Starting to change my mind

3,976 Views | 51 Replies | Last: 3 yr ago by STxBear81
fadskier
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I have always said that our health care system is broken (as far as insurance is concerned)...my son went to wound care for four months with a copay of $52.16...it ended Dec 31, 2020. I get a bill for $1,378 for his vistis all the way back to September. I call and ask...billing tells me it is my deductable. I say, I didn't ask that question. I wanted to know why I wasn't billed monthly (no explanation) and why it costs so much...again I get the that's your deductable...again, I say...not my question. What is the cost? They don't know and direct me to another department whrere I have to request itemized bills. I submit request.

I get a packet of pages where every visit to woulnd care is $574 and with visits have an additional $950 added on. I call and ask what these charges are for....no one can answer except say that the amount is not what I owe bu twhet they are billing insurance for. Yes, I know what what was done in wound care that merits $574 and $1,400...no answer,...treansferred to patient care...patient care understand my frustration and will ensure that I get answers...that was a month ago. I got a new bill saying that I am part due.

Maybe it's time for a different way to do this.
STxBear81
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if they cant explain it ( the medical necessity)then it shouldnt be billed
fadskier
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BornAgain said:

if they cant explain it then it shouldnt be billed
Billing told me to request the patient file that would reveal the codes...when I talked to that office they said that I would not understand the codes because they were medical codes.
STxBear81
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they shouldnt make up your mind for you
STxBear81
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tellthem you are an medical coding expert
Gold Tron
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We physicians agree with you for the most part. Medicine has become a game. The winners are the ones that focus their attention on billing changes instead of their patients.

A change is coming however. The newer physicians coming out of training programs with their <80 hour/week limits has created soft, poorly trained doctors. Medicine in this country has jumped the shark.
My pronouns are Deez/Dem.
Oldbear83
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Just think about how insurance "works".

I had knee replacement surgery in January. Now I pay every paycheck for my insurance, and so does my employer. So my insurance company already gets paid.

But before anything else on my procedure started, I had to "meet my deductible". So in addition to paying every paycheck for my insurance, I have to pay again to satisfy this requirement.

Then, I still have to pay for the procedure and hospital and everyone associated with it. But since my insurance "covers" it, I 'only' have to pay 20% of the cost. Although it's really more than 20%, since I had to pay my deductible plus years of premiums.

Now that I am in recovery, I am seeing my doctor and doing rehab. I get to pay again for those, a "co pay" to the doctor and something more than 20% of the cost for my rehab, because rehab is "not fully covered".

Pay before you ever use it, pay a chunk of bucks when you decide to use it, then pay some or all of your costs and expenses when you use it.

And we're the "LUCKY" ones, because we 'have' insurance?

That which does not kill me, will try again and get nastier
Wrecks Quan Dough
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The hospitals might as well issue their bills on a postcard with one line item. It could read like this:

1. Because We Can..............................................$150,000.00

Please make payment using the envelope provided.
STxBear81
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Our insurance is what we choose to pay each year either through an employer or by ourself. The employer should make it your choice of which plan to choose. That plan you choose should have options for premiums, deductibles, co paid amd co insurance.
bularry
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fadskier said:

BornAgain said:

if they cant explain it then it shouldnt be billed
Billing told me to request the patient file that would reveal the codes...when I talked to that office they said that I would not understand the codes because they were medical codes.
yeah, that is all hospitals know.. billing codes..


had an issue when my daughter was about 13 and night had a violent regurgitation episode and our pediatrician said take her to an ER. so my wife did and they went, sat in a room, they did vitals and a pregnancy test and by then she wasn't getting sick any more and was able to drink some water and hold it down... so they came home.


My bill was almost $3k. I told them to F off and paid $180. crazy, because the "visit" triggered all these billing codes for things that were never done on my kid.
STxBear81
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Sad thing is these medical costs aren't going to be any less tomorrow or next year
fadskier
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I have filed a complaint with thr Better Business Bureau. I know I will pay them but I at least want to know what cost $574 in wound care. Gauze? Dr by the hour? What?

I am giving it a month and then I am making an appointment with the CEO. It's a local hospital so I feel fairly sure I'll get somewhere up the ladder before they shut me up.
Oldbear83
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fadskier said:

I have filed a complaint with thr Better Business Bureau. I know I will pay them but I at least want to know what cost $574 in wound care. Gauze? Dr by the hour? What?

I am giving it a month and then I am making an appointment with the CEO. It's a local hospital so I feel fairly sure I'll get somewhere up the ladder before they shut me up.
Tell your insurance that the provider refuses to provide support for charges. Most insurance companies care about that.

