patrick.net

rootvg says

Are you on HMO or PPO?

Patrick, has it ever occurred to you that you need to move somewhere that has living costs you can actually afford?

Yes, I know you like Menlo Park. I'd like to have a brand new Cirrus SR22T with my buddy from San Diego teaching me how to fly it in the clouds but it ain't happening, at least not now.

PPO. It occurs to me all that time that I shouldn't be living here, but it's 3 to 1 against when we vote about moving. Anyway, the kids will be in college in a couple of years and then it will be easier. Except for the college costs.

badmigraine says

It's absurd that that people (customers) even need to pay attention to medical billing codes. And yes there should be a clear and fixed price list openly displayed. This is like those scam restaurants in NYC where the tiny basket of bread and two tap waters costs $375.

It's exactly the same kind of scam. "Oh, no, there's no price list. How CHEAP of you to even ask about that! Aren't you ashamed of yourself?"

That place is nuts. You could easily live in Danville or (perish the thought) Alamo for what I think you're paying.

Actually, I can live here as a renter without any big problem. I just can't buy any house of the same size and quality as the one I'm renting.

The other side of my issue is that I refuse to get a normal job while Patrick.net is still alive. I wish it would really flourish or die. As it is, it doesn't make money, but it's too much fun to give up. How many people get to say what they really think all day long?

the kids will be in college in a couple of years and then it will be easier. Except for the college costs.

http://www.youtube.com/embed/a7PT5pkwa6E

How many people get to say what they really think all day long?

Old people, children, and Patrick. At least you're in good company. :)

I went in for my physical exam, knowing that it would be covered by my insurance, and when the doctor asked me about any issues I was having, and I recited my list: funny mole, can't digest gluten, some asthma, etc. So he said we should go over the list and do the rest of the physical at a later date. I agreed.

Doh! That was a $329 mistake!

I think you're reading your own post you wrote wrong.

YOu just made an argument for NOT having insurance in the first place. Paying $329 out of pocket every five years, and forgoing the insurance premiums, seems about right.

Considering the bastards want $1400 a month for me and my family. Here you had a whole slew of tests done and it didn't come anywhere near that.

I will never visit any doctor again, ever, unless they tell me exactly and in advance what everything will cost.

Then you most likely won't be going to see a doctor again.

rootvg says

Patrick, has it ever occurred to you that you need to move somewhere that has living costs you can actually afford?

Yeah, that same procedure would have only cost you $300 here! Such a bargain (can you sense my sarcasm?)

CaptainShuddup says

YOu just made an argument for NOT having insurance in the first place. Paying $329 out of pocket every five years, and forgoing the insurance premiums, seems about right.

Considering the bastards want $1400 a month for me and my family. Here you had a whole slew of tests done and it didn't come anywhere near that.

If it were just me I'd skip the insurance and take my chances, but where you're really cornered is when a family member get sick. Then you could very easily be bankrupted quickly by medical bills. As opposed to being bankrupted slowly by the insurance cartel, like now.

I actually didn't have any procedures done at all! The doctor just looked at me and asked some questions. It was totally just his time, maybe 20 minutes.

I went in for my physical exam, knowing that it would be covered by my insurance, and when the doctor asked me about any issues I was having, and I recited my list: funny mole, can't digest gluten, some asthma, etc. So he said we should go over the list and do the rest of the physical at a later date. I agreed.

Doh! That was a $329 mistake! He re-coded the visit as "office medical" on the spot on instead of the physical exam I signed up for. So now the insurance won't cover it.

Doh indeeed. I guess the lesson is to save the worry-list until the end of the exam, or intersperse the answers into the Q&A. And not agree to any re-schedulings or further visits.

Is your plan one of those "free yearly physical but otherwise a high deductible applies" plans?

...when a family member get sick. Then you could very easily be bankrupted quickly by medical bills.

I've got news for you Sunshine, if someone gets that kind of sick, you'll be bankrupt anyway. Especially if that someone is you(the bread winner) and your paychecks stop coming in, along with your premium payments, and your employer makes a graceful exit to leave to your own defenses.

