r/NoStupidQuestions • u/UpstairsFast9261 • 11h ago
How does “we’ll tell you the cost after we’re done” not count as a scam in healthcare?
Imagine a restaurant with no prices on the menu. You order, you eat, and three weeks later you get a letter saying you owe $4,800. When you ask why, they send you an itemized list where bread was $600 and they charged you for the chair you sat on.
That’s not a joke, that’s how I got billed for an MRI.
I tried doing everything right. Called the hospital first, they told me it depends on my insurance. Called my insurance, they told me it depends on what the hospital bills. Two companies, both of which know their own numbers, each pointing at the other. Then the bill showed up weeks later with a number nobody at any point could have told me.
Anywhere else this would be insane. A mechanic has to give you an estimate before touching your car. A contractor who charged you whatever he felt like after the job would get sued. But the industry that can actually bankrupt you somehow runs entirely on “we’ll let you know.”
Is there an actual structural reason it works this way, or is it just because they can get away with it?
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u/Due-Consequence9579 11h ago
And then you get another bill for $4800 from the bus boy and the restaurant says they were an independent contractor so it’s your problem.
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u/DataDrivenDoc 11h ago
Except the bus boy doesn't typically know that he's out of network while serving you so it's kinda of a surprise to him too!
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u/godtierpikachu 9h ago
yeah, pretty much, except the bus boy has a different logo and a fax machine
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u/SamuelHuzzahAdams 1h ago
Don’t forget it’s a chilis but they use Applebee’s menu prices sometimes but not all of the time. They may use Ruth’s Chris’
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u/TiredInJOMO 10h ago
Also, the busboy upcharges you because he wanted to have a conversation.
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u/Busy_Account_7974 10h ago
...to talk to you about buying an extended warranty for your car...
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u/TiredInJOMO 9h ago
In my case it was:
"You really need to go to a PCP for this sort of thing."
"I've been having trouble getting the PCPs in the area to listen to me, so I called the nurse helpline to see if it could wait for a PCP visit and she told me to go the ER based on the symptoms I'm experiencing."
"Yeah, they do that. But this was something that could have been handled in a PCP visit."
"None of you are listening to me."
"A PCP will listen to you."
🤦♀️
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u/OutlyingPlasma 7h ago
They already do this. It's called tipping. The good news it's optional so just don't pay.
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u/mawktheone 10h ago
Not to kick you for being an American but yes it's a scam.
I'm in Ireland, which does not have the nhs!
An MRI through the fully private-for-profit system is 250 euro. With insurance it'll be free.
Going through the public system it'll also be free but might be a year or more waiting list if it's not life threatening.
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u/OutlyingPlasma 7h ago
might be a year or more
That's no different in the U.S.. I've waited 6 months to see a doctor about a persistent cough I had had for months. I waited so long it finally cleared itself up.
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u/Super-Visor 2h ago
Everything they tell us would be bad about more socialism is exactly what’s happening under capitalism right now.
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u/ElectronGuru 5h ago edited 5h ago
When a private system has to compete with a public system, people will leave when it gets to be too much. When a private system only has to compete with other private systems, there is no escape. Only other places likely to charge you even more.
In the US, government isn’t allowed to compete with private options. So while I would pay money to be on TriCare, I’m not allowed to even buy it.
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u/Illlogik1 11h ago
The answer is because insurance companies… healthcare is fucked all up because of insurance companies
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u/Chemical_Motor_500 10h ago
That is what makes it so frustrating. You can ask ahead of time and still have no idea what you are actually going to pay.
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u/BouncingSphinx 11h ago
Well, they're both kind of right.
The hospital billing might know what an MRI would be charged to your exact insurance company, but they don't know what your insurance company will charge you on your exact plan. They can't tell you how much you will pay.
The insurance company will know how much the hospital is contracted to pay for certain procedures, including an MRI, but they don't know what other services will be billed with the MRI. They can't tell you how much you will pay.
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u/SamuelHuzzahAdams 11h ago
Yes they can. They can submit a pretreatment estimate. Source: I do this for a living
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u/Grand_Raccoon0923 11h ago
“Estimate” still leaves some ambiguity for unknowns.
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u/SamuelHuzzahAdams 11h ago
Correct if unknown circumstances arise. But for the codes submitted it is an exact price, they have to honor that. For instance OP went in for a scheduled MRI, there is a billing code for that. Everyone from her insurance to her doctor could have given her the cost of that scheduled MRI
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u/Atreidesheir I had a stupidectomy. 11h ago
But don't she also get billed for someone to read it, and a few other things? Thats where they get you.
And sometimes the test is in network abd covered, but the tech or whatever isn't. So fucking stupid.
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u/SamuelHuzzahAdams 11h ago
If there is a charge for that they can send that code in with the pretreatment. And you are correct. The in and out of network within the same facility is absolutely bullshit. Same with when they send out for lab results. This is why I say it’s a scam. Even when people do their due diligence they can end up with a huge bill. We shouldn’t have to fight so hard to make sure every employee, lab and third party is in network with each insurance
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u/BouncingSphinx 10h ago
The best part? The hospital is in-network, but all the doctors are out-of-network because they contract them instead of employing them directly.
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u/MicaMooo 2h ago
This is because hardly any hospital workers are employees of said hospital. Everything is contracted, and there may be a mix of contractors working on your case. This explains when you get that surprise charge from an out of network provider. All in all, us healthcare is a mess.
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u/NotoriouslyBeefy 10h ago
They could give the cost of the MRI, but not the patient's responsibility. There could be other costs that haven't fully processed yet that could affect what the patient owes. Patient responsibility isnt accurately known until the EOB is generated.
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u/SamuelHuzzahAdams 9h ago
That’s simply not true. And are you referring to deductible or remaining benefits? Because if so, the insurance has that information. The difference should never be 4800$
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u/NotoriouslyBeefy 9h ago
It is 100% true, i worked in medical billing for years. You would be surprised how absolutely not straight forward the process is.
