Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

U.S. health care's widespread overbilling problem

axios.com

Post reply on HN
Print view View original

221–230 of 273 posts

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

#221

Post by u801e »

DougWebb wrote: post #137
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…

Price transparency is probably not feasible, most of the time. For the software developers, here's an analogy: asking your doctor how much it will cost to treat you is akin to a product manager asking you how long it will take to implement a feature. You might have a rough idea, but until you get into the requirements, do some design work, and dig into the details you can't even come up with a precise estimate. And y…

> asking your doctor how much it will cost to treat you is akin to a product manager asking you how long it will take to implement a feature.

Not in all cases. If your doctor orders labs or procedures, then getting the price should be straightforward. The fact that it currently isn't is a problem.

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

#222

Post by u801e »

binarymax wrote: post #90
projectramo wrote: post #84

Earlier quoted context omitted.

I suppose this would be helpful if they gave us the pricing before the decision of where (or, for many unfortunate people, if) to have the procedure or test done. You seem to be talking about medicare and medicaid, and not about private hospital services. Is that correct?

Yes, also sorry for the insensitive sarcasm in the previous post. It's a chicken and egg problem. In many cases you don't know if you need a test unless you've already had it. In the case of a procedure, there may be things that come up while it's happening that may complicate things. The irony is that OPPS/IPPS (inpatient) and APC (ambulatory) are meant to simplify things. Doctors and nurses usually do their best to…

> In many cases you don't know if you need a test unless you've already had it. In the case of a procedure, there may be things that come up while it's happening that may complicate things.

If you're getting something like a chest x-ray (posterior and lateral views), or an abdominal ultrasound, or a lipid panel, you should be able to call around to various labs with the appropriate CPT code(s) and ask them what the price would be.

What's you're talking about would be something like if they order a test and based on the result of that test, they need to perform more tests to confirm or eliminate a possible diagnosis. But for each test, you should be able to get the price since each test has a couple of possible CPT codes that it would fall under for billing purposes.

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

#223

Post by rsync »

drdaeman wrote: post #187
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…

> I'm sure there are rare people here and there that care how much a mile of highway costs No offense meant, but I find this attitude really odd. I'm not from US and only have an overall idea how things work there, but I wonder... Isn't that still your money, even if you pay $0 directly and the rest comes from the shared pool your insurance payments or taxes are also in? I just tend to believe there ain't no such thi…

"Isn't that still your money, even if you pay $0 directly and the rest comes from the shared pool your insurance payments or taxes are also in?"

Well, please do read the first sentence of my reply - I do care and I do wish that price transparency were extant.

Further, as a net tax payer, in California no less, I am quite interested in the actual costs of things like road paving and bridge building and subway tunneling.

But neither of those (net tax paying and interest in the pricing of social goods) are common traits.

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

#224

Post by u801e »

cptskippy wrote: post #21
Osiris wrote: post #8

Earlier quoted context omitted.

Health care is the only industry where you only find out how much something costs after you're already bought it. Basic supply and demand theory depends on consumers having perfect information. A free market cannot work when a consumer has no information.

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…

> The cost of fixed cost procedures (e.g. lab work) are unknown.

I don't think that's the case. For example, if you get a lipid panel, it's going to be coded under a given CPT. The billing department should be able to obtain the cash and insurance price. The problem is that they're not forthcoming with it (at least in my experience even when I had the CPT).

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

#225

Post by maxsilver »

drdaeman wrote: post #187
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…

> I'm sure there are rare people here and there that care how much a mile of highway costs No offense meant, but I find this attitude really odd. I'm not from US and only have an overall idea how things work there, but I wonder... Isn't that still your money, even if you pay $0 directly and the rest comes from the shared pool your insurance payments or taxes are also in? I just tend to believe there ain't no such thi…

> I find this attitude really odd. (snip) I just tend to believe there ain't no such thing as a free lunch - someone has to pay for the medical services, highway pavement or sewer line installation. People can't be expected to work for free, right?