I actually didn't have any procedures done at all! The doctor just looked at me and asked some questions. It was totally just his time, maybe 20 minutes.

Well he did think your insured. I go to doctors that KNOW I'm not insured. They tend to be more upfront with you and anything under that $1400 a month premium budget. I consider a good deal. Not that I have ever seen a Doctor bill anywhere near that.

justme says

Is your plan one of those "free yearly physical but otherwise a high deductible applies" plans?

Yes, exactly. $8,000 deductible, $770 per month premium for family. So my total possible financial damage from health costs is limited to $8,000 + $770 * 12 per year I think. That's $17,240. I suppose I should be grateful that there is some upper bound, but if they keep raising premiums at more than 10 times the rate of inflation (and they have!) there really is not any upper bound.

CaptainShuddup says

I've got news for you Sunshine, if someone gets that kind of sick, you'll be bankrupt anyway.

The insurance is suppose to cover all major medical costs above $8,000 per year.

You can never know what anything costs in advance.
I am always fascinated that the one area where people expect to be getting over on the service provider is when that provider is the most highly educated and capable person they'll likely meet in their entre professional lives.
If you are annoyed at medical costs, ask yourself why they keep rising.
Is your insurance company being bound by laws passed in the middle of the night on Christmas Eve?
Is your health provider bound by rules that prevent him from charging a fair price to his older patients because of laws?
Is your health provider being bound by law to treat those who will never pay any medical bill or insurance bill in their whole life?
In 5 years an exam for $320 works out to $66/year for your health, the most important possession any person has.
Want to know how much it's worth? Ask someone with cancer with 6 months to live how much he would pay for 1 year more of life.
Lawyers are good at telling you their rates up front, because they gouge everyone, and don't do much work to make 40% of the settlement from an insurance company.
Oh, if there is no insurance company to go after, your case will never be taken by a lawyer, unless you are a millionaire yourself.

clambo says

You can never know what anything costs in advance.

Sure you can. Take your car in for repairs and they will give you a pretty good estimate no problem.

I'm not complaining about the costs per se here, I'm complaining that for medical bills, they won't tell you what it's going to cost.

I just want a damn price list. Why won't they give me that?

The insurance is suppose to cover all major medical costs above $8,000 per year.

Am I the only one that took math in high school?
I'll pay double in premiums than that. $1400 X 12 = $16800
More over if you get the kind of sick that I would worry about being bankrupt over, you will have $8000 a day medical bills.

Cancer, Massive Trama from a collision of some other accident, Organ transplant, open heart surgery. Otherwise your average upper middle class family should be able to cover preventive upkeep on their own. Some where along the way it flipped. When I was a kid, you paid for the dickey shit on your own, and you were insured for catastrophic ailments and trama.

But along the way the insurance companies found a way to cover the basic shit that actually cost less than your premiums, while not covering or with limitation the things they should cover.

It's damn con job through and through, and it's embarrassing to discuss it with adults, even if I am the one that ends up being chastised for not being covered.

Restaurants should start doing this also. List a bunch of dishes and do not put a price on it. "Don't worry about the price. Your date will pay for it." Once your date bails, you end up paying $140 dollars for a salad.

Doctors should be required by law to provide an estimate prior to performing/billing for any services. It does not matter that an insurance company is supposedly paying for it. Medical costs are rising because patients are paying with monopoly money (insurance) while the uninsured ones have to pay with real money (their own money).

I just want a damn price list. Why won't they give me that?

Because then you will shop around. They don't want you to do that. That and it's extra work for them to give you a quote since you are most likely the only person in a while who bothered to ask for one.

If I were you I'd call and demand he changes the billing code. They have many codes they can use, it's a flexible system. Often they choose the one that pays the most.

This happens a lot with medicare, once government stops paying for certain codes, everyone simply starts using the other similar once.