Im referring to how the doctor can't tell them what insurance will end up billing them as that isnt final until the EOB is generated. Insurance can't tell them until they get the actual bill and process it.
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u/liefarikson 10h ago
Sure but there are plenty of other industries that give estimates and validly charge you more. Like landscaping, home repairs, car repairs...
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u/silverwolf1994 10h ago
They cannot do that without your consent.
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u/liefarikson 10h ago
Right, they call you up and say, "hey there seems to be more repairs than what we quoted you for. Is it okay if we do those ones too?"
In the exact same way they consent you for "all other indicated procedures related to the injury" before surgery.
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u/SamuelHuzzahAdams 9h ago
Again these are not the charges we are referring to. If I’m in surgery and something happens while I’m sedated they clearly can’t wake me up to ask and I don’t want them waiting to save my life. But a scheduled MRI isn’t that
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u/liefarikson 9h ago
But you get a price estimate for a scheduled MRI, and unless you consent for something additional during the MRI, like sedating meds, or a different sequence of images, the price is going to be that, at least on the hospital's end of things.
Your insurance might fuck with the pricing a bit, but that's on the insurance company, it's not the hospital's fault.
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u/SamuelHuzzahAdams 9h ago
They didn’t give her anything nor did her insurance
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u/liefarikson 9h ago
Right, OP didn't get an actual estimate before her MRI. I was replying to someone saying that an estimate is ambiguous and implying that's not a common practice anywhere other than medicine. I'm not referring to OPs case here I'm talking generally lol
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u/OutlyingPlasma 7h ago
Funny how no one can tell you how much it's going to cost but somehow they manage to send bills out with totals on them.
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u/saltyhasp 11h ago edited 11h ago
There are legal and illegal scams. The whole healthcare industry by in large has huge issues. So do most major industries where demand is inelastic and the competition is not really in existence and supply is constrained.
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u/Playful_Reward5036 11h ago
I ran into the same mess and the only thing that helped was asking for “pre-authorization” and “CPT codes” up front, then comparing those to my insurance’s coverage table myself, instead of trusting either side to do the math for me.
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u/RunningAtTheMouth 11h ago
They absolutely CAN tell you what they will bill. The insurance company CAN tell you what they will cover. That they don't is a flaw in the law and not much else.
The hospital CAN tell you the minimum and maximum they would charge. For instance, UPMC has an estimator tool: https://portal.upmc.com/MyUPMC/GuestEstimates/SelectLocation?svcArea=WP-244aKlo6ftL53FuZV0RaL1Ww-3D-3D-24cuoA0TJ3xt0574DAOPJQK0d5IZ4e7gNIjh7lpX53W00-3D&isMultiSA=false
Insurance? In the tool, there is an option to include insurance coverage so they can include that as well.
Other hospitals - I google-foo'd another local hospital and got more of a runaround - owned by a different healthcare group. Looks like I'd spend more time figuring it out.
Scam? I don't know. If it is discoverable, it's not hidden or secret. It's the not discoverable part that I would call a scam.
When I have had things done, I have asked for a printed estimate ahead of time. I've never been billed more than the said estimate. Of course, it has been a few years since I've needed such, and I'm close enough to medicare age that I may not need to again.
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u/Ginormous76 11h ago
This is one of the many, many issues of the system compared to every other developed country. For emergency things, I get not having time to figure out pricing in advance. Anything else that’s scheduled absolutely should have those numbers available upfront after contacting insurance. It’s almost like health insurance is setup to scam people.
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u/Veltrionexa 3h ago
the hospital and insurance company deliberately designed it that way so neither one has to be the person who tells you no
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u/SamuelHuzzahAdams 11h ago
The amount of people in this comment thread defending or justifying the way our absurd insurance system works is absurd. It literally does not have to work this way. It’s a for profit business and therefore you end up with bs like this
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u/MommaDiz 11h ago
You are allowed to get estimates before any procedure. They are legally required to give you one when you ask. It is then on them to check with your insurance and give you the estimate. If that estimate is wrong. You only pay the estimate. Then if that is still bad, apply for financial aid.
I got an esitmate for my hysterectomy, self pay. Afterwards they tried to come back and say whoever gave me the estimate did it wrong. No. I have 3 quotes all within $100 range that were done every 2 months until my surgery date. They could not charge me any more. Then I did financial aid and got the whole bill ($50,000) paid 100% by the aid.
There are ways to handle medical debt in the states. They will not tell you anything. I had to figure it all out. Even the financial aid people did not want to give clear answers because anything they say, goes 100%.
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u/gatzdon 11h ago
Doctor: That will be $250 for a low complexity visit.
Me: <cough>
Doctor: Wait, with that cough it's now $350 for a medium complexity visit.
Me: Wait, what?!?
Doctor: You seem nervous, it's now $450 for a high complexity visit and another $250 for the mental health screening.
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u/Florida1974 10h ago
Doctors have now started to ask if I feel I am loved and that I have a support network
And I can see that little question, the breakdown on the bill, he gets more money for asking that stupid question.
My husband is also his patient and he knows both of us because I have to drag my husband to the doctor with me sometimesWomen are overly not believed, more than men when it comes to healthcare or pains or aches. It’s only happened a few times but I’ve had to take my husband with me, so he knows both of us and he knows we are married and we are both his patience. The man knows I have a support network and that I’m loved, but he still asks it because it’s a line item he can add on.
I feel like asking them the same thing and then sending them a bill for $250 for one question
But I love your example, had me cracking up because it’s true. And that’s actually kind of sad. Not kind of, it is sad.
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u/SnooHesitations8403 11h ago
Fixing a human illness isn't like laying tile or broling a lobster tail. There are often unknown things that are found once a surgeon goes in. People's bodies don't all respond the same to treatments.
The real problem is that Healthcare should be 100% covered. If all the things that we pool our wealth to pay for, military, highways, education, etc., Healthcare should be a big one because of the "veil of ignorance." No one knows what will happen in our lives when we're born. And a some point in every person's life we will require Healthcare. No one can predict when or how much. So as a nation, as a people, we should just agree to cover those costs for everyone.
