Quote:Let me give you an example. I went to my doctor for my annual physical. Fortunately, I got a clean bill of health. I do have this mole thingy that I would like removed, as it can be a nuisance on the exercise bike. He suggested a skin tag removal. I called my health care plan, and it is not covered. I called the doctor's office back, they couldn't give me a price estimate on the procedure. This type of garbage is ridiculous in my opinion. All of the free market champions talk about competition, letting the market dictate things. If there is no readily available way for the consumer to compare services, there is no true free market. 

 

Your situation isn't a matter of a free market, it's a matter of contract law applied to the servicer (your insurance) and the client (your employer assuming you have a group plan through them). That price you want is dictated by your doctor's contract with your insurance company, so even if the service isn't covered you sometimes still get the benefit of an insurance discount. As such, your physician probably doesn't know what it's going to cost you until the insurance company denies the claim because they don't always adjudicate claims the same way for the same service. Most insurance contract also mandate that the physician must file the claim even if the service is known to be non-covered so they have a complete medical file on you for actuarial purposes. If your doctor was greedy he'd just charge you his master fee for the procedure, but you might get an insurance discount and then he'd have to give you a refund (or just keep it as many do).

 

One way around that is for you as the patient to exercise your HIPAA rights and file a Requirement of Non-Disclosure form with your doctor for the service. Doing so overrides the insurance contract and ensures that no claim goes to the insurance, but also means you lose any shot at the discount and have to pay the full rate at the time of service. You can see why something like that would be important in Behavioral Health and other sticky situations. Here's a brief on the process:  http://www.psychiatrictimes.com/hipaa/co...osure-rule

 

Long story short: as long as someone else is paying there isn't a free market.

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