Who is "they?" (Insurer, hospital/facility, doctor's office, system/medical group, lab, etc)Paingod wrote:Somewhat off-topic, but this is the part that's really frying my bacon anytime we see a medical bill. They just send us this big "$523" bill with absolutely no idea what it's for. When we ask for an itemized list of charges, they sputter and stammer and have a real hard time doing it. We don't pay unchallenged lump sum bills, sorry.RunningMn9 wrote:utter lack of cost transparency to the consumer.
You should always get a breakdown that includes either a line item description or a code (DRG or CPT or HCPCS). Some facilities and/or insurers try to simplify with "consumer friendly" data obfuscation but they should always be able to provide a breakdown.
Out of professional curiosity, I line-itemed every charge when we had our kid recently and found about $80 in incorrect charges to billed me. All from 3rd party professional services. I actually considered that pretty good but it still burned me up that some out of state lab that got sent a hearing test result not only charged $125 to read it but tried to over charge my coinsurance on top of it.
On the cost discussion that I missed, a facility's procedure cost is not a great gauge for pricing. Procedure-specific cost doesn't account for losses in free care, Medicaid, delinquencies, bad debt, reserach, etc. You'd get a vicious circle in poor/underprivileged areas where prices are driven up by no-pays and payer mix which result in more no-pays which results in higher prices... Should cardiac cath surgeries help support losses in ER and psych? Do we want our hospitals to turn into surgery centers that only perform predictable, highly profitable procedures and nothing else? Just getting into an ambulance run by the Chicago Fire Department results in a $975 bill. Mileage is extra. I'm guessing $200 of that is for the actual service and $775 is for the 24 hour availability. Acute care hospitals are similar. They staff, train, and keep available very expensive personnel for the rare instance that you need them.
Even if there were a simple way break such things down into each procedure the insane cost of equipment, implants, drugs, and liability are still going to result in costs, and therefore pricing, that the average person will think is insane. Cost containment has to include the supplies hospitals use. Fun fact, implant supplier reps are often on-site outside ORs waiting until someone needs a rare, expensive piece of equipment stuck into their body. The purchase contract is signed right there and the rep procures the devide so the hospital doesn't have to carry the overhead for a device that they may never use or that my go bad in a store room. The reps also advise the surgeons in theater on the specifics of the device during surgery (thus ensuring their place outside the OR for the next sale).
You also have the extremely complex relationships that most hospitals have. Not all doctors are employees of the hospital. They are merely on-staff which means they have privileges to admit and/or perform certain procedures at the hospital. They are freelancers who may or may not be in he same insurance plans as the hospital and who may or may not share the same pricing/cost philosophies as the hospital. You may have per diems and locums. You may have on-site 3rd parties. Then consider that a hospital may see 20-30 core insurances and well over a hundred total, all with different rules and networks. It's a mess.