Know Medical Costs Before the Procedure

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Kelly H

Subject:

How odd that Alan W has reopened this discussion 3 months after it ended.

While I understand the sentiment, we can't fully appreciate Mr Preston's situation because the article fails to explain how he got coverage. Did he take a job at a company with group health insurance where all employees are eligible without regard to pre-existing conditions? Did he take out a private policy with the insurance company accepting him as a customer at their own peril? That's an option that's hard to believe. Did he pay a rider for a pre-existing condition? Or did he grow old enough to qualify for Medicare? We may never know.

What we do know is that very few doctors would welcome a single payer system because it is the equivalent of becoming a government employee without any of the benefits of paid holidays, vacations and/or pensions! In other words, "All the bad without any of the good!" If that were to happen, I predict that so many doctors would retire early that it would force American healthcare into a tailspin! And just when soooo many citizens (Baby Boomers) are about to enter their twlight (read less healthy) years!

It's common knowledge that the health of Senior Citizens decline as they age. Gutting the best healthcare system in the world just before this completely predictable strain is placed on the system would be incredibly unwise and short sited.

Best thing to do first is encourage the purchase of insurance across state lines.

My family left an insurer in Florida because they had underwritten so many Senior Citizens and so few younger, healthier patients, that our rates were three times the cost of what BCBS was able to offer us! Just because we were with a small company with few clients in Florida to spread the risk across!

Allow folks to shop across statelines before something as drastic as a single payer. Many doctors are already saying the risk benefit ratio is already impossibly strained. Let's don't put the final nail in the coffin just yet!

Alan W.

Subject:

Your November "Price Check" article has bothered me ever since my first read. 61-year old Rick Preston is certainly a poster child candidate for what's wrong with the domestic health care system. He carried no health insurance until faced with major cardiac surgery and then somehow found a health care insurer who, without regard to a preexisting medical condition calling for major surgery, would allow him jump aboard just days before his surgery? Preston is quoted as saying that (since being insured) he has no concerns about the bottom line costs of his surgery. Based on how Preston dealt with health insurance before his diagnosis, I think that we can assume that since his surgery, he has stopped paying his premiums. Based on horror stories like these, is it any wonder why health insurance is as expensive as it is? I can't think of a more powerful argument for a single-payer, government managed health care system.

Alan W.

Subject:

Your November "Price Check" article has bothered me ever since my first read. 61-year old Rick Preston is certainly a poster child candidate for what's wrong with the domestic health care system. He carried no health insurance until faced with major cardiac surgery and then somehow found a health care insurer who, without regard to a preexisting medical condition calling for major surgery, would allow him jump aboard just days before his surgery? Preston is quoted as saying that (since being insured) he has no concerns about the bottom line costs of his surgery. Based on how Preston dealt with health insurance before his diagnosis, I think that we can assume that since his surgery, he has stopped paying his premiums. Based on horror stories like these, is it any wonder why health insurance is as expensive as it is? I can't think of a more powerful argument for a single-payer, government managed health care system.

Kate T

Subject:

A year ago I tried to obtain the pricing of a prescribed medical procedure. I could use several facilities, and as it was the end of the year and open season, I considered changing insurers to obtain the cost. No facility could give me an actual price, I was told that I would have to have the procedure and be billed to find out the cost. That made sense (NOT). So, then I called my insurer at the time as well as one I was considering changing to, and each of them said that the price would depend on the facility and they did not have one single price they paid for this procedure (it would depend on the facility). My outrage cannot be politely expressed. While of course it is a great concept to know the cost of a procedure, and I exerted much effort to do just that, I have found (with this experience and others) that it is simply not possible to do so. Until these practices of insurers and providers are outlawed, we are all pawns of the current insurance practices and forced to pay prices which will not be revealed to us until after the fact.

Chris

Subject: also unable to find costs

I had a similar experience as Kate did. My provider and insurance company both refused to tell me the cost (based on my insurance) ahead of having a standard bone density test. Of course they were perfectly capable of looking up the cost after the procedure. They would tell me what the non-discounted "sticker price" was but since that isn't what I would pay, it was useless to me.

I changed insurers at open enrollment time and my current insurer promises they will look this up for me. Fortunately, I do not need much health care, so I have not yet tested their promise.

Mark

Subject:

Doctors are basically good people but they are like everyone else, in business. So shopping around is crucial. Ratings like those on Angies List are rare, which makes them all the more important. I agree with those who comment on dentists. I have had drastically different costs with different dentists, and even had some fees charged for services I supposedly received but did not know I was getting (e.g., "Oral Cancer Screening" which the dentist did without telling me and then charged me $35 for it!). I refuse to pay for what I am not told in advance for a dentist, unless it's truly emergency service: in an emergency I don't expect a physician or a dentist to be able to predict costs.

