Edited to say: Thank you so much for coming! We're signing off now, but we'll try to come back and catch up later.

We do this work not only on our home site at ClearHealthCosts, but also in partnership with other news organizations. You can see our work with CBS National News here, with WNYC public radio and Gothamist.com here, and with WVUE Fox 8 Live and NOLA.com I The Times-Picayune here on our project pages. Other partnerships here. Our founder, Jeanne Pinder, did a TED talk that's closing in on 2 million views. Also joining in are Tina Kelley, our brilliant strategic consultant and Sonia Baschez, our social media whiz. We've won a ton of journalism prizes, saved people huge amounts of money and managed to get legislative and policy changes instituted. We say we're the happiest people in journalism!





Comments: 904 • Responses: 80  • Date: 

perrohunter406 karma

What is the craziest cost for something in health care that you’ve seen?

clearhealthcosts722 karma

OMG, there are so many it's hard to say. I think the worst thing we have seen now is the price of insulin, because it is a medication that was invented many years ago and has not required any upgrading. jbp

clearhealthcosts656 karma

Also we are hearing a lot about women who are being asked to pay extra for screening mammograms, which are supposed to be free, because they have dense breast tissue or have a history of breast cancer in the family. So they think of it as a penalty for having cancer or having dense breast tissue, which affects 40 percent of women. Some of these women say they're no longer having mammograms because it's too expensive.

Good on you, US health care system! jbp

geminiloveca287 karma

I just had this happen. My mammogram was covered 100%, but the ultrasound the radiologist recommended because they had discovered I had dense tissue and a mass in my breast.... not covered 100%. Cost to me? $360+

clearhealthcosts282 karma

We're seeing that it's becoming more and more common unfortunately. We did a story with CBS News back in October about its rise: https://www.cbsnews.com/news/cost-of-mammograms-preventative-breast-exams-leave-women-with-unexpected-bills/

We're also seeing that women are refusing to get tested because they're afraid of those surprise bills. slb

jnseel37 karma

I wonder if this might be remedied by recent increases in mammography by ultrasound? I remember seeing a fairly recent study (within the last 2-3 months) with the conclusion that ultrasound technology has improved to the point of detecting cancerous lumps with fewer false positives than mammograms.

clearhealthcosts28 karma

We are not in possession of medical info. But we do know that docs and insurers agree (with the US Preventive Services Task Force) that regular mammos are important and covered by insurance. After that, Ultrasound or MRI are not covered -- and they can be very expensive. There is some legislation in various states seeking to cover these costs --- bt if the employer is self-funded (self-insured) the proceedings are governed by federal law, and they don't have to pay. Check out the stories referenced upstream.

IOW, it may be better, but not covered. There is the rub. -jbp

ItsMrDeath2You41 karma

$360 Ouch. Seems like a shady practice for sure

geminiloveca92 karma

oh, that was what my insurance company said was their "max allowable charge", which I'm responsible for because I haven't met my deductible yet.

The imaging center wanted $265 PER SIDE ($530 total). For an ultrasound that was less than 10 minutes total.

(And it's been recommended that I have the ultrasound or 3D mammogram annually (vs. every 2-3 years) for at least the next couple of years to watch this lump.)

clearhealthcosts120 karma

Unbelievable. You should know, by the way, that you might be able to get that ultrasound cheaper at a self-standing radiology center or a breast center -- instead of at a hospital. And you should ask "what will that cost me on my insurance? what's your cash price?" You might save a ton of money . -jbp

geminiloveca103 karma

That was a self-standing imaging center. The hospital my insurance would cover wanted almost $680 per side.

Welcome to California....

(I did shop around before I got the test done, which I scheduled because I had found a lump in one breast (the mammogram found another on the other side I did not know about). But it's disgusting that, while worried about my health, I should have to comparison shop for a "deal" while I'm trying to find out if I have cancer or not.)

austinmo228 karma

If only there was a tool to make comparing medical costs quick and easy.

clearhealthcosts49 karma

It us!

We have both billed charges, cash rates, and some of the negotiated rates. Our data comes from our survey of cash prices for 30-35 common, "shoppable" procedures; crowdsourced prices from our community reporting charges and payments, via our interactive software; prices sent in by providers separate from our survey; and data from government Medicare pricing formulae. To see an example of how it works, go here to our interactive software and search 76700 ultrasound of the abdomen within 100 miles of 70145, a common New Orleans Zip code. You will see all the various kinds of data in this search. -jbp

nanfranjan8 karma

This happened to me as well, and I was not informed that my insurance would not cover the ultrasound.

clearhealthcosts4 karma

This happens a lot.

