An American Sickness: How Healthcare Became Big Business and How You Can Take It Back by Elisabeth Rosenthal
(what is wrong)
- Medical Devices
- Testing/Ancillary Services
- Contractors, billing, coding, etc.
- Research and good works for profit
- Healthcare as business
Economic Rules of the Dysfunctional Medical Market
- More treatment is always better. Default to the most expensive option.
- A lifetime of treatment is preferable to a cure.
- Amenities and marketing matter more than good care.
- As technologies age, prices can rise rather than fall.
- There is no free choice. Patients are stuck. And they're stuck buying American.
- More competitors vying for business doesn't mean better prices; it can drive prices up, not down.
- Economies of scale don't translate to lower prices. With their market power, big providers can simply demand more.
- There is no such thing as a fixed price for a procedure or test. And the uninsured pay the highest prices of all.
- There are no standards for billing. There's money to be made in billing for anything and everything.
- Prices will rise to whatever the market will bear.
(what you can do)
Chapter 13: Doctor Bills
Questions to ask your doctor:
- Is the practice owned by a hospital or licensed as a surgery center? (Answer should be No)
- Will you refer me only to other physicians in my insurance netwrok, or explain in advance if you can't?
- If I need blood work or radiology testing, can you send me to an in-network lab?
- Will there be charges for phone advice or filling out forms? Is there an annual practice fee?
- If I'm hospitalized, will you be seeing me in the hospital? What is your coverage on weekends?
Questions to ask any healthcare provider:
- How much will this test/surgery/exam cost?
- How will this test/surgery/exam change my treatment?
- Which blood test are you ordering? Why?
- Are there cheaper alternatives that are equally good, or nearly so?
- Where will this test/surgery/exam be performed and how does this impact the price?
- Who else will be involved in my treatment? Will I be getting a separate bill from another provider? Can you recommend someone in my insurance network?
Chapter 14: Hospital Bills
What you can do:
- Vet your hospital beforehand
- Make it clear you did not request a private room
- Before signing financial documents, write in "as long as the providers are in my insurance network"
- Ask if you are being admitted under "observation status"
- Ask to know the identity of every person who appears at your bedside, what he or she is doing, and who send him or her. Write it down.
- If the hospital tries to send you home with equipment you don't need, refuse it
Dealing with bills:
- If you receive an outrageous bill, negotiate
- Request itemization
- Check the bill against your notes from the hospital
- Protest bills in writing to create a record
- Argue against surprise out-of-network bills
Chapter 16: Drug and Medical Device Costs
- Shop around
- Consider imports
- Be skeptical of advertising
Chapter 17: Ancillary Services
- Only use in-network providers
- Avoid having tests sent to a hospital lab
- Ask for a printout of your results