Hospitals pledge to fight admin price transparency plan in court • Hacker News Board

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

#181

Post by SilasX » Tue, Nov 19, 2019, 7:42 PM UTC

lucozade wrote: post #104

js2 wrote: 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…

Sure, this is the reason why you can't get an answer but it's not a justification . There are 2 parts to it. The first, which is reasonable, is that a lot of treatments are bespoke. Fine. That's a justification for their being costly not for your having to imagine the cost because no one can tell you. Even for flights, the truth is I can get a bespoke flight if I can afford it. And if I want to know how much it is th…

Interesting comparison, because airline pricing is notoriously complicated, resulting in things like hidden-city fares[1] and such considerations as "do we expect to be able to be to sell that seat to some business traveler at the last minute whose only choice is us?"

Furthermore, there are all kinds of unknowns that can happen on the flight.[2]

And yet they still have no problem quoting you a price.

[1] where a flight from A to B costs more than a flight from A to C with a stop in B.

[2] Earlier discussion of whether unexpected events make it comparable to health care: https://news.ycombinator.com/item?id=18719867

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

#182

Post by pnw_hazor » Tue, Nov 19, 2019, 7:44 PM UTC

munk-a wrote: post #119

lotsofpulp wrote: post #73

Earlier quoted context omitted.

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…

The procedure codes involved in your visit explicitly call out what your treatment was, since information about your state of health and ongoing medical information is considered private information we have HIPAA to protect that privacy. Information about what procedures you've had done are relatively important to keep private so that knowledge of such procedures isn't used to influence your employment - while gettin…

Unless the patient is prescribed a controlled substance. Then docs force patients to sign a waiver that enables the police and just any other state agency to take a peek for any reason. Of course, the patient always can refuse to sign the waiver and seek out non-traditional/conventional sources of treatment.

As a lawyer it is shocking to see how far the medical profession has fallen w.r.t. patient privacy.

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

#183

Post by rolltiide » Tue, Nov 19, 2019, 7:49 PM UTC

istjohn wrote: 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…

I just want a way to sue the fuck out of all medical professionals that told me something would be covered by my insurance

Getting evidence of these statements is a challenge but a civil court would easily put them on the hook for the cost they said I wouldn't incur and 3x it with punitive damages

and then double whammy with a review of their license

They'll go ahead and try to argue what "covered" meant, and everyone will laugh them back to med school because of the shared experience of this bullshit

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

#184

Post by TheSoftwareGuy » Tue, Nov 19, 2019, 7:49 PM UTC

bluGill wrote: post #126

topicseed wrote: post #64

Earlier quoted context omitted.

From the UK. Health care cost stories in the US seem incredibly dreadful. Hard to grasp how a huge power like the US can't get itself around decently-priced healthcare.

It is incentives. Most people get their heath care from insurance, which is subsidized by their job. I can legally buy my own insurance, but it will cost a lot more than what I pay through work so of course I don't. My boss wants me to keep working, and so high medical costs keep me from quiting to start my on competitive business. I can live for a couple years on cheap food and little else, but I need at least emerg…

> I can legally buy my own insurance, but it will cost a lot more than what I pay through work so of course I don't.

Which is entirely frustrating too. This only happens because employers only subsidize specific health plans, instead of letting the employee spend that money on the health plan that they deem best for themselves. Isn't that ridiculous? Why would my employer care what health insurance I get anyways, they don't know my health situation. I should be able to use the money they spend on my health insurance however I want!

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

#185

Post by jonlucc » Tue, Nov 19, 2019, 7:50 PM UTC

triceratops wrote: post #162

mark-r wrote: post #138

Earlier quoted context omitted.

> all the pharma companies would save millions every year. Their savings would never be passed on to the customer. And it's hard to believe there would be any savings overall, because the advertising must be bringing in more money than it costs or they wouldn't be doing it.

I'm not disputing pharma advertising is profitable for individual products. I'm skeptical if it's profitable in aggregate. Drug demand is a function of the occurrence of disease. Advertising can increase profits by: 1. Taking market share away from a competitors. Profitable for that product, zero-sum for the industry. Competitors respond by increasing their ad spend, equilibrium returns (unless one drug is genuinely…

There are two niches in which your analysis is incomplete.

First, There are underdiagnosed diseases for which patients don't seek care, sometimes because they do not believe there to be a treatment. The lack of treatment means that it isn't as vital for physicians or patients to pursue diagnosis. Those patients might see an ad and return to a physician to ask if that treatment is a fit.

Second, not all physicians are as on top of new treatment options as we expect. It might have slipped their notice or be in a field with which they aren't the most familiar, and those patients might benefit from revisiting whether a new treatment is a good fit.

I don't really think these two cases make up for all of the advertising, but they might be missed if advertising is cut or abolished.

It might have some fairly large drawbacks, but I think it would be good for pharma and biotech companies to put some amount of money into a fund based on the disease and have awareness campaigns around the diseases. For example, companies with diabetes treatments could form a group that puts out diabetes ads urging patients to talk to their physicians. It gets dicey for first-in-market treatments, but I think it would be an overall improvement from the current system.

