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One Mom’s Nose for Savings

Exorbitant Hospital Pricing in the U.S. Undermines Morale, Employee Compensation, and Employer Profits — It Must Stop

As the sun dipped below the horizon on a brisk spring evening, a young mother crouched behind home plate, catching for her daughter.  Already showing signs of a future softball superstar, Gisele unleashed a wicked rising fastball.  It clipped the edge of the glove and smashed into her mother’s face, cracking bone and pushing her nose sharply to the left. 

In a display of savage tenacity, Mom wiped the blood away, grimly reset her nose with a crackling snap, and resumed her catching duties for the evening.  Despite her efforts, the misshapen lump and the nose’s noticeable leftward slant gave her the hardened appearance of a seasoned mob enforcer.

Doctors told her she’d almost certainly require surgery but wanted to let the swelling subside and see how her breathing progressed before they intervened. 

Months later, she couldn’t breathe through her left nostril; she wanted her beak fixed. Luckily, she found herself on a Mahoney Group plan backed with Reference-Based Pricing and Cash-Pay options at recognized centers of excellence.

• So no, UHC and Adventist, her plan isn’t going to pay $74,000. 
• Nor will she pay the $58,000 sought by Cigna and El Camino Hospital. 
• Not going to pay $73,000 either, Western Health and John Muir. 
• And we say nay nay to the $73,000 Santa Rosa Memorial wants from EVERY commercial payer.  (Hat tip to the late, great John Pinette.)
• She’ll pass on the $51,000 Stanford and Blue Shield want.
• And UCSF and Aetna can only dream about that $69,000 they lustily crave.  

At 140% of Medicare, we will pay $7,811 for this surgery.  If circumstances such as geography, timing, or specialized surgeons demand a higher price, we can negotiate.  But that is seldom required.  In this case, Gisele’s Mom is getting her nose fixed up for a voluntary cash price of $7,750. 

Plus, since Mom agreed to use the cash-steerage option, her employer is paying 100% of the cost of the procedure and waving all deductibles and coinsurance. 

And from now on, Mom’s going to wear a catcher’s mask.