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20 yrs of medical billing experience and this is the most useless thing ever.
You’ve always been able to call and ask the cost of a procedure. However that has very little to do with the actual final bill due from the patient.
You’ve always been able to call and ask the cost of a procedure. However that has very little to do with the actual final bill due from the patient.
1st problem, to know the cost of a procedure you need to know the CPT code that will be billed for your specific care. If you get that code from your doctor there is no guarantee that the code won’t change once you’re being treated.
If you go into the hospital to have a baby vaginally you would look at CPT 59400. However your baby is in distress so you have to have a c section which is CPT 59510.
2 different codes and 2 different charge amts.
(This is an oversimplification but for this explanation will do)
2 different codes and 2 different charge amts.
(This is an oversimplification but for this explanation will do)
Ok so c section performed and Mom is recovering. Now one Mom may recover easily while another gets an infection in the incision so there again you have another difference in the care received that could not have been anticipated when “shopping around” for a low price
And really what parent is going to the bargain hospital when delivering their baby. When we want the best outcome for sour child who is going to quibble about the price?
So now Mom is home and the claim is sent to the insurance company. If the Mom has BCBS they have 1 negotiated rate and if UHC a different negotiated rate. Another difference that may not be able to be accounted for in an estimate
Also 2 Mom’s could have different levels of coverage with their ins plans. 1 Mom has a $200 deductible with 80% coverage after that and another Mom a $5000 deductible with 100% coverage after.
So even if both Mom’s had identical CPT codes billed that doesn’t mean they will owe the same amount in the end.
Now what if a Mom’s ins required her to go to a specific hospital for her delivery but she’s traveling and in distress. The ambulance takes her to the closest ER which is out of network for her insurance and doesn’t get the proper auth to be treated at the out of network Hosp
I can guarantee you that she isn’t thinking of lowering her bill when she just wants her child safe and healthy.
And since she didn’t go to the right hosp her ins makes a payment but has no negotiated contract with the hosp so she gets a bill with no discount
And since she didn’t go to the right hosp her ins makes a payment but has no negotiated contract with the hosp so she gets a bill with no discount
As you can see there are a thousand different factors that can affect the final bill due from a patient. So when you ask the customer service person about what your potential cost will be they cannot give you a definite estimate.
They can give you the CPT charge amount but not how much you might owe.
Oh and good luck trying to figure out the specific CPT codes that need to be billed before you’ve actually been examined by a doctor.
Oh and good luck trying to figure out the specific CPT codes that need to be billed before you’ve actually been examined by a doctor.
So this idea of price transparency probably didn’t come from anyone who actually understands medical billing in the US.
It’s pure fluff with no substance
It’s pure fluff with no substance
