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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

#121

Post by arethuza »

EvanAnderson wrote: post #47
mfoy_ wrote: post #42

Just to be clear... the "grown up" conversation you wish Americans could stomach is the one that involves socializing medicine and not the one that involves letting random people die needlessly, right?

I am an American. When I'm particularly exasperated with the healthcare system (usually in the weeks/months following some kind of medical engagement) my answer would be "I don't give a damn which we choose. Let's just make a decision to either socialize medicine completely or let people die." (My mood is unreasonably caustic after dealing with anything medical. The stress of dealing with healthcare billing, health i…

"fear-factor"

Worth noting that the book describing the principles of the UK NHS by its founder was called "In Place of Fear":

https://en.wikipedia.org/wiki/Aneurin_Bevan

Medical emergencies are stressful enough when there is no money involved - I have no idea how people cope when there is a stressful financial situation added on top as well.

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

#122

Post by Paul-ish »

wl wrote: post #112
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…

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 Medic…

I wonder if there is a straightforward way to aggregate people's bills to estimate the cost of a procedure (eg appendectomy) at a given hospital. Eg pay people $1 to scan their bill. This would only work for common procedures I suppose.

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

#123

Post by Dove »

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…

Colorado has this cool law which, as far as I can gather, requires hospitals to report prices for various conditions.

It results in tools like this: https://cha.fhsclearquote.com/ You put in your zip code, how far you want to go, find the condition, and it gives you a list of hospitals, average charge, case volume, and 5th and 95th percentile costs.

I'd love a more nuanced analysis that looked at outcomes, too. Still. It's a great tool for planning purposes ("If I have an emergency, take me to . . . ")

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

#124

Post by [deleted] »

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…

[deleted]

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

#125

Post by Terr_ »

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…

> "And these are your reasons, my Lord?"

> "Do you think I have others?" said Lord Vetinari. "My motives, as ever, are entirely transparent."

> Hughnon reflected that 'entirely transparent' meant either that you could see right through them or that you couldn't see them at all.

-- The Truth, by Terry Pratchett

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

#126

Post by jamroom »

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?

So what do you do when you get cancer and run up $1 million in bills? That's what insurance is for. Not sure if your monthly fee is going to work for you like that.

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

#127

Post by virmundi »

yequalsx wrote: post #77
opportune wrote: post #16

Earlier quoted context omitted.

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.

My wife recently completed her residency. She has $370,000 in student loans. In order to pay off the loans she needs a high salary. The high salary doesn't go away once the school loans are paid off. It'd make a whole lot more sense for the country to just pay for higher education upfront. We'd be fine with her making half her salary and have the loans forgiven. It'd be much cheaper for society to do this.

Indiana, and other states, have programs that will pay for your medical degree provided you go to an in-state institution and work with the under served. Now the definition of under served, just means people with not enough doctors per capita. In the case of Indiana, this includes large portions of the inner-circle of Indianapolis. So you could work with a 30-45 minute commute inside the circle (465) and go home to lovely Carmel Indiana. You'd have access to a diverse cultural center and no loans.

While it doesn't help your wife, this information can help readers that either want to go into medicine themselves, or have family members seeking such employment.

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

#128

Post by shakestheclown »

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…

That's part of the reason I ended up switching away from HD. It was a ton of work to get estimates, and there was such a delay if there were multiple invoices from different providers with my deductible that I ended up having to pay several thousand over my deductible and wait to be refunded after everything had processed through the system.

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

#129

Post by getemback »

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…

Agreed on the scam. The way to handle this is to not pay, and send a letter claiming that you don't owe it. If they send it to collections you can sue for collecting a debt not owed. If a collector contacts you about debts they know or should have known are disputed then you can also collect statutory damages from those people. If they report to credit rating agencies, and you dispute the facts with them and they take more than a month to resolve the issue you can also sue those agencies, and you have fresh grounds for suing the debt collector as well. You may be awarded treble damages!

This is an amusing pastime if you can afford temporary depressions in your credit score.

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

#130

Post by cmurf »

grasshopperpurp wrote: post #102
cmurf wrote: post #86

Earlier quoted context omitted.

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…

What about people who live in food deserts?

What about them? They'll live longer automatically, that's one incentive.

Every state should probably require every food related corporation to be a benefit corporation, with clear phrasing that an equal motive to profit for that business is incentivizing customers to eat healthy. If the incentive is just profit, you get crazy things like government subsidized sugar farmers and boner pill pharma.

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