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Yes.
Expected payout does not equal pay out.
In car repair your estimate may be off by a few hundred to a few thousand dollars. Maybe more than a few thousand dollars at maximum.
In healthcare your estimate can be off by hundreds of thousands of dollars or more.
This impacts the wisdom of giving estimates and the validity of the practical validity of those estimates.
And AGAIN you have yet to establish why cost matters. As previously stated repeatedly healthcare workers are often prohibited by law from making decisions based off of cost and often by necessary convention when not prohibited by law. Patients almost never pay cost and are rarely charged it. Why does it matter?
Engage with the substantive and relevant portions of the discussion.
I'm not sure we can proceed much further. You have a highly unorthodox definition of "fundamentally unknowable". You seem to apply it to a thing that I view as incredibly knowable. Perhaps we just have different levels of background in probability and decision theory. Perhaps I should wave my degrees and/or publications around (they do happen to be highly relevant) and say that if you can't answer highly technical questions about probability and decision theory, you don't know anything about what you're talking about? How should I think about how you might feel about that form of argumentation?
We're talking about patient decisions.
This is obviously not true, as evidenced by the constant uproar about medical billing. To repeat myself:
The old saying just happened to pop up in my mind: "The first step is admitting that you have a problem." I'm not quite sure what else it will take for you to realize that your industry has a problem. I hope it's not more assassinations or slap-dash regulations.
What information do you deliver to the patient. The maximum? The median? The average?
These are all wildly different, would potentially impact patient decisions, and do not matter because the patient isn't paying it.
What, if anything, a patient gets stuck paying after insurance has nothing to do with the cost or the charge.
You're forgetting your own answer again. You gave a perfectly fine answer. It contains the information that you know. You know that it typically costs about $5k, but about 1% of the time, it costs $1.5M. You know this. You "plan around" this. You just choose to not let your patient know anything about the costs part of your plan. You choose to keep your patient in the dark. You choose not to inform your patient.
Look, we know that you don't know everything with deterministic precision. That's fine. We also know there's a knowledge gap between you and the patient, both in terms of medical costs/benefits and in terms of financial costs/benefits. You understand that part of your job is to at least try to inform your patient, to the extent you can, about the medical costs/benefits, as you understand them. This will not always be perfect. Moreover, there will be unknown unknowns. Some might even say that some of the medical costs/benefits are "fundamentally unknowable". But you don't just throw up your hands and say, "Therefore, we never bother informing the patient at all." It's that your story changes 180 degrees when it comes to the financial side. You don't even try.
"The first step is admitting that you have a problem." Please please please don't let it take more assassinations or new slapdash regulations before you get this.
I mean patients ask sometime. We answer. Depending on the thing I can give hard numbers and explain that would be misleading, depending on the thing I cannot.
Ultimately it doesn't matter. What the thing costs, what the mark-up is, what the charge is, what the insurance pays, and what the patient ultimately pay are all different numbers.
You have to yet to explain what the relevance and importance of this number is, despite me repeatedly asking.
Ok, I am glad that we have come to agreement that you can, indeed, actually give price information. It is not impossible, despite your previous protests. We have made progress. We should celebrate this moment.
Yes, indeed. Give them the information you have. Inform your patient. Stop hiding behind the false claim (that we have now agreed is false) that you are unable to inform your patient. Different costs and different insurance parameters will result in it not mattering sometimes. It will result in it mattering sometimes. This is no different to how you inform your patient about medical costs/benefits. You certainly try to inform them and provide information, even in cases where some piece of that information may not end up mattering for some specific cases. There are other cases where it will matter. "Live not by lies," they say. Stop with the lie that it is impossible for you to inform your patient. Just inform them. Sometimes, it won't change anything. Do it anyway. You know you can, and have now said as much.
You refuse to answer the question.
But the question is the point. When patients ask "what does this cost" they usually mean "what does it cost me."
We don't know. Because who the fuck knows what your insurance company is going to do. Usually we ask in advance and the answer is supposed to be nothing but insurance companies do whatever they want and we don't lie to accidentally lie to you.
Price is not cost and you need to commit to what you are talking about.
If the question is "what does this thing truly cost the hospital" the answer is "it is not your business" and "we don't truly know." Patients are not entitled to what has the potential to be business critical information. Nor is it simple to explain how much things cost. What if the case goes late because the patient is obese and requires thousands of dollars in overtime? Does that count as part of the cost? Do the administrative staff count as part of the cost? Potentially hundreds of individual people are involved in a surgery in some way or another. Do we count these? I can check my professional fees and the supply etc cost easily but I don't necessarily know how the hospital business team handles the rest of this.
Hospitals have entire departments whose job it is to figure this stuff out and deal with insurance. We also bundle things frequently to simplify this, but if you are asking for the true financial cost to the hospital you have to unbundle!
I have asked repeatedly, why is this the physicians job and why do you need to know specifically the cost?
The question is, "What charge will you be submitting to my insurance, and what is your negotiated rate for that service with my insurance?" If there is further discussion to be had about the chance of coverage for the service being denied altogether, you should have that discussion. And potentially involve the insurance company if it could be a big deal; you know full well what a pre-auth is and when it might be useful if there is significant uncertainty about the insurance company. You're being intentionally obtuse by going on about the hospital's cost. (EDIT: You obviously know what I'm talking about, given your other answers. You already gave an example of how you can answer. You already said that you do answer sometimes. Stop being ridiculous.)
I don't care whose job it is.
The charge we submit to the insurance and the negotiated rate with the insurance are generally but not always completely made up numbers.
Sometimes the insurance neglects to the pay the negotiated rate. Sometimes that changes with phone calls and appears. Sometimes it doesn't.
The charge to the insurance for a roughly 5k dollar procedure might be 50k. The insurance might pay 5.5k. Medicare pays 4.5k. If you pay cash you get to pay 5k, assuming nothing goes wrong. If you have a cardiac event mid procedure and end up on ECMO the cost is suddenly 5 million dollars.
What number do you tell the patient? We've been arguing about this for literally days and you still don't seem to get it - am I supposed to go through all of this with a patient in my 15 minute appointment? Is the average person going to follow this? What if they are medically unwell?
You have to be exhaustingly specific about much of this. Yes I know what a prior authorization is. You can't always do them. The insurance company may authorize something and decline it later. Certain aspects of the care (like a consulted specialist who is the only person in the hospital for that thing) may not be covered. Etc. Etc.
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