A few years back one doctor tried to pull a stunt like that on my wife by attempting to charge her $650 for a consultation. After a few frustrated phone calls they did dismiss the bill, but I did refuse to pay the bill and threatened to sue them until then.

Perfect they could charge you Market and Seasonal prices.

"I'll have the Cob salad and the Colonoscopy..."

Just because an insurance company is paying for your medical care doesn't mean you shouldn't care about the price.

There should be a change that requires a good faith estimate of what the charges will be prior to any services being performed.

Soon, you will see doctors mailing flyers to people offering coupons, and special promotions.

Patrick,
They will not name a price. I went through Kafka-esque trials trying to get Palo Alto Medical Foundation to tell me the cost of a very specific ultrasound procedure I had to get (and pay for myself) to no avail. I found out the code to the procedure, placed calls for a week (supervisors and all) but they would not name a price. They kept saying: 'well, there's no telling what the tech may have to do once they're in the process" I said: "It's an ultrasound! I'm not going to be under anesthetic, I can tell them not to proceed with another procedure cause I can't afford it! They specifically want it to be squirrely.
I went ahead and had it done (because no one would insure me till I had it done) Fortunately, I lucked out with the particular technician: I explained to her that I was paying for it and she minimized the work. She said they had listed various other procedures to add to it! In other words, had I not been vigilant, the $500 would have probably tripled.
Sorry for my lack of brevity.

I really think we do need national pickets outside of clinics and hospitals with very short clear slogans, like:

* Tell us prices!
* Give us a price list!
* No blind billing!
* What's the cost?

Any others? There are probably some humorous and very clear slogans that I just can't come up with right now.

CaptainShuddup says

Am I the only one that took math in high school?

No, but if you took this math in high school you were way behind me.

bighorse says

Restaurants should start doing this also. List a bunch of dishes and do not put a price on it.

Some do. Ever seen a "Chef's Special" or similar on a menu?

Rental car agencies, hotels, video service providers are also great at the blind billing practice. With most of those there's some alternative, so one can choose to just not give them business. With medical work, man, they've got you. Having a baby has caused me to just close my eyes and hope some of the people have less greed connected with their medical practice than it appears.

I really think we do need national pickets outside of clinics and hospitals with very short clear slogans, like:
* Tell us prices!
* Give us a price list!
* No blind billing!
* What's the cost?
Any others? There are probably some humorous and very clear slogans that I just can't come up with right now.

Call it Occupy Medical Billing

Slogans? Did you ask for slogans?

State the price before you slice!

Don’t make my health a roll of the dice, just be fair and name your price!

Before you hook up that breathing device, please be kind and name your price!

Don’t do more than will suffice, if I cannot be told the price!

Dear Sirs and Madams, for hearts enlarged, pray tell what will I soon be charged?

Do not engage your various devices, until in writing I see prices!

Give me the bills before you show me your skills!

What’s the price for that pack of ice?

and finally:

(ring ring) Have I reached medical billing? What’s the code for a mercy killing?

"We want a pitcher not a glass of liquor"

Oh wait that's little league.

I've started being very straightforward when I go to the doctor

"I don't want any services that are not covered by my insurance. If something is not covered, I want to know what the cost of it is in advance."

Also, I did notice that on my current insurance, Aetna, they have a calculator that shows the cost of a given procedure based on the doctor that you go to. So they are helping you "shop around". It says it is not totally accurate, and it also doesn't list every procedure, but it gives you some idea, which is a plus.

For instance, I can see that it would cost $240 to get a test from an allergist.

Yes, exactly. $8,000 deductible, $770 per month premium for family. So my total possible financial damage from health costs is limited to $8,000 + $770 * 12 per year I think.

Patrick, there might be a co-pay after the deductible is fulfilled. I have a hdhp with a deductible around 3k, but after that I still have a co-pay. There's another element called "maximum out of pocket", which is deductible + my copays. So that's my actual max out of pocket, this number plus premiums. Have a look at the documents to verify, it probably varies by company and plan.

