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Hospitals pledge to fight admin price transparency plan in court

healthcaredive.com

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Re: Hospitals pledge to fight admin price transparency plan in court

#81
My uncle wrecked his motorcycle once. He ended up in a ditch unconscious.

Someone called 911. For what ever reason a life flight helicopter was then called and picked him up and took him to a local county hospital. He woke up there a few hours later. After they had already ran all kinds of tests. They had a large list of all the problems from busted spleen, broken bones, head concussion, etc.

After a day of rest in the bed, the only thing wrong was a sore ankle and some deep scratches on his face. He checked himself out and we went and drove him home. They sent a bill of $16,000 the next month to him. He asked why it was so high since the only thing they did was give him a helicopter ride and a bed to sleep in (none of which he consented to but of course hard to consent when you are unconscious).

He sent them a check for $16 which was the minimum amount required. He fully expected to pay $16 per month for the rest of his life, but they never sent another bill and he never asked... That was 15 years ago.

Re: Hospitals pledge to fight admin price transparency plan in court

#82
While publishing the negotiated prices for each procedure code would be interesting, I don't see how it would change much since it wouldn't necessarily be the price they would actually charge me, and it wouldn't help me know beforehand what sort of add-on procedure codes/bills were going to be part of my care.

The policy I would like to see is that patients should only be legally liable for costs that they sign off on up front (at least for most elective care). It never ceases to bother me that every time I go to the doctor I have no option but to give the hospital a blank check and have to cross fingers that they will not hit me a month later with ridiculous charges.

Re: Hospitals pledge to fight admin price transparency plan in court

#83

Earlier quoted context omitted.

Or we could just make healthcare a human right. No debt at all.

Oh, you're preaching to the choir, but I'm not optimistic about our country's chances of doing the right thing. If we're not going to follow the successful examples we've been presented with (because it's socialism! /s), and we're going to have capitalism, then we should have capitalism and engage in transactions where both parties have complete knowledge.

> and we're going to have capitalism, then we should have capitalism and engage in transactions where both parties have complete knowledge

That's not capitalism, that's free market. You can have a free market by bartering chickens, you don't need capital for that.

Re: Hospitals pledge to fight admin price transparency plan in court

#84

Earlier quoted context omitted.

To be clear, I think in virtually all respects orange man indeed is very bad. This headline suggested to me that orange man may actually be attempting something worthwhile.

Agreed. While I disagree with him on a great many things, he's right about this one.

Even an orange man can be right twice a day.

Re: Hospitals pledge to fight admin price transparency plan in court

#85

Earlier quoted context omitted.

That's because it's illegal.

Is it illegal to write “we will bill your insurance for procedure codes x y z for your visit”? They don’t need to tell you the cost, but they know what they’re going to charge you beforehand. They should be able to tell you the codes so you can give it t your insurance company to find out how much it will cost. The reason healthcare providers don’t give out codes for known predictable procedures is it would enable cu…

Yes, it is illegal to send that information to your email account or your mailbox. These days most providers have services that enable them to communicate with patients electronically, but it's a totally separate system that you have to login to. Your private health information will never show up in your email inbox.

Re: Hospitals pledge to fight admin price transparency plan in court

#86
post #51

Earlier quoted context omitted.

Normal countries do this by imposing price controls, and it works remarkably well to contain costs. Why can't the US do the same?

Unfortunately, central planning stifles innovation. We have the best cutting-edge medical technology in the world for the few who would like it and can afford it. But by eliminating pricing transparency we've also eliminated the incentive to make those technologies cheaper and more accessible to the common man.

You don't need innovation for the usual complaints that you see a primary care physician for - broken arm, throat infection &c. That stuff lends itself to standardization and following of protocols.

Re: Hospitals pledge to fight admin price transparency plan in court

#87
post #48
post #33

Earlier quoted context omitted.

From a Bogleheads topic titled “How to Minimize Your Emergency Care Expenses”: > Fifth, nobody you interact with at the hospital at the time of your visit has any idea how much anything costs. Part of that is the whole price transparency thing. Those who know the price don't want the front line workers to know it. Part of it is the fact that there are so many moving parts. Medicine gets inappropriately compared to av…

Thing is, this was self-pay for a single routine lab test. It's the simplest possible scenario.

Couldn’t you have called Labcorp and got the test from a lab? My doctor doesn’t do any lab testing. It goes to the lab in my county that’s connected to the hospital or to lab corp.

Re: Hospitals pledge to fight admin price transparency plan in court

#88
post #25

We need price transparency! Went to a quick care the other day because of a flu that would not go away, was seen and diagnosed with bronchitis in less than 5 minutes. The quick care billed my insurance $1,840, which they talked down to $300, and had me pay $115. What?

Crazy, that's the price you would have paid at Minute Clinic without insurance. https://www.cvs.com/minuteclinic/services/price-lists

Yep. I don't mind paying the $116, but the disparity in pricing is so ridiculous. It's like throwing darts at a board and saying "Pay us this much"

Re: Hospitals pledge to fight admin price transparency plan in court

#89

Earlier quoted context omitted.

That's because it's illegal.

Is it illegal to write “we will bill your insurance for procedure codes x y z for your visit”? They don’t need to tell you the cost, but they know what they’re going to charge you beforehand. They should be able to tell you the codes so you can give it t your insurance company to find out how much it will cost. The reason healthcare providers don’t give out codes for known predictable procedures is it would enable cu…

HIPPA and privacy laws. Communications have to be secure.

Re: Hospitals pledge to fight admin price transparency plan in court

#90
post #22

I spent 45 minutes at the hospital where I was to get a lab test done, trying to get a quote for said test. Prescribing doctor didn't know the cost. Lab tech didn't know. Billing department told me I needed a procedure code. Lab tech who was ready to draw blood couldn't tell me the needed code even after spending five minutes at a computer looking for it. Prescribing doctor gave me the code. Called back billing. They…

Lab tests are particularly complicated to price because usually they are being processed by someone else. Usually labs won't even try to get an authorization from insurance until they get your sample and start working on it as it affects their turnaround time which is one of their main differentiators, and each insurer will have different rules about what they will pay for under what conditions (insurers also have se…

> The short answer is they can't tell you because they don't know.

Bingo. My partner works in revenue cycle management (arguing with insurance companies to pay their bills) for a large hospital chain, and even she can't get accurate prices for procedures. She can walk down the hall to the finance department, and ask them, but even they can't figure it out.

I found this out after asking her why they don't prioritize cases with the largest bills, and she said it's because the billed price of the procedure has no relation to the actual priced paid. They could review a $800,000 cancer case and only recover $750.

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