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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

#91

Post by anigbrowl »

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…

If it's massively complicated and obscure, then it's not transparent. Transparent means the information is available up front or for the asking, not that it's possible to obtain it if you have expert knowledge.

What you're sharing is great information and a fine foundation for people to build on. But pateients shouldn't have to go off and do a pile of research, they should be able to get a straight answer from their health provider when they ask for one.

If you have a pet and have to visit the vet, you already know they prefer to get paid up front. They'll generally tell you there's a fixed fee for the consultation/ Then depending on what's wrong with your animal they offer a treatment estimate, which is prepared within minutes and about which the administrative staff are generally competent to answer questions (eg why there might be variations in price for some items like anaesthetic). Animal medicine is at once less complex than human medicine (narrower range of treatment options, fewer administrative/legal considerations) and more complex (considerable variation among species).

I've been to good vets and bad vets, but the administrative aspects of both regular and emergency care have been painless and yes, transparent. Until we get universal healthcare, veterinary service would be an excellent model to imitate.

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

#92

Post by anigbrowl »

maxxxxx wrote: post #6
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…

Totally agree. If people in the US want to have markets for health care there should be price transparency. When I had a high deductible plan I always tried to compare prices but you almost never get a straight answer. If the Republicans want to reform health care that's where they should be starting.

If people in the US want to have markets for health care

I think only certain 'legal persons' and their executive officers and major shareholders want that. Patients, not so much.

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

#93

Post by ewhanley »

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've had this happen many times as well - a non-itemized invoice for services rendered six or more months ago. It's not my problem that they can't get their billing service sorted. When I worked in the oil industry, vendors were expected to bill promptly (within 30-60 days) or not get paid.

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

#95

Post by mikestew »

Johnny555 wrote: post #79
cptskippy wrote: post #21

Earlier quoted context omitted.

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…

One difference with auto repair: I expect the garage to call me before they do any work that exceeds the estimate. And I may very well decide not to do it. They may tell me that I need a $1000 timing belt replacement when I ask for a $200 water pump replacement, and I may decide not to do it. I can even ask them to put everything back together and tow the car somewhere else for repairs. If they tell me I need a $3000…

One difference with auto repair: I expect the garage to call me before they do any work that exceeds the estimate.

It's not just an expectation, it's the law in many places. When I was a pro mechanic in Indiana, anything over original estimate + 10%, and authorization from the customer is required. Well, not required I guess, since if you show up and the bill is 20% over, you just pay the original estimate. (Yes, in the worst case you might have to sue to get your car back. Personally, I've never known that to have happened, because most shops aren't looking to rip you off.)

But, as you point out, me being in the middle of a top end job is a little different than a surgeon who's working on a running engine when it comes to needed extra work.

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

#96

Post by binarymax »

anigbrowl wrote: post #91
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…

If it's massively complicated and obscure, then it's not transparent. Transparent means the information is available up front or for the asking, not that it's possible to obtain it if you have expert knowledge. What you're sharing is great information and a fine foundation for people to build on. But pateients shouldn't have to go off and do a pile of research, they should be able to get a straight answer from their…

Yes, hence the "transparent" in quotes and the overt sarcasm (apparently harder to detect than I intended). Of course patients shouldn't need to download a dataset and figure it out on their own! But please see my other response to see why it is tricky.

Regarding pets, they are not beholden to hospital/insurance provider duality, and it follows that since it is out of pocket, you would not be able to afford a $60k set of procedure if your dog had a broken leg...so the prices stay affordable.

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

#97

Post by ChemicalWarfare »

wvenable wrote: post #74
pancreas wrote: post #70

Earlier quoted context omitted.

It will be nice to have socialized medicine, but please, not as in Canada. Their system is not good. I would prefer Medicare expansion to all, or a VA-like system while medicare and medicaids are phased out. This will happen eventually, but alas not soon.

I'm a Canadian, what's wrong with our system from your perspective? (No system is perfect; there is always room for improvement and trade offs) Just two weeks ago, my wife had an emergency appendectomy. She went to the free clinic first thing Sunday morning as she had terrible pains all night. They immediately referred to the local hospital. She had the ultrasound in the afternoon and Surgery at 3:00pm. She's been of…

>> I'm a Canadian, what's wrong with our system from your perspective?

longer wait times for non-emergency treatment and (most of the time) not being able to pay cash and get the procedure done without the wait. personally know ppl in Canada (Toronto, so not some little town in the boonies) who had to wait few months to get an MRI.

on the US side - takes 2 weeks or so to get the insurance company's approval (they do this dance with a mandatory x-ray and electromyogram appointment before approving) or $500 or so gets you in like tomorrow.

the kicker of course is they will charge the insurance company $3k.

that said - the current US system needs a major overhaul, no doubt. both Obamacare and the not-there-yet "Trumpcare" are lipstick on a pig solutions though.

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

#98

Post by jazzyk »

dboreham wrote: post #88
mfoy_ wrote: post #36

Earlier quoted context omitted.

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.

I have lived in the US for 27+ years and I think Americans tend to be very generous, a lot of people donate their time and money to charities, churches, etc.

They just don't want to give their money to a bunch of bureaucrats, who spend it mostly on themselves, and seem to multiply like rabbits.

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

#99

Post by arethuza »

LyndsySimon wrote: post #76
skummetmaelk wrote: post #38

Earlier quoted context omitted.

Americans cannot stomach the idea of giving anyone anything for "free", without thinking about longer term benefits.

I don't think this is it at all. The argument is that there is no such thing as "free" , there are only transfers of cost. Someone is paying.

Well, we usually refer to the UK NHS as "free" but we all know that it means "free at the point of delivery" we know it gets funded from our taxes and therefore all taxpayers pay.

As someone who just had a few days in an NHS hospital I'm pretty much delighted with the experience. When was money mentioned? Not once, not once.

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

#100

Post by waqf »

maxxxxx wrote: post #3

To me hospitals are basically scam operations. My girlfriend has had several surgeries in the last two years. In addition to already outrageous standard prices ($40000 surgical center cost for a surgery where we spent in total five hours at the center) pretty much every bill had mistakes. Then after a few months a collection agency will try to collect for something that never got billed and never has happened. I can…

To quote from my own comment when we discussed this six months ago (replying to https://news.ycombinator.com/item?id=13325022):

"[…] there's adverse selection. The hospitals that make errors in the client's favor or that don't make errors at all are more likely to go out of business than the ones that make errors in their own favor. So guess which ones are still around when you need a hospital. In other words, just because the errors are accidental, it doesn't mean they happen at random. (This argument applies to any shady business practice that "looks" like an accident, for example dark patterns on websites, or having great customer service for taking your money but terrible customer service for refunding it.)"

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