Pricing out medical work

[Gin1984]

I have a HDHP health plan so I wanted to find the best prices for my blood draw and thyroid ultrasound.  I called around and was told they could not tell me the negotiated rate, only the insurance company could.  I called the insurance company who said that was impossible.  That the companies could give me approximations but no one could tell me the negotiated rate prior.  Has anyone has this issue and solved it?

[FiguringItOut]

I'd like to know answers to this too.  I need to get knees xrayed and have my blood work done as well and I haven't been able to figure out how to get an estimate for these.

When I was going to see my doc when I first signed up for HDHP, I called the office and asked what codes they will bill my insurance as this was a repeat appointment. They gave me two codes which were billed for the prior appointment.  I called insurance and insurance basically said they can't tell me for sure what they have negotiated with that particular doc, but estimated rates they have on file were a total of almost $400 for those two codes.  When I went to see the doc, the bill ended up being $126.
I also called doc office before to find out what their out of pocket rate would be if I didn't have insurance and they said it's normally $150, but they would discount it for me to $125. 

Also, I'm going to see a new doc tomorrow (switching docs) and this will be a new patient consult.  The new doc called me yesterday and said the insurance rate and what I would have to pay is $193.  I think it's reasonable as it is a new patient consult with tons of info that needs to be covered and recorded.  I expect follow up appointments to be cheaper and closer to $126 I paid with my old doc.

But now I also need to have my knees checked out and I have no idea what that will cost as it will involve xrays during the appointment.  Going to see doc, leaving for xrays, coming back to review xrays is not an options and will only cost more, I think.  I'm waiting till Jan to do that to start using up next years deductible.  I will not meat my 2015 deductible regardless, but there is a good chance I will meet and exceed 2016 deductible, so I'm pushing this till next year. 

[Leanthree]

I have a HDHP health plan so I wanted to find the best prices for my blood draw and thyroid ultrasound.  I called around and was told they could not tell me the negotiated rate, only the insurance company could.  I called the insurance company who said that was impossible.  That the companies could give me approximations but no one could tell me the negotiated rate prior.  Has anyone has this issue and solved it?

The best I was ever able to do was to negotiate my own rate with a Dr. (who owned the sports medicine practice) who then said if the insurance rate was lower I'd get charged the lowest of the two. At least then I had some cost certainty on the worst case. The insurance rate ended up being about 2% better than what we had negotiated prior so it was moot ultimately but therefore ultimately fair.   This was for a hand ultrasound A2 pulley injury and PT sessions which might be more straight forward than your issue.

[TheAnonOne]

I have a HDHP health plan so I wanted to find the best prices for my blood draw and thyroid ultrasound.  I called around and was told they could not tell me the negotiated rate, only the insurance company could.  I called the insurance company who said that was impossible.  That the companies could give me approximations but no one could tell me the negotiated rate prior.  Has anyone has this issue and solved it?

The best I was ever able to do was to negotiate my own rate with a Dr. (who owned the sports medicine practice) who then said if the insurance rate was lower I'd get charged the lowest of the two. At least then I had some cost certainty on the worst case. The insurance rate ended up being about 2% better than what we had negotiated prior so it was moot ultimately but therefore ultimately fair.   This was for a hand ultrasound A2 pulley injury and PT sessions which might be more straight forward than your issue.

I think PTs are a bit more like independent consultants with a value that is hard to quantify, so the rate can be negotiated a bit more.

[Million2000]

The lack of adequate pricing information is something that has astounded me since I got my first real job and health insurance. I don't think there is an easy answer beyond what others here have written. I find it ironic that the thing consumer driven healthcare and consequently HDHPs were supposed to do (get people to scrutinize health costs) is ultimately impossible given the complete lack of pricing information from doctors and insurance. That's why there is a whole class of professionals of "medical billing specialists" who need specialized training in order to accurately bill patients and insurance. 

[Capsu78]

I just left a conference this morning talking about how Healthcare providers are being forced toward "pricing transparency" by multiple federal agencies, including the IRS, so it is currently a VERY BIG topic.
I don't know if you will find your specific answer here but you might want to read this newish Consumer Reports article to at least get up to speed on some of the strategies for having a conversation with various providers.  It seems the first tip I heard at the conference is if they know you are "shopping around" and trying to be consumer savvy, you will get the most straight forward answers and maybe even some "...I'm not supposed to tell you this, but..." advice.

http://www.consumerreports.org/cro/healthinsurance/avoid-medical-bill-sticker-shock

[rantk81]

This is a huge issue, and I think it is ridiculous that the whole "billing/insurance" "system" is so complicated that nobody knows what anything is until it is "run through the computer."   It is also ridiculous how vastly different prices can be from one provider to another!  Like an order of magnitude (or two!) of difference in price!

If it is an emergency, there may not be time to "shop around", but you would at least hope you could shop around if you had time to plan it out!

I kind of hope our health system in the united states "blows up" as a result of the ACA, and we finally get a single payer system for everyone.

[firewalker]

The experiences I've had tells me that you won't get any real answers until you become a pit bull on the phone. Finally you will get "escalated" to someone who has the authority to ignore the script sheets and fudge the numbers on a case by case basis. It can take hours on the phone.

[DocMcStuffins]

I am a doc who owns his practice.  It depends if the practice is owned by a hospital system or if it is independent.  Generally independent offices will work with you more and are cheaper (especially if they do in-house xrays/labs).  When you talk to a place that is large or hospital based, there are too many layers to get a clear answer.  However, if you are talking about a smaller office or an independent one, when you call the office, ask them what the codes are for a level 4 visit.  If you are on a medication or two this is your level of visit (E&M code) the majority of times, so you can ask what is a level 4 visit as a new patient.  They have this specific number already negotiated with your insurer BUT what you must understand is that "Humana" or "Anthem" is not just one plan but is literally 50 different plans.  If you find a good office, let them know what your deductible is, what your copay is, and ask what a visit will cost.  The major reason most of the time you can't get an answer is b/c the billing department doesn't know what level of visit you will be (easy or complicated....goes from level 1 to 5), what ancillary services you will require like X-rays, injections, labs.  The more specific you are when you talk to them the more info you can give.  Also, if you have a really high deductible and don't expect to reach it and don't go to the doc much, ask what the cash / no insurance cost is.  I give an enormous discount for this.  Let me know if you have any questions more about this process.  I can help.