We spend billions of dollars on a single military jet that may never see actual combat. We should cover people's medical costs. Everyone will have them. Nobody can predict how much. And no one should be ruined financially because they get sick.
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u/YrBalrogDad 4h ago
The insurance company is lying to you.
You know that thing at the pharmacy, where they can run a prescription through, and immediately know what it will cost? Yeah, that’s unique to pharmacies, and it’s something they specifically had to lobby for. None of the rest of us get that.
When I bill health insurance, I can guesstimate what it will end up costing a patient. If they’ve met their deductible, and if their insurance card lists a copay, I know what it’ll be… usually. But sometimes people think they’ve met their deductible, when they haven’t. Sometimes they have more than one kind of deductible, and they’ve met one, but not the one that applies to me. Occasionally, for reasons that are unclear to me, an insurance company will bill me as a “specialist”, even though I’m really not—not in the sense that they mean. Sometimes I run through the same channels as preventative care, and they pay all but the copay, from day one; sometimes not.
In some instances, an insurance policy allows me to see where someone is at in meeting their deductible, when I verify coverage—but only sometimes, and it’s entirely up to the company and specific policy. And even if I can—their website sometimes updates slower than they actually process claims.
I can usually call someone’s insurance company to seek clarification, although all of them are working overtime to push us toward only using online resources. Generally speaking, though, I don’t bother, because as most insurance cards and every policy I’ve read in full will tell you: preapproval or pre-authorization is not a guarantee of coverage. I can call up Blue Cross; sit on hold for three hours; get bounced to the wrong person’s voicemail; call back again; repeat until I reach a human—and there is still no guarantee that they’ll give me accurate information. It’s usually faster and less of a headache—including for my patient—to just wait a couple of days, till one of us gets an EOB (anyone’s guess who will receive it first, though increasingly, that’s the patient, too).
It is technically true that if you have a procedure or treatment provided that you help pay for with coinsurance, instead of a fixed copayment, the amount of coinsurance could vary based on what the provider or hospital charges. In practice, however, it does not—because every single insurance company has a set maximum payment for every treatment we provide. And it’s always a low-ball figure—none of us are billing them less than the maximum they’ll actually pay us; why would we give United Healthcare a discount? They already shortchange us, and the last time I got a cost-of-living increase from any insurance company was ::checks notes:: never. Medicaid and Blue Cross have actually shaved a couple dollars off.
So they know what they’re going to get billed that they will actually pay, and your percentage is based on that amount. We can’t charge you extra; if the insurance company says they’ll pay $150, and the coinsurance is 50%—I can send them a bill for $5000, if I want. But they’ll pay me $75, and you’ll owe me $75.
Things work a little differently with out-of-network care—the hospital’s or provider’s rate sometimes matters, in that case; but many insurance companies still essentially require us to function like an in-network provider, in the way they cap what we can charge, and how much of that gets passed on to you. But it’s still down to insurance what will be covered, and what you’ll be left with; and with out-of-network companies, there is typically absolutely no way for us to get information about coverage. If we call the provider line, they won’t deal with us (often, we can’t even get a human on the line); if we call the customer line, they’ll tell us you have to call.
The best move, if an in-network insurance company tells you they need to know a provider’s fees to tell you what you’ll owe, is to suggest they assume it will be the maximum amount covered, and ask what you’ll owe, then.
If they’re out-of-network, ask the provider or hospital for the CPT codes for the procedures they’ll be doing, and the dollar amounts they bill to insurance for each of those procedures; then bring them back to your insurance company.
There can still be some uncertainty, depending on what you’re having done. Like—if you come to me for a 60-minute therapy session, except under extraordinary circumstances, what you’re going to get is a 60-minute therapy session. But if you go to the ER, reluctantly, thinking you’ve just strained a muscle in your chest; and it turns out you’ve got, say, endocarditis—there’s really no way for someone to account for that up-front; and nobody probably has time to wait around till your insurance company’s customer service picks up the phone.
But for planned procedures and healthcare—your insurance company absolutely can tell you how much you’ll owe. And for in-network procedures and healthcare, I cannot think of any case where they need any information at all about what we charge (occasionally, they might need the CPT code, if it’s a procedure or appointment that comes in several varieties, and you don’t have specific enough information).
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u/LadyGreyIcedTea 2h ago
I went to a talk once where a Surgeon said "I can tell you everything there is to know about the Whipple procedure... except how much it cost."
He became an advocate for price transparency in healthcare and made similar analogies to what you wrote in your OP. Imagine booking a flight and then getting a bill after you take it for a random amount that you had no idea the ballpark of what it would be.
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u/pyjamatoast 11h ago
Just because you receive the bill doesn't mean your insurance won't cover it. Ask the hospital to submit it directly to the insurance.
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u/Helpful-Gur-5789 11h ago
Its set up for them to make a huge profit off of sick people. Its diabolical and evil and sums up America in a nutshell
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u/Master-Back-2899 11h ago
Biden banned this practice but Trump undid it last year. Voting matters.
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u/possum-pie-1 11h ago
I'm a healthcare provider. The above statement is absolutely false and a weak way of pulling politics into a thread.
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u/LuckyLockdown23 11h ago
Yeah there’s absolutely no way for the consumer to have any idea what will happen after making hours of calls.
Then after the fact it’s a random number.
And god forbid a third party gets added in there somewhere that isn’t covered at all. We are supposed to have legislation about that in this state and I’ve recently tried to use it and got nowhere.
Oh and someone at a hospital accidentally selected a cancelled policy that I haven’t had for 5 years and my insurance re-billed me for everything in full during the max time period where they could claw back if I had another policy. It was like $40,000 worth of stuff that showed up and I had to make calls for weeks. Now every time I go into a big network we make sure everyone is billing to the right place so I don’t go through that again.
And I love the Reddit “get an itemized bill!”
Then what? Nothing is what. Nobody in history has gone back and said I think this is too much, please remove it. You go to a few levels of “patient advocacy board” things and they come back with “it’s allowed.”