Disclaimer: I work in big pharma biology research; pricing and advertising are done in a fancier building with more marble floors, so I've thought about this a bit, but it isn't my department.

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

#186

Post by jagged-chisel » Tue, Nov 19, 2019, 7:51 PM UTC

enjo wrote: post #172

notyourday wrote: post #149

Earlier quoted context omitted.

> The first, which is reasonable, is that a lot of treatments are bespoke. Fine. That's a justification for their being costly not for your having to imagine the cost because no one can tell you. Treatments are billed using billing codes so they are definitely not bespoke.

Those billing codes are CRAZY complex tho. One example: when you see a doctor you may generate multiple billing events. For instance they may draw blood, take an X-Ray, and perform a specific type of test. In a sane world you would generate three billing codes, sum them, and you'd have your price. But that's not how it really works. Instead certain billing codes can be combined to form new billing codes which makes t…

Don't forget each piece of equipment involved in drawing blood. Had to try three times because you're dehydrated? Different-sized needles because you're a person of smaller stature? Gotta bill you for each piece consumed, and the premium for being outside the range for 'average.'

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

#187

Post by gamblor956 » Tue, Nov 19, 2019, 7:54 PM UTC

maerF0x0 wrote: post #49

> Transparency is not going to work where there is no competition, Emily Gee, a health economist at the left-leaning Center for American Progress, told Healthcare Dive. That's bs. I will drive to a further away hospital if it saves me $75 an hour of time spent... (edit: clearly I'm talking about non-emergency here)

That "further away hospital" is literally "competition."

Also, 1 hour away is not much in terms of time or distance, considering that many metropolitan residents have a daily commute in excess of 1 hour, and many rural residents live several hours from the closest hospital.

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

#188

Post by jonlucc » Tue, Nov 19, 2019, 7:55 PM UTC

maerF0x0 wrote: post #157

bluGill wrote: post #132

Earlier quoted context omitted.

But it won't. Your insurance will pay for it either way, so you are spending an hour of your time to save your insurance $75 - which won't even be given back to you in form of lower premium.

> Your insurance will pay for it either way This is an assumption based on a very good insurance package. Most have out of pocket co-pays . So yes, we have to gross it up by the co-pay percent and discount it by the Annual deductible limitt, but generally the point stands. If I can save enough money I might travel away from the monopoly. Until that data is transparently available I can't optimize that scenario w/ my…

Sort of; in my experience, even with a high deductible health insurance plan, the insurance company's negotiated rates are still in effect. In other words, if a visit would be billed to an uninsured person at $200, but my insurance caps it at $100, then $100 is the price accepted by the doctor's office no matter if I'm paying because I haven't reached my high deductible or insurance is paying because I have a regular, not high deductible plan.

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

#189

Post by AtlasBarfed » Tue, Nov 19, 2019, 7:55 PM UTC

programmertote wrote: post #140

Berobero wrote: post #98

Earlier quoted context omitted.

I was in Japan two years ago; got pneumonia and needed antibiotics. Went to a hospital with no insurance and no appointment. I was being seen by a doctor within 30 minutes. Doctor wanted to do some additional labs just to rule other things out, but he was worried that it would be expensive for me given the lack of insurance. He called up billing with me still in the room and had a price within a couple minutes: ~$70…

Exactly the way it works in a SE Asian country I grew up. The private and public hospitals have price quotes on different procedures and it's for everyone to see. The comments above using Boglehead's quote as a justification of why medical pricing has a lot of variance is mostly a lie. My wife, who is a doctor trained in our home (SE Asian) country and is doing her residency in the US, and I were just laughing at the…

Have you seen radiologist salaries?

It's a scam, Jim.

There are four pigs at the trough of US health care:

Insurance Device/Drug Lawyers Doctors

Everyone points the finger at other people and desperately fight to maintain their bloated share of the bloating pie.

Unfortunately doctors are not your friends in hospitals. They are trying to get billing.

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

#190

Post by prklmn » Tue, Nov 19, 2019, 7:55 PM UTC

bluGill wrote: post #114

legitster wrote: post #8

The previous administration had a similar effort that failed. I hope that this effort is successful. >"For instance, it could allow one provider to follow and match the prices of the other provider (like two gas stations across the street from one another who face no other competition)," Garmon said. I understand this argument, but I think they underrate how much people are willing to shop around when they actually h…

I'd pay more for quality. If I knew hospital X is better at hip replacement I'd pay extra to go there. Of course how much extra I'm not sure, and I'm also not sure how you compare hip replacement quality like that. It is only emergency rooms where I don't get a choice - if you need an emergency room close is important.

You compare hip replacement quality by asking what the center's/surgeons complication rate is. How many are they having to go back and redo, a revision as they call it. It would be nice if these rates were publicly accessible in a easy to search database. As it stands now, hospitals market themselves on size, volume, and fancy buildings all of which don't mean much compared to complication rates.