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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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