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I'm not sure I fully understand this, even a car mechanic won't give you a price up front, they'll give you an estimate, and sometimes, even with a machine, a repair doesn't go the way they expect, and your bill is higher than the estimate. Are you asking for medical care to have set, up-front pricing unlike car repair, or are you saying their estimates are significantly worse / harder to get?
This bit. They won't even give you an estimate (or they might just lie to you). Sometimes, they'll claim that it's "impossible for them to know" (that's a fun one to get into; they try to hide behind the fact that an insurance company will be involved; just wait, I'm sure someone will try to jump in here and claim this). And this will be the case even for many procedures that are pretty standard, without much likelihood of something happening.
I'd be perfectly fine with the same sort of, "Looks like you've got a bad CV joint; we're gonna replace that, and it'll cost this much," with an always-implied, "...and if we get in there and see something else, we'll let you know." Just tell us what you plan to do, what you plan for it to entail, and what the price will be for your plan.
I mean it is impossible to know. You know how much an average thing costs more or less, but a bad outcome or routine complication can make the cost 10x or 50x, or more very very easily, and that's just with the planned treatment.
If you find something incidentally that needs management then you start getting into the territory of "oh yes, you could later make a case that not treating this immediately led to the patients death and lawsuit" or "anesthesia is bad for you and has excessive risks, doing it now while the patient is under will improve recovery time and decrease overall costs." Costs are way more complicated than is typical in medicine because people have more variety than manufactured products.
And that says nothing about charges, your insurance company can approve everything or nothing for a variety of reasons that are constantly changing and may be appealable or not appealable.
Healthcare providers can't easily predict what the insurance company is going to do because of enemy action, and many things are not practical to be done via cash pay outside of sketchy situations because if anything goes wrong the patient is on the hook for a bill they can't pay and the hospital has burned a lot of resources.
Right on cue. Thank for the evidence, so others here can see.
This is all distraction, akin to a mechanic saying, "Yeah, it'll cost you $X to replace the CV joint, but when we get in there, we might see something super major that we didn't know about that could be $10X," but instead saying, "It's impossible to know." Sure, but you can still tell me how much it costs for your plan to replace the CV joint. That's not impossible to know. If it's a "routine" complication, this can be pretty easily estimated; it's routine, after all. I've had a grand total of one provider do exactly that for me, up front ("Here's the base charge for our planned procedure, but we see X a fair number of times when we get in there, and if we see that for you, we'll do Y, and it'll cost $Z.")
Certainly, issues can arise while a patient is under anesthesia, when it is impossible to consult with them and get further consent for further charges. I see nothing wrong with that. But when a patient is conscious and coherent prior to a procedure and you have a planned course of action, you can provide a price for the planned course of action.
Oh well. Don't really care. You can still give a price. You have both a list price and a negotiated price. You have my insurance; you made me give it to you when I walked in the building. You know which list to look at to find my plan's negotiated price. Honestly, if you're at all worried about it being denied (and even if you're not), you probably should just provide the patient both prices. They should be informed about both what it will cost if their insurance accepts the charge and what it will cost if the insurance denies the charge. That is all important information that could perhaps lead to a conversation about whether the procedure in question typically has much risk of being denied and why or whether they'd like to get a pre-auth, etc. Things that are relevant once you realize that patients can't really have informed consent1 to the costs/benefits of a procedure if they have literally no clue whatsoever as to one of the significant aspects of "costs". This is an excuse for choosing to not give them the prices, not a reason why you can't.
(Disclosure, I used to work at a shop long ago, and I would literally call, with a phone, different parts stores to get quotes for parts in order to give the customer an estimate. It's much easier for you, because you've already negotiated an agreement with the insurance company; you've already signed a copy of the list of prices that you've agreed to.)
1 - On the theme of informed consent and anesthesia, the considerations here are very similar to any other costs/benefits of any procedure. Yes, if they're under or unconscious for some other reason, they can't really consent to the price of an additional procedure that might need to happen once you discover something, but they couldn't have regularly consented to the non-price costs/benefits either. So yes, we have special considerations for those cases. In literally all the other cases (most of them, TBH), just give them the price.
I don't know how many times I can tell people that medicine isn't like other fields.
A gallbladder removal can cost say roughly 5,000 dollars or 1.5 million. Sure the latter is 1% of the time, but you need to plan around it because it's a regular occurrence with the numbers involved.
We don't know what is going to happen, and if we told patient before they went under that they'd be paying 5k and woke up to a million dollar bill....that's not better.
Magnifying this is the fact that nobody knows what your insurance will pay because your insurance breaks the rules and makes shit up all the time. Regulate them better, most things are getting paid for by insurance anyway.
This seems to be like something you can tell the patient. I mean, you just told me. Why can't you tell them? Why can't you plan around it?
