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Ely, Counselor at Law
Category: Legal
Satisfied Customers: 102379
Experience:  Private practice with focus on family, criminal, PI, consumer protection, and business consultation.
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Why do most business transactions involve the consumers full

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Why do most business transactions involve the consumer's full knowledge of the charges before services are rendered, except for medical procedures? Drs & hospitals seem to be exempt from normal consumer protection practices. Example: car repairs. The shop always provides me a quote upfront, and I can say yes or no, or choose a different shop. However, I have limited options with medical care, they do not know upfront how much I will be required to pay, and they all require me to agree that they can sic a collector on me. If I refuse to sign, they refulse treatment. That seems wrong to me, because normally when consumers face limited choices, it is unethical for a business to take advantage of that and charge excessively high rates. However, med. clinics & hospitals do it all the time.

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Is this a homework question? What is the need behind this? Was there a contract dispute? Or is this for general knowledge?

Customer: replied 7 years ago.
None of the above. It's just that the way the medical profession conducts their billing practices seems unethical to me. What can I do to protect myself?
Well, do you go through insurance, or pay yourself?
Customer: replied 7 years ago.
I have insurance, but my portion typically is far higher than I was expecting. It pays a higher portion for in-network than out. But if a dr charges $1000 and insurance pays 80%, I'm still left with $200. But if the dr charges $500, I'm left with $100. That's a big difference, but the med office staff don't tell me how much my portion will be; they just insist that I sign. It doesn't seem right that having insurance should be a factor. If my house is damaged and insurance pays for it, I may have to pay a $500 copay, but I would know upfront how much. A contractor doing a bid would have to tell me what the total cost of the job would be, and I would have the option of saying no and getting more bids. It isn't right that medical offices don't have to do that also.
I agree with you and it is not right. The thing is, when you sign up with the insurance company, you agreed to accept their co-pay whatever it is. The company then negotiates with the office, many times AFTERWARDS, for what the payment actually should be. The offices actually don't KNOW many times what the charge will be to you, that's the problem. It's a whole tangled mess, and that is why there is a big push to put through reform to the healthcare system. But I don't have a solution for you. If I did, I'd be next to Omaba in the oval office right now. :)
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