Fun with health care pricing

[matt819]

Fortunately, my health issues are not as dire as many who have posted in this group and elsewhere on DU.

But, like many people my age (which is old enough, thank you), I have some issues. One of these is not quite in the medical mystery category, but no doctor has quite put his/her finger on it. So, what a surprise, tests.

In my area, I'm in network with a statewide group of hospitals and clinic, one in my town and another - the lead medical center/medical school - is about 75 miles away. I need some blood tests, so I thought I'd checking pricing. Again, we're not talking thousands of dollars for complex procedures, just some blood tests.

The prices?

Test Local clinic Mother ship
1 $95 $282
2 $108 $180
3 $147 $205
Total $350 $667

I haven't checked yet, but I assume that my insurance will cover either one after whatever my lab deductible is. But the fact that one unit charges 90% more than the other - in the same hospital system - is well beyond outrageous.

Now, this group publishes its pricing online for common procedures, and you could dig further for the lab tests and other stuff, though it would be tedious. My guess is that I'd find comparable results.

You can see pricing differences for prescriptions using the GoodRx app or website. This is just nuts.

Then again, the issue exists for OTC medications as well. I was "prescribed" an OTC antihistamine. Price would have been $29 for a generic. The brand name at the pharmacy and at the local grocery store was $17.99, and at Amazon it was $15.49.

Did I say it was nuts? Just checked. Yes I did. But let me repeat. This is nuts.

[Hoyt]

1. If you have health insurance, the price a clinic or hospital charges does not matter.

It's what the insurance company allows.

For example, in #1 if the hospital charges $282, it's likely the amount allowed by the insurance company is $50. That means the hospital has to write-off $232 immediately. Odds are, the clinic is also allowed $50 and has to write-off $45 right off the bat. Sometimes, insurers allow more for tests performed in a hospital than those provided in a doctor's office, but there will still be a big write-off.

If the clinic/hospital is sophisticated, they can tell you right away how much you will personally owe as co-insurance.

Point is, if you have insurance, what a clinic or hospital charges doesn't mean a lot. It's definitely a stupid system, run by stupid people.

Where you really get screwed is if you don't have insurance. In that case, the clinic will try to collect $95 and the hospital $282. Of course, it is unlikely most people can pay that, so they'll usually negotiate.