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

[proverbialwisdom]

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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[Hoyt]

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.

[bluesbassman]

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.

[Hoyt]

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.

[glowing]

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?

[Hoyt]

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

[glowing]

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

[Hoyt]

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

[littlebit]

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.

[mrmpa]

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.

[Hortensis]

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.

[ReRe]

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?

[UCmeNdc]

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

[bemildred]

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.

[ljm2002]

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.

[bemildred]

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

Because: profit.

[PoliticAverse]

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

[B Calm]

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

[Sgent]

18. 100% of the allowable

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

[KG]

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

lets force everybody to participate in the scam!

[B Calm]

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

[Fumesucker]

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.

[TheProgressive]

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

Its all about grabbing the last penny from the middleclass.