We did this piece with our partners at WNYC detailing ways you can appeal down toward the bottom in "what you can do. Please let us know of details; we are amplifying the message to cause legislative/regulatory change. This piece with partners at CBS News also explains.

Please put deets here or send to me at [email protected], and thanks!

snoopyowns29 karma

If your insurance covers preventative care 100%, how can they even get away with that?

clearhealthcosts47 karma

Loophole: Screening mammo vs higher level of screening.

Here's a story with our CBS partner about how this happens.

cactusflower421 karma

This just recently happened to me. I'm 30 but I found a lump, and they told me it was going to be $500 for a mammogram, or $50 for an ultrasound WITH insurance. So I noped on the mammogram. They said I just have dense tissue, but I still have the lumps and I'm a little afraid that they straight up missed something.

clearhealthcosts5 karma

This happens a lot.

We did this piece with our partners at WNYC detailing ways you can appeal down toward the bottom in "what you can do. Please let us know of details; we are amplifying the message to cause legislative/regulatory change. This piece with partners at CBS News also explains.

Please put deets here or send to me at [email protected], and thanks!

Gemmabeta99 karma

has not required any upgrading.

That is not really true. Banting and Best's original insulin (still sold today for pennies as Insulin regular--i.e. that bottom shelf Walmart insulin everyone mentions) is very finicky in terms of getting the dosage and timing right. It also has some very serious side effects if you get it wrong. And because of that, it is not often used outside of hospital settings where meals are highly regulated and 24-7 monitoring provided.

So, the development of newer synthetic insulins is definitely a positive in terms of patient life expectancy.

Now, the pricing issue is definitely fucked...

clearhealthcosts31 karma

I am sorry, I stand corrected about the upgrading. But yes, the pricing is fuckt.-jbp

ItsMrDeath2You35 karma

The insulin pricing bugs me a lot. I'm not diabetic, but do have diabetic family. The creator made it so that he didn't profit and it could benefit the world. Now three big pharmaceutical companies have made slight changes to the formula, monopoliezed the market in the US be working to together to increase cost by well over 100% in a ten year span. This is a big issue.

I do find it interesting more companies have not started making insulin in an effort to undercut the existing seudo monopoly of those three larger companies....

clearhealthcosts7 karma

This drives us crazy too. We do note with interest that some states are trying to cap insulin prices. -jbp

Cheeto-dust20 karma

The Virginia General Assembly just passed a bill capping the price of insulin at $50 per month. New Mexico just passed legislation that would cap the cost at $25 per month. Colorado and Illinois have capped the price at $100.

clearhealthcosts4 karma

Thank you for this! -jbp

HerrMilkmann18 karma

My girlfriend was insisted at medical center (forget the name) to have her brain scanned as she has been struggling with severe anxiety and depression. Go figure, the whole thing was not covered at all and she was even told it would. Bills came in one after another adding up to almost $6k. This shit is out of control and ClearHealthCosts sounds like exactly what this country needs. If a test could cost so much it would financially cripple the patient, they should be obligated to make that abundantly clear before they do it.

clearhealthcosts13 karma

We definitely agree. Please ask her to use our search and share tool and our handbook on costs. We know this is not a full answer to the problems, but maybe it will help next time. -jbp

UncleBigHead15 karma

Regarding insulin, have you ever suggested people in the US that live close to the border with Mexico to make a quick trip and buy insulin there? I've seen videos of people giving that advice due to the huge difference in cost.

clearhealthcosts41 karma

It's not scalable and it's not global, but if it saves people money and gets them the life-saving medicine they need, then yes, they should go to Mexico or Canada to get it. slb

MangoCupcakeBabe15 karma

How much does insulin actually cost to manufacture? Is there a difference in cost between rapid acting, regular, etc.?

clearhealthcosts31 karma

It costs from $2-6 to produce one vial, which is in no way reflected in the price insurance companies force patients to pay. That's one of the problems with our healthcare system! slb

clearhealthcosts35 karma

What about you? What's the craziest cost you've seen? -jbp

mizz_understood85 karma

I work as a financial counselor for a non-profit hospital. (In a rural area) Let's see:

Infusion treatments-45k for an hour 4x per year for life saving medication for people with MS.

Inpatient stays

Ambulance trips-$1100 to bring a patient less than 1 block away. Patient was in a LTC facility.

