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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

#171

Post by EvanAnderson »

arethuza wrote: post #121
EvanAnderson wrote: post #47

Earlier quoted context omitted.

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.

Thanks for that link. I'm looking forward to reading about Bevan and, in particular, finding this book.

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

#172

Post by tptacek »

ams6110 wrote: post #170
tptacek wrote: post #163

Earlier quoted context omitted.

The United States will get single-payer before it gets government-set pricing for 15% of its economy. Both, by the way, are problematic solutions! There are options for transparency that don't involve a government takeover of health care. But the brinksmanship in the politics of health care --- almost entirely the fault of the GOP --- is keeping us from exploring solutions.

Don't Medicare and Medicaid pay fixed prices? And aren't they generally below cost for the provider? So they have to "make up the difference" by charging private insurers and cash payers more?

I think so. My point is, government price ceilings on all health procedures are so noxious to half the polity that nobody will support it, and we'll get single payer by default.

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

#173

Post by u801e »

bonzini wrote: post #115
rsync wrote: post #106

Earlier quoted context omitted.

"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.

Car insurance doesn't cover routine maintenance, for example. So the prices for things like oil changes are relatively reasonable. If we had to go through insurance for things like that, then I'm willing to bet that the price of the service would increase substantially and auto insurance premiums would go up quite a bit as well.

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

#174

Post by maxxxxx »

grecy wrote: post #155
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…

Healthcare in the USA is not a scam, it's simply a for-profit business. They have worked extremely hard to maximize those profits for decades. They're actually good at it, and it were a startup extracting those profits they would be applauded for it.

I think most startups that repeatedly charge their customers for services not provided would be out of business quickly.

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

#175

Post by boneheadmed »

beat wrote: post #149
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…

The core difference between the American health insurance model and the Japanese model (which costs half as much and has better outcomes) is fixed pricing. In Japan, a government commission sets prices for every medical product and procedure, tuning the prices to insure profitability, while preventing profiteering. In America, price negotiation is done between providers and insurance carriers. This has a few obvious…

You're not completely correct. Medicare has fixed prices that it will pay for visits, procedures etc. The prices depend on what region of the country you live in. Insurance companies then set their prices up or down from there. Independent physicians have little negotiating power and often get paid by private insurance companies less than the fixed government rate. Larger systems with more bargaining power can get significantly more. But medicare's irrational price setting system is a big part of the problem.

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

#176

Post by jessaustin »

Paul-ish wrote: post #122
wl wrote: post #112

Earlier quoted context omitted.

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.

HIPAA was passed largely to prevent this potential catastrophe for healthcare executives. b^)

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

#177

Post by cptskippy »

biomcgary wrote: post #166
Johnny555 wrote: post #79

Earlier quoted context omitted.

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…

I've often thought this could be solved by requiring a doctor to carry "estimate" insurance. The patient's bill would be the quoted price and the doctor's insurance would cover any complications leading to additional costs. This would have the additional benefit of increasing the costs of doctors with frequent complications. This would only work for immediate complications from surgery (i.e., less likely to be impact…

It might also lead to doctors "missing" complications to avoid insurance premium increases.

Complications during surgery aren't necessarily caused by the surgeon or known ahead of time. The same is true of other things like home renovation where "we won't know until we open her up" is a common enough phrase.

Case in point, we want to remodel a bathroom that has a 7ft ceiling and my wife wants the ceiling raised to match all of the others. Why is it 7ft instead of 8ft? Can it be raised? Without significant cost? We won't know until we get in there.

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

#178

Post by thaumasiotes »

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…

> Medicare pricing is a special case, but you can't get that price without being on Medicare.

As far as I recall, Medicare pricing is defined by law as a percentage of the lowest price the provider ever charges to anyone else. For the sake of this comment, call it 40%.

If Medicare pricing is public, you can look it up and try to negotiate for 250% or whatever of the Medicare price.

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

#179

Post by heartbreak »

Paul-ish wrote: post #122
wl wrote: post #112

Earlier quoted context omitted.

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.

That's a great idea because the codes are usually on the bill, too. The problem, of course, is keeping all of that volunteered data secure.

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

#180

Post by heartbreak »

jessaustin wrote: post #176
Paul-ish wrote: post #122

Earlier quoted context omitted.

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.

HIPAA was passed largely to prevent this potential catastrophe for healthcare executives. b^)

So build it in Europe?
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