April 23: Doctors experiment with a single price, single bill for surgery

  • Article by: Jackie Crosby , Star Tribune
  • Updated: August 10, 2013 - 10:11 PM

So-called “bundled” procedures are gaining popularity here and nationally.

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swmnguyApr. 22, 13 9:31 PM

If this really is an effect of the Affordable Care Act, then this would be the first part of it I've heard of that I would whole-heartedly support. The Fee-For-Service model is the heart of the crisis in healthcare finance which is bankrupting America. If Obamacare forces the medical industry to disclose pricing and honor estimates, like every other industry, that's fantastic. Nobody should deal with any business that won't provide upfront transparency about pricing, and since healthcare providers insist on getting paid, they need to be held accountable.

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SammyBoyApr. 22, 1310:24 PM

Towards the end of the article, you see the natural culmination of healthcare: Direct Employer Contracting. As you might have seen in the Business section, UnitedHealth Group reported that they were going to see a significant reduction in revenue because a large client was moving to a "self-funded" contract. What that means is that the employer or group in question has turned UnitedHealth Group into a backroom accounting office that handles the claims payments. Now, it's more complicated as UnitedHealth Group and other insurers maintain their provider networks that have contractual requirements for payments in exchange for being listed as "in network" for curious consumers, but the fact of the matter is that insurers will find themselves marginalized more and more as large and even medium employers develop their own models of healthcare delivery and rely on the insurers are sources of best-practices data and claim payments from a company-managed fund.

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mcjoe1Apr. 23, 1312:06 AM

Sounds like a great idea.. but it also sounds a lot like Medicare's fixed rate reimbursement model than anything else. All it's going to take is some conservative talking heads to trash the idea and it'll fall apart. "Flat rate medicine is socialism.. you should only pay for what you use.. etc.." Maybe one day we'll be able to ignore these folks and create healthcare and goverment programs that work efficiently. The Medicare model is the only insurance model that's able to control costs in the healthcare industry. It's the only healthcare coverage that appears to rationalize that a $2,000 medical device shouldn't be billed to a patient at $20,000, and will instead institute a maximum reimbursement rate of say $4,000.

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mnpikeyApr. 23, 13 1:17 AM

I just had a simple, 3 hr, outpatient, shoulder surgery in Feb and am still getting different bills. Anesthesia $1600, facility charge over $16,000. Surgeon charge over $21,000, etc...another bill from the same company but JUST for a sling. One bill for the pre-op Anesthesia, one for the in surgery Anesthesia. Both from the same health care company but billed seperately and to different addresses/departments? Just ridiculous.

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handsomepeteApr. 23, 13 3:01 AM

"The Affordable Care Act is spurring a host of efforts to make health care more patient-friendly and less costly." Complete lie. It has been widely known for many, many years that if you arrange to pay your surgery bill upfront you can achieve significant savings with many providers. The reason is because the uncertainty of payment has been removed and also the labor costs of having staff deal with insurance companies (and patients) for payment has been eliminated. I remember hearing about this 15 years ago! The only thing in this propaganda article I have read that sounds unique is the "unlimited physical therapy appointments" which I expect has some limitation applied to it as I do not see any clinic that is going to provide a lifetime of weekly physical therapy appointments for one low cost.

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comment229Apr. 23, 13 4:03 AM

mnpikey: we've all seen what you have many times over. The last two we had were "slippers" for a price you would not believe. The same stretch slippers were under $3 at Walmart. Another person I know had to pay for an entire tube of a medication, even though a small amount was used. The nurse who was her care giver, told her to demand that if she paid for it, that she would get the "rest of the tube" before going home. She did, but what a joke. The two dollar aspirin, is still there, and until that ends, health care is going to be more and more, for a few select Americans. Our health care system is probably the best in the world, that more and more Americans cannot afford to use.

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YoganaziApr. 23, 13 5:46 AM

A 3 day ip hospital stay is required for Nursing home benefits. If you need more rehab services, or medical care that does meet hospital criteria, your nursing home stay won't be covered by your insurer.

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capsule2Apr. 23, 13 7:22 AM

handsomepete: It has been widely known for many, many years that if you arrange to pay your surgery bill upfront you can achieve significant savings with many providers. - So how many times have you or someone you know arranged this? None? It took the ACA to bring this about and hopefully make it a reality across the board.

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bobby2478Apr. 23, 13 8:08 AM

capsule2: I've inquired about this, and the facility I spoke to in the cities said they don't negotiate upfront payment if it goes through insurance. So as long as you have health insurance, they bill your insurance company and your insurance can negotiate "usual and customary" discount, but that's it. So your scenario appears to only work if you have no insurance at all, which wouldn't be an ideal scenario. On a side note, I got 2 different quotes from this facility for facility and anesthesia charges. $2,000 if the procedure was elective (and I pay out of pocket), or $7,700 if it gets billed through insurance. I'm going to tell my insurer, they shouldn't have to pay over 5,000 more for the exact same procedure

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edoggyApr. 23, 13 8:18 AM

SammyBoy - Self funded contracts are not new. As a matter of fact, most employers with over 200-250 employees self fund their healthcare. They buy stop loss protection from an insurer and "self insure" up to a certain max for each member. It's commonplace in todays group insurance market. One of the major issues with healthcare today is the so called "transparency" that insurance carriers say they are for, but don't practice what they preach. Example: Blue Cross of Mn will not release claims information for self insured groups to help their members find a better quality/lower cost MRI, or lab procedure. Instead, they tell the members they HAVE to use their online tool, which costs the employer more money in administration fees. Its typical of BCBSM to do what's best for them and not for their members.

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