Basically everything is rising. Our system is such a mess and I am doing my best to assist those who cannot afford their bills or even their ridiculous deductibles.

Also, MFA. Can we make this happen?

Edit: Changed 85k to 45k per treatment. I was adding two infusions together. Less ridiculous, but not really.

clearhealthcosts38 karma

Hi, I'd like to talk more about this -- i'm messaging you for a longer deeper dive into this. thank you so much for your work. -jbp

thebikerdad44 karma

We took my son to the ER for headaches. Turned out he had a hematoma and would need to see a pediatric brain surgeon. That hospital didn't have one so they had to transport him to a different hospital in the area. The cost of a 15 minute ambulance ride was over $1200. He was conscious and under no medical duress. I was flabbergasted. If he hadn't been 'admitted' I could have driven him there myself.

clearhealthcosts41 karma

Have you tried arguing the bill? Some bills like that can be fought, though there’s no guarantee of success. Here’s a description of steps to take, if your insurance refused to cover it (if you’re insured). https://clearhealthcosts.com/blog/2016/12/appealing-claim-denial-draft-spm-notes/ Going forward, one can also refuse some treatments/procedures, “against medical advice” and drive the patient to the new facility, if it can be done safely. -- tk

ItsMrDeath2You33 karma

I was T boned in a car accident. It ruptured my spleen (grade 3), and cracked 3 ribs. 3 days icu, 3 days in a recovery room, an embolization surgery, and an ambulance ride. The hospital charged me $162,000!!!! However I was insured under a good plan. BCBS made the hospital write off $105,000. BCBS paid $48,000, and told the hospital they could only charge me $3,000.

If I were not insured the doctors life saving efforts would have caused a financial suicide

Milfoy26 karma

First though the insurance company, will all the insurance companies in the USA conspire with hospitals to drive the notional cost through the stratosphere. Why? The negotiators get big bonuses depending on the size of the discount they negotiate. So if the hospital has a $1k procedure and they negotiate 50% off then small bonus time. Hospital makes that $20k and they negotiate a 90% discount, bigger bonus and a bigger bite out of your deductible. It also make people terrified of not having insurance due to the insane apparent costs. The American healthcare system is insane and dystopian.

clearhealthcosts9 karma

Bloodcurdling. I am messaging you!-jbp

clearhealthcosts4 karma

phew! hope you're having a smooth recovery.

ProfessorRiffs18 karma

Got a cortisone shot in my back last year. Cost me over $6k, AFTER insurance. If that's not crazy then I dunno what is.

clearhealthcosts16 karma

It might be possible to argue that bill. See if this is of any help, and good luck! https://clearhealthcosts.com/blog/2016/12/appealing-claim-denial-draft-spm-notes/

toddmaddison382 karma

To your point on secrecy...   We have laws right now requiring advance approval of almost every charge in the universe, including the Good Faith Estimate in mortgages, estimate requirements in car and TV repair, proposals in home remodeling, etc.  There are almost no situations where it's acceptable to only tell you the charge after a service has been performed.

Why is a "Medical Good Faith Estimate" not a requirement in healthcare, and is there any way to get legislators attention to something like this?

clearhealthcosts242 karma

Todd, you are so right, there should be a requirement that these be ironclad. But they aren't. I wonder if the reason there isn't a requirement to do this has something to do with pay for play politics: As you know, the campaign finance wings of the health care industry make the military campaign finance wings look like the Little Sisters of the Poor. Since legislators depend on that money, this theory goes, they're reluctant to rein in abuses.

Also: There's a revolving door between industry and government. That plays a huge role.

How do you think we could get legislators to pay attention to this? I mean -- good journalism does it, but any other thoughts? -jbp

mci25130 karma

Are you familiar with the work on this being done by Johns Hopkins professor and surgeon Marty Makary? He wrote an awesome book called The Price We Pay. Keep up the great work this is so needed!!!

clearhealthcosts105 karma

Thank you so much! Yes, I know Marty, and we talk from time to time. He's a great comrade-in-arms.

And thank you for your thanks. Together we are strong! -jbp

toddmaddison26 karma

"Accountable" is awesome as well.

clearhealthcosts33 karma

Yes, you are so right! Marty knows where a lot of bodies are buried. -jbp

clearhealthcosts22 karma

Hey there, do you have a story to tell us about why you feel it's so needed? We're always interested in learning from others! -jbp

toddmaddison103 karma

A recent Arm and A Leg podcast outlined a process where one could challenge "surprise bills" in small claims court.  I've often wondered about this, being a small business owner that has had to defend myself in small claims on cases where customers were actually given estimates and approved in writing prior to our charges, even that is difficult to prevail on at times. 

