When I needed an MRI, I called five different places and only one of them would actually tell me a price. All of the others said "we don't know the price until we submit the claim to insurance". Not sure if they were telling the truth or just being lazy at their jobs. Either way, getting a price in advance is not as simple as just asking.

In fact, they know two exact prices: (1) the price they will bill your particular insurance company & (2) the lowest price in actual total they can accept

Unfortunately, there's no benefit to them to tell you (2). And without verifying your exact insurance coverage (i.e. submitting a claim) they have no idea how (1) relates to your eventual out-of-pocket costs (and they're disincentivized from telling you the billed rate in case you're actually another insurer trying to negotiate lower rates).

Actually, as pmorici notes, there are three relevant prices. Without insurance, you will be charged the "cash price", which is always far greater (maybe 3-4 times) the price that they have negotiated with your insurance company. For large insurance companies, that price can be close to the lowest price that they will accept.

Even if you have insurance, they may be able to bill you for the difference between the cash and negotiated prices. It depends on relevant law and terms negotiated with your insurance provider. It's prudent to ask. Also, providers will sometimes "accidentally" bill you for that difference, even if they're not permitted to.

> Also, providers will sometimes "accidentally" bill you for that difference, even if they're not permitted to.

It's been my observation that hospital billing departments do many things "accidentally". Strangely, these never involve under-billing. A lot of bad things would have to happen to them (and insurance) before I'd start to feel even a little bad about it.

when something involves lots of process, mistakes are inevitable. sometimes by mistake, sometimes maliciously.

It's worse than that, because there's adverse selection. The hospitals that make errors in the client's favor or that don't make errors at all are more likely to go out of business than the ones that make errors in their own favor. So guess which ones are still around when you need a hospital.

In other words, just because the errors are accidental, it doesn't mean they happen at random.

(This argument applies to any shady business practice that "looks" like an accident, for example dark patterns on websites, or having great customer service for taking your money but terrible customer service for refunding it.)

When the same agency is the one influencing, if not directly creating and enforcing, the process, my sympathy tends asymptotically to zero. Especially when said processes are largely driven by a motivation for profit, if not merely to exist as a middleman.

it's actually a little more nuanced than that. Hospitals/providers have what they call charge master. it is probably the cash price you are mentioning.

Even uninsured can end up negotiating the bill, albeit after the fact.

Sometimes, insurance might negotiate lower prices than what a certain procedure/treatment costs, i believe that's not uncommon. They make up for it from other procedures in general.

1. The lack of health care cost transparency reduces price competition. 2. people not asking for price in advance, or not caring because the are already past their 1. deductible 2. out of pocket maximum makes healthcare expensive[a]. Similar to reference pricing, high-deductible health plans (with added HSA benefit) makes people think twice before going to doctors. I also felt a lot of people are not price conscious about healthcare - just yesterday a friend mentioned "i picked the most expensive plan so i don't have to think about it". Completely reasonable, but one reason why prices get higher each year.

[a: reference pricing] http://www.nytimes.com/2016/08/09/upshot/how-common-procedur...

> Even uninsured can end up negotiating the bill, albeit after the fact.

Yes. One could say something like "I know that you're billing me three times what you get from insurance companies, and I know that you'd pay at least 50% to a collection agency, so will you accept 40% now?"

> Sometimes, insurance might negotiate lower prices than what a certain procedure/treatment costs, i believe that's not uncommon. They make up for it from other procedures in general.

True. Also from payers with less negotiating strength.

"Yes. One could say something like "I know that you're billing me three times what you get from insurance companies, and I know that you'd pay at least 50% to a collection agency, so will you accept 40% now?""

Unfortunately, this misses another pertinent point, that the provider/facility will be able to charge off and deduct as a loss either that 50% of the original amount they're going to charge you, as well as getting 50% from collections, or 100% if they're... 'creative'. This can often reduce incentive to negotiate.

Maybe so. But wouldn't that increase the incentive to negotiate?

that's still a hassle, though. there is a point, but it probably works better with individual practices than large hospitals.