Gosh, I am a little disappointed. I look to all of you for real estate type of expert opinion and have assumed most of you were pretty much on the target. Patrick makes a declaration that you can't get your medical prices up front and everyone chimes in on how scandalous it is.

Well, I am not an expert in the economy or real estate but I AM a real live expert physician. Most of these comments refer to an inability to know prices beforehand and are complete hogwash. All of us have "self pay" fees and we are happy to share them with you up front. The only exception to this rule is the emergency department, my specialty, where federal law does not allow that discussion until AFTER I have determined if you have a medical emergency, although you can waive that right and find out before any testing is done.

Getting your care in any hospital based setting will cost you exorbitant charges due to the facility fees, however I think you would find most physicians professional fees for an office visit to be very reasonable.

FortWayne says

If I were you I'd call and demand he changes the billing code. They have many codes they can use, it's a flexible system. Often they choose the one that pays the most.

This happens a lot with medicare, once government stops paying for certain codes, everyone simply starts using the other similar once.

A few years back one doctor tried to pull a stunt like that on my wife by attempting to charge her $650 for a consultation. After a few frustrated phone calls they did dismiss the bill, but I did refuse to pay the bill and threatened to sue them until then.

Quality Auto Repair Since 1979

You might even consider explaining the quirks of your insurance policy and asking if the doctor could submit a different code, instead of "demanding" it. If it is not going to be fraudulent this is a very reusable request, however if you demand it you probably won't get your phone call returned. Just sayin'

clambo says

You can never know what anything costs in advance.

Sure you can. Take your car in for repairs and they will give you a pretty good estimate no problem.

I'm not complaining about the costs per se here, I'm complaining that they won't tell you what it's going to cost.

I just want a damn price list. Why won't they give me that?

They will give you fees up front. You are mistaken on this.

jvolstad says

You want medical services for free? The manger of our Hospital Emergency Department tells me they get swamped with illegal's coming in for basic medical care. Sutter can't turn them away due to California law. (??!!)

Not California law, federal law. Illegals, as you derogatorily refer to them are very small part of the volume of patients I see in the ED. They are extremely grateful for the services I provide and come in later in the illness as they do want to incur bills, which they often spend years paying off. On the other hand a majority of abusers are the Medi-cal patients who use the ED as a clinic. The worst costs are incurred with the 90 year old demented patients
with sepsis that go to the ICU and get tube fed and watered for weeks until the family finally can be badgered into letting us pull the plug, after weeks of torturing a vegetative shell that hasn't had a lucid conversation in many years.

I really think we do need national pickets outside of clinics and hospitals with very short clear slogans, like:

* Tell us prices!

* Give us a price list!

* No blind billing!

* What's the cost?

Any others? There are probably some humorous and very clear slogans that I just can't come up with right now.

You should have yelped before going. There are great, personable, and honest doctors out there. I have found a few, especially in Berkeley (one in San Ramon). My friend's husband is a GP who works in a lower income area, serving many cash only patients--he has a price list (almost like a menu).

@pedro3000

"It is difficult to get a man to understand something when his salary depends upon his not understanding it."

Medical field salaries are inflated for the services they provide.

You will see a very big collapse in the medical field.

Robber Baron Elite Scum says

You will see a very big collapse in the medical field.

The ICD 9 code for syncope & collapse is 780.2; in other words, it's billable.

Robber Baron Elite Scum says

@pedro3000

"It is difficult to get a man to understand something when his salary depends upon his not understanding it."

Medical field salaries are inflated for the services they provide.

You will see a very big collapse in the medical field.

Member of Banking Aristocracy

Let's hope so. As I mentioned in my previous post, end of life Care for the, elderly, as well as unnecessary surgeries, expensive medications etc are absurdly expensive and need to go away.

