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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

#111

Post by ashark »

drewbuschhorn wrote: post #89
briffle wrote: post #24

Earlier quoted context omitted.

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.

One of the more surprising things for me, watching major medical events from a distance and relatively close-up in my family, has been that hospital billing departments are at least as inconsiderate, incompetent, out-to-get-you, and generally shitty as insurance companies. And considering how much trouble I've seen/had with insurance companies that's saying something.

The number of times I've seen a bill that made no sense and been told, "oh, yeah, you're not misreading it, it's a bill, but you can ignore it because [reasons]"... WTF are they doing? Seriously, no-one else gets away with being so entirely sloppy.

Then there's the wonderful "we sent you one bill for a trivial amount which you probably lost in the pile of 50 other damn bills from 20 different providers, many of which were bills but didn't actually need to be paid (see above), plus twice that many not-bills-but-still-kinda-look-like-them statements of benefits and whatnot, didn't send a followup or call you or anything, but now you're in collections for $90 or whatever and your credit's dinged, sucks to be you".

Then if there's a dispute with insurance the hospital/providers will harass you until it's over. And sometimes just try to bill you even though they know it's being disputed. I guess they think you're not already spending enough time on the phone fixing their screw-ups.

I'm not necessarily in favor of fully nationalized healthcare exactly (some form of universal health care, yes) but it'd almost be worth having the government directly take it all over just to drink up those sweet, sweet hospital billing/admin and insurance company CEO tears. I truly wish everyone involved all the worst.

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

#112

Post by wl »

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…

Pricing is not even nominally transparent. By law, you can get access to the chargemaster, which is the list price that nobody actually pays. If you try to get access to the negotiated price your insurance company will pay, you'll quickly discover that it's confidential up until the point where the provider actually issues a bill. Medicare pricing is a special case, but you can't get that price without being on Medicare. Also, many providers won't accept Medicare because reimbursement is meager and often unprofitable.

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

#113

Post by rrdharan »

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…

This is exactly what Castlight was originally trying to solve with their transparency tool: https://en.wikipedia.org/wiki/Castlight_Health

Always thought their approach was quite clever and I think they did end up having some success though I'm not sure the overall impact has been as transformative as was originally hoped.

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

#114

Post by gnicholas »

mac01021 wrote: post #81
pancreas wrote: post #52

Earlier quoted context omitted.

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?

It's not unavailable to the non-rich, just unaffordable.

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

#115

Post by bonzini »

rsync wrote: post #106
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…

"Let me add my big one: price transparency." Lack of price transparency bothers me as well and I wish we had it. However, I don't know if there will ever be enough pressure to manifest this. Price transparency really only matters to the person paying the bill. Our society is very rapidly evolving to consider any healthcare cost of any kind to be an insurmountable burden that no normal person could ever be expected to…

> Our society is very rapidly evolving to consider any healthcare cost of any kind to be an insurmountable burden that no normal person could ever be expected to pay

On the other hand, if prices are not managed properly, premiums get higher and higher. So even if insurance pays, you should care that prices are reasonable.

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

#116

Post by grasshopperpurp »

jazzyk wrote: post #98
dboreham wrote: post #88

Earlier quoted context omitted.

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.

What a pile of garbage. Your charities and churches do more harm than good, and they allow people like you to justify your selfishness.

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

#117

Post by anigbrowl »

binarymax wrote: post #96
anigbrowl wrote: post #91

Earlier quoted context omitted.

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 se…

Tbh if I broke my own leg I think I'd rather have the vet do it. Every time I have had to bring a friend or family member to hospital I'm just appalled by it all.

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

#118

Post by sidlls »

softawre wrote: post #87
sidlls wrote: post #78

Earlier quoted context omitted.

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.

No, I'm not missing that. It doesn't make as much of a difference as you'd think. There are plenty of companies and organizations in this space who offer "price transparency" services to varying degrees of accuracy.

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

#119

Post by alistairSH »

EvanAnderson wrote: post #11
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…

An an anecdote: I've been on a high-deductible plan for nearly 13 years. I have been regularly met with shock and incredulity that I could possibly want to know the cost of a procedure. My wife and I have spent, collectively, hours on the telephone trying to get answers. It's particularly galling when we get "guilt trip" treatment for asking about costs for procedures for our young daughter. We have been met with bot…

The average person I know has employer-provided insurance and doesn't think a bit about the costs of procedures.

While that has been true for decades, in my experience, those employer-provided plans are beginning to transfer some of the cost to the consumer through higher deductibles and copays.

My last few visits to the doctor tend to support this, as in both cases, the doctor offered cost-saving options and advice.

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

#120

Post by ashark »

jrs235 wrote: post #68
trey-jones wrote: post #51

At the risk of spiking my blood pressure I will write a few words on this topic. I will start by saying this: The whole system is fucked. I am referring to the system that facilitates American residents getting healthy and staying that way. What is the basis of my claims? I admit that I am a healthy 33 year old white male and I probably have only seen that tip of the iceberg. I am also a father of 3. My oldest daught…

A family friend had twins. One born before midnight, the other after (different birth days). When they got their bill(s) from the hospital they noticed they were charging room fees for both infants starting the day of the first born. The second child wasn't even "alive" (born) for the first day they were trying to charge for! What's also absurd is that the first child wasn't in the receiving room until after midnight…

Can confirm. Three births, hospital/insurance both effed up the billing on all three. If we hadn't been vigilant and wasted hours, and hours, and hours, on the phone and in one case gotten our state rep and the state insurance board involved we'd have been out several thousand dollars that we shouldn't have had to pay. I hate to think how much we didn't catch. Similar stories from others, plus tales from non-pregnancy major medical procedures that shake out similarly, though are even harder to sort out.

Everything that touches healthcare billing is scammy, incompetently managed, and often outright fraudulent. Good luck getting any compensation or justice other than what you were originally entitled to, though.

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