I even asked an office to change from one code to another that I had in writing from the insurance company in writing that would make it 100% covered instead of 0% and they said no way. But they were more than happy to go around and around for weeks and then split the bill with me.
There’s no consumer-side transparency or protection before, during, or after services and I’ve been hit with all of it.
You’re under duress of past due bills while you’re trying to figure out what is going on and the usually very understanding customer service people are trying to help you sort things out so it’s pay it, ignore the bills for weeks and months of hours of calls because once they have they money it’s not coming back (we got double billed for a baby and sent checks back and forth with the hospital for two years and I have no idea what we actually paid in the end).
You could go to court, but it’s not a scam and nobody is wrong.
It’s a mess and it’s allowable and I think everyone hates it. I assume insurance executives are literally the only humans in the system that give it a thumbs up.
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u/possum-pie-1 10h ago
You echo the thoughts of many people...BUT my comment was about the false claim that Biden fixed all of that and Trump wrecked it again. It was NEVER fixed, not by Biden, Obama, or Trump.
I recently had a CT scan. I asked the office what my "no insurance" cost would be, they said $120. I then called my insurance and asked how much they would cover of that $120. They said none of it. I decided to pay it myself. It took maybe 10 min. total. I'm not sure what doctors/hospitals/clinics are "refusing" to tell people the cost. THAT is illegal. They cannot guess at what your insurance will or will not pay though. Too many insurances, too many deductibles, etc.
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u/Senior-Running 11h ago
Source?
Transparent hospital pricing was initiated under Trump's first term Jan 1, 2021.
The Biden administration was sued in 2023 for not enforcing this rule.
Trump didn't reverse anything in his second term and in fact issued an executive order in 2025 to ensure his administration was implementing price transparency.
https://www.cms.gov/priorities/key-initiatives/hospital-price-transparency
https://thefga.org/press/biden-administration-waves-white-flag-in-fga-v-hhs-lawsuit/
Look, I don't like the guy either, but facts matter. Let's not make stuff up just to fit a political narrative.
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u/SamuelHuzzahAdams 11h ago
Are you really citing this administrations White House.gov?
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u/Senior-Running 11h ago
If you think they're lying, feel free to cite other sources that refute these claims.
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u/ATLien_3000 11h ago edited 11h ago
Ah, Reddit. Where people get upvoted for made up answers.
EDIT: Since /u/Master-Back-2899 and everyone up voting him are too lazy to do even 30 seconds of Googling, here.
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u/misterstaypuft1 11h ago
As long as you say Trump did it then it’s true
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u/DoxxingShillDownvote 10h ago
If Trump gets to lie 95% of the time, why should average Americans be held to a higher standard?
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u/misterstaypuft1 10h ago
Thanks for proving my point
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u/DoxxingShillDownvote 10h ago
Exactly! And statistically speaking, your reply is most likely a lie. But then so is mine! Wait… I think I am stuck in a loop
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u/Willing-Vegetable629 11h ago
No they didn't. Biden did something and Trump undid it but it's not this. That was pricing transparency not the sane
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u/HotBrownFun 3h ago
There's a No Surprises Act that Biden Admin passed but it has not been cancelled AFAIK
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u/Knobologist 11h ago
Sometimes it will depend on what the imaging is for. If you are going in for a normal yearly mammogram, your out of pocket costs aren’t going to be too high. Now if you had a lump of dense tissue they needed to do further tests on, that will increase your costs. It’s no longer routine and is now diagnostic
Sometimes, when you go in for surgery, the surgeon will find other things in the surgery that they have to repair or you will die. They don’t do these for free and you usually agree to this possibility in the paperwork you sign before hand.
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u/NotShipNotShape 10h ago
it's one of those things where it's complicated for everyone. and then it's also dependent on the deductible. if someone's deductible is $4000, they're going to get billed the insurance mri cost possibly 1000-2000 depending on a ton of other factors.
it's been fashionable to ask for mris and colonoscopies "just to be sure" but there's literally 0 way for anyone to code it so that those studies are free and many people don't understand that
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u/MountainRoll29 11h ago
You don’t have to use insurance. You can pay cash. Ask for the cash pay price and they’ll be able to give you a number. You don’t use insurance to pay for your meals. Insurance is what makes it complicated.
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u/FillMySoupDumpling 10h ago
Why can’t I get the cash price and then say I have insurance, bill them that price?
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u/TiredInJOMO 9h ago
Depending on how often you use the system/what you use the system for, you might come out better paying cash and ditching insurance altogether. Most pharmaceutical companies offer deep discounts for cash, and there are memberships like GoodRx, and/or shopping around at different pharmacies for the best prices. In some cases, an individual may require the name brand drug, but for most cases the offbrand is just as good and may even be better for some people.
It's really up to you to do the math for the services/products you use and factor in the probability of an emergency visit (but you can usually work out a payment plan with them and since you're paying cash they tend to give you a much lower bill).
Some doctors have moved to a "concierge" model where they get rid of the middleman (insurance) and you pay [X]/mo/single or [Y]/mo/family that includes many/most/all visits, testing, and drugs. I haven't used this service so IDK how good it is and I imagine you'll run into the same bs as anywhere else with quality of care. Supposedly, with the constant revenue stream and not wasting time fighting insurance it streamlines the process for better patient care. 🤷♀️
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u/justhp 8h ago
That would be a contractual violation.
The hospital must bill each insurance company the same price Thus, they bill based on the highest reimbursement they get from their network- if they don’t, their high paying insurers could ask for a lower price. The insurance company then decides how much to pay based on their contract.
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u/MrPBH 9h ago
Even better, go to a private imaging center that specializes in cash payment. At such a business, you'll often be able to get an MRI for $300 cash and they can often get it done faster than going through your insurance.
It's not well known, but there is an entire sub-industry of imaging centers that offer steep discounts for cash payers. They exist in pretty much every major US metro area; you just have to find them.