I think the issue is that most of these services are so cheap that the cost isn't ever a major factor. "No one cares" is probably more accurately stated as "no one is forced to care, because the general public can have confidence it's handled mostly responsibly".

In Michigan, for example, to completely tear down and rebuild new a lane-mile of freeway that is rated to last 20 years, cost roughly $2 million dollars in 2016. So, a brand new stretch of freeway, 4 lanes wide and 100 miles long, would cost about $400 million dollars. (That distance covers, just as an example, an entire trip from Chicago to Milwaukee)

That cost sounds insane at face value, and gets everyone worked up about "costs". Until you math that out and realize it comes out to 33 cents per citizen per month. At which point, freeways seem like a crazy good bargain. Even if you go crazy and build 20 times more freeway than that, the total cost is still cheaper than a Netflix subscription.

They're not all that low of course, but this tends generally holds true of many social services or utilities (water, sewer, electrical, firefighters, schools, police, etc). High upfront cost, high "sticker shock" value, but as a common good everyone can benefit from it becomes a pretty reasonable cost per person. Far lower than it would ever cost to do so any other way.

---

The only thing that doesn't seem to work that way in the US is healthcare. And I don't know why, but I suspect it's because it's so privatized and unregulated (so lots of profit and overhead) and also so intentionally hidden in terms of cost (so there's no way to look up costs, the way you can with any normal social service).

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

#226

Post by Neliquat »

rogerbinns wrote: post #135
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 next stage is asking them what the number needed to treat is for the drugs: https://en.wikipedia.org/wiki/Number_needed_to_treat > ... average number of patients who need to be treated to prevent one additional bad outcome ... Here is an example for aspirin preventing a first heart attack or stroke (NNT is ~1,667): http://www.thennt.com/nnt/aspirin-to-prevent-a-first-heart-a...

I really amused and annoyed a few with this.

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

#227

Post by actuallyalys »

jamroom wrote: post #126
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.

I think they meant they would still have insurance, just not for preventive care.

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

#228

Post by tedmc »

technics256 wrote: post #212
harisenbon wrote: post #154

Earlier quoted context omitted.

I'm heading back from Japan today, and my family got a bunch of checkups and medical stuff done while we were here. Even without insurance all our procedures cost total less than ~$100 apiece. The most expensive thing I've ever had in japan was my full body workup last year for $500. It included: stomach ultrasound, 5 blood tests, eye exam, MRI(brain) and barium scan. All without insurance. By comparison, in the US I…

Did you need to speak Japanese to get this done?

Google Translate is magical. I've used it to speak with vendors and negotiate prices in China. Not optimal, but amazing. Works on text too....

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

#229

Post by gnicholas »

Dove wrote: post #140
gnicholas wrote: post #114

Earlier quoted context omitted.

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

Your information is outdated. It was unafforadable fifteen years ago . . . in the last five to ten, it has become very, very affordable and has exploded in popularity to the point that it's available all over the country. Here's one example: https://atlas.md/wichita/our-fees/ Children 0-19 years old, $10/month with at least one parent membership Adults 20-44 years old, $50/month Adults 45-64 years old, $75/month Adul…

I don't have a dog in this fight — I was merely pointing out that no one is stopping non-rich people from buying anything. It's just that people with lots of money can afford more than people with less money, in medicine as in anything.

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

#230

Post by 1123581321 »

yellowstuff wrote: post #165
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…

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.

If your dental office is recommending 3-4 cleanings a year and you have dental insurance that covers two, there is a good chance that they may cover more. My Delta Dental (a popular dental plan in the US) lets you add a free* rider via the website to cover four cleanings a year. It has a menu of medical reasons for the extra coverage from which you choose one.

I'm told diabetes and maternity are the most common reasons people access the additional cleanings.

* I realize this is priced into the default premiums.

Post reply on HN