Mike Myers

Subject:

Would be more useful if it gave some table information on costs at various locations by procedure, and provider.

Alex Fair

Subject:

Great article and comment stream. The fact is that many doctors are willing to come to the negotiating table. New online systems are enabling this. Angie's list is great for finding ratings and quality data about doctors is readily available. Sites like HealthcareBlueBook.com enable us to determine a fair price. Finally, new sites like FairCareMD.com let you get the care you need in seconds. Yes, you need to do something more than just look in a book, but at least on our site I can tell you that you will save over 35% on average. Doctors get paid better too and don't have to fight the insurance company to be paid a pittance to "care" for you. For those of you who have had to shop for care like I did a few years ago you know it is not easy. That is why we made this system. We hope you like it!

Lee M.

Subject:

Yes, Kelly, not only the many years of schooling and practical for doctors, but they have to pay back outrageous sums of student loan money, also. And because of insurance allowable charges, I have always wondered how a physician ever pays this loan back. Doctors have paid their dues to do what they do, so I do not begrudge them the charges they make.

However, I do have to say that dentists have become out of control, and most people have inadequate dental coverage or qualified dentists to even be allowed to go to by dental insurance companies. I cannot afford to go to the dentist; every checkup and cleaning seems to cost me a lot because they always seem to find something wrong, and I take good care of my teeth. I don't know why there is always something wrong!

bea

Subject:

I can understand why dentists would object. They've gone way over the top with no one to set limits for them.

Eric B

Subject:

I completely agree with Kelly H. A physician can charge a million dollars for removing a splinter, but will only be paid what the negotiated amount is with the insurance company. This is why consumer driven health care is a complete misnomer. For example, say you need a procedure and call Dr. A to find out his/her charge and you find that he/she charges $100 for that procedure. Then, you call Dr. B who charges $80 for the procedure. But Dr. A is paid $50 for that procedure while Dr. B is paid $70. If you chose the "cheaper" doctor you have actually paid more for the procedure. The catch twenty-two in this whole equation is that insurance companies are not allowed to disclose what they pay to physicians because of Stark Law which was designed to prevent price fixing as Kelly mentioned.
Another factor that should be evaluated is what are the outcomes for each physician? If Dr. B has traditionally worse outcomes, you may have to go back for another visit. Hence costing you, the patient more in charges.

Richard D'Albergo

Subject:

It is important to check ahead of time to shop for the most inexpensive health provider like your life depends on it

Andy S.

Subject:

I really love the quote from the Dentist "It (cost) should be about sixth on the list of deciding factors." Trying to get reliable information for the other five factors (?) on the doctors participating in my insurance plan is about as easy as getting the costs. Angie's list is a start but it is still a very tedious process at best.

Kelly H

Subject:

True, Lee - nobody expects to win the lottery by suing a plumber for unexpected complications on a shower renovation. Nor is a plumber required to go to school for a minimum of 9 years before taking the first paying customer. A General Surgeon studies 13 years before taking his first job. During the last 5 years of that training, residents earn less than minimum wage.

Apples and Oranges, for sure.

Lee M

Subject:

I have to agree with Kelly H.'s comments. Doctor's are not the evil money grubbers that people always try to make them out to be. As for being compared to a plumber; a plumber is not going to be sued for a client dying! Apples and oranges.

JF

Subject:

If you are having surgery, you need to know all the providers so you can find out if they are contracted with your insurance. Even something as simple as a colonoscopy can have a surgeon, an anesthesiologist, an OR and a lab, and they usually don't tell you upfront that all of them bill separately. I've found out the hard way you need to ask about ALL of these and it may be hard to find a doctor you trust who uses a contracted OR with contracted anesthesia and lab. It's not like you get to choose those things.

Kelly H

Subject:

Mandym, Pharm and Medical are NOT your local private practice physician! Most doctors are in private practice and are small business owners, not part of some giant lobyist system. Kindly, don't lump them in with the lobbyist lot. While we're at it, the AMA does Not represent American doctors by any stretch of the imagination! They have a paultry percentage of physician's as members, less than 20% last I heard.

Your local doctor doesn't deserve this kind of wrath. However, if he does treat you or your loved ones disrespectfully, don't label all doctors as a result.

Kelly H

Subject:

Thank God I've never been to a doctor that didn't value me as a customer. Nor have I seen a doctor use a God Like demeanor with me or any other patient for that matter. Gosh George, where do you live that many doctors act that way? It sounds like you need to find better doctors.

Jackie B.

Subject:

I love George’s comments.
The biggest lobbyists in Washington are pharmaceutical and medical industries. Is it possible all laws that have been passed have something to do with the profit of these corporations - and not too much to do with our health?