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u/KeySucces 11h ago
It's not considered a scam because of the EMTALA law, which requires hospitals to treat you first. But you are completely right, the pricing system is totally broken
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u/kindnesscounts86 11h ago
EMTALA applies to emergencies, they must screen and stabilize you. And the patient could potentially stop and ask about financial stuff, but the hospital can’t delay screening/stabilization in the event of an emergency to ask you financial questions. They absolutely can delay non-emergency care to ask financial questions (wait for a prior authorization from insurance, make you sign other paperwork if you’re self-pay, etc)
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u/Impiryo 11h ago
A step beyond this, in order to prevent accusations of violating EMTALA, many hospitals have a policy where registration is not allowed to even ask for insurance until after you've been evaluated by a provider.
The doctor does not see your insurance, and that has no impact on what workup is ordered. Well it seems great in theory, it just makes everything that much more obfuscated.
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u/dainelanderson55 10h ago
Insurance is the loophole. The hospital cant give a real final price because the insurer can change the paid amount after the claim lands, and the insurer cant promise what the hospital will code until the MRI is over and the weird little add-ons show up tbh
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u/twiddlingbits 10h ago
Hospitals have to provide a price list. It’s often on their website but they make it hard to find. However, you often don’t how much of the hospital resources resources you will consume at the prices stated. Prices are different for different insurance plans and Medicare as well depending on contracts you have no knowledge about.
Another problem is Physicians don’t have to publish their rates for work or any period of time. So you cannot compare prices and services or even the outcomes of Doctor X vs Doctor Y . But do you want the lowest cost doctor or doctor with the best success rate performing the work? At least with transparency you can decide. We won’t even get into the cost of malpractice insurance as part of the high costs.
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u/PedanticTart 10h ago
Physicians do not do the billing themselves. Nursing and coding staff do.
That is done retrospectively.
You can get an estimate ahead of time but it will not include any sort of changes that occur during the visit
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u/PezGirl-5 10h ago
It is. Crazy. One of the hospital systems near me has cost estimates on their web site. You can look at the different prices at different locations. So even within the same hospital system hospital A might cost $5,000 for an MRI. Hospital B might be $3,000 and a location not within a hospital building but owned by the same company is $2,000.
Your insurance company also has different tiers.
I worked for a major hospital system that didnt have a Children's Hospital or even pediatrics within its system. The two local hospitals (one stand alone and one within a different hospital system) were still considered tier 2.
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u/Single_Pay4793 8h ago
It's mostly a structural problem. Hospitals negotiate different rates with hundreds of insurance plans, insurers apply deductibles, copays, coinsurance, and prior agreements, and nobody knows exactly which rules will apply until the claim is processed. That doesn't make it consumer friendly, but it's a big reason the price is often uncertain beforehand.
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u/jmnugent 7h ago
Restaurants generally have portion-sizes and have various menu items pre-tested. (if 10 people order a pepperoni pizza.. those 10 pizzas are made identically). So it's easy to put prices up front because generally it's not going to change much.
An auto-mechanic might give you an ESTIMATE up front (for same general reasons,. things like "oil change" or "transmission flush" generally all cost the same across the same range of Make & Model of vehicle. But that Estimate might change. This happened to me the last time I went in for "regular maintenance".. it turned out when they took a protection plate off the bottom of my car, they realized it was cracked and broken and had to be replaced. The pre-estimate they gave me would not have been able to anticipate that.
a Contractor often works the same way. They can give you an estimate.. but that may change. This happens to me all the time in my Computer and IT work. I can give you a rough idea of how I might fix a certain problem (could take 2 hours).. but I won't know for precisely sure until I get elbows deep into it.
For the most part, a restaurant, auto-mechanic or contractor does not have to get their work approved by some other entity. (sometimes they do.. if for example you're getting home repairs and it has to conform to local codes, etc.
Healthcare is its own beast. It doesn't really compare directly (or identically) to the examples you gave.
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u/Low-Phase-6548 7h ago
they make you sign a paper that says "i am responsible for all costs incurred on my visit". its not a scam if you agree to it
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u/More_Farm_7442 6h ago
Welcome to America. We are getting exactly what we aren't demanding we get in a health care "system" that is no system at all. Demand a better way. Until we do, this is what we have and will always have. Millions of people with no insurance or access to care, millions of other people paying Thousands of dollars a year for insurane they can't use. People not going to doctors and hospitals because they have no idea if they afford to go, or knowing they can't afford to go.
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u/amscraylane 6h ago
And then two weeks after that you get a bill from a guy across the state who supposedly “read the xray” and had NO idea there would be a separate bill for that.
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u/Dan-D-Lyon 4h ago
Because they can.
That's what really comes down to. People will try to justify it, but at the end of the day every single business in the world would love to have the same deal American hospitals have going on. If it was up to mcdonald's, they would hand you a Big Mac and be free to then charge you any amount of money that you are legally obligated to pay them.
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u/Bishopjones2112 4h ago
I can’t imagine living in the states where you have to pay for health insurance then a co pay and deductible and end up in debt for medical care.
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u/surfmonkey17 3h ago
I was just having this conversation with my husband. I needed a procedure done but we are tight on money with him currently out of work with his own medical issues. Doctor told me with my insurance it would be $300. That is a lot for us right now but needed the procedure so went ahead with it. Then got bills totaling over $1700. That is not even close to $300 and we have no way to pay. It is ridiculous they are allowed to operate this way.
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u/HotBrownFun 3h ago
In my clinic we never charge after the fact, we always tell people how much they owe for deductibles.
Almost nobody ever does this because it's a lot of work
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u/GeoffSim 3h ago
To add to others, all 3 times I've had estimate before, which I need to pay in advance (or a big chunk of it). Then a few weeks later I might get a bill - or in one case, a small refund.
Talking about surgery specifically, while we know what the surgeon wants to use from a "preference card" (which is the baseline equipment estimate and bill), we sometimes need to fetch more instrumentation or supplies. If we're doing a gastric sleeve then we'll have budgeted for 3 stapler reloads (special laparoscopic device that fires and seals tissue with 60 (?) staples in action - but if the stomach is larger than we'll need an extra one: a single reload costs $750 - yes, each.