Do we know of any cases where this has worked, would it be beneficial to all to see some examples of that to encourage people to make that attempt?

clearhealthcosts100 karma

We have not heard a lot about small claims court challenges. We have a handbook for people to use in arguing bills, and it doesn't include small claims court. But it probably should. Here's [our handbook.]https://clearhealthcosts.com/blog/2016/12/appealing-claim-denial-draft-spm-notes/

AnxiousSun76 karma

How useful is knowing the cost of care when most people don't have the option to shop around for services and few healthcare centers accept cash-only business?

clearhealthcosts72 karma

So! We are learning that a lot of people can indeed shop around. And with rising deductibles and rising co-insurance, people can actually save a lot of money by shopping around and paying cash.

Here's a woman who shopped around and saved $3,786 on an MRI [using her insurance].(https://clearhealthcosts.com/blog/2017/05/saved-3800-mri-people-use-data/)

clearhealthcosts14 karma

And here's a blog post about shopping around -- putting away your insurance card and paying cash. I know it sounds crazy, but we hear this A LOT. Infuriating. -jbp

drgsforthepeople51 karma

We are software startup helping hospitals comply with the CMS price transparency requirements for shoppable services, and we are also paying member ($100/month) of the ClearHealthCosts Patreon program. Are you interested in working together towards a common cause?

clearhealthcosts47 karma

Yes, thank you so much! We reached out to you before via Patreon, but we didn't hear back. I want to hear more! -jbp

belledamesans-merci40 karma

Why do I have a high deductible instead of having it rolled into my premiums? It makes me feel ripped off and like I might as well not have insurance at all.

clearhealthcosts52 karma

That is such a great question! I am not an expert in insurance plan design (such a sexy topic!!) but from where I stand the industry looks like this: They find many different ways to get their hands in your pocket. Some examples: 1. premium 2. high deductible 3. co-insurance (the percentage you pay after you meet your deductible) 4. hospital deductible separate from general deductible 5. drug deductible 6. "this service is not covered" 7. opaque billing 8. a persistent effort industry-wide to discourage you from thinking there's any reasonable or effective means of appeal.

When you get right down to it, it feels like an extractive industry, doesn't it? -jbp

crispysilicon36 karma

Who are the worst offenders for these kinds of things?

clearhealthcosts55 karma

OMG, where would we start? The entire industry works on the principle of keeping you in the dark. It's almost true that by calling out one, you do a favor to the others. -jbp

MySockHurts33 karma

What are your thoughts on Senator Bernie Sanders’ Medicare for All single-payer healthcare plan?

clearhealthcosts44 karma

We’re really interested to see how Medicare for All has become a headline topic—reflecting how much pain people are feeling over the rising cost of health care.

That said, though, we are journalists—we’re not advocates for one system or another. We’ll leave the policy advocacy for others who find that as their primary focus.

So what we’re doing here: Rather than talking policy, we’re helping real people on the ground with real medical costs. We’re saving people money, increasing access to care (if you think you can’t afford it, you won’t get it) and changing the way people think about the system by giving them real, actionable information to protect themselves and get the care they and their loved ones need. slb

wjmacguffin31 karma

Is there any truth to the argument that prices are high to cover 1) low govt reimbursements and 2) uninsured people not paying?

clearhealthcosts23 karma

Hi, good question. We notice that the big managed care companies and the big hospitals (nonprofits and for-profits) seem to be doing well financially.

The hospital industry also has many make-goods on low gov reimbursements -- the "disproportionate share" hospitals are supposed to be made whole for the fact that they treat a disproportionate share of patients getting uncompensated care. See here. There's never enough money for them, don't you know?!- jbp

lstanger30 karma

I thought transparency was built into the ACA. Where did it disappear to? In fact, it's the most overlooked part of the ACA. What happened!

clearhealthcosts36 karma

There were a lot of things originally built into the ACA that vanished or were hamstrung after the fact: The public option, the co-ops, among other things.

The truth is that the ACA was flawed but was about as good as it was going to get on many points at that time. (Imagine trying to pass such a thing now.)

