Why can’t in the American healthcare system get to know how much I am liable to pay right when I walk into the doctors office? Doctor office will say contact the insurance, who will say it depends on how it’s billed and to go back to the billing department of the provider. Any end in sight for this ridiculous and joke of a system?

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Because there is rarely any way to know exactly what’s going to happen when you go to the doctor. For example: I go to my dermatologist for a full-body skin check every quarter (history of multiple types of skin cancer). The exam itself is one procedure and one ICD-10 code. While I’m there, there is a good chance that I’ll need a biopsy or two, and removal of some precancerous spots. All of these are different procedure codes. What ultimately gets charged is a combination of them all. The insurance company has “negotiated” rates for every procedure code, and you may have a deductible or coinsurance to meet, so unless you’re going to the doc for one specific thing and that thing only, there’s almost no way they can tell you in advance how much your visit will cost.

Note: I’m not saying this is right or the way it *should* be, just that it’s the way it *is.*

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Adding on to what BAH1 said, I went to the ortho two weeks ago for lingering shoulder pain. While I was there, the doc ran a standard battery of physical tests to identify any issues detectable at that level.

He then had me do some x-rays which showed minor deformation in my shoulder blade which could impact the shoulder pain. I then had an MRI which showed small years in the muscles in the shoulder.

The standard battery of physical tests would have been the only thing the ortho would have known to bill up front, everything else came out as a result of that examination.

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The US operates in a fee for service environment where the specific health plan you have through your employer dictates the amount you will pay based on a variety of variables, including what your provider bills (15 min sick visit, 15 min follow up, 90 min annual, etc) and the specific diagnosis and procedure codes (10 mm skin biopsy, detailed history, etc)

The technology exists to make price more transparent, but that it's not in everyone's best interest to make the information more accessible or to make the investment needed to build a system so that patients can easily and quickly see information that is most relevant to them.

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At most of my doc appointments, the claim w/Dx and procedure codes is submitted electronically to my insurance company while I’m in the office and I’m asked to pay my portion of the bill on the spot. I don’t get any additional bills after that, except in the case of procedures that require anesthesia (they can’t ask you to sign things after you’ve been under GA), or if I’m at a provider that isn’t a “participating” provider with my insurance plan. A week or so later I get the explanation of benefits with the codes on it.

I agree that it’s a ridiculous system and the inefficiencies, waste, and lack of transparency contribute enormously to the stupidity that is healthcare in the U.S.

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Super relevant to this bowl

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Read American Sickness. Great book with great recommendations.

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Seconded. This is by far the best analysis I’ve read re: the problems in the American healthcare system.

Strongly agree and it should be a thing in a developed country. My mom wanted to get her tonsil removed in Hong Kong and the doctor was able to give her a price before the surgery. The surgery itself came out within 100 USD of the quoted price. This won't be possible in the US

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Republicans

funny

It's a legal a cam where patients have no say.

Because it’s a business. Insurers want to save as much money as possible. Doctors want to get as much money as possible.

And that begins the debate

Yes but let’s not also forget about the advancement of healthcare technology that’s mostly unique to the US. In Canada or Ireland, it’s very difficult to find/get into a specialist and most people go through their primary care doctor. Or another example is how the US is able to perform arthroscopic surgeries regularly while this barely happens in Europe.

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