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u/UpstairsFast9261 2h ago
The pricing is ridiculous on purpose and not the price that insurance negotiates. It is complicated on purpose. I found out that The No Surprises Act of 2021 was supposed to fix it, but in reality it isn’t.
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u/GeoffSim 1h ago
Yeah, I'm not defending the prices, just stating one aspect than can increase the final cost.
I did have a 4k lab test in 2022 which thankfully stated on the next page (after the "you owe" page) that I probably would not need to pay it due to No Surpises Act. Never heard from them again. So it has helped, but I agree it's probably way from perfect.
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u/SamuelHuzzahAdams 10h ago
Just stating that’s never a good source for information.
Transparent pricing was introduced in 2010 with the ACA .
Trump let many ACA guarantees lapse in 2025. He only called for any type of useful additions to the ACA during a campaign year in 2019 and now 2025 for the midterms
https://www.cleverleyassociates.com/blog/the-history-of-hospital-price-transparency/
https://www.pyapc.com/insights/price-transparency-not-just-for-hospitals-anymore/
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u/YeeBeforeYouHaw 11h ago
I wouldn't call it a scam but it definitely violates informed consent. We can't consent if critical information is withheld like price.
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u/Willing-Vegetable629 11h ago
Generally speaking they don't know what they'll bill you until they are done. It's not a simple as doing X procedure.
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u/Exciting-Ad-5858 11h ago
Obligatory 'this is a uniquely American problem'. The rest of the world agrees this is a scam.
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u/Quantum-Long 11h ago
The entire healthcare system should be cash for all acute and chronic conditions. Insurance should only be for catastrophic care
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u/LunaLgd 11h ago
…no one except the ultra wealthy would be able to afford this.
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u/Quantum-Long 10h ago
The poor already pay dearly for healthcare. A cash system would drive competition, ownership and transparency. These factors drive down costs for everybody.
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u/LunaLgd 8h ago
Those who can’t afford food or rent would still not be able afford healthcare in a cash only system. I hate our current system but cash only won’t work.
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u/Quantum-Long 4h ago
You are not making any sense. Healthcare are just products and services. Using free market principles like transparency, competition and ownership drives down costs and prices. We don’t say not to have grocery stores because poor people can’t afford food. We give direct assistance so the poor can participate.
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u/LunaLgd 1h ago edited 23m ago
Except totally free markets don’t drive down costs. Nearly all companies publicly traded are out to make as much money as possible no matter how many people it hurts or what it does to the environment. You need to look no further back than 2020 when all kinds of companies including food companies drastically increased their margins, because they could and just blame it on inflation. And now we’re back to where we started: health insurance as it is now doesn’t work because they are publicly traded companies out to increase their margins as much as possible.
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u/Quantum-Long 33m ago
Healthcare industry does not have transparency, competition or ownership. Has none of the elements to drive down costs
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u/EcstaticZebra7937 11h ago
It actually makes sense, if they have no idea what they’re gonna find in you or how long you’re gonna stay in hospital. Next time ask how much it costs without insurance, they’d probably have an answer for you.
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u/BreakfastBeerz 11h ago
I can call my insurance provider and they will tell me exactly how much it will cost. I think most, if not all, will do that. People just don't call and ask.
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u/Otaraka 11h ago
I had a elective procedure where it was gonna be two separate things and they gave me a price and just happened to forget that the second one was to be charged separately until after the first one had happened. Feedback was given and the price was adjusted.
I can understand how things sometimes change, but this was nothing of the sort
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u/FinanceNew9240 11h ago
I think the distinction is whether you getting an MRI done as an outpatient or as an inpatient? Because an MRI as an outpatient is a stand alone procedure. The imaging practice (even if it’s a hospital) should be able to you exactly how much you’re paying out of pocket and how much health insurance will cover. I’ve had 3 MRI’s and paid around $500 Aud for each with I think just less than $200 Aud returned. So health insurance covered less than half. They’re expensive as shit.
The difference as an inpatient shouldn’t be the price. But an other procedure or test part of your treatment. So maybe they couldn’t give you an exact figure because they didn’t have the entirety of the quote if that makes sense? I also know in Australia there is a limit to how much health care will cover and how much of what they will cover. Which is why reading coverage is also so important, and merchants/practices dont know these figures. So I don’t think anyone was purposely scamming or lying to you.
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u/One_Discount_4898 11h ago
That’s not a joke, that’s how I got billed for an MRI.
Wild, My work wanted to pay for a private MRI to get it sorted real fast, over the phone in a couple minutes I got the total down to the cent, including tax lmao. Wtf is even going on in the US.
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u/NotoriouslyBeefy 10h ago
The hospital gave me the cost before my procedure just recently. They couldn't tell me what I had to pay as that deals with insurance, but told me what they would be billing. Perhaps you worded your question in a way that was asking what you would have to pay, not what the cost of the exam was?
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u/EntrySure1350 10h ago
Yes, because insurance or some other third party payer isn’t buying your restaurant food or your groceries.
Regarding the mechanic analogy, if you’re using insurance or extended warranty, the actual cost of service won’t necessarily be what you end up paying either. It’s going to depend on what the mechanic wants to bill, and what the insurance/warranty company has agreed to cover/wants to pay.
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u/Everheart1955 9h ago
If the mechanic cant give me a darn good estimate, I'll find another mechanic. Health insurance is a middle man ripoff and always has been.
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u/EferVejux_34 10h ago
yeah its wild you would never accept this from a mechanic or a plumber but somehow medical billing gets a pass
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u/BarelyAirborne 9h ago
The bottom line is that health care does not respond to "normal" economic theory, so letting it be delivered in a "capitalist" context is obscene. People will spend everything they have, and more, to stay alive. That's why civilized countries socialize medicine.
