Podiatrist has different prices based on insurance

[Brian Tymchak]

It depends on the doctor (or group).
I have had that exact "orthotics" situation that you describe.
When doing PT (for one thing or another *sigh*) I casually asked about pricing, even tho' insurance was paying for it.
Billing would be different (slightly lower) for those paying cash.

I was surprised at the difference in billing levels. My first reaction was to wonder if my podiatrist is overbilling the insurance company.

[Patty Hann]

I was surprised at the difference in billing levels. My first reaction was to wonder if my podiatrist is overbilling the insurance company.

If I remember correctly.... the "bill" for one pair of orthotics (paid by BCBS through employer) was $750.
If I had to pay [cash] for them because they weren't covered by insurance the bill would have been $395 or there-abouts ( I do recall thinking something like: wow...almost $400)

[Brian Tymchak]

If I remember correctly.... the "bill" for one pair of orthotics (paid by BCBS through employer) was $750.
If I had to pay [cash] for them because they weren't covered by insurance the bill would have been $395 or there-abouts ( I do recall thinking something like: wow...almost $400)

Wow, $750... My first pair billed to insurance would have been $495. The self-pay price was $350. I just ordered 2 more pairs. The insured price would have been ~$350 / pair. I self-paid $250. That HSA is coming in handy in retirement.

[Jim Becker]

It really troubles me as a retired MIT graduate / Harvard Medical School resident and clinical fellow that 70% of Harvard graduates go into finance. That's what the best and the brightest in our country do. Just make money, and not benefit society. Just think of the advances we might have if our brightest students went into medicine. Didn't used to be that way. Sigh....

Professor Dr. SWMBO is out of Harvard School of Public Health with a D Sci in Epidemiology. She's about to retire from teaching for health reasons...and we have to do the whole insurance dance. She can stay on the university plan by paying the full, non-subsidized premium and will have to do that until she turns 65, more or less. I could stay on that plan, but it's most cost effective for me to "embrace my Medicare". The cruelty is with our younger daughter because the "retirement" version of the university health insurance only covers spouses, not kids under age 26 who are still on the parental unit's plan. So she's going to have to get insurance from the PA exchange 'cause as an independent contractor, she doesn't get benefits. Oy!

[Alan Lightstone]

Professor Dr. SWMBO is out of Harvard School of Public Health with a D Sci in Epidemiology. She's about to retire from teaching for health reasons...and we have to do the whole insurance dance. She can stay on the university plan by paying the full, non-subsidized premium and will have to do that until she turns 65, more or less. I could stay on that plan, but it's most cost effective for me to "embrace my Medicare". The cruelty is with our younger daughter because the "retirement" version of the university health insurance only covers spouses, not kids under age 26 who are still on the parental unit's plan. So she's going to have to get insurance from the PA exchange 'cause as an independent contractor, she doesn't get benefits. Oy!

Social Security Disability (which is amazingly hard to get if you have a pulse) isn't an option? That gives you the ability to get on Medicare before age 65, but bizarrely after a 20 month waiting period. I had to go through the insurance exchange thing after my COBRA ran out. Wasn't pretty, and was crazy expensive for mediocre coverage at best.

Love epidemiology. I love how the Freakonomics guys talk about what an improvement in math education would exist if we teach students how to analyze data instead of algebra, much less calculus. Read lots of epidemiology papers during the plague (I needed something to read that was scientific, not political). Also took courses at MIT on virology. Was stunned how much had changed since my biology degree there (although to be fair, that was 42 years ago - an eternity in science/medicine). Was brought back in time hearing a guest lecture from my college biology department advisor. Amazing to hear him again. And that he was totally up-to-date albeit so many years later (I guess that Nobel prize was pretty well deserved.)

[Mike Henderson]

If you go to a "for profit" hospital as a self-pay patient and you don't pay, many hospitals are now getting judgements against people and will file a lien against their house and garnish wages. And the amount is not the negotiated price, it's the full price.

