They Got Estimates Before Surgery — And A Bill After That Was 50% More

Jan 2020
Dan

A patient recently experienced the price transparency issue that plagues the healthcare industry when he went to get non-emergency hernia surgery. Even after working diligently to get price estimates from the hospital and surgeon before the surgery, his actual bill after a successful surgery was 50% higher. Medxoom’s proprietary pre-service price and quality comparison tool allows fast simple price searches based on any health plans historical payments data.

From Kaiser Health News:

“The hospital told him that the normal billed rate was $10,333.16 but that Cigna, his insurer, had negotiated a discount to $6,995.56, meaning his 20% patient share would be $1,399.11. The surgeon’s office quoted a normal rate of $1,675, but the Cigna discounted rate was just $469, meaning his copayment would be about $94. (Although the Balzers made four calls to the anesthesiologist’s office to get a quote, leaving voicemail, no one returned their calls.)

“Having an estimate means you can make an argument with your provider and insurer that you shouldn’t be charged more than you expected. It could work.

Laws requiring some degree of accuracy in medical estimates would help. In a number of other countries, patients are entitled to accurate estimates if they are paying out-of-pocket. “There’s no other consumer industry where this would be tolerated,” Farren wrote in an email.””

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