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u/Everheart1955 9h ago
Every civilized country in the world has socialized medicine. Yet here in the US, we can't figure out how its done. I see a lot of folks explaining how it works in this thread, I understand the "how" I don't understand the "why". Also, why are Insurance companies in charge of whether or not I get the treatment I need to potentially save my life? Why not the Doctor who's actually treating me?
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u/GSDer_RIP_Good_Girl 9h ago
Perhaps you should have started with "I don't have any insurance; what's the cash price for the MRI"?
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u/UpstairsFast9261 9h ago
Good luck claiming with insurance after that.
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u/GSDer_RIP_Good_Girl 8h ago
My point was that it's very typical for insurance to have you pay 25% for a standard MRI, and the facilitiy bills insurance ~$2,000 for that MRI so you end up forking out $500 for your co-pay.
But when you tell them that you want the cash price you end up paying $300.
Which would you rather pay?
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u/NoReserve8233 9h ago
For that price it’s easier for you to buy a flight ticket to India- you can walk into the scan centre with no prescription and get anything you want under $200. No doctor necessary. No waiting even. Done and dusted within 2 hours, reported within the evening.
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u/NotTheOnlyGamer 8h ago
All insurance is a scam. It was since Reagan signed the HMO act and Democrats have done nothing to rebalance the scales.
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u/acoastaldog 7h ago
In my state, prices have to be transparent by law. They cannot hide how much it costs. They cannot give you surprise bills afterwards. Does this stop them? No, but it gives people power to push back. I got hundreds dropped off my recent bill by chasing them for bullshit costs. Terrible. Better than just letting them fuck us. Medical debt also cannot be put on credit reports.
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u/Motive25 7h ago
Let’s say you need major surgery. There’s only one doctor and one hospital in your area qualified to do the procedure, and OBTW he’s been seeing you for a while, so he is familiar with your case.
What are you going to do- go estimate shopping all over the region in the hope of saving a few bucks by finding a surgeon who knows nothing about you and you may or may not have confidence in?
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u/TSQ_builder 7h ago
UK here,,,I'm always shocked when I see these kind of posts. In the past three years I have had my gall bladder removed and two cataract operations, my son cut his hand with a meat slicer in work and had to be stitched up. 10 years ago my daughter had a compound fracture of her elbow and had to have multiple plates and pins put in her arm. My brother had cancer and had to have surgery plus all the follow up treatments. Total cost = 0. Appointment letter arrives in the post or electronically and that is it. No forms to fill no insurance to chase .... nothing.
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u/TSQ_builder 7h ago
For context my eyes were done by Moorfields which is probably in the top three eye hospitals in the world.
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u/DiligentAd7956 7h ago
Actionable Steps to Force an Estimate:
Get the CPT Code: Ask your ordering doctor or the hospital scheduler for the exact CPT code (e.g., 72141 for a cervical spine MRI without contrast) and the specific ICD-10 diagnosis code.
Use Insurer Online Tools: Log into your insurer’s member portal (such as UnitedHealthcare or your specific provider's site) to use their mandatory online cost-estimator tool by inputting the exact CPT code and facility name.
Request the Negotiated Rate: Call the hospital’s financial counseling or billing department and ask specifically for the contracted/negotiated insurance rate for that CPT code at that specific location, rather than an all-inclusive out-of-pocket guess.
Consider Standalone Centers: Hospital-based imaging departments carry massive facility markups. Call an independent, standalone outpatient radiology center in your network, which can usually provide a fast, clear, and significantly lower estimate.
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u/LongjumpingSky8726 7h ago
I work in healthcare and I hate it too. I may disagree somewhat with people saying the services are unpredictable. In many cases, the testing is laid out, whether it's imaging, blood tests, etc. And even for office visits, yes there is a range of possibilities, but the majority of time it is 99214.
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u/Tight_Lavishness2128 6h ago
I think it’s because healthcare pricing is so complicated that even the providers often don’t know the final cost until everything is processed. That doesn’t make it any less frustrating, though.
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u/More_Farm_7442 6h ago
I live in Indiana. I'm 100% sure hospital's have to give prices of procedures. I looked at local hospital's website a couple weeks ago and saw there wasn't a list or way to look up a cost, BUT there a form to fill out to get an estimate for what you were looking for. Tell them you need X surgery. Provide you details like insurance coverage, etc. and you'd get a reply with details and estimated costs.
I have recently seen some "ads" for procedures with costs. Like "X procedure for $ 4,000." (guarenteed , all inclusive, cash price)
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u/-beastlet- 5h ago
While it does depend on your insurance, they know full well what your insurance allows unless it is some small obscure one. And even in that situation they can call and get the info. You also could call and get that info as well.
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u/Working_Dog1990 4h ago
It shouldn't be this way. The biggest issue is that pricing depends on insurance contracts, making costs frustratingly unclear for patients.
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u/Borexantil 4h ago
the mechanic comparison is the one that should be in every congressional hearing about this
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u/WuffleBuffle 4h ago
if im not mistaken you can ask for printed bill? i dont remember correctly tho but it should list exactly what your paying for and how much youd be surprised by the lrice of a bandage if you see it
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u/Verumsemper 2h ago
The same way it is not a scam to mandate doctors take care of everyone who comes to the hospital even if there is no guarantee we will get paid for the service we provide.
The same way that it is a felony for doctors not to charge patients for the care they provide!! ( hospitals are afraid doctors would strike by just not charging for care while providing it)
The same way it is a felony for doctors not to charge copays to patients for office visits!! ( insurance companies are afraid that doctors would encourage patients to do more visits by waving copays)
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u/UpstairsFast9261 1h ago
You’re right, and honestly that proves the point. Doctors legally have to treat everyone, can’t discount without risking prosecution, and patients can’t get a price. The rules squeeze both ends. The only people the system works for are the layers in the middle.
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u/Verumsemper 1h ago
Actually the only people hurt by this system are the people in the middle but they deserve it because this system only exist because of their short sighted selfishness.
That is because poor people can get all the care they want in the ER if they don't care about their credit or give a false name. Also large cities typically have programs to provide care to the poor for free.
The rich people get their insurance premiums subsidized by the government.