So in that case, the self-pay person is paying the highest price - much higher than the hospital would get from insurance. But they have to pay to collect it.

Mike

[Edwin Santos]

If you go to a "for profit" hospital as a self-pay patient and you don't pay, many hospitals are now getting judgements against people and will file a lien against their house and garnish wages. And the amount is not the negotiated price, it's the full price.

So in that case, the self-pay person is paying the highest price - much higher than the hospital would get from insurance. But they have to pay to collect it.

Mike

Most "not-for-profit" hospitals are absolutely "for profit".
The "not-for-profit" designation gets the hospital certain reimbursement and purchasing advantages as well as marketing advantages. So it's great to have it, but also great to make money.

So how does a health system become not-for-profit-but-not-really?
Establish subsidiaries and related entities that are for-profit and direct income to those entities through intercompany transactions. A good example with be the affiliated real estate holding entity to whom the hospital will pay rent. Another example is ancillary service divisions that provide services and supplies to the hospital.
It can become a very complicated web but the idea is for the not-for-profit entity to be the jelly surrounded by a donut made of for-profit businesses.

[Jim Becker]

Social Security Disability (which is amazingly hard to get if you have a pulse) isn't an option? That gives you the ability to get on Medicare before age 65, but bizarrely after a 20 month waiting period. I had to go through the insurance exchange thing after my COBRA ran out. Wasn't pretty, and was crazy expensive for mediocre coverage at best.

We're familiar with SSDI as our older daughter qualified for it because of her own real disability. (surprisingly, got it first try which is HIGHLY unusual) For The Professor, it's not really worth the effort give there is only a year until her 65th birthday and it likely would take multiple tries with no assurance of getting it. SSDI Medicare benefits cost the same as normal Medicare, and there's a waiting period once you qualify as you mention, so there's little benefit in this case. There's no money issue with her paying for the retirement healthcare (identical to our current coverage other than loss of subsidy). As noted, it's just more complicated for our 24yo daughter who currently uses our family coverage.

Yea, Epi is kewel...I've learned a lot over the years from her. She did research for many years on liver cancer related to Hep-B including some association with Nobel Prize winner Baruch Blumberg and the Hepatitis B Foundation and Fox Chase Cancer Center (study populations in Senegal and China), but has been teaching Epi and related at a large university school of public health in Philadelphia. Interestingly, one of her colleagues and friends from Harvard is also in the program and will also soon be retiring. Her undergrad is from the University of Chicago.

[Jeff Clode]

I always find these (medical threads” interesting as they go in so many directions….I had a wonderful 45 year career in clinical medicine with some fascinating forays into administration and governance and I’d like to offer a couple of observations:

• it’s almost impossible to understand charges, billings, collections etc as these have the transparency of a brick (for many reasons) and not affected by ordinary logic. Trying to understand will drive you mad.
• there is little direct relationship between charges, payments and the cost of delivering a service. Lots of reasons for this also.
• the medical system is Balkanized, fragmented, siloed (- pick your own word here-) into multiple semi independent parts - each it’s own financial and/or profit center.
• this means terrible duplication of administrative functions, a lack of sharing savings and losses amongst the silos and therefore a lack of common goals (- if not competing goals).
• the word “evil” is frequently used or implied when this system is discussed but in all my time in medicine I met very few folk to whom I would apply that term. I think it’s important to recognize that we get the behavior we reward the most highly and we’ve created a horribly complex system in which financial survival of each silo is the primary goal - “everybody’s got to eat”. That survival mode applies whether one is in charge of a hospital, a nursing home, a provider group, a pharmaceutical house etc. etc..
• also realize no good deed or intention goes unpunished- for example, Medicare advantage plans were designed to reduce per capital costs but have done the opposite.
• I don’t see much hope for substantial changes unless we actually have a national debate and decide whether health care is a right or a privilege- I don’t want to get political here but this is a fundamental question. If it’s a privilege, we can keep going as is, if it’s a right, then we have to figure out how to make this sucker more efficient and get it to all. As it is we have islands of brilliance in a sea of mediocrity. It is what we designed either consciously or not
• End of rant