Like all other less expensive healthcare systems, after reform there will always be those who wish to pay extra for quality and expertise and those who want just the basics and don't care about waiting hours to get minimal care. The quality of care that I provide will always be in demand, whether I am paid in dollars, rupees or chickens. I am not worried about my professional wellbeing as I have an irreplaceable skill. Times like this I am happy I spent an extra eight years after college honing my trade while some of my buddies took the easier path to a quick buck. PS I am looking forward to Obama reelection and hoping he can pull of a major overhaul of our broken healthcare system.

they are, and seem to always have been, in collusion with the insurance companies (otherwise those companies would NOT rule the day as they do now). doctors could have banded together to keep facility & equipment costs down through some kind of shared/bulk purchase of same. instead, the current system allows them to raise, and raise, and raise their own rates simply because the customer is now the insurance company instead of the person who was just standing in a paper gown in a windowless room wondering how they got highway-robbed and bankrupted for having a thermometer shoved up their arse.

they like the obscurity of the present system because it enables them to not have to pay office staff to act as a debt-collection service anymore. they like it because it allows them to bill 5 'customers' for the same 1 hour consultation when they literally have 3 people scheduled for the same doctor in the same 10 minute window (actual experience, i kid you not. the waiting room was full of "i too have an appointment with Dr.Soandso at 10:15" testimony, until it became a chanted punchline for the next guy walking up to the window).

imagine trying to get away with billing an actual client for a whole hour when they da*m well know you only 'consulted' with them for 10 minutes, during which time you tried to play catch-up on your homework like a naughty schoolkid because you apparently didn't even bother to read their file before stepping into the room. "what are you here today to see me about again? ohyess, i see....no, i didn't look at that MRI/test/specialist report. let me do that now."

it's the same kind of pete-and-repeat stuff every single time you're sent out to another specialist who also doesn't seem interested in anything other than scheduling his next conference, or spring break skiing vacation. actually, considering how all of them only seem to be 'In' the office every other day of the week, and their scheduling assistant has every second thursday off, and between this and playing phone tag with their answering service, it's a wonder that you can ever schedule that 10 minute window at all.

and they all want to cry about how the system as it is is so unfair. try being a patient who wants some kind of answer or resolution to the problem at hand in that kind of system. imagine dragging your car (or better yet, your kid) around town from one specialist to another and playing this game for months.

now watch them all crawl out of the woodwork trying to prove that they aren't like that, they don't do that, they deserve that because of all the extra time and expense they took to obtain a lucrative level of expertise.

and no, i don't hate doctors. but nearly every time i've ever had the (mis)fortune of dealing with one, they seemed to indicate by their lack of interest in solving my actual problem and continual guess-and-check misdiagnoses that they could not care less about me except as an adjunct to the insurer that they could bill.

Geez guys. So much anger here. That last comment from suspiria_2 is so full of misinformation, that I would not know where to begin responding to it, so I won't.

Getting back to my initial response to this post, I am concerned about how folks here speak like "experts" on things that they don't seem to understand. I think you might be better off sticking to housing issues, as there is a lot more room for creative interpretation.

I am all about spewing out your anger and venom in the form of subjective negativity about whatever topic you desire (I think it is quite healthy to externalize it that way) but it was an eye opener to see how passionate some folks get about topics that they don't know much about- I fear that the uninitiated might be misinformed by it.

When I initially came onto Patrick.net it was to learn about the bear market, and I think it did it's job. I knew really nothing, and had bought a house at the peak. Mostly through the links, and some of the posts, I gained a decent understanding of the housing market. I can now smell the trolls and uneducated with regards to housing topics. Obviously I can also recognize those who are speaking about healthcare and not making any sense.

Actually I just got word (yesterday in fact) that our short sale purchase has been approved by the bank, so we are moving out of our rental and into a house. I had stuck around here until the last minute, because I wanted to find solace in the permabear links to balance the stress of not knowing if the short sale would go through, as I would have continued renting in that case.

Now that I am in escrow, it means I will turn off Patrick.net, and start reimbibing the Kool Aid from the mainstream media about where real estate is going, because up, up, up, sounds good at this point even if that opinion would be as off base as some of the healthcare comments expressed in this post.