The transparency clause of the ACA that was actually implemented - making hospitals reveal chargemaster prices -- is actually extremely non-transparent. The fact is that the entire system wants to keep you in the dark, and maintain non-transparency, so they can have All The Money. -jbp

drgsforthepeople3 karma

There was a clarification from CMS in the form of "additional FAQ" that hospitals post prices by DRG, but for some reason it was generally ignored. Do you know why?

Here is the statement (from attachment) issued by CMS:

Q. In addition to establishing (and updating) and making public a list of the hospital’s standard charges for all items and services provided by the hospital, what hospitals are required to establish (and update) and make public a list of their standard charges for each diagnosis-related group established under section 1886(d)(4) of the Social Security Act?

A. All hospitals operating within the United States are required to establish (and update) and make public a list of their standard charges for all items and services provided by the hospital. Under current guidelines, subsection (d) hospitals are additionally required to establish (and update) and make public a list of their standard charges for each diagnosis-related group established under section 1886(d)(4) of the Social Security Act.

Would you like us to provide the full attachment?

clearhealthcosts3 karma

Hi, thanks, sure, send it along! We will note, though, that the charges are not as useful as the negotiated rate. And the DRG can stand to further obfuscate, because it is a "package rate."-jbp

RotaryJihad30 karma

Is there a professional, such as a specialist lawyer or accountant, that could be hired to help a medically complex patient navigate the financial side of healthcare?

My question is absurd, we shouldn't HAVE TO hire a professional specialist to read and settle a bill. I ask because I have friends with chronic illness who just need an assistant to deal with insurance. I can't help directly, I don't know how, but if such a professional existed I'd happily hire them for a friend.

clearhealthcosts23 karma

Yes, they do exist. And yes, it is absurd. They are called "patient advocates." You should shop around carefully before you hire one.

I don't recommend any of them because I am reluctant to say I can speak for your friends --- it depends a lot on where they are, whether the advo needs to be knowledgeable about the field, say IBD or mental health or cancer treatment -- to be effective.

That said know Trisha Torrey from my membership in the Society for Participatory Medicine. You can find her here . There are many others -- here's Grace Cordovano who is also in SPM. That's a start anyhow.

clearhealthcosts6 karma

We are also really big on peer-to-peer support: Those patient communities are kickass sources of information. There's PsychCentral for mental health, and also the Facebook Group Matt and Doree's Eggcellent Adventure for infertility.

You have to be careful here, because those online groups are, of course, public. And some of the patient advocacy groups are in thrall to Big Pharma. But a group like Eggcellent Adventure has TONS of information -- not in thrall to Pharma, but owned by Facebook, of course.

clearhealthcosts8 karma

Reasons why you might not want to put sensitive health info on Facebook are many. Here are my friends @FredTrotter and @BraveBosom on one specific case.

rachelschmitz_29 karma

What kind of changes in the American health system can we look forward to in the near future?

Also, you guys are doing amazing work!

clearhealthcosts45 karma

Thank you so much!

We think the easiest and most obvious systemic change from the top should be legislation outlawing surprise bills. Such legislation exists in New York, though it's imperfect. There is a bill in Congress that has bipartisan support, but it has been blocked by industry players who are raking in cash on the very practice of surprise billing.

We had thought late last year that this one would finally pass -- even though it's so narrowly drawn that it doesn't affect a lot of the most egregious problems. But it's stuck and no one will say they think it will pass anytime soon. -jbp

clearhealthcosts16 karma

That said, it's also true that the journalism we're doing is making change happen.

We hear from people saying 'we've started asking the right questions and have saved hundreds already." We were instrumental in getting legislation passed in Louisiana.

One of our stories with partner Anna Werner at CBS News got Gov. Andrew Cuomo on the phone to fix the guy's bill and also to make regulatory changes strengthening New York's surprise billing law.

This journalism does not require legislation or regulation. It gives you and others actionable information, ways to make change happen in your own medical care. Power to the people! -jbp

crackercandy26 karma

Why does it happen so often that when a hospital is in network, the anesthesiologists are not and nobody tells you about it (even if you ask, they lie and assure all providers will be in network) and you only find out after they send you a bill for many many thousands of dollars?

clearhealthcosts23 karma

They're trying to make money off of you.

The system is designed to be opaque. That's why we're here.

There are ways to fight back: Catch this story of a guy who was given a paper to sign saying he'd be responsible for all the charges that weren't covered by the insurance company. He refused to sign without editing. We wrote a story about it. They let him edit the paper eventually.

