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U.S. health care's widespread overbilling problem

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Re: U.S. health care's widespread overbilling problem

#21

Post by cptskippy »

Osiris wrote: post #8
projectramo wrote: post #4

I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price. On the 10th call, I finally got someone to tell me what the out-of-poc…

Health care is the only industry where you only find out how much something costs after you're already bought it. Basic supply and demand theory depends on consumers having perfect information. A free market cannot work when a consumer has no information.

A lot of trades give you estimates but you don't know the actual cost until the work is complete. Auto repair, construction, plumbing, electrical, etc. There are plenty of fixed costs that can be accounted for easily but there are a lot of unknowns that can't be seen ahead of time. That's why quotes and shopping around so prevalent because it allows for competition in price.

However in healthcare that's not an option, there is no competition. The cost of fixed cost procedures (e.g. lab work) are unknown. You can't shop around for surgeries or doctors. Everything is wrapping in mystery even after the fact, there is no final bill. Even if you pay everything you're asked to, you might still get a bill 2 years down the road for reasons no one can suitably explain.

Re: U.S. health care's widespread overbilling problem

#22

Post by koolba »

projectramo wrote: post #4

I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price. On the 10th call, I finally got someone to tell me what the out-of-poc…

How much did it actually cost? Was the estimate correct?

Re: U.S. health care's widespread overbilling problem

#23

Post by rscho »

Moshe_Silnorin wrote: post #2

Healthcare will always be overpriced so long as we allow this guild system to limit the supply of doctors for its own member's profit. Everything else is window dressing.

Coming from a country where the number of MDs per capita is 100x that of the US, I am sorry to tell you that this would not have the impact you think it would have. As of now, no first world country seems to have found a real solution to healthcare prices. My personal opinion is that doctor salaries have a minor impact on prices. Healthcare system structure and culture (as in how much do insurance companies control, and how readily you perform expensive tests) is much more important, I think.

Re: U.S. health care's widespread overbilling problem

#24

Post by briffle »

projectramo wrote: post #4

I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price. On the 10th call, I finally got someone to tell me what the out-of-poc…

Along with price transparency, everyone should leave a doctors office with a copy of their bill. Sure, it will probably also get sent to insurance, etc. But I have had doctors bills come to me 6 months after the fact, and it is extremely confusing to try to figure out what has been billed, what hasn't, etc.

Re: U.S. health care's widespread overbilling problem

#25

Post by wvenable »

mfoy_ wrote: post #19

It's also telling when the hospital gives you different bills depending on if you're insured or not. If you're insured they charge waaay more. They give you a more "realistic" bill if you are uninsured. It's a ridiculous system.

It's back-handed socialized medicine. Hospitals cannot turn anyone away so the money has to come from somewhere and this is how they do it. Oddly enough this is what keeps the whole system from collapsing.

Re: U.S. health care's widespread overbilling problem

#26

Post by pragone »

opportune wrote: post #16
Moshe_Silnorin wrote: post #2

Healthcare will always be overpriced so long as we allow this guild system to limit the supply of doctors for its own member's profit. Everything else is window dressing.

Yep. The AMA/AAMC is essentially screwing the rest of the US so that they can keep doctors' salaries artificially high. There are tons of medical school applicants who get rejected every year, and not because they can't become doctors, but because medical school sizes have remained constant while the country's population (and demand for healthcare) has increased drastically.

The problem is not medical school spots, it's residency spots. Having medical school graduates is useless if they can't get licensed or board certified.

Re: U.S. health care's widespread overbilling problem

#27

Post by projectramo »

koolba wrote: post #22
projectramo wrote: post #4

I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price. On the 10th call, I finally got someone to tell me what the out-of-poc…

How much did it actually cost? Was the estimate correct?

You know, that is a great question.

I have (excellent) employer provided care and I knew my cost would be low. But I will post this when I find out.

Re: U.S. health care's widespread overbilling problem

#28

Post by maxxxxx »

maxerickson wrote: post #20
paulpauper wrote: post #5

Earlier quoted context omitted.

but you have to also take into account that a lot of people don't pay (charity care)

Some non payment is also considered bad debt (they expect the patient to pay, the patient doesn't pay). With charity care, the bill is explicitly forgiven. The hospital industry claims non payments total around 6% of hospital expenses. http://www.modernhealthcare.com/article/20120106/BLOGS01/301... I do wonder if they calculate that 6% on what they bill though, rather than on what things actually cost. The margin on…

I remember reading that the 6% are from the billed prices, not the cost. The same when they claim to do things for poor people. They do a few procedures for free and claim the billed price so they can have nice PR for cheap.

Re: U.S. health care's widespread overbilling problem

#29

Post by EvanAnderson »

mfoy_ wrote: post #19

It's also telling when the hospital gives you different bills depending on if you're insured or not. If you're insured they charge waaay more. They give you a more "realistic" bill if you are uninsured. It's a ridiculous system.

Another anecdote to this point: I had an experience in which a doctor accepted me as a patient (knowing what insurance I had and what reimbursement rates the insurer would pay), performed a procedure for me, then subsequently found out my insurance would not cover the procedure (because of a preexisting condition waiver I did not know was still in force).

The doctor then demanded full payment for his non-discounted rate-- 6x the insurance reimbursement rate.

To my mind, acceptance of the "deal" was done when the doctor took me on as a patient and agreed to perform the procedure. At that time the practice had full knowledge of what the reimbursement rate would be. I see the doctor's "windfall" of demanding the non-discounted rate as being fraudulent.

Re: U.S. health care's widespread overbilling problem

#30

Post by sixdimensional »

For more information about the rough guidelines by which pricing works in the US (or doesn't work), check out the often referred to term "usual and customary" (UCR) charges. Read about it and then form your own opinion - I'd rather not bias too much by offering mine.

https://en.m.wikipedia.org/wiki/Usual,_customary_and_reasona...

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