Also, get the actual ICD-9 codes for the billing if you can, because sometimes the procedure can change in price according to how its coded. I remember from long ago, for example, that inpatient rates for almost everything are much higher than outpatient rates, but a provider has to meet specific requirements to use inpatient codes.
That which does not kill me, will try again and get nastier
57Bear
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Gold Tron said:

We physicians agree with you for the most part. Medicine has become a game. The winners are the ones that focus their attention on billing changes instead of their patients.

A change is coming however. The newer physicians coming out of training programs with their <80 hour/week limits has created soft, poorly trained doctors. Medicine in this country has jumped the shark.
I recently had a PET/CAT scan with Axumin. I received a bill from the hospital for almost $28,000 - I was stunned. Medicare paid $1,000 + change in settlement of the charge! Wow. Then my doctor spent less than 3 minutes covering the result of the scan.
Canada2017
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57Bear said:

Gold Tron said:

We physicians agree with you for the most part. Medicine has become a game. The winners are the ones that focus their attention on billing changes instead of their patients.

A change is coming however. The newer physicians coming out of training programs with their <80 hour/week limits has created soft, poorly trained doctors. Medicine in this country has jumped the shark.
I recently had a PET/CAT scan with Axumin. I received a bill from the hospital for almost $28,000 - I was stunned. Medicare paid $1,000 + change in settlement of the charge! Wow. Then my doctor spent less than 3 minutes covering the result of the scan.


That is criminal .
STxBear81
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Medicare allows 1,000 for The Scan. They can charge what they want but the insurance carrier has an allowed amount. They provider will likely use the excess unallowwd amount as write off. Only reason I know of to charge so much when they know it won't get paid.
Gold Tron
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BornAgain said:

Medicare allows 1,000 for The Scan. They can charge what they want but the insurance carrier has an allowed amount. They provider will likely use the excess unallowwd amount as write off. Only reason I know of to charge so much when they know it won't get paid.
This is illegal. Physicians cannot write off bad debt.
My pronouns are Deez/Dem.
STxBear81
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this is my guess.. i dont know what they really do. physiscian or radiology company not owned by MDs is that still illegal?
BearFan33
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It's a hopelessly complicated mess. Providers either sign a contract with medicare and insurance companies or they don't. Once they sign a contract, what they get paid for a service is set, regardless of how much they charge. The people with no insurance are hit with the big bill. Which of course they can't or don't pay.

As a provider, I can tell you that once you sign a contract, the games begin. Medicare and the insurance companies are constantly coming up things that you need to do to collect the payment for your service. Some hoops you have to jump through are so complicated that you need to hire people to help you jump through. These people may or may not know what they are doing. Of course their expense comes out of your end. Sometimes u jump thru the hoops only to be denied payment anyway. It's crazy.

With everything they pass in DC, it just continues to get worse. A lot (probably most) of the cost of healthcare these days is from all the administrate suprastructure that is required to navigate this dysfunctional system. The bureaucracy intrudes on the one time simple doctor patient relationship. It's a shame.

Please remember that physicians cannot unionize or collude to try to make things better. Insurance companies are allowed to collude against us, however.

I'm afraid we may have to burn it down to ever make it better.
STxBear81
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although i do not know legally what a Radiologist can or cant do. with regards to write offs for XRays or CT or MRI to a patient it doesnt seem illegal to write off the difference as allowed or unallowed debt. it would be if you allowed one person and not another. I would like to see what law or citation states that it is illegal for a radiologist to not do this for tax purposes
BellCountyBear
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BearFan33 said:

It's a hopelessly complicated mess. Providers either sign a contract with medicare and insurance companies or they don't. Once they sign a contract, what they get paid for a service is set, regardless of how much they charge. The people with no insurance are hit with the big bill. Which of course they can't or don't pay.

As a provider, I can tell you that once you sign a contract, the games begin. Medicare and the insurance companies are constantly coming up things that you need to do to collect the payment for your service. Some hoops you have to jump through are so complicated that you need to hire people to help you jump through. These people may or may not know what they are doing. Of course their expense comes out of your end. Sometimes u jump thru the hoops only to be denied payment anyway. It's crazy.

With everything they pass in DC, it just continues to get worse. A lot (probably most) of the cost of healthcare these days is from all the administrate suprastructure that is required to navigate this dysfunctional system. The bureaucracy intrudes on the one time simple doctor patient relationship. It's a shame.

Please remember that physicians cannot unionize or collude to try to make things better. Insurance companies are allowed to collude against us, however.

