I like the notion that any normal person should ask for a discount with health-care bills, Paul! –ask questions about prices Beyond that, two thoughts to your points: I advocate that ALL imaging studies be billed at cost plus fair profit percentage. In the 8 years since, nothing much has changed about it. I am one of a few surgeons in the Southern California Kaiser Permanente region who uses robotic surgery for the treatment of bladder cancer and who performs cryoablation (freezing) treatment of the recurrent prostate. So I talked to the office mgr who said if I paid upfront and agreed not to report the procedure to Blue Cross, that it would be $580.”. First off, I am under wc (workers compensation) now for my back, and although my case is moving towards settlement (finally), the third-party insurers for my former employers, have refused to approve almost all the treatment my doctors have asked for the care of my not-so-good lumbar spine. No, transparency has to come from changes in the system (the way we pay for services) or from non-governmental groups that step up to inform the public. Can you ask for a discount? It set a reference price of $30,000 and 46 of the 110 hospitals in the region agreed to do the surgeries for that price. It is interesting that on the largest physician only internet forum (SERMO) how paranoid docs are about sharing prices. 6: Provider, Vallejo MRI on Glen Cove Marina Road in Vallejo; insurer, Blue Cross. After numerous denials, living with increased pain and symptoms, recently, I asked my doc what would a radiology center charge me as a cash patient and his answer was around $850. I have proposed the creation of specialized Health Courts. A note: We are often asked in this crowdsourcing prototype project if we believe what we are being told by people who fill out our online form at the PriceCheck page. Meanwhile, the confidentiality agreements between insurers and providers need to be eliminated so both patients and referring doctors can easily learn the insurer’s contract payment rate before services are rendered. Couple of questions for you. It’s also important to note that roundly 50% of inpatient hospital admissions come through the emergency room. Yeah, there’s all kinds of things wrong with that, but I think that’s what he had to do in order to avoid such a gross abuse of his pt. Another odd pricing quirk, that doesn’t seem intuitive, is that it cost more to X-ray a finger than it does an ankle at Kaiser. So although they made a mistake, it was not of the nature of springing unanticipated charges on me after the fact. In those countries docs determine the “need” while some restrictions on access is required for the cost. That’s their business model (insert deep and gusty sigh), http://www.nytimes.com/2013/05/17/business/bayonne-medical-center-has-highest-us-billing-rates.html?pagewanted=all&module=Search&mabReward=relbias%3Ar%2C%7B%221%22%3A%22RI%3A10%22%7D, Did you challenge the $2,300? What they billed separately for the facility was $0, for the anesthesia $0. Or the $600 one. This person was charged $1,660 and paid $1,660, out of HSA funds. So in order to stay in business, imaging centers will bill “twice Medicare,” to use typical jargon. Yet, the hospital records got updated from the clinic with the correct address, so I got those bills. The Medical Group operates under three corporate umbrellas; Kaiser Foundation Health Plans, Kaiser Foundation Hospitals and … Had I been uninsured, they would actually have tried to bill me more. The problem goes much deeper…it is systemic. Provide Emotional Personal Protective Equipment (PPE) for Physicians Facing Psychological Trauma From the COVID-19 Crisis, We Need to Fix COVID-Damaged Care Sites and Give the Country Better Care and Universal Coverage in the Process. Santa Cruz. This person was charged $973.25 and paid $973.25; insurance paid nothing. Clearly, though, there needs to be better billing transparency so that people know that, in the majority of cases anyway, it is not that doctors are greedy. Also one of our community members sent in a pricing sheet for imaging procedures from Health Diagnostics (see below). Be the first to see new Kaiser Permanente jobs 1. But the situation is SO corrupt, SO far out of control, with the money-makers in charge, you’re right: only crowd-sourcing from the grass roots will go around the perverted structures. For questions, please call (818) 901-6600. 3. It seems that this crazy system could be fixed by allowing providers to bill patients and insurers the rate that the insurer has agreed to pay or, in the case of the public insurers, their administered price. One person, at Imaging Healthcare Specialists in San Diego, was charged $1,984, insurance paid $0, and the patient paid $305. Charged price, $466.69; insurance paid, $459.03; you paid, $0. The list price turned out to be $1,800 but my insurer’s contract rate was $495 of which my share was 20% or $95. It’s hard to defend that from any perspective, if you ask me. Thank you so much! The court’s opinion would be binding. If a firm decides to send huge bills to non rich customers, they go broke. And, irony of ironies: a friend who’s a health economist says that some European nations with variations of single-payer are looking to private enterprise to save them from the effects of rising health costs on their government health outlays. Think what happened to airline ticket sales, real estate sales, car sales when