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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

#191

Post by xenadu02 »

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…

It would "help" in the sense that people would forgo care.

Sure you might shop around for a non-emergency specialist one-off procedure like an MRI, but the cost of MRIs is a drop in the bucket and wouldn't meaningfully impact overall healthcare costs if they were an order of magnitude more expensive. If you have "normal" insurance plan your insurance provider has presumably already shopped around and only providers willing to take the reduced rate are "in-network".

Don't get me wrong: you should be able to get a cost estimate up front and it is silly that it is so difficult.

Price transparency isn't the major problem in healthcare. The free market and profit are the major problems with healthcare. To set prices a free market requires price discrimination and the ability to price some people out of the market. That translates into debilitating illness (a deadweight loss to our economy overall) or death for serious medical issues. A free market in healthcare absolutely requires that some people be allowed to die of treatable diseases in order to maximize profit.

To put it another way: As a technical matter it is impossible to discover the maximally profitable price for a treatment without raising the price beyond at least some people's ability to pay.

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

#192

Post by passivepinetree »

Spooky23 wrote: post #169
yellowstuff wrote: post #165

Earlier quoted context omitted.

My dental hygienist once told me to get 3 cleanings a year. I told her my insurance covered 2. She told me that it was like chemotherapy- you should do what's medically necessary whether or not your insurance covers it.

That's probably good advice. The extra $80 for a cleaning is cheaper than many of the dental procedures that many folks will need.

Or you could spend a fraction of that on decent floss, toothpaste, and a toothbrush. If you have decent home care, you really don't need to be getting cleanings three times a year.

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

#193

Post by passivepinetree »

EvanAnderson wrote: post #29
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.

Another anecdote to this point: I had an experience in which a doctor accepted me as a patient (knowing what insurance I had and what reimbursement rates the insurer would pay), performed a procedure for me, then subsequently found out my insurance would not cover the procedure (because of a preexisting condition waiver I did not know was still in force). The doctor then demanded full payment for his non-discounted r…

What ended up happening in this case?

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

#194

Post by SilasX »

waqf wrote: post #100
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…

That's not a complete explanation, as it would likewise prove that every business errs as much as possible in their favor. It wouldn't explain what's different about hospitals and health insurance that makes them so brutal about it.

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

#195

Post by Spooky23 »

extra88 wrote: post #190
Spooky23 wrote: post #169

Earlier quoted context omitted.

That's probably good advice. The extra $80 for a cleaning is cheaper than many of the dental procedures that many folks will need.

I find it hard to believe that a two month difference between cleanings (4 months vs. 6 months) is going to prevent any more serious dental procedure.

It all depends on you. If you develop plaque more quickly, you want to go more to prevent gum disease. Gum disease never goes away and always requires more intervention and more $$$.

The recommendation that you go twice a year literally originates from a toothpaste ad in the 1950s. It was an arbritary number intended to encourage you to get preventative care, aided by their toothpaste. (In those days dentists were mostly tooth pullers)

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

#196

Post by HarryHirsch »

Dove wrote: post #123
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…

Hey, that's wonderful. Price transparency is always touted as the panacea for the relentless runaway growth in healthcare costs in the States. Here's the natural experiment. Has this law managed to rein in healthcare costs?

You'd think it hasn't, and the missing focus on outcomes gives it away.

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

#197

Post by maxxxxx »

empath75 wrote: post #183
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…

My son was born last year. We had two insurance companies and accidentally filed with the wrong one as primary. I used my hsa to pay the balance of about $800 9 months later, instead of refilling with the correct insurance company, they sent us a $20k bill. After we called them and said, hey you know you should probably refill with the right company, they did. The insurance company declined because they took to long…

This describes the whole craziness well. How is a regular person supposed to be able to figure all this stuff out?

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

#198

Post by SilasX »

alistairSH wrote: post #119
EvanAnderson wrote: post #11

Earlier quoted context omitted.

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.

Yep. And employer plans don't avoid the random bill in the mail from "lol you still have to pay the balance because we decided not to cover all of that even though you never had a chance to know the max downside".

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

#200

Post by ChemicalWarfare »

wvenable wrote: post #133
ChemicalWarfare wrote: post #97

Earlier quoted context omitted.

>> 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…

Yeah, waiting a few months to get an MRI if your condition isn't serious isn't uncommon. Diagnostics like that tend to be the longest wait times -- actually getting surgery after a diagnosis is pretty quick. On the other hand, my experience with the US is that the service is great. They'll even send you for unnecessary tests just because. And it's all pretty fast. But then you have so many people who get nothing at a…

sure, it's a balancing act. another downside to mention - wait times in walk in clinics in Canada during the flu/cold season are pretty extreme - it's free so ppl just go if they suspect anything is wrong.

I remember reading in the news they were considering charging a nominal fee, like $5 to cut down on these types of visits. On the US side you'd pay around $50 for one of those visits (unless you go to your doc) - wait time is like 10 min.

I actually wouldn't mind something similar to a Canadian system - if they can manage that without tax increases :) - plus a private "network" someone who can afford paying for a private insurance (or using straight up cash) can use.

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