Incorrect we need more free market in health care to reduce cost not price controls. The reason prices are through the roof is because there is no upfront pricing and competition. You don't know what you are going to pay before you sign up for care. If you knew the different cost at the different hospitals in advance you might pick the cheaper option. Instead, you don't care as they dont disclose up front and insurance covers it so you pay no attention as they charge you a thousand dollars to sleep in a cot for a night.
You couldn't be more wrong. They don't disclose because people don't ask. People don't pay attention because they haven't been taught.
1) Always ask if they have verified if the hospital AND the surgeon are in-network and the procedure requires pre-auth
2) Always ask if they have verified that the procedures are going to be covered. If they give you some line about how they don't know what the surgeon/doctor wants to perform tell them to find out. Its not like that doctor/surgeon hasn't performed the procedure before (they should be able to tell you what CPT codes will be billed)
3) Call you own insurance company and ask about your deductible and copay/coinsurance along with the CPT codes. Ask if any of those require pre-authorization
4) AbrahamG is correct in that comment about profit. Insurance companies are TOTALLY for profit. A few years ago I believe it was Aetna that was busted for immediately denying ALL claims no matter what just to see who would fight for their money
5) There's no competition pricing. It is all based on YOUR insurance company. There is something called 'reasonable and customary' fees. They vary from company to company....not hospital to hospital or office to office. What I get paid from BCBS is different than what I get paid by UHC / Aenta / Medicare / UMR / Ambetter / Amita/Etc. So when you bitch about how much 'you' get charged. Talk to your insurance company about how much they feel each procedure is worth to them NOT the facility. They aren't making up the costs...your insurance carrier does.
6) AFTER any procedure, look at your EOB's (explanation of benefits). Look at the procedures that were done. If you do not understand it, call the hospital/office. Explain to them what each thing is if you need to. That is YOUR right. DO NOT focus on what is billed. The 'allowed' amount is what you are concerned with (see below). Providers/facilities bill way above what is allowed because they have to have ONE fee schedule across the board otherwise it could be construed as 'fee splitting'. Look at how much less they are paying for the 72100 code. If that procedure code was billed out of network, the reimbursement would be so much higher.