How practical would it be to recreate the charge master through crowd sourcing? If everyone scanned their invoices and submitted the hospital name and insurer, a picture would very quickly emerge that might allow consumers to get a reasonably accurate view of what line items are typically in a certain procedure and what it all costs.

There's nothing which prevents the sharing of this information, is there?

Anecdote: My son broke his arm when I was between jobs and had no insurance.

The doctor had an x-ray machine on premise, but he admitted to me that his costs for it were high and that I could get a better price at the imaging place across the street.

Once there, when I explained my lack of insurance, I was told that not paying up front adds $75 because billing is a PITA.

Even though an insurer might be able to negotiate a good rate, they can't beat cash on the barrel head because cash pay doesn't require nearly as much work.

I'm actually not sure that they know (2), as I've read a number of articles and posts which say that almost no healthcare organization uses cost accounting.

I can confirm that, at least for an N of 1. Contracts with individual insurers are typically negotiated to be set to a percentage of (known) Medicare reimbursement for a given procedure. As it is with any negotiations, more powerful insurers get better rates. The costs are usually monitored at a macro accounting level, since what really matters is staying in the black.

As an aside, in addition to other confounding factors, cost accounting would likely affect physician compensation since it would shine a light on their actual effort. Expect that to Just Not Happen in an organization with more than one provider. They enjoy their compensation, and they will fight to keep it.

Edit: perhaps the physician compensation scheme I am familiar with is wildly atypical. Hence the N=1 disclaimer.

> Contracts with individual insurers are typically negotiated to be set to a percentage of (known) Medicare reimbursement for a given procedure

It's usually pegged at multiples of what Medicare reimburses (ie, "300% of Medicare rates")

> Expect that to Just Not Happen in an organization with more than one provider. They enjoy their compensation, and they will fight to keep it.

It has nothing to do with physician compensation, because most are salaried now anyway, and they make a lot less than people think. The problem is that they literally do not know what the reimbursement rates are.

Given that the median salary for a physician (not specialist) is $180K, I'm not sure what you think people think they make if they think it's a "lot more" than that.

By law, nobody can be charged less than Medicare.

I think you guys are getting screwed.

1) unless this is the first time they've done it, they'll at least have a range and an explanation for the difference.

2) They're motivated to not tell you. By staying quiet, they prevent you from shopping around. They maintain the ability to decide charges rather than having to negotiate. Telling you only once you owe them is something other businesses would love.

Is there a doc in the house who can give us their perspective? What's up with this pricing?

Not a doctor, but I have spent ~10 years working with data on the reimbursement side of a large hospital. Please see my comment above.

If they can send you a bill with a figure on it, they can produce a quote.

That's not true, due to price discrimination. They can't precisely tell how much they can get paid for something until they submit invoices to insurers.

If you opt to submit the claim to your insurance company yourself, this is not an issue.

Same. I spent 20 minutes on the phone with someone, got frustrated, and asked flat out, "are you telling me there's no way to know how much I will pay for this procedure until after it's done?". The answer was "yes".

Part of that is because of insurance companies. They don't know exactly what your coverage is in all cases so they know what they'll send to the company but how much they pay will vary a lot from person to person often by a lot.

I wonder if someone has made a video of this - asking for a price and getting a response like "we can't tell you" or "we don't know." It shows how absurd the system is.

Why yes: https://www.youtube.com/watch?v=Tct38KwROdw

Tell them you want to know the "cash" price.

Sometimes they need a little prodding. Tell them you're getting a price from [name of competitor].

My experience is that few physicians have any idea what various procedures cost, especially in a hospital setting. Advance cost information is very difficult to obtain, and often there isn't time to obtain it.

I'd like to see at least the protocol used in automobile repairs. You get an estimate and approve it. If the estimate turns out to be incorrect, you have the option of deciding on another course of treatment. This scenario can't work in many situations, such as surgery, but knowing some costs up front would help everyone make better decisions.

If adherence to estimates can't be made to work, I'd like to see limits on how long after a procedure you can be billed. At present, it's not at all unusual to get a bill months after a procedure from a completely unexpected source. There's usually no way to determine whether the amount billed is correct.