We're not going to claim this works in every case, but questioning these procedures will help us all challenge the sytem. And if you have specifics, let us know -- we might want to write about it! -jbp

Boroflow12 karma

What reasons would a Medicare Advantage company (Amerigroup) have for denying me generic, inexpensive drugs (Rx are for alzheimers)?

clearhealthcosts13 karma

The Medicare Advantage companies are run by the same folks who do your BLue Cross, United Healthcare, Cigna and Aetna policies. They are privately managed versions of Lyndon Johnson's Medicare.

They have generally narrower networks, more restrictions, and more denials than Original Medicare (I also call it Lyndon Johnson's Medicare). We don't make recommendations on what insurance to buy, but we do recommend that you fully educate yourself on the options. -jbp

clearhealthcosts6 karma

Resources: Your state has a SHIIP program, with federally funded advisors. Find it here.

Here's a New York Times story about the topic. -jbp

baddada112 karma

I had xrays done in Dec. Insurance paid all but $130.00 of the cost. I paid the hospital the remainder as thats where it was done. Yesterday I got another bill from radiologists. How many more people are going to claim I owe them?

clearhealthcosts14 karma

You have no idea how many times we hear this. Sometimes there are even "facility fees" on top of the doctor visit, the hospital and the reading fee for the radiologist.

We do suggest that people try to ask up front what it will cost. Here's our handbook. It does not always work, but if we all ask these questions all the time, we can turn this into normal behavior - and make the people who won't give answers into the people who will! (maybe).

Also, in practically every case, a hospital will be more expensive than a self-standing imaging center or an orthopedist's office. You could try googling "x-ray san francisco ca." or whatever your location is. -jbp

nostan018 karma

What role do you think medical professionals play in these practices (if any)? And what corrective actions do you believe can be taken to alleviate inflated healthcare costs?

clearhealthcosts15 karma

We aren’t advocating for doctors to become financial advisors. But we would like them to be aware that cost is often a deciding factor when a doc tells a patient to get a particular expensive test or drug. Patients who tell their docs that they simply won’t get a cost-prohibitive procedure may learn that there are cheaper options that could be better than nothing. But that requires great doctor/patient communication, a rare bird. More important is to rein in runaway costs, so you’re the length of your life doesn’t depend on the fatness of your wallet.

The money is gutting the relationship between doctors and patients. Not healthy. -tk

dvaldivia448 karma

Do you think an insurance that forces for you to go to the X cheapest places on your list would work?

clearhealthcosts33 karma

We think that all prices should be public all the time, so you can make choices yourself.

You should be able to see the cash price, the price your insurer (and other insurers) will pay. The Medicare and Medicaid prices, too, obv. And the chargemaster price.

There's no reason for all this secrecy. Secrecy like this usually means one thing: People are keeping you in the dark to make money. -jbp

PresidentialMemeTeam7 karma

What do you think of President Trump’s executive order on price transparency?

clearhealthcosts5 karma

It supposed to make things to happen, but it will depend on the rule-making process that HHS comes up with. Historically there has been little insight and transparency in prices, that anything at all could be a step in the right direction but we've yet to see the needle move one way or the other.

We could see them try to do something, then have insurance and hospital lobbyists step up and get them to reconsider. Ultimately, we don't think that much will come from it. -slb

1dvs-bstrd6 karma

My wife just went through chemo treatment for breast cancer and part of the treatment included a neulasta injection they day after the chemo. The hospital was billing the insurance around $38,000.00 per injection. I know medicine is not free, but of all the things that she went through, I found this to be the most ridiculous cost. Is neulasta really that special?

clearhealthcosts6 karma

It is terrible that we are having to argue over lifesaving medications and we hope we as a nation come to better delivery systems for people like your wife (hope she’s doing well.) We did see a page claiming the list price is $6231 per dose, with information about possible financial assistance lower down, if that is helpful. https://www.neulasta.com/support/?gclid=CjwKCAjwmKLzBRBeEiwACCVihi5tVJagNVMQqDC6uT6hRMH4E5T33cBlf_1FEWyj2E8ndjXcq1NuSxoCHhQQAvD_BwE&gclsrc=aw.ds -- tk

pyrrhios5 karma

Have you ever done a workup on how much in total tax dollars, Medicare, Medicaid, VA, federal and local, etc., we spend on healthcare in the US, and expressed it as a percent of GDP?

clearhealthcosts7 karma

Nationally, ModernHealthcare.com says we’ll spend 19.4 percent of our GDP on healthcare in the coming decade, https://www.modernhealthcare.com/article/20190220/NEWS/190229989/healthcare-spending-will-hit-19-4-of-gdp-in-the-next-decade-cms-projects while in Massachusetts, 24 percent of the state budget goes to health care. http://massbudget.org/reports/pdf/MassHealth_2019.pdf These aren’t numbers we came up with, but they are ginormous, and confirm that it’s very useful to look at what’s behind your individual bills. - tk

markjwilkie5 karma

Do you have the opinion (like we do in the UK) that the NHS is the epitome of what Americans should aim for?