transparency came. $84K Kaiser Permanente MRI Technologist without location (1 salary) +$22K (30%) more than national average MRI Technologist salary ($62K) +$23K (31%) more than average Kaiser Permanente salary ($61K) Advertisement. The comment: “At the time I was billed for this procedure, Kaiser Permanente did not have on record that I was covered under COBRA. hospital stay - free. However, there is a published national rate for the procedure. Prior to wc I fought my private insurer (starts with a B) for back surgeries, which I got, but with them or wc, there is a common thread: they do not play by any rules and they do not have the patients best interests in mind. Now what’s really interesting here is that they were not being greedy or trying to screw me–this turned out to be an extremely competitive provider. We could not find it on the Health Diagnostics website, so we are reproducing what was scanned and sent here. Rather like the situation in postwar Europe, where the Communist party was a real threat and the parties in power enacted many social benefits so as to keep out the Communists. Barry I would be delighted with the regulatory changes that you propose. Skip to Job Postings. Kaiser spends approximately $10 million dollars annually in training in the Southern California Region. Emergency care by a physician, level 2 $205. How Much Does an MRI with and without Contrast Cost? Those on high deductible health plans or without insurance can shop, compare prices and save. MRI Technologist salaries at Kaiser Permanente can range from $92,328-$165,204. I’ve been told, however, that most hospitals now require non-employee doctors who practice in the hospital to be members of the same insurer networks that the hospital itself participates in. I received a letter from the state wc entity that they were requesting missing info from the wc company they needed to determine the IMR. Directory. I have personally been hit with this issue with my daughter’s dentist bill. Usually, the letter gets forwarded to the appropriate department in the organization and it just about always gets resolved to my satisfaction on a timely basis. I take it that they consult and develop data/info and then sell it to practitioners. Or would you rather discuss that issue with a physician, who is preferably free of financial attachments to said study/test? My proof? *Depending on your plan, these services may be preventive and covered at no cost or at a copay. Doctors should be able to walk into any hospital and perform any procedure that is necessary for the patience well being. The point of the “discount request” is precisely because there is such a wide disparity between “actual cost” and “billed charges.” While this may be distasteful, it is the practice that has been in place. Prediction: watch for a move to prohibit crowd-sourcing of price data, complete with assertions that the resulting conclusions would be unreliable. Charged price, $319.92; insurance paid, $223.72; you paid, $96.20. On MDsave, the cost of an MRI with and without Contrast in California is $1,340. For more complex procedures like heart surgery, credible quality information is also critical but the transparency movement appears to be gaining some momentum albeit slowly. Here’s one example: DOJ brought an antitrust action against BCBS of Michigan re: MFN clauses and then dropped it when the state legislature banned MFN clauses. Patients must meet the eligibility requirements below to qualify. Those are supposed to be 100 percent covered under the ACA (though we are learning that they are not always — quite often people are asked to pay a portion as deductible or co-insurance). Sometimes they say the claim is denied, other times they ignore what tests show. Vuong again declined an MRI and referred Anna to Kaiser‟s physical therapy department. Number two: would love to see a infographic highlighting the range of options you’ve found! If my neighbor wants a $6,000 MRI, she should have it — just don’t make me pay for it! Charged price, $3,163; insurance paid $0; you paid $3,163. It would be enormously helpful if this information were readily ascertainable in a systematic way in real time. For that same procedure — the price of an MRi in the New York area … Need to shop around assuming can even get a price quote.”, No. I completely agree, we need regulators. Your email address will not be published. The comment: “Insurance paid $0 because deductible not yet met.”, Another person, at Kaiser Permanente Medical Center on MacArthur Boulevard in Oakland, who is insured by Kaiser, was charged $2,294 and is being billed for $2,294. My family has Kaiser Permanente HSA Plan with individual deductibles of $2,700 and family of $5,450. 