Negotiated hospital rates can be much higher than you think for different procedures says the NY Times.
If you have ever wondered why your insurance costs continue to skyrocket, the answer may lie in the negotiated fees your insurance company has with y9ur local hospital.
Years ago, I found out that an MRI for the lower back under my Blue Cross Blue Shield would cost me $800 under their negotiated rate. Then I had a patient without insurance who went to a local MRI center and paid half that amount. Crazy, No?
In an investigative report, the NY Times recently showed that one hospital can have markedly different fees for the same procedure depending on the plan you are insured with.
Hospitals and insurers did not want you to see these prices because they are both parts of the problem of why healthcare costs so much, with hospitals leading the way as they became larger. This was caused by years of predatory practices by insurance companies to boost profits by disenfranchising lower-cost providers using tiered plans which guided patients at a lower cost to higher-priced facilities while financially staving private practices.
Insurers make more money with higher premiums due to their pricing structures and hospitals. Hospitals own parts of the market and buy more physician’s practices, using their influence to demand higher prices for everyday physician services.
Meanwhile, the government has been asleep at the wheel as premiums continue to rise and deep flaws in the system are laid bare by the covid-19 pandemic. Ironically, Medicare is the only plan that has the negotiating clout to demand better pricing.
What’s a healthcare consumer to do?
If you are home and you have chest pain, likely, you will never go online and shop for a hospital to go to. If you have an elective procedure, you may be more likely to shop but you will also want to make sure you use the hospital affiliated with your physician.
While you should shop around, making healthcare decisions is often more complicated due to access, trust, immediacy, and emotions.
On the other hand, you do have control of whom you visit first. Often, the specialist will not thoroughly check you out which is why visiting a trusted primary physician may be your best first option.
On the other hand, medical providers have a huge blind spot called the musculoskeletal system, resulting in many people have tests they may not need, often at a high cost to them.
If you are experiencing back, neck, shoulder, or even foot pain, a primary care physician who specializes in musculoskeletal system care may be all you need to avoid unnecessary tests. It has been said that who you see first can make a huge difference in risk, effectiveness, and cost.
Chiropractors are the only physician-level providers who specialize in primary care of the musculoskeletal system. Rather than just looking at the area of symptoms, they will perform a thorough history and examination to determine why you hurt. If your problem requires medical attention, they will refer you to the appropriate physician.
While chiropractors may also order tests, they are most likely to work with you first to see if you feel and function better, before ordering costly tests that can lead to risky and expensive interventions and drugs that are not likely to help.
For many conditions, simplicity is better. Seeing the right primary care provider can make a huge difference in your experience.
What should we do as a society to reduce the cost of healthcare?
We need competition and the huge healthcare systems are anticompetitive. Insurers have set the conditions for this to happen and now are trying to control the cost by lowering or restricting care to independent and lower-cost providers who actually save us money. Perhaps, this is why hospitals continue to expand while small groups of providers are now joining hospital systems.
Despite the political discussions, single-payer healthcare may be the best option and Medicare with a few tweaks can begin the transition by allowing Americans who are younger to join a proven system. Secondly, Medicare must be able to negotiate drug prices on behalf of its members.
Third, Medicare should include functional medicine providers in their networks and pay them appropriately for their time and effort. They use an approach that treats holistically the cause, rather than using the multi-specialist symptom approach which is complicated, costly, and is not necessarily better. If you have a chronic condition that is only managed by a drug, you are a victim of this idea of management rather than care which may be curative. Hospitals are making a fortune off the current segmented system of care and are not looking to change unless the economics of healthcare in the USA begins to reward providers for results and delivering them more cost-effectively.
Segmentation of care reenforces hospital systems and the practices they purchased as primary care providers are incentivized to spend less time with patients and refer to the system’s higher-priced offerings. Insurers meanwhile pass on those higher costs to us.
Chiropractors must be fully reimbursed for all the services Medicare provides. Currently, they are only paid for manipulation of the spine but patients may require x-rays, other tests, evaluations, and rehabilitation that is often provided by the chiropractor but paid for by the patient, rather than the plan. Chiropractors reduce costs but having financial roadblocks to visiting them makes little sense. This has to change. You can help by clicking here.
Bigger is not necessarily better and our for-profit system has waiting times just like systems in other countries. Turing the corner on this requires us to embrace primary care and expand its definition to include all providers who can satisfy those needs. Incentives need to be placed on preventative medicine that is not necessarily based on big pharma and the next drug. It must be based on health, healthier eating by Americans, and a more cost-effective health system with a lower barrier to entry. Huge deductibles often have patients delaying care and do not necessarily save anyone money other than the insurer.
Whether self-insured or fully insured, all costs go up because of how we practice healthcare. We are all becoming victims to a system that is out of control, is far from the best in the world in keeping us healthy, and needs real competition. If you were looking for more proof at how capitalism does a poor job with healthcare costs, look at our system compared to others around the world. Single-payer; anyone?