I'm afraid we may have to burn it down to ever make it better.
I always thought the AMA was physicians' lobbying arm? Are they getting paid off by insurance companies too?
Mitch Blood Green
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Oldbear83 said:

Just think about how insurance "works".

I had knee replacement surgery in January. Now I pay every paycheck for my insurance, and so does my employer. So my insurance company already gets paid.

But before anything else on my procedure started, I had to "meet my deductible". So in addition to paying every paycheck for my insurance, I have to pay again to satisfy this requirement.

Then, I still have to pay for the procedure and hospital and everyone associated with it. But since my insurance "covers" it, I 'only' have to pay 20% of the cost. Although it's really more than 20%, since I had to pay my deductible plus years of premiums.

Now that I am in recovery, I am seeing my doctor and doing rehab. I get to pay again for those, a "co pay" to the doctor and something more than 20% of the cost for my rehab, because rehab is "not fully covered".

Pay before you ever use it, pay a chunk of bucks when you decide to use it, then pay some or all of your costs and expenses when you use it.

And we're the "LUCKY" ones, because we 'have' insurance?




Get well, one knee. You're kicking off in September.
Gold Tron
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BornAgain said:

although i do not know legally what a Radiologist can or cant do. with regards to write offs for XRays or CT or MRI to a patient it doesnt seem illegal to write off the difference as allowed or unallowed debt. it would be if you allowed one person and not another. I would like to see what law or citation states that it is illegal for a radiologist to not do this for tax purposes


It is absolutely not permitted under current IRS regulations. We are the only industry that can neither barter or write off bad debt (if you are a Medicare provider).
My pronouns are Deez/Dem.
STxBear81
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i will take your word for it. But why in this instance the large discrepancy in billing for something that pays 1000$? Makes no sense
BearFan33
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BellCountyBear said:

BearFan33 said:

It's a hopelessly complicated mess. Providers either sign a contract with medicare and insurance companies or they don't. Once they sign a contract, what they get paid for a service is set, regardless of how much they charge. The people with no insurance are hit with the big bill. Which of course they can't or don't pay.

As a provider, I can tell you that once you sign a contract, the games begin. Medicare and the insurance companies are constantly coming up things that you need to do to collect the payment for your service. Some hoops you have to jump through are so complicated that you need to hire people to help you jump through. These people may or may not know what they are doing. Of course their expense comes out of your end. Sometimes u jump thru the hoops only to be denied payment anyway. It's crazy.

With everything they pass in DC, it just continues to get worse. A lot (probably most) of the cost of healthcare these days is from all the administrate suprastructure that is required to navigate this dysfunctional system. The bureaucracy intrudes on the one time simple doctor patient relationship. It's a shame.

Please remember that physicians cannot unionize or collude to try to make things better. Insurance companies are allowed to collude against us, however.

I'm afraid we may have to burn it down to ever make it better.
I always thought the AMA was physicians' lobbying arm? Are they getting paid off by insurance companies too?


I think the AMA tries (kinda)but Is generally staffed by weaklings that don't fight. Also they are mainly academic folks that aren't paid like the community physician. They get paid by training residents mainly.
Someone like fauci runs the ama
Oldbear83
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tommie said:

Oldbear83 said:

Just think about how insurance "works".

I had knee replacement surgery in January. Now I pay every paycheck for my insurance, and so does my employer. So my insurance company already gets paid.

But before anything else on my procedure started, I had to "meet my deductible". So in addition to paying every paycheck for my insurance, I have to pay again to satisfy this requirement.

Then, I still have to pay for the procedure and hospital and everyone associated with it. But since my insurance "covers" it, I 'only' have to pay 20% of the cost. Although it's really more than 20%, since I had to pay my deductible plus years of premiums.

Now that I am in recovery, I am seeing my doctor and doing rehab. I get to pay again for those, a "co pay" to the doctor and something more than 20% of the cost for my rehab, because rehab is "not fully covered".

Pay before you ever use it, pay a chunk of bucks when you decide to use it, then pay some or all of your costs and expenses when you use it.

And we're the "LUCKY" ones, because we 'have' insurance?




Get well, one knee. You're kicking off in September.
Been practicing. Look forward to 10 yards by start of season, so maybe we should just do onside kicks all the time
That which does not kill me, will try again and get nastier
Mitch Blood Green
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Oldbear83 said:

tommie said:

Oldbear83 said:

Just think about how insurance "works".

I had knee replacement surgery in January. Now I pay every paycheck for my insurance, and so does my employer. So my insurance company already gets paid.

But before anything else on my procedure started, I had to "meet my deductible". So in addition to paying every paycheck for my insurance, I have to pay again to satisfy this requirement.

