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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

#81

Post by mac01021 »

pancreas wrote: post #52
alphanumeric0 wrote: post #39

I would like to ditch insurance and find a doctor who would allow me to pay a monthly subscription fee, much like a gym membership, for preventative care. Isn't the primary purpose of insurance for exceptional and accidental situations? If that's true, then why am I using it for predictable monthly expenses?

This is available for rich folks. This is "boutique medicine". Possibly the way of the future - to coexist with social medicine, of course.

How rich do you have to be? Why is it not available for the rest of us?

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

#82

Post by maxxxxx »

firebird84 wrote: post #34
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.

My experience is the opposite. The uninsured receive absurd bills because the hospital doesn't actually expect them to pay. The sell the debt to collections and get a big tax writeoff with little relation to reality.

You are probably right but this invites and rewards unethical behavior. If you pay the bill you are a sucker. You have to be a deadbeat.

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

#83

Post by mac01021 »

jrs235 wrote: post #69
chiph wrote: post #60

I would love to go to a doctor that had a price board hung in their waiting room so I'd know up front what the cost would be. Well-baby checkup: $120 School sports physical: $150 Blood tests: $80 Minor broken bone: $400 Major broken bone: $1200

"But we don't know [major vs minor] until we look at it!..." So add what all car shops say: Hourly rate: $100 / hour. And begin with a 30 minute to 60 minute diagnostic estimate (providing findings at 30 minute increments).

But then they wouldn't be able to bill $1350 for a 15 minute visit.

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

#84

Post by projectramo »

binarymax wrote: post #80
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…

Surprise! Pricing is "transparent", although massively complicated. There are several systems, but let's take a look at Outpatient procedure pricing... A good outpatient pricing guide is here: https://www.cms.gov/Outreach-and-Education/Medicare-Learning... And coupled with the OPPS dataset here: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Paymen... as well as a couple others, along with a quick read of the…

I suppose this would be helpful if they gave us the pricing before the decision of where (or, for many unfortunate people, if) to have the procedure or test done.

You seem to be talking about medicare and medicaid, and not about private hospital services. Is that correct?

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

#85

Post by fredgrott »

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…

at least in the US one has to remember that Medicaid pays less than Medicare for the same procedures with private insurance taking the price higher hits

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

#86

Post by cmurf »

wlesieutre wrote: post #41
projectramo wrote: post #32

Earlier quoted context omitted.

I agree with you in that this is another problem but I think the two are highly related. Consider: 1. If you don't have insurance, how do you know where to go? 2. If your insurance company wants to reward you for picking lower priced options, how do you comply? 3. If the government wants to lower systematic costs, how do they give you incentives? Without basic pricing information, all the benefits of a free market ar…

Related to 1 and 2, people on high deductible health plans are paying everything out of pocket until they hit their yearly cap (then insurance kicks in). It's not even whether you have insurance or the insurance company wanting to reward you, it's trying to save your own money like any other purchase. High deductible health plans are becoming more and more common, from what I gather.

Mine's $5500. The monthly premiums are ~$300. It's an obscenity for someone who's healthy, runs, bikes, or swims pretty much every day. But it gets worse.

Recently I went to a doctor for a minor problem, but did not get pre-authorization. I knew exactly what it was going to cost for the visit, and knew it would not be covered by insurance. What I did not know is, due to lack of pre-authorization, it also would not be counted against my deductible! Dicks.

I think major medical (true insurance for unpredictable things like congenital disease or accidents) should be something everyone gets, and it's paid for with taxes. Done. And then for poor lifestyle choices like smoking and having a crappy diet, you should either die (seriously) or you should pay the system out of your own pocket to take care of you (start a gofundme, see if anyone cares about your problems).

There is no possible way to fix healthcare in the U.S. with the multilayered middle man, for-profit approach we have, where everyone touches it wants their cut.

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

#87

Post by softawre »

sidlls wrote: post #78
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…

Price transparency is not going to fix much, if anything. It may induce rage increased blood pressure on the front end (prior to receiving service), but ultimately health care is often a "must have." Having a price list in hand doesn't suddenly make the price conscious consumer more of an expert regarding the necessity of various services estimated. Nor does it really encourage competition between competitors.

You seem to be missing that people want to compare prices at various firms, as well as deciding whether to have a procedure.

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

#88

Post by dboreham »

mfoy_ wrote: post #36
EvanAnderson wrote: post #31

Earlier quoted context omitted.

This "shadow" socialized system fills me with anger simply because we can't seem to deal with it in a mature and constructive way. As long as Americans can't stomach the idea of turning away people who cannot pay for emergency care to die we have socialized medicine. I don't understand why we can't, as a society, have a "grown up" conversation about this fact.

Why not just have proper socialized medicine, such as in Canada? Instead of this perverse system of "shadow" socialized medicine, fraud, and over-billing, why not just make it come out of everyone's taxes? That way everyone pays a very modest amount in tax and no one has to be financially ruined by flukes of nature. Also kills a huge amount of overhead in the billing departments, collection agencies, insurance compan…

Because Americans are selfish.

Source: lived in US for 20 years.

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

#89

Post by drewbuschhorn »

briffle wrote: post #24
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.

I had a hospital decide to restart the entire billing process on me after it was all paid for. Only time I've ever been glad for the insurance company (car, not health). I dropped it in their lap, and 3 mo later got an "our mistake" from the hospital, didn't have to lift a finger to fight it.

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

#90

Post by binarymax »

projectramo wrote: post #84
binarymax wrote: post #80

Earlier quoted context omitted.

Surprise! Pricing is "transparent", although massively complicated. There are several systems, but let's take a look at Outpatient procedure pricing... A good outpatient pricing guide is here: https://www.cms.gov/Outreach-and-Education/Medicare-Learning... And coupled with the OPPS dataset here: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Paymen... as well as a couple others, along with a quick read of the…

I suppose this would be helpful if they gave us the pricing before the decision of where (or, for many unfortunate people, if) to have the procedure or test done. You seem to be talking about medicare and medicaid, and not about private hospital services. Is that correct?

Yes, also sorry for the insensitive sarcasm in the previous post. It's a chicken and egg problem. In many cases you don't know if you need a test unless you've already had it. In the case of a procedure, there may be things that come up while it's happening that may complicate things. The irony is that OPPS/IPPS (inpatient) and APC (ambulatory) are meant to simplify things. Doctors and nurses usually do their best to know ahead of time, but medical procedures are complicated.

Fraud does happen most often against medicare/medicaid (as covered in this article with one trick known as "upcoding"), but I believe these codes are used with insurance providers as well. If a hospital or doctor is in your provider network (HMO/PPO) then there is a pre-agreed cost between the two set on these fees. Out of network occurs when there is no agreement, so there is no "trust" between the two and the insurance provider offsets the cost to you because they are legally able to do so.

In my opinion - overbilling is really caused not by pricing complexity, but by the control of the hospital and insurance provider duality. If there was no such thing as a network, and you were covered everywhere, then shenanigans with certain hospitals and providers would be more difficult.

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