On that note, I would definitely encourage everyone to educate themselves about the medical system as it is truly a major issue, and unlike realtors, it will be very, very hard for you to avoid interacting with the medical system over the course of your lifetime.

For those of you who are following along with the comments, and are in need of some expert advise from a real physician, who actually cares about his patients I will give you a few cost saving tips. It is also what I do myself and for my family.

1. Look at highest deductible plans, but make sure they are not scam type plans that don't give you any real benefits. They will be your best bet for a low cost monthly plan. They are still overpriced, and padding the insurance companies pockets but they are better than the others. They are considered "catastrophic" and will cover the huge bills you would incur if you get hospitalized. Also, and equally important, you get access to the cheaper "negotiated" rates that the insurance companies force physicians to accept, so your out of pocket will be in many cases, very reasonable.

2. Try to avoid a prescription plan, and whenever possible buy generic medications. Target has a large selection of $4 a month prescriptions.

3. Unlike the Patrick's original post, or many of the comments here, all physicians have a fee schedule. Many will give you a very fair price for consult (if you are not an asshole) to help you out.

4. If you need a surgery, look for a doc who can do it in an ambulatory surgery center. Much easier to negotiate a lower price, as the bloated hospital facility charges will not be relevant. Keep in mind though it still won't be cheap.

5. Don't expect to get your gallbladder taken out for the price of a dinner for four at Cheesecake factory. Not going to happen. If you are going to pay out of pocket, expect to pay at least what you would pay to get your transmission rebuilt. Need a bypass surgery? Don't get to upset if you have to forgo the kitchen remodel, or purchasing a Kia to cover the bill.

6. Lose weight, watch your stress, don't smoke, watch your diet, exercise a bit, have no more and no less than 1 drink a day. Sheesh, if you all did that how much would you (and the country) save on health care?

7. Stay out of emergency departments. Extremely expensive. However, all ED's are obligated to care for you without regard to ability to pay, i.e. they cannot refuse to treat you, HOWEVER, they will also bill you exorbitant fees after they provide the care. You can negotiate those fees down after the fact, but you are going to be starting with very very high fees to begin with.

8. Urgent cares are reasonable alternatives to the ED, although many times they will just send you to the ED after seeing you there, especially if you have high risk complaints like abdominal pain (may be appendix), chest pain (may be heart attack) shortness of breath (may be PE, etc.). This is because of concerns about missing a serious diagnosis and the urgent cares do not have the resources of an ED.

Good luck, and REALLY follow #6. If you are a bloated, stressed out, unhealthy person, don't complain about how much it costs to try to fix the damage you are doing to your own body.

The doc.

^

I agree that I also hate people who fail to take care of their body but than bitch n moan when they damaged their own health through neglect of proper diet, exercise, sleep, stress, alcohol, drugs & cigarettes.

But the fact still remains that doctors are overpaid. Not all but so many doctors are so damn greedy & money was the only reason they chose this profession.

Nothing wrong with wanting money but only cowards who don't have the courage to go into business, finance or wall street chose to go the safe route of artificially high salaries of MD's.

One doctor I know did $10,000,000 million dollar insurance billing fraud. What Patrick is saying here is not wrong or inaccurate.

Another doctor I know did $2,000,000 million dollar insurance billing fraud. He is in prison right now. Went to prison in 2009 and will be spending 5 years behind bars.

The guy that did $2 million dollar fraud had $30 million dollars of legitimate made money yet was so greedy that he was willing risk his medical license for a measly $2 million when he already had $30 million in assets.

I have seen a lot of corruption, greed and a complete lack of care towards the actual patients. It's as just as much about the bottom line as it is for realtors.

In fact, realtors are better people. They just rob you financially. But "doctors", they rob your health and your money at the same time.

I'm sorry but I have a very low opinion of the majority of doctors and even those aspiring to be as most of them just go into it for the money which is not as much as it was anymore and the salaries are beginning to fall year by year.