Kelly H

Subject:

Also, if your doctor is a participating provider for your insurance company, it doesn't matter what he charges, only the negotiated fee that matters! That means your 20% responsibility is taken on the allowable charge not the billed charge, same for deductibles. This article is quite misleading.

Kelly H

Subject:

Yes, Claude! As I understand it, it's actually a Federal Anti Racketeering law to prevent price fixing. This article seems to be yet another attempt to paint doctors as evil. Unfortunately, the government also has laws which allow them to sue a physician for insurance fraud if they provide discounts to non Medicare/Medicaid patients. Perfect examples of unintended consequences of poorly drafted legislation!

God Save Us!

George B MacDonald

Subject:

Physicians fear being compared to plumbers, carpenters and other skilled labor -- and for good reason! Many of them rely on a God Like stature and superior demeanor in order to intimidate their customers into following their orders without question.

A good physician, like a good plumber, provides his customers with adequate information and choices as well as providing quality service at reasonable prices.

Physcians greatly fear being placed into that scenario where they actually have to treat their patients as valued customers.

the same could also be said for outpatient facilities such as blood labs and such.

Claude Farley

Subject:

Are there not laws in some states essentially forbidding physicians from discussing their fee?

Betty

Subject:

I somewhat disagree with KellyH. One reason seniors' health declines is poor life choices and dependence on prescription drugs. I'm 72 and take NO medications. Anyone starting one med will likely be taking a dozen more. One med requires another for symptoms the first one causes. It's a vicious cycle; I've seen it in too many times.

JC

Subject:

This article was not helpful, although it had common sense suggestions, the health care system is too complicated for simple "shopping around". How about a checklist of questions to ask so that a person knows how to get an apples-to-apples comparison? A list of commmon vocabulary to use to get complete information would be helpful; otherwise I still won't be sure that I have good information.

Dawn S

Subject:

Yesterday, came from a follow-up from a specialist who did not deal in the relevant details. Got out of her Board Certification. This has happened to me many times Dr. get paid for doing no work.

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I second the original question (still unanswered). Speaking as someone who logged in today to try to find an attorney, I see this category as one that's exactly what I have my Angie's List membership for:

1. It's important that I find a good one
2. I'm not an expert enough to know myself who is a good one
3. The industry is full of advertisements and misinformation
4. I wish I knew what experiences other people have had


?
I don't care about lawns--I planted mine in clover and don't have to mow it. When I do need to mow I use a rotary Fiskars mower, which is great--or a scythe. That's right--a scythe (the European type, which is smaller, and it's very good exercise). Gas-powered mowers, chemical fertilizers and weed killers--all nasty stuff that gets into everyone's air, soil, and water. I'm sure my neighbor doesn't like my wildflowers, semi-wild pockets of fruit bushes, and unmown areas and yes, dandelions (I have 10 acres) but that's too bad. It's better habitat for wildlife, especially the pollinators on which our food supply depends. I think this obsession with the Great American Lawn is a waste of time and resources. Plant some food instead.


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I'm not sure Angie et. al. want you to have a complete answer to this question. By re-subscribing at the Indiana State Fair in 2012, I think I paid $20.00 per year for a multi- year subscription. Maybe even less. At the other extreme--and I hope my memory isn't faulty about this--I think the price, for my area, for ONE year was an outrageous $70.00. And they debited me automatically without warning. I had to opt out of that automatic charge. I like Angie's List, but if some of the companies they monitor behaved the way they do in this respect, they'd be on some sort of Pages of Unhappiness. I'll be interested to see if this comment gets published or censored out of existence.
?

That's very difficult to answer without seeing the house. As one poster said, the prep is the most important part. On newer homes that don't have a lot of peeling paint, the prep can be very minimal even as low as a couple or a few hundred dollars for the prep labor.

On a 100 year old home with 12 coats of peeling paint on it, then the prep costs can be very high and can easily exceed 50% of the job's labor cost.

A 2100 sq ft two story home could easily cost $1000 just for the labor to prep for the paint job. That number could climb too. Throw in lots of caullking  or window glazing, and you could be talking a couple or a few hundred dollars more for labor.

Painting that home with one coat of paint and a different color on the trim could run roughly $1000 or more just for labor. Add a second coat  and that could cost close to another $1000 for labor.

For paint, you may need 20 gallons of paint. You can pay from $30-$70 for a gallon of good quality exterior paint. The manufacturer of the paint should be specified in any painting contract. Otherwise, the contractor could bid at a Sherwin-Williams $60 per gallon paint and then paint the house with $35 Valspar and pocket the difference. $25 dollars per gallon times 20 gallons? That's a pretty penny too.

That was the long answer to your question. The short answer is $2000 to $4000 and up, depending upon the amount of prep, the number of coats, the amount of trim, and the paint used.