I'm at the age where periodic colonoscopies are required. While living in southern CA over the past nine years, I was a Kaiser Permanente HMO member so the cost of these procedures was not apparent. I just paid the nominal copayment. Now, having moved to AZ last summer, I have Aetna Preferred Access healthcare coverage purchased via my employer. I recently had a colonoscopy and was amazed to see the difference between "retail" pricing and the price negotiated by Aetna. There were three different charges, for the facility, the gastroenterologist, and the anesthesiologist: Facility: $1,900 original bill, $455 Aetna agreed pricing Gastro: $650 original, $247 Aetna agreed pricing Anesthesia: $665 original, $422 Aetna agreed pricing So, if I didn't have healthcare coverage, I would have been billed $3,215? This is crazy, when you compare to the Aetna agreed pricing of $1,124. In general, people who don't have healthcare coverage have relatively low incomes. Yet, those individuals are asked to pay such a high price for medical care?
What ends up happening is that those who are uninsured get medicaid, and often times the resulting price is negotiated down.
Many 'experts' suggest negotiating with the hospital/clinic before hand for a better price than the one on the 'menu'. Having never tried that myself, I'm not sure how effective that really is. But the experts claim that something like 70-80% of people are successful in negotiating lower rates.
The base prices are all a scam, I believe. Some articles that came out during the heat of the HC debate seemed to indicate that if you don't have insurance (ETA: and don't qualify for assistance), many doctors will negotiate directly with you for a more reasonable fee.
All good, but who would think the retail price is 3x the price that a large insurance provider can negotiate? How much can an individual negotiate off retail: 25%?
Patrick, the real egregious billing conduct is the 'facility' fees. Google stories from Seattle if you want details. Otherwise just avoid hospital based services if at all possible. Do realize that off-site clinics can still fall under the billing umbrella of the mother hospital facility, so a telephone call is in order.
What?! You have to...no, never mind. No point hastening the move of this thread to the political forum.
we were able to negotiate in some but not all cases. it ranged from 25% to 50% depending on who it was, and we found hospitals are much harder to negotiate with. in a few cases we had to delay paying the bill until they were ready to send to collections- but they offered a pretty good % off if we paid in full, so i took the deal. other times at the end of the year they would make an effort to shore up all their accounts so they offered a % off. most of this involved being way behind on the medical bills, and i really do not miss those days.
Hew..... Glad I live in a developed nation (universal health care system). Also, as a citizen, I wouldn't want to pay twice as much as I do now for a system that achieves such a poor general performance (in terms of infant mortality and life expectancy: same as Cuba) (Health care system - Wikipedia, the free encyclopedia).