Where treatment is based on need and free at the point of use.

clearhealthcosts4 karma

We look in admiration at nations that have figured this out. For some of us (many of us?) our system is a national embarrassment and an outrage.

How can we suggest that people would need to choose between getting medical treatment or putting food on the table? How can we sentence people to a life in which they can afford the diagnosis but not the cure? How can we witness deaths of innocents because their GoFundMe didn't raise enough money for their insulin? -jbp

Amanplanmanplan4 karma

Do you think the coronavirus will impact healthcare costs in the future?

clearhealthcosts8 karma

This pandemic proves that we need affordable healthcare and humane work policies for everyone – people who don’t have paid days off will likely be forced to choose between feeding their families and spreading a virus, and all people have to be able to access healthcare for the nation to get a grasp on the spread of and best ways to contain coronavirus. Hats off to Washington State (and other states) for its insurance commissioner ordering insurance to waive deductibles and copays for coronavirus testing. https://www.insurance.wa.gov/news/kreidler-orders-washington-health-insurers-waive-deductibles-and-copays-coronavirus-testing Perhaps knowledge that safety depends on the actions of the herd – that we’re all in this together – can result in similar actions to slow the spread of the disease and protect those most vulnerable.

OTOH, the entire system will likely get slammed by increased use, so more planning and preparation for future epidemics will likely take up a lot of healthcare brainspace going forward. - tk

3j2m233 karma

Do you eat your chips with guacamole or salsa?

clearhealthcosts5 karma

Guac! -jbp

clearhealthcosts4 karma

love us some healthy fats! guacamole, hands down! -tk

saviorofthemultivers3 karma

Why isn’t insulin free? That’s up there with food and water for me ya know

clearhealthcosts3 karma

Agree that it should be. -jbp

I-wish-l-was-you3 karma

What’s the most you have saved someone cost wise?

clearhealthcosts7 karma

We’ve saved one woman in New Orleans $3,786 after she read how to shop around for an MRI, https://clearhealthcosts.com/blog/2017/05/saved-3800-mri-people-use-data/ and we know that Frank Esposito’s insurer forgave much of his $650,000 surgery bill, after Anna Warner covered his story for our partner, CBSNews. https://www.cbsnews.com/news/man-hit-with-650000-in-medical-bills-gets-relief-after-cbs-news-story-2019-09-25/ But we want to save more people more money, and we want to see policy changes to make surprise bills less common. Sunlight is the greatest disinfectant! - tk

Jaebeam3 karma

Are there online tools that one could use to research

  1. cost of a procedure based on your insurance coverage
  2. Outcomes of said procedures at that particular location

so we could make an informed choice about where to purchase services?

clearhealthcosts5 karma

1) Our system! https://clearhealthcosts.com/pricecheck-share-form/ We have both billed charges, cash rates, and some of the negotiated rates. Our data comes from our survey of cash prices for 30-35 common, "shoppable" procedures; crowdsourced prices from our community via our interactive software; prices sent in by providers separate from our survey; and data from government Medicare pricing formulae. To see an example of how it works, go here to our interactive software and search 76700 ultrasound of the abdomen within 100 mil es. You will see all the various kinds of data in this search.

2) If there was a good quality measure we would incorporate it into our system yesterday, but it doesn't currently exist. - slb

Norgeroff2 karma

What color is your toothbrush?

clearhealthcosts2 karma

White with purple stripes! -jbp

Sandeerrss2 karma

Why is dental care so expensive. Is it not just as important?

clearhealthcosts2 karma

It is indeed important!

We have prices for dental exam, teeth fillings, teeth cleaning and teeth whitening. We're deep in the cities where we have partners: NY, SF, Dallas, Philadelphia, NOLA, Miami, TampaSt Pete. Go here and search on those terms, and you can see the wide range!

Dentistry is very much a cash marketplace these days -- so few people have dental insurance any more. -jbp

Yellohsub2 karma

How does your team manage to do this work day in and day our and not be overcome with hopelessness and depression? You must hear some heartbreaking stories every day.

clearhealthcosts2 karma

We do hear heartbreaking and infuriating stories day in and day out.