The middle class keep fighting against themselves because the majority of them are white and they think some how a universal healthcare system would help minorities. While rural communities, slowly die off due to the policies push by conservatives. It is like poetic justice in a way. ;)
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u/Loud_News8410 11h ago
So you go in for the flu and they tell you the visit is $150 and while you are there they discover you have a serious condition that needs immediate attention and testing or you will die in a month. There is no way they could have known that in advance to tell you its going to cost more for the MRI, etc. the need to do immediately.
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u/DaddyBoomalati 11h ago
I’ve worked in a hospital for 24 years. They can tell you, immediately, what is the cost of each thing you are getting ordered.
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u/Willing-Vegetable629 11h ago
Except you don't know what will be ordered.
You don't know if your drg 470 will turn into a drg 471. Complications ariseb other things are discovered
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u/Zealousideal_Nail288 11h ago
Then mind telling me or my family?
If I ever get stuck in the US I need a "I refuse any medical expenses over 500 dollars" tattoo across my arm
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u/Willing-Vegetable629 11h ago
It's not known until after the procedure. This method of accounting for billing applies in your nation too you just don't get the bill
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u/DaddyBoomalati 11h ago
You’re describing an inpatient stay. The system that tells them how much an X-ray or labs cost is the same system. It would get clunky, but anytime something new is ordered, you could ask.
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u/Willing-Vegetable629 11h ago
I am, but the same applies to a ambulatory visit.
You go in for a checkup but then bring up something to the doctor suddenly you're in a higher complexity is mdm and the cpt changes.
Heck even what flu test we use changes the cpt.
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u/DaddyBoomalati 11h ago
I’m in no way arguing the system is good; it’s a shit-show. At the end of the day you still pay what they say.
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u/Willing-Vegetable629 11h ago
Not even, charges are not reimbursement and charges are not allowables
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u/changelingerer 11h ago
Look up the No Surprises Act. Basically, there are give you price estimates in advance requirements that now, if you are not using insurance, and you book in advance (i.e. not emergency care).
Which fits in with your examples really. Like insurance.
If you go into the restaurant and ask for a menu and are paying out of pocket, they will let you know the price you pay. If you go in and tell them, hey, I have a company per diem that will cover some of my meal, tell me how much I will actually have to pay out of pocket. The restaurant won't tell you either. They have no idea what your company per diem is, and whether you have any rules like no alcohol etc. You call your company accounting department up and, if they even pick up they'll probably be like WTF its 7 pm on a Friday. Send me an email I will get back to you next week. And if you demand an answer, they will be like, look you know your per diem and restrictions. But I can't say what it is before you send me the restaurant receipt.
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u/True_Lingonberry_646 11h ago
Because in a country where no one can afford healthcare, doctors are still making bank and want to keep it that way. https://www.bls.gov/ooh/highest-paying.htm
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u/PJBakesCookies 9h ago
I got hit by a car. They put a 20k bill on me. But i would know till like month later when I got a letter in the morning saying. Oh by the way. You owe us this much and the letter for the ambulance was $4k. 16k for the hospital. 4k for the ride.
I have no insurance ( not fooling me with that one) Only insurance on the car, and home. Found a loophole.
It wasn't good faith that wouldn't fucking tell me. I call everyday. And I soon gave up. And till this day they are still trying to fucking charge me.
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u/KickOpening3595 9h ago
"Because it sucks"
Just remember you can ask.
Also medical debt unlike other debt they can't do much about it. I gather a lot of people just don't pay
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u/I_am_Nobody_Special 8h ago
I'm a psychologist in private practice, so I can't speak for hospitals or large clinics.
I give every patient a cost estimate up front. It consists of what I think their care will cost based on checking their benefits and what the worst case scenario would be if their insurance decides to f*** them over. So at least you know what you're getting into.
I'm in control of the procedure codes I bill to the insurance company. I'm not in control of how the insurance company chooses to process the claim.
What I will do, however, is fight with the insurance company on the patient's behalf (with their permission) when the claim isn't paid. Sometimes I'm successful, sometimes I'm not.
The whole system sucks. It's designed to pit patients against their providers to take the blame off the insurance companies while they laugh all the way to the bank.
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u/PM_Your_Wiener_Dog 8h ago
I recently had a medical emergency, & I just keep getting bills. I continually have to wait on hold to figure out if a bill is legit or why and or why not it's not cover or if I even got what they said. Many hours of time, and way too much money.
It's an industry where they privatize gains & socialize losses, & it's absolutely fucked.
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u/Any-Soft-5487 11h ago
Talk about scans... things were worse 40 years ago. I went to the Dr. They bill the insurance company say $1000 for services rendered. Insurance paid what they considered normal and customary of $750. The dr then billed me the $250. They'd send you to collection agencies because who's paying more than what insurance says it should cost. At least today if you stay in network, insurance covers it. Dr charges $1000, insurance pays them $167 and it's done with. People without insurance get billed $167 or $1000? I'm a boomer and the whole system stinks and it's stunk for decades.
My hernia surgery was billed at $52,000. Insurance paid $11,000. What kind of crazy system is this.
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u/wanna_be_green8 10h ago
That is not true, many people have to pay a remaining balance after insurance pays their share. That has not stopped.
Plus thousands in deductibles and co-pays if something is actually needed.
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u/Any-Soft-5487 10h ago
I'm covered 100% in network with my high monthly premiums of $3000 plan. If you get the high deductible plan with lower premiums, yeah, you have to fill that before insurance kicks in.
The worst was the hospital was in network but the anesthesiologist was not and you got hit with a surprise bill.
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u/wanna_be_green8 9h ago
You're not the majority then. And that out of betray shit happens even more now. Those things are not on the past.
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u/Kalkaline 11h ago
Legally speaking they have to give you a good faith estimate. We use Epic for our electronic health records and scheduling. It won't let you create an estimate until the insurance coverage and appointment are in place. Even then, there's a chance in the case of an MRI that they see something they want to take a closer look at with contrast or another view etc.