Medicare and Health Insurance company rates for procedures?? Good Luck
Reader comment on: Getting Around a Price Cap
Submitted by Ron (United States), Dec 27, 2010 10:31
Possibly things have improved but a number of years ago when I was told to get a nuclear stress test I called two major NYC hospitals for their rates and then my insurance company for the reimbursement amount as I would be on the hook for the full amount minus the insurance company's reimbursement but only after a substantial deductible.
My insurance company at the time (Principal) said that their reimbursement amounts (based on HCFA codes for the procedures involved) were confidential.
As I had a substantial deductible, my bargaining with the hospitals for the price of the procedure would have benefitted me (ultimately, pay less) and it was not relevant for the insurance company as they would only pay a certain fixed amount.
What I learned from the exercise:
Neither the insurance companies, healthcare providers nor Medicare is interested in making their fee schedules readily available to the health consumer.
If the consumer doesn't know prices then he can't make intelligent purchasing decisions and force the providers to compete on prices.
1- the insurance company gave me a ballpark figure (30% of what the hospitals were charging)
2- both hospitals lowered their fees 50%
What the medical consumer might want to do when faced with elective procedures:
1- Get the HCFA codes for any elective procedure. (this is crucial)
2- Medicare does not publish their reimbursement schedule by HCFA codes and region in a way that the layman can access (which is so stupid as it prevents the market from functioning optimally) BUT there are medical insurance consultants who can get you the medicare fee schedule by HCFA codes.
3- Hospitals are no different than any other type of business in that they want customers and will cut their prices if faced with competition for the use of their facilities.
Notice that I have not entered into the morass of physicians billing for their services as that is another ball game. All the above refers to facilities and equipment fees for services provided by hospitals and other healthcare providers.
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|⇒ Medicare and Health Insurance company rates for procedures?? Good Luck [341 words]||Ron||Dec 27, 2010 10:31|
|A bit naive|
[w/response] [92 words]
|ben||Dec 26, 2010 16:46|
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