I've tried to do that for relatively routine care and it's a headache and a half. I spent half a workday (because, of course, I could only do it during business hours--good thing I have a job with a flexible schedule) calling up doctors' offices and waiting while they figured out how much they charged for a new patient appointment. If ZocDoc reliably had that information, it would make shopping around easier (my insurance had a directory but most of the price info was wrong).

In the absence of that, it's just not so easy to shop around for medical care.

I never had such problems. I asked, they answered (even if they had to go ask their accounting dept). I then asked for a discount, and got one. Doctors' offices are a business, and if they balk, tell them you're going to their [insert name of nearby competitor]. Don't let them get away with pretending not to know - after all, they are perfectly capable of sending you a bill.

I don't think you appreciate how fortunate you have been.

I recently served jury duty on a civil case where the heart of it was about determining medical costs, and listened to people whose expertise was to determine what was reasonable and customary pricing for a given service tell me price ranges that spanned orders of magnitude sized differences in price. They needed access to multiple private databases (whose costs were prohibitive for a single use case) to determine these prices... but even with those databases they had to temper what they found with their own expertise as the data could be incorrect or incorrectly encoded. They also explained that prior to providing a service, you might anticipate only one item to be charged, the end result might actually be an order of magnitude more items charged, some of which were literally additional instances of the anticipated services.

A few years ago, when it was rolled out, I was trying to help my mother-in-law shop around for Medicare Part D plans. This should have been the easiest thing to price out: I had a list of prescription items, I knew exactly what doses and medicines she needed, and how often. I got a list of eligible providers, and proceeded to determine their their pricing and coverage rules. I figured it should be as simple as building a spreadsheet and doing basic linear optimization. First, it turned out to be very hard to get pricing, particularly in an easy to digest fashion. Beyond that, I was told the pricing could be missing some entries, could be incorrect, or could be out of date and/or could change in the near future. I also found that coverage policy invariably had subjective elements that made outcomes nondeterministic. Nobody was willing to stand behind a fixed price.

Most of the time it is a #@$@#%ing crap shoot.

I'm genuinely curious where and for what types of procedures you have had so much success in getting pricing/cost info up front for.

As most of the people in this thread have experienced its a maddening process. I've tried several times for routine procedures and its a huge headache that takes lots of time and lots of waiting on hold.

One way is to show up in person and ask. It's a lot easier to negotiate face to face than over the phone. It's the same when negotiating a price for a car, a hotel, stay, etc. I answered your other question elsewhere in this topic.

If the bill is potentially one of those crippling high ones, I'd suggest it's worthwhile to invest the time doing this, despite it being maddening.

Hmm. Driving from provider to provider when trying to "shop around" is really not that feasible for most people.

But I suppose it could work better. I'm skeptical though. Finding the appropriate "accounting" folks in person would be a nightmare. A lot of the hospitals and providers I've dealt with use "third party" billing so your in person strategy with these types of parties would basically be impossible.

> Doctors' offices are a business, and if they balk, tell them you're going to their [insert name of nearby competitor].

This seems like the absolute worst way to chose a doctor. I know some people in England chose hospitals based on car park charges, and I guess that's worse, but still.

Honestly, having asked the question, I can tell you while so few people ask. The answers you get and the effort you have to put in to try to get a real answer is @#$@#$ing absurd.

Sorry, that should be "why so few people ask". Autocorrect is so mean.

Very often, the answer to that question is not known. I went through this when my wife was pregnant with out first and I was in graduate school. We were sitting down with the accounting rep from the hospital planning the next few months and she had zero idea of what the cost was going to be for routine procedures.

An accounting rep with no idea what the bill would be? I'd laugh at them and ask for someone who was actually from the accounting dept. Don't put up with that garbage.

What would your reaction be if you went to a dealer to buy a new car and he claimed to be unable to come up with a price?

You seem to be literally the only person who has been able to get straight answers from anyone on anything related to health care.

As you can probably see from this thread, most of us would have the same reaction: impotent frustration. I can go to another dealer if I don't get straight answers. I can walk away at any point up until the final signature. This is simply not an analogous situation, as evidenced by the repeated testimony of everyone here.