But! We say we're the happiest people in journalism. We are changing people's lives -- giving them the information they need to get the care they and their loved ones need. We're giving them access to care, bringing their voices into the halls of power.

You should see the love letters we get. Take a look at this blog post from our Louisiana sojourn: You're "tremendous," "awesome," what a "great service."

NOBODY gets love letters like we get love letters. People think of us as their gladiators. We are honored to take this role! -jbp

5demandsknot1less1 karma

Do you ever worry that the drug or insurances companies whose secrets you're revealing may go after you? How do you find the courage to disregard that and continue your work?

clearhealthcosts2 karma

We think this is our duty -- to fight for your right to know. As long as we are healthy and can fight for this information, we will do so.

Also, little-known fact: A lot of the drug and insurance companies -- and the hospitals, and other players -- know this is wrong. But they don't know how to get out of it. We can show them the way. That the world will not end with cost transparency -- and with journalists asking impertinent, inquisitive, uncomfortable questions, and TELLING THE TRUTH. (#sorryforshouting #sorrynotsorry)- jbp

jjr921 karma

This is a very specific question, pertaining more to insurance costs. But if anyone can explain it any better I'd love the help.

I am looking over my explanation of benefits and I have my Amount Billed, $4,099.00. Then I have my plan discounts. For one of the line items this is -$3,114.00. My total "Amount Allowed" the number they used to calculate the coinsurance on, is $7,213 or $4,099-(-$3,114). Anyone know what is going on here?

As a side note, the hospital is telling me that the negotiated rate is $3,516.01. Insurance is telling me that the $7,213 is the actual negotiated rate. Insurance is supposed to be calling the hospital (I asked to be on the call).

Any insight anyone has into this mysteries of hospital and insurance billing would be appreciated.

Note: I have a pretty solid understanding of the concepts on the insurance wiki (copay, coinsurance, premiums, etc). But any insight would be greatly appreciated.

Edit: What I owe, in case you're wondering: $3,479.32. (7,213-1,879.17[my remaining deductible])*.3[my coinsurance rate] gives me my coinsurance of 1,600.15 + deductible of 1,879.17 = $3,479.32

clearhealthcosts2 karma

Hi, thanks, I can look at your bill if you want. The hospital and the insurer will be arguing about this for a while. They should be calculating co-insurance on the allowed rate, not the charged rate. Though sometimes the plan document lets them charge on the charged rate. It's infuriating!

For detail on how people get paid, see this post.

And for a menagerie of billing shenanigans, take a look at this piece on how to read that crazy paperwork. -jbp

leahandra1 karma

On the topic of estimates. I'm currently pregnant and my prenatal care billing and hospital birth will get covered by my insurance much faster and smoother if I get estimates for these services. To get that I've called billing (who does offer to put together estimates) but I have to speak directly to both the clinic and the on ward to get all the codes.... Even though billing is in the same damn building and you know this is going to be thousands in cash for the hospital system. Why in the world is it my responsibility to hound these departments/clinics for the info. Why cant I just sign a waiver for billing to talk to them?

It's made much harder as a general number or email for each department/clinic isn't available. I asked billing on the best way to get the codes and they had no answer other than talk to department clinic. There's no protocol just for specifically this situation.

clearhealthcosts2 karma

I feel your pain. We have a handbook for how to ask for prices, but the process of childbirth has so many moving parts that it's not that easy.

We have heard of places that have global billing. That is fraught also, because it is sort of an average, and you might actually need less or more. It's a mess. I feel your pain, did I mention? -jbp

phillyEMdoc1 karma

Why oppose an independent third party decision for fair and customary prices like FAIRHEALTH as opposed to median in-network rates which insurers can game and use to squelch physician group negotiating powers?

clearhealthcosts3 karma

Not sure I understand the question. We don't oppose FairHealth. We don't think that is the only key to fixing the system, though! -jbp

TheyCallMeEric1 karma

Other than collective actions, what are some things we can do ourselves to help our own situations?

clearhealthcosts2 karma

The short answer: Ask in advance “What’s the price for me, on my insurance? What’s the cash price—that’s right, for someone without insurance? Take notes, take names, take numbers. Ask several providers.

Here's a piece we wrote on the “10 questions to ask” https://clearhealthcosts.com/blog/2017/04/find-stuff-costs-10-easy-questions/