[Alan Lightstone]

We're familiar with SSDI as our older daughter qualified for it because of her own real disability. (surprisingly, got it first try which is HIGHLY unusual) For The Professor, it's not really worth the effort give there is only a year until her 65th birthday and it likely would take multiple tries with no assurance of getting it. SSDI Medicare benefits cost the same as normal Medicare, and there's a waiting period once you qualify as you mention, so there's little benefit in this case. There's no money issue with her paying for the retirement healthcare (identical to our current coverage other than loss of subsidy). As noted, it's just more complicated for our 24yo daughter who currently uses our family coverage.

Yea, Epi is kewel...I've learned a lot over the years from her. She did research for many years on liver cancer related to Hep-B including some association with Nobel Prize winner Baruch Blumberg and the Hepatitis B Foundation and Fox Chase Cancer Center (study populations in Senegal and China), but has been teaching Epi and related at a large university school of public health in Philadelphia. Interestingly, one of her colleagues and friends from Harvard is also in the program and will also soon be retiring. Her undergrad is from the University of Chicago.

It's great having a spouse who's really smart/talented and in a totally different field of work than you. But I don't have to tell you that. In my case she's an award winning pastel artist. Me, I can't draw a stick figure at gunpoint, but logistics, numbers, pattern recognition, multitasking - that's what benefitted me in my career. The woodworking just came later as a fun hobby.

[Lee DeRaud]

My dentist has a variant of that system for uninsured patients.

There's a yearly subscription fee which is roughly his "retail" price for two cleanings. It covers those two cleanings, a set of xrays, and 20% off all other work.

[Curt Harms]

[COLOR=#000000][FONT=UICTFontTextStyleBody]I don’t see much hope for substantial changes unless we actually have a national debate and decide whether health care is a right or a privilege- I don’t want to get political here but this is a fundamental question. If it’s a privilege, we can keep going as is, if it’s a right, then we have to figure out how to make this sucker more efficient and get it to all. As it is we have islands of brilliance in a sea of mediocrity. It is what we designed either consciously or not[*]End of rant[/LIST]

A very difficult topic indeed. If health care is a right, it seems like there'd have to be some sort of rationing, society can't afford unlimited care to every sick person. Talk about a difficult/uncomfortable topic.

[Mike Henderson]

A very difficult topic indeed. If health care is a right, it seems like there'd have to be some sort of rationing, society can't afford unlimited care to every sick person. Talk about a difficult/uncomfortable topic.

Any service that's free will generally be over used. To limit utilization some type of rationing is required. Today, we ration by cost. If you can't pay for service, you don't get any.

Incidently, that's somewhat a problem with Medicare. Once you pay for your Part B and supplemental plan, you have no incentive to limit your utilization.

Mike

[Malcolm McLeod]

... medical system is Balkanized, fragmented, siloed ...

I saw a long and fascinating discussion (debate?) about what the delivery of health care would look like without insurance. Insurance industry would clearly fight it. Most patients would say they would just have to die, since they couldn't afford it. And providers would thus all go out of business.

Or maybe look at changes in the price and downtime of a woman's 'enhancement' procedure over the last couple of decades?

What's that old saying about compromise? ...Everyone is unhappy?

No citations on this either, so maybe I just made it up??

[Malcolm McLeod]

Any service that's free will generally be over used. To limit utilization some type of rationing is required. Today, we ration by cost. If you can't pay for service, you don't get any.

Incidently, that's somewhat a problem with Medicare. Once you pay for your Part B and supplemental plan, you have no incentive to limit your utilization.

Mike

Media (probably 60Minutes?) did a segment about retirement center in FL - busing residents to the doctor's plaza. Asked do they need to go? Paraphrasing, "I paid my money, so I'm going."

It was treated like a trip to a shopping mall or the zoo. Que sera. And this is probably 10-15 yrs ago.