There's clearly a category of unknown unknowns, but you're telling me that you have extremely known unknowns, such that you can spout the dollar figure and the percentage incidence off the top of your head. All I'm asking for is that when you have such a well-known unknown (such that you already have to "plan around it"), you should discuss it with the patient.
It's like you didn't even read my comment.
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What mechanic are you going to? Every mechanic I've seen has standard prices based on hours worked and cost of parts. I mean if I bring in a car without knowing what's wrong with it, yeah the cost of "Make this car work again" is unknown. But with a known problem the cost is fixed and they can tell you the exact price to replace a transmission, change the breaks, swap out a strut, you name it.
They might have fixed prices but things don't always go to plan. Maybe something goes wrong and it takes them four hours to get at some part of the car, instead of one. Maybe they find (once they get in there) that the problem isn't just with part A, but also part B. It isn't typical that the final bill exceeds the estimate, but it isn't unheard of either. Diagnostics and repair are not an exact science and shit goes wrong sometimes.
I'll also chime in here that this is not how most auto shops work. Probably not all of them; who knows what Jim-Bob is doing up in the hills. But most places are "flat rate" shops. They list their labor charge as $X/hr, but the way they figure out the amount of the actual charge is not by setting a stopwatch for when the mechanic starts/finishes the job. The history here is that many mechanics would get paid a direct portion of the shop rate (say, P% of the $X/hr that is billed). A lot of places still do this to incentivize the mechanic to get more stuff done and make the business more money (usually the final pay being determined as the minimum of either their labor charges for the pay period or a different hourly rate for on-the-clock time; e.g., they could get paid $20/hr for on-the-clock time or $45/hr of billable labor).
But obviously, it would be dumb incentives for them to be able to start a job, lollygag, take an extra few hours getting it done, and rack up the money. Instead, what the majority of shops do is just use a "book" (a computer these days, for sure) that estimates how long it would take an average mechanic to do that procedure on that car. That determines how much they quote/bill the customer... and how much the mechanic will get paid for that billable labor. This is extra incentive for the mechanic to work hard. If he can be more productive than the average book rate (e.g., he can get a three hour job done in two and a half, then start another job and rack up more billable labor hours), he can make even more money.
I will admit I have no insight into the inner workings of auto mechanics, as I experience it only from the customer side. I was speculating as to what might happen, but I can say that I have had auto shop bills come in higher than the estimate. So whatever the cause might be, it does happen.
Of course it happens. Most people are mostly okay with it happening sometimes, because they got an estimate, were told what the plan was and what the estimate was based on, were able to make an informed decision, and then were told what happened and why the charge was higher. Often times, we would call people when we ran into something that we saw would increase the price and tell them what was going on and if they had options. Many customers are price conscious, and you had to be communicative. If you were, and you made sense in your communication, they're mostly okay with it.
Contrast with the medical industry. Most consumers aren't nearly as price conscious, probably in part because they hardly feel like it's even an option to be1. (There are other reasons, more cultural, but one would have to get off on a tangent about Robin Hanson's terminology of the sacred/profane.) They just go to the doctor, do what he says, and magically a bill goes through their insurance company... and maybe they have to pay some of it. If they bother to inquire, there's a half decent chance they'll be told that it's impossible to know anyway. Every part of it is completely the opposite of the pro-active, communicative pricing information that even only half-decent auto shops provide. If we could get the median medical provider to have price transparency resembling the 25th percentile auto shop (with similar allowances for some situations to happen sometimes where final bills are higher than the estimate, but with similar communication), I'd be super happy. I think this is pretty possible to do.
1 - Yes, and some patients are in situations where they really really really aren't price conscious at all
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Fine, but don't pretend that an edge case in car repair being the norm in health care makes them equivalent.
I mean, it's not the norm in healthcare. It's uncommon to have the kind of issues @ControlsFreak describes - I've never had it happen, and if I think to my wider social circle I can think of perhaps once that someone I know has run into that. I think it's perfectly fair to compare an edge case in healthcare to an edge case in auto repair.
You've always had them provide a price up front? You've never been hit by a surprise? This seems unlikely, especially because this is one of the most common complaints. We've had multiple laws passed in recent years specifically attempting to go after this problem in response to public dissatisfaction, but they've been kind of half-measures (the surprise billing law about out-of-network providers at in-network facilities/emergency care and the price transparency law that only resulted in some incomprehensible websites).
This comes up a lot on reddit, because a lot of people are frustrated with how often it keeps constantly going on. A lot of those times, you have doctors showing up claiming that folks just don't understand; that they don't even know the price of things; some say it's basically impossible to know.
I haven't gotten prices up front (but I don't ask either). I have never been surprised by "oh actually this isn't covered, sorry". My insurance gets billed, either they pay the charge or (if I haven't met my yearly deductible yet), I do. Everything works smoothly.
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