Then, I still have to pay for the procedure and hospital and everyone associated with it. But since my insurance "covers" it, I 'only' have to pay 20% of the cost. Although it's really more than 20%, since I had to pay my deductible plus years of premiums.

Now that I am in recovery, I am seeing my doctor and doing rehab. I get to pay again for those, a "co pay" to the doctor and something more than 20% of the cost for my rehab, because rehab is "not fully covered".

Pay before you ever use it, pay a chunk of bucks when you decide to use it, then pay some or all of your costs and expenses when you use it.

And we're the "LUCKY" ones, because we 'have' insurance?




Get well, one knee. You're kicking off in September.
Been practicing. Look forward to 10 yards by start of season, so maybe we should just do onside kicks all the time


Keep doing the work. Get well.
4th and Inches
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bularry said:

fadskier said:

BornAgain said:

if they cant explain it then it shouldnt be billed
Billing told me to request the patient file that would reveal the codes...when I talked to that office they said that I would not understand the codes because they were medical codes.
yeah, that is all hospitals know.. billing codes..


had an issue when my daughter was about 13 and night had a violent regurgitation episode and our pediatrician said take her to an ER. so my wife did and they went, sat in a room, they did vitals and a pregnancy test and by then she wasn't getting sick any more and was able to drink some water and hold it down... so they came home.


My bill was almost $3k. I told them to F off and paid $180. crazy, because the "visit" triggered all these billing codes for things that were never done on my kid.
diagnosis related macros- tells drs what to do and admin office what to bill for... on flip side the ins company has DIagnosis related guidelines for reviewing the claims for payment. Its a chess game with your health and your money...
JXL
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fadskier said:

I have always said that our health care system is broken (as far as insurance is concerned)...my son went to wound care for four months with a copay of $52.16...it ended Dec 31, 2020. I get a bill for $1,378 for his vistis all the way back to September. I call and ask...billing tells me it is my deductable. I say, I didn't ask that question. I wanted to know why I wasn't billed monthly (no explanation) and why it costs so much...again I get the that's your deductable...again, I say...not my question. What is the cost? They don't know and direct me to another department whrere I have to request itemized bills. I submit request.

I get a packet of pages where every visit to woulnd care is $574 and with visits have an additional $950 added on. I call and ask what these charges are for....no one can answer except say that the amount is not what I owe bu twhet they are billing insurance for. Yes, I know what what was done in wound care that merits $574 and $1,400...no answer,...treansferred to patient care...patient care understand my frustration and will ensure that I get answers...that was a month ago. I got a new bill saying that I am part due.

Maybe it's time for a different way to do this.


Pretty much every developed country in the world does health-care billing better than we do,
Gold Tron
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JXL said:

fadskier said:

I have always said that our health care system is broken (as far as insurance is concerned)...my son went to wound care for four months with a copay of $52.16...it ended Dec 31, 2020. I get a bill for $1,378 for his vistis all the way back to September. I call and ask...billing tells me it is my deductable. I say, I didn't ask that question. I wanted to know why I wasn't billed monthly (no explanation) and why it costs so much...again I get the that's your deductable...again, I say...not my question. What is the cost? They don't know and direct me to another department whrere I have to request itemized bills. I submit request.

I get a packet of pages where every visit to woulnd care is $574 and with visits have an additional $950 added on. I call and ask what these charges are for....no one can answer except say that the amount is not what I owe bu twhet they are billing insurance for. Yes, I know what what was done in wound care that merits $574 and $1,400...no answer,...treansferred to patient care...patient care understand my frustration and will ensure that I get answers...that was a month ago. I got a new bill saying that I am part due.

Maybe it's time for a different way to do this.


Pretty much every developed country in the world does health-care billing better than we do,


Blame Medicare. And people want government totally in charge of medicine...
My pronouns are Deez/Dem.
LTbear
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Oldbear83 said:

Just think about how insurance "works".

I had knee replacement surgery in January. Now I pay every paycheck for my insurance, and so does my employer. So my insurance company already gets paid.

But before anything else on my procedure started, I had to "meet my deductible". So in addition to paying every paycheck for my insurance, I have to pay again to satisfy this requirement.

Then, I still have to pay for the procedure and hospital and everyone associated with it. But since my insurance "covers" it, I 'only' have to pay 20% of the cost. Although it's really more than 20%, since I had to pay my deductible plus years of premiums.

Now that I am in recovery, I am seeing my doctor and doing rehab. I get to pay again for those, a "co pay" to the doctor and something more than 20% of the cost for my rehab, because rehab is "not fully covered".