And this guy: https://www.youtube.com/watch?v=Tct38KwROdw

Except the problem is that in the car situation you're the one paying for the car, not a third party. This is more like your car getting totaled, and your auto insurance company saying "you go pick a reasonable new car, we'll negotiate a price with the dealer (in secret) and then you'll pay 20% of whatever we agree upon"

Nobody asks because no one knows the price.

"Shopping around" for healthcare in the US is impossible.

Staff are not allowed to tell you negotiated prices. They don't even know. On top of that, medical billing will jack up the prices by adding extra billing codes.

Healthcare in the US is a scam. Without transparent prices it will stay this way.

> impossible

That's certainly not true. Try it. I've negotiated with a lot of outfits who claimed their prices were not negotiable. That's just a crock.

A good friend of mine is a successful businessman, and certainly does not need to negotiate. But he negotiates everything - it's entertainment for him. I'm constantly surprised at the amazing deals he gets on supposedly "non-negotiable" items, including medical bills.

> That's certainly not true. Try it.

Your suggestion is laughable. We asked three different hospitals what the cost for our daughter's birth was going to be; none of them could provide us with the answer until after the claim was submitted to our insurance. The out of pocket from the hospital we picked was $12k.

Now negotiating a bill down after the fact? Sure, if you can't afford to pay and document it, it can be done. But if you can afford to pay? Be prepared to be raked over the coals.

US healthcare sucks, and your anecdotal evidence is weak at best.

We had a home birth, and the billing was pretty straightforward. We paid $5k for the all care through the birth. However, we knew that if at any point the pregnancy became abnormal enough that we needed to transfer to hospital, we would be stuck paying whatever the hospital and our insurer agreed to, and we wouldn't get any of the $5k we paid to the midwives back.

You can ask them what the uninsured bill would be.

Why would I want to know that? It has no relation to what my actual out-of-pocket expense is going to be.

And I can have the exact same test done twice and get different bills.

I did. They would not provide the cash price. It does not exist.

I'll echo what others have said. I have requested rates multiple times, and gotten numbers, but the numbers they give is the amount they bill insurance. However that number is practically meaningless. Even for something as simple as a yearly preventative care visit, my wife and I each went to a different doctors, both of which billed the insurance about the same amount, and both of which were in-network. However, they had different negotiated rates with the insurance, and coded things slightly differently the end result being a factor of 10 difference in our out-of-pocket expenses for the two visits.

None of this information was available in the computer systems of the providers who file the claims, nor have I been able to get it from my insurance in advance.

it's because they don't know. What insurance provider considers preventive care is different from what doctors think it is.

Recent anectode: 10minute chat to doctor about general health costed my wife 200$. She didn't get any blood work done, it was the price of the "visit/consultation". It was supposed to be preventive care, but not coded as such.

I ask, every time. They will do just about anything to not tell you, or to tell you only the insurance rate. You're screwed if you go to the ER. I had to get an EKG done - they managed to charge my insurance over $1000, something that in almost any other country would be around $50, and even some hospitals in the US.

I think the hugest problem in the US thats not been looked at is regulating the providers - I don't think competition alone will help in emergency situations, but at least with doctors visits knowing how much something would cost would be incredibly helpful.

I've tried asking multiple times (for non-emergency procedures) and each time they've said they don't know. (Kaiser)

"Shopping around" is often a fantasy because you will very rarely actually get a price.

I've definitely asked the price of some non-emergency procedures in advance before and it was rare I could get a straight answer (I live in California). But maybe for some things it's possible.

I remember accompanying a friend and having her arrive at a hospital for an extremely expensive, previously planned plastic surgery procedure and being confronted with unexpected, unannounced costs of several thousand dollars.

It was one of the most traumatic experiences of my life.

Eh, I've tried that many many times for many different things, and I've never been able to get an exact price quote beforehand. The response is always "you need to talk with so-and-so" who is always someone or something else. It's a maze of runarounds, with no one willing to commit to anything in particular.

It's one of the many things broken about the US healthcare system. In no other market would a seller be able to get away with not providing a contractual quote before the service is provided.

And ask for the price with insurance or out of pocket. Sometimes out of pocket is 50% less. Truly insane.