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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

#231

Post by dghughes »

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.

I have GERD but before diagnosis the acid from coughing was terrible on my teeth.

My dentist with many years experience diagnosed it. I went to the doctor who confirmed it was GERD.

I lost my job but when I was working the insurance paid for two cleaning per year. I chose to keep the insurance but it's a lesser plan that only covers one cleaning every nine months.

Twice per year was good for me since I got lazy about three or four months after visiting the dentist. I needed the twice yearly pep talk.

And I should also say that 75% of people who are diagnosed with IPF a fatal lung disease have GERD. My father has IPF and GERD I have GERD but I hope I don't develop IPF. My grandfather died of emphysema at 52 I really hope there's no connection! So yeah a dentist could point you in a direction that may help you more than you realize.

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

#232

Post by mnm1 »

arrty88 wrote: post #208
mnm1 wrote: post #72

I think this is a great argument for a single payer system. Let the government and hospitals duke it out. When it's the government's money that is being lost, the government might actually care and start negotiating with these providers. Even if it doesn't, at the very least, patients lives won't be ruined by bills for services that they had no control over or knew the cost of beforehand. Not only that, but the gover…

Since when has government cared about losing money?

That's my point. They don't care that much. And if they decide to care at some point, they have the resources to fight it out. Let these abstract entities (gov't, healthcare providers) fight it out on their own so that people don't have to die.

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

#233

Post by int_19h »

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?

Fun fact: Medicare is prohibited from negotiating drug prices with suppliers, by law.

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

#234

Post by gscott »

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…

It is difficult because each insurance provider will have a different contract with the hospital or care provider. My wife works at a hospital that just upgraded from an all Dos based system to a windows based system. Her job is resolving provider disputes where the provider billed a rate that was different then their contract. Old systems + lots of different rates = confusion!

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

#235

Post by int_19h »

mnm1 wrote: post #72

I think this is a great argument for a single payer system. Let the government and hospitals duke it out. When it's the government's money that is being lost, the government might actually care and start negotiating with these providers. Even if it doesn't, at the very least, patients lives won't be ruined by bills for services that they had no control over or knew the cost of beforehand. Not only that, but the gover…

Single payer is overly restrictive (although it would still be a lot better than what we have now). A non-profit public option, with an explicit legislative grant to negotiate prices with its full strong-arming ability, would deal with this stuff just as well, while still enabling people to shop for insurance if and when they want to.

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

#236

Post by DougWebb »

tptacek wrote: post #164
DougWebb wrote: post #137

Earlier quoted context omitted.

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…

Hang on. The comment you're replying to is complaining that they can't get a price for a single test , a discrete unit of health care. That's not like not being able to get a price for a completed Rails app; it's like not being able to get a price for a Macbook. I think you've moved the goalposts a little.

I did say that lab tests have less variability, which means they should be easier to price. My guess is that the reason the OP had so much trouble getting a price is because the lab simply doesn't work that way. It doesn't have a consumer price list; instead they do the work first, then determine which insurer to send the claim to, and then sometime later get paid whatever the insurer has set the standard reimbursement to be.

What the OP found on the 10th attempt to get a price was somebody who was willing to look up claims for other people who had the same test, determine what the reimbursements were, and let him know the cross-insurer range of those amounts. Or maybe the range was over the claims sent to the insurance companies, rather than the amounts the insurers actually paid. If that's the case, then the range reflects actually differences in the test processing rather than differences in the insurers.

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

#237

Post by int_19h »

wvenable wrote: post #74
pancreas wrote: post #70

Earlier quoted context omitted.

It will be nice to have socialized medicine, but please, not as in Canada. Their system is not good. I would prefer Medicare expansion to all, or a VA-like system while medicare and medicaids are phased out. This will happen eventually, but alas not soon.

I'm a Canadian, what's wrong with our system from your perspective? (No system is perfect; there is always room for improvement and trade offs) Just two weeks ago, my wife had an emergency appendectomy. She went to the free clinic first thing Sunday morning as she had terrible pains all night. They immediately referred to the local hospital. She had the ultrasound in the afternoon and Surgery at 3:00pm. She's been of…

Not OP, but my biggest problem with your perspective is that it is almost pure single-payer, meaning that there's usually no choice in areas where government is involved, even if you're able and willing to pay for something better or faster.

In comparison, e.g. most European countries use a combined two-tier approach, where the role of the government is to ensure universal basic coverage and affordability of that coverage, but not to replace private insurance entirely.

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

#238

Post by rayiner »

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…

Having recently had the opportunity to compare Tokyo's rail system to DC's, I'd trust the Japanese government to set prices. But here in the US I suspect prices wouldn't be set to "ensure profitability while preventing profitability." Instead, they'd go back and forth between untenable extremes.

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

#239

Post by dingo_bat »

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…

> tuning the prices to insure profitability

Highly offtopic, but thanks to anyone who helps me with this: wouldn't ensure be a better fit here?

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

#240

Post by Consultant32452 »

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…

I had an equal and opposite experience getting an MRI. I also have a high deductible plan. When I was told I needed an MRI I went on my insurance provider's website to find MRI locations that are in network nearby. I called the first 5 on the list. I found that some place that was basically MRI-R-US was several hundred dollars cheaper than going to the local mega-hospital.

Pricing isn't transparent because people usually aren't paying with money they perceive as their own. What do you care if your insurance company pays $200 or $2000 for that MRI? Eventually that difference shows up in the form of higher premiums, but that's far too complicated for people to respond to intelligently.

Let's go one step further and imagine a world in which we completely replaced Medicare with a catastrophic coverage system. If you have a heart attack or something we'll take care of you, but for your day to day healthcare we'll just cut you a check for however much the government was previously paying. You can choose to use that money on anything you want whether it's healthcare related or not. You want to see price transparency and the power of competition to lower prices? Boom, done.

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