Pay before you ever use it, pay a chunk of bucks when you decide to use it, then pay some or all of your costs and expenses when you use it.

And we're the "LUCKY" ones, because we 'have' insurance?


I'll probably have to join the ranks of terminator knee someday, but I'm trying to put it off for another couple decades.
Oldbear83
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LTbear said:

Oldbear83 said:

Just think about how insurance "works".

I had knee replacement surgery in January. Now I pay every paycheck for my insurance, and so does my employer. So my insurance company already gets paid.

But before anything else on my procedure started, I had to "meet my deductible". So in addition to paying every paycheck for my insurance, I have to pay again to satisfy this requirement.

Then, I still have to pay for the procedure and hospital and everyone associated with it. But since my insurance "covers" it, I 'only' have to pay 20% of the cost. Although it's really more than 20%, since I had to pay my deductible plus years of premiums.

Now that I am in recovery, I am seeing my doctor and doing rehab. I get to pay again for those, a "co pay" to the doctor and something more than 20% of the cost for my rehab, because rehab is "not fully covered".

Pay before you ever use it, pay a chunk of bucks when you decide to use it, then pay some or all of your costs and expenses when you use it.

And we're the "LUCKY" ones, because we 'have' insurance?


I'll probably have to join the ranks of terminator knee someday, but I'm trying to put it off for another couple decades.
One thing I learned, is that it's important to start exercises and certain therapies before the surgery, to make recovery easier.

Also, do your homework on your surgeon. I am very happy with my results, because I used a board-certified Orthopedic surgeon who not only has a lot of experience with knee replacement, he has written articles published in the AMA Journal. Internet is a good tool for that, as is finding out from former patients how things went.

And most of all, rehab rehab rehab rehab rehab rehab rehab rehab rehab rehab rehab rehab rehab rehab rehab!
That which does not kill me, will try again and get nastier
BearTruth13
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fadskier said:

I have always said that our health care system is broken (as far as insurance is concerned)...my son went to wound care for four months with a copay of $52.16...it ended Dec 31, 2020. I get a bill for $1,378 for his vistis all the way back to September. I call and ask...billing tells me it is my deductable. I say, I didn't ask that question. I wanted to know why I wasn't billed monthly (no explanation) and why it costs so much...again I get the that's your deductable...again, I say...not my question. What is the cost? They don't know and direct me to another department whrere I have to request itemized bills. I submit request.

I get a packet of pages where every visit to woulnd care is $574 and with visits have an additional $950 added on. I call and ask what these charges are for....no one can answer except say that the amount is not what I owe bu twhet they are billing insurance for. Yes, I know what what was done in wound care that merits $574 and $1,400...no answer,...treansferred to patient care...patient care understand my frustration and will ensure that I get answers...that was a month ago. I got a new bill saying that I am part due.

Maybe it's time for a different way to do this.


Wait, you are actually admitting our "beautiful" health care system sucks?
TechDawgMc
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It's an unsustainable mess. I really think we need to move to something close to the British system. (pause for screams of socialism--ok that's done).

The multi tiered approach they use means everyone can get care, but if you can afford it, you can get quicker access to things like knee replacements. But you're never surprised by the billing. And the ability of a pharmacist to give you something strong for a simple cold was nice as well.

Despite all the comments from the right here, I didn't meet anyone in England that didn't love the system -- including both expatriate Americans and local Brits. We were there for four months. Had to use the system a few times. If you had to go to the emergency room, it wasn't blazingly fast (of course, what's new about that?) but it was quality care and there was no charge.
Beaneater
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Public price tags. Posted on the medical provider's web site, published in pamphlets available at the provider's office.

Just like every other service provider, docs, hospitals, labs, etc should be required to tell people what it costs before the consumer says "ok go ahead." That way, the consumer can shop for the best deal. the best deal may be taking the more expensive option, because the more expensive doc is better, but at least the consumer knows what he/she is getting into.

Then, the insurance company publicly says what it will pay. Doc charges 10k and insurance pays 5k? Consumer has a conversation with the doc. Doc says I'll take the insurance payment and you owe $1500. Consumer says I'll pay $500 or I'm going to a different doc. (Just like shopping for a car.) Doc says deal, consumer says ok, let's go.

What a concept--to know the price of the can of beans before you put it in your cart.

Anyway, it seems to me the answer is transparency. What does the provider charge? Tell me in advance. What will the insurance pay? Tell me in advance. Then the consumer makes the call.

The lawyer, accountant, and architect tells you in advance what the charge is and how the price can vary based on what may be needed (usually via an hourly rate). Why can't doctors do the same thing?

Sounds like capitalism to me.
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