... blkmusclmachine May 2014 #105

Explain to who? I don't count you. Tarheel_Dem May 2014 #179

This message was self-deleted by its author woo me with science May 2014 #77

The propaganda brigade typically ignores OP's about Democratic betrayals until about 35-40 recs, woo me with science May 2014 #78

It takes a little time for the PM "phone tree" to get going. 1000words May 2014 #101

"woo" doesn't provide constructive debate. joshcryer May 2014 #109

This is how it already is with private insurance. Indeed, they can decide after the surgery to pay McCamy Taylor May 2014 #39

The reporting seems to be confused Egnever May 2014 #48

Yes, private insurance sucks. We know that. That's why making them a permanent part of Doctor_J May 2014 #49

Hey look it's dishonest reporting again.. Egnever May 2014 #46

It IS honest & dated May, 2014. Divernan May 2014 #53

You left out some good quotes from your own link. Hoyt May 2014 #57

Glad to see someone digging for the truth in all the bitter screaming davidpdx May 2014 #130

Another transfer of cost and pain from corporations to ordinary people. woo me with science May 2014 #83

OP is dishonest. Sheepshank May 2014 #214

Of course it's "dishonest reporting." ProSense May 2014 #61

Yea I know Egnever May 2014 #64

Why read anything when you can just label EVERYTHING that disagrees with your ill informed Number23 May 2014 #80

Shocked. Shocked I am...nt SidDithers May 2014 #91

"adequate access to quality providers" joshcryer May 2014 #111

Yup Egnever May 2014 #201

SURELY YOU JEST!!!! Whisp May 2014 #207

I would think this is for out-of-network coverage ramapo May 2014 #52

Sounds like a loophole the GOP could exploit. Kablooie May 2014 #55

Obama doesn't care. He seems to be campaigning for a Republican congress anyway Doctor_J May 2014 #63

I suspect that's exactly what they are doing. It's worth reposting this: woo me with science May 2014 #81

I cannot see it any other way. Enthusiast May 2014 #150

It's even simpler than that: Dems are fine losing midterms so they can use repuke congress as a Foil yodermon May 2014 #177

Spin it!!... SidDithers May 2014 #66

Culling the herd. WinkyDink May 2014 #67

Thank you to all the people who debunked this OP Cali_Democrat May 2014 #70

There was not a single post that successfully debunked the OP. Enthusiast May 2014 #151

Actually...this thread has not only been debunked, it's now great flypaper for determining msanthrope May 2014 #187

Every single insurance policy sold have these sobenji May 2014 #75

In the past they negotiated rates with health care providers. Jesus Malverde May 2014 #173

Of course they are still negotiating rates sobenji May 2014 #220

That Woo-Democratic President!!!1 n/t UTUSN May 2014 #82

The insurance racket is now a partner with government and is too big to fail. Jesus Malverde May 2014 #88

If the insurer pays $1000 less for a procedure, $800 goes to the policyholders bornskeptic May 2014 #205

This regulation change applies to even private employer insurance, not sure what the government Jesus Malverde May 2014 #217

This seems to be part of the plan. It's not a "mistake," or 11-dimensional chess. It's something blkmusclmachine May 2014 #94

Why the outrage at the insurance companies? The Obama admin did this. The ACA did this. Skip Intro May 2014 #95

K&R DeSwiss May 2014 #108

+100000 "...As is most of the population." woo me with science May 2014 #113

+a billion nationalize the fed May 2014 #122

Their fear is that we'll wake-up one day..... DeSwiss May 2014 #134

Plus one a whole bunch. Enthusiast May 2014 #152

Double K & R L0oniX May 2014 #200

"this shows that an insurance-driven health system is doomed to fail." merrily May 2014 #115

I believe South Korea uses prices that are fixed for procedures as well davidpdx May 2014 #132

Some experts are concerned. Jesus Malverde May 2014 #218

With emergency surgery, no time to check out prices. This is indefensible. madfloridian May 2014 #141

Thanks to Obama care... 951-Riverside May 2014 #142

The subsidies are paid by taxpayers to the corporate profitmongers. woo me with science May 2014 #148

Thanks to Obamacare, I was turned into a newt. IronLionZion May 2014 #169

I agree. We must have single payer. Enthusiast May 2014 #144

The Oligarchs, Corporations And Banks Own And Control The Politicians That Own And Control Us cantbeserious May 2014 #153

I am beginning to heaven05 May 2014 #157

My agenda? DeSwiss May 2014 #159

I have no problem with the oligarchy heaven05 May 2014 #161

I don't blame him either. DeSwiss May 2014 #164

no deflection or obscuring intended heaven05 May 2014 #170

Some people think attacking these reforms will somehow bring us single payer IronLionZion May 2014 #168

thanks for the lucid clarification heaven05 May 2014 #171

All of our forward momentum was wasted. raouldukelives May 2014 #158

Is Obama intent on making sure humbled_opinion May 2014 #160

The new strategy works like this: ... Jesus Malverde May 2014 #162

WOW OMG! is right! SammyWinstonJack May 2014 #166

Very misleading ProSense May 2014 #172

Sorry prosense this is about IN NETWORK providers. Jesus Malverde May 2014 #176

This is horrifying, and the article clearly states that it applies in-network. woo me with science May 2014 #191

The true measure of the success or failure of the ACA Maedhros May 2014 #193

+10000000000 woo me with science May 2014 #196

The ACA is emblematic of the failings of the Democratic Party on a wider scale. Maedhros May 2014 #197

Greed, money, politics... davidthegnome May 2014 #165

Post removed Post removed May 2014 #167

This is all alarmist conjecture, and is really no different than the way the system is now. cbdo2007 May 2014 #174

It's very different Jesus Malverde May 2014 #180

Exactly: the ACA is really no different than the way the system is now. Maedhros May 2014 #194

Too much bullshit to endure. JEB May 2014 #182

Obamacare both guarantees 20% margins to the for-profit insurers AND $2500 savings to each American. Romulox May 2014 #183

No it requires that 80% be paid out for care or paid back to the customer. IronLionZion May 2014 #198

Yes, this has been extensively discussed here. They have *guaranteed* their obscene profits woo me with science May 2014 #219

Fucking thank you Obama.. BlueJac May 2014 #184

PLEASE DO NOT MISS POST 162 by Jesus Malverde. woo me with science May 2014 #192

Screwed again. GoneFishin May 2014 #204

No single payer according to Obama's HHS nominee. pa28 May 2014 #209

They've got the corporations' backs. woo me with science May 2014 #210

To me that looks like the end of the state single payer waiver. pa28 May 2014 #212

"has no intention of renewing (the state single payer waiver) for legislation after 2016." woo me with science May 2014 #213

Blessed insurance... Blue Owl May 2014 #211

Just Another Betrayal colsohlibgal May 2014 #215

We need price controls for everything in medicine. alarimer May 2014 #222

What an ProSense May 2014 #224