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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.
Don't care. Inform your patient.
Don't care. Inform your patient of what you've agreed to and what you will be charging.
Inform your patient of these things. You have the numbers. Just tell them.
We've already discussed unknown unknowns. Not an excuse for not informing your patient of the known knowns and known unknowns.
You tell them the information that you have. Preferably, "Here is what we charge, and here is the negotiated rate." You can add, "Things don't always go perfectly with the insurance company, but that is our information." You can add nice answers like you gave two days ago if you have some known unknowns.
I don't care who does it or when, except that it should be before a procedure occurs, because you need to get informed consent first.
Don't care. Do it anyway. The average/unwell person might not follow some of the things you say when you're informing them of the medical costs/benefits in order to get informed consent. If they're unwell enough (or for example, unconscious) that you would feel it is acceptable under the ethics of informed consent to not inform them of the medical costs/benefits, you can apply the same analysis here.
I just have.
Inform your patient to the best of your ability. Tell them your plan, expectations, and what that entails. Things happen, just like how medical things happen on the table. That's not an excuse to refuse to even try.
So you want to increase the shortages in healthcare by requiring every service to involve a 15-30 minute lecture in billing paradigms and want every physician to receive additional training in multiple other people's jobs so that they can talk about this in a maximally fluent fashion?
This is why healthcare is so expensive "great, tell me how much it costs or I get charged or whatever" starts off reasonable but turns into thousands of hours of unpaid administrative labor a year and hundreds of salaried employees who are required to manage what is ultimately unnecessary and adds minimal value while creating a tremendous amount of expense.
Nobody needs to be on a receiving end of a lecture that explains that their insurance is paying 110% of the number that medicare randomly decided is an appropriate amount to pay for their diagnosis and that that number has absolutely nothing to do with the actual amount of money that the hospital is paying to provide that service or is charging the insurance company for it or would ask the patient to pay if they were financially on the hook.
The solution to government regulation and insurance making healthcare expenditures stupidly complicated to understand is not to subject everyone to a lecture about it, and it's certainly not to increase the cost of healthcare by adding unnecessary complexity that adds zero value.
Since these numbers are all made up and mostly unrelated to each other and de-tethered from reality and changing on a frequent basis, would you just accept us creating a new category of pricing which is "whenever a patient asks how much we give this answer" and then we can just call it a million dollars and call it a day?
Let's say you passed a law that says "a patient is required to get a sheet of paper with the cost, price, insurance charge, and so on for the median procedure of that type, and if you don't provide this accurately you get fined." Do you have any idea how expensive that would be to do because of how frequently these things change? You'd have to hire an extra department which works 24/7 365 and has a multiple staff in the hospital at all times or hospitals would have to just eat the fine.
Good faith estimate. Details of what needs to go on the sheet of paper can be haggled over. I'm sure we can come to a compromise. I bet you can do that pretty easily. Sounds a lot more efficient than a lecture. Glad you're starting to come up with better ideas than having the head of billing personally show up and manually do every single estimate and talk to every single patient (but I do remember the prior catastrophization, which is why I'm feeling pretty good right now).
The funny thing is, if this sort of law actually got passed, I'm pretty confident you'd figure it out pretty quick. It's actually pretty simple compared to a lot of other things that happen in your industry and others. You'd stop swearing that it would take 24/7 365 bullshit (which is Obvious Nonsense) and just do the damn thing. Shit, I am intimately familiar with the scramble to implement EHRs. Sucked for a while, probably still some lingering unintended consequences. But you figured out a process and did it. Bottom line: I absolutely do not believe your catastrophization of what it would take. It's Obvious Nonsense.
EDIT: BTW, you don't actually have to convince me. You have to convince the people who are willing to shoot CEOs dead in the streets of New York City and those who are cheering for them.
Actually no. A rule very much like this was passed a few years ago. Guess what happened? The information was inaccurate in the places that attempted to follow it and many hospitals chose to just be out of compliance and ignore it.
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