323-857-2421(4605) - Southern California Kaiser Foundation Hospital - Los Angeles CA - Get direction to this MRI center. IMHO, I am not the greatest speaker, however, but I do have a love for writing. Comment: “Aetna did not actually pay $5,647. When I’ve had disputes in the past with hospitals, insurers or large companies in general that I was unable to resolve through normal channels, I’ve written a polite letter to the CEO summarizing the facts and my preferred remedy. Six Kaiser Permanente hospitals have been recognized among the world’s best hospitals by Newsweek magazine. My favorite resolution actually involved a colleague of mine who received hospital and doctor bills totaling about $20K that our employer’s health insurer initially refused to pay following an inpatient surgical procedure because she failed to notify them after she went to the ER late at night. Although their billing sheet used by the doctors correctly describes it, the code used is actually for draining via incision not by cautery needle. They had 15 days to respond or they would be fined $4,500 and I might be granted the IMR. We’re eager to learn! The facilities of a Southern California Kaiser campus should be similar to that of Northern California. To foster price transparency, regulators or legislators need to eliminate the confidentiality agreements between insurers and providers that currently preclude the disclosure of actual contract reimbursement rates. How much does a ct scan cost at kaiser It shows the estimated amount Kaiser Permanente members would be charged for certain It doesn't include costs for hospital services, facility fees, or other kinds of services. At this time I do not know who will supply the political pressure to get them enacted, however. If it was preventive, why were they telling you you need to pay 40 percent? COBRA should pay for this eventually, once everyone’s paperwork gets caught up. Yes, Massachusetts is wrestling with price-fixing. I asked my referring neurologist what it would cost but he didn’t know. It’s taken me months to sort this out! We’re looking for writers & cross-posts. That sounds like it would pretty much match why they got Medicare to stop reporting “never events.”. Keep going. 1. was it a regular preventive colonoscopy? Is triage making some wait in line unethical? Medical Malpractice – MRI Misread. As of 3 years ago, I believe about 20 states had MFN clause bans on the books. Kaiser Permanente of Northern California provides grants, technical assistance, communications support, and other services to community organizations that serve low-income, at-risk communities. People without insurance could be billed at some reasonable percentage above Medicare which I would define as 115% and perhaps a bit more for outpatient services for which Medicare tends to underpay more than inpatient services. Also, New Jersey: Ah, that hospital. Within a short time, another dozen or so agreed to the price so as not to lose business. This is very similar to the one coded 72148, and usually the prices are comparable. Where do you live? Our heretical notion: make it possible for the people to disclose those confidential rates, without waiting for state legislators, insurers, providers and all the other parties to come to an (improbable) agreement on disclosure, making such an agreement moot. But the former two remain as issues to overcome. Really. (This is another issue – I’ve been covered under COBRA for nearly 6 months, but this information was not communicated to KP’s MRI Department, despite my numerous calls to KP and the COBRA insurer. With such clauses in place, providers couldn’t offer discounts without having the discounted price applied to a whole lot of their volume, and so they were loath to do so. No. Clinical services are provided by providers or contractors of the Southern California Permanente Medical Group. We are all in this together, and the billing people — and the docs, the hospital administrators, the Big Pharma folks, the insurance phone bank folks — are patients too at some point. So … TAKE BACK THE BILLS. Patients incurred no penalty for choosing a high cost center and quality was deemed to be comparable no matter where they went. The machine and the personnel involved don’t really care whether the image is of the stomach, back, liver, brain or whatever. I still think that health courts could be like a nuclear option that is not enacted, but is threatened so that some action does take place. Longer term, I’m optimistic about this. This is why I’ve been saying for a couple of years now that, as part of every single medical encounter, people-commonly-called-patients MUST ask “how much is that?” before making any decisions about treatment with their care team. http://blogs.kqed.org/stateofhealth/2014/06/23/share-your-bill-make-health-costs-transparent-in-california/. This person was charged $973.25 and paid $973.25; insurance paid nothing. Read more about how MDsave works. Emergency care by a physician, level 4 (high severity) $455. If they set the amount at the Medicare rate plus 15%, that would be all that the health care provider could collect. They don’t understand or see the simplicity of eliminating this strange phantom billing practice that exists everywhere, in favor of a more one-to-one billing practice employed by many companies when they offer a product up for sale. So: We put our hand-collected survey prices in the database first, in both SF and LA areas: that’s the data that you can see that doesn’t have the “crowdsourced” flag. Kaiser Permanente is an HMO plan with a Medicare contract. If you have a similar issue in the future, writing to the hospital CEO is worth a try. And then I was never billed again. Washington, DC 20037 202-419-6250 . For example, an insurer could tell its members it will pay $500 for CPT-4 code 72146 and here is a list of 10 hospitals and independent imaging centers in the region that will do the test for that price. We hear quite often that bills are sent in error, and that when people call either the provider or the insurer, the response is “Oh, never mind, you don’t have to pay that.”. 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