Show HN: Compare prices that US hospitals charge patients, insurance companies

Looks interesting. How is this different than test claim submissions available from Eligible, Waystar, PokitDoc, etc?

And are you licensing out cpt codes from the ama? IMHO the AMA and their copyright of CPT codes is the biggest setback to progressive change, transparency, and adaptive change in tech... Payers and well funded companies can afford licensing, otherwise they will strangle you with lock down...

Did you switch to getting it without insurance?

Chargemaster prices (the non-negotiated price) are ridiculously high in the US. They’re so high that some hospitals will give uninsured patients a break of “half off” without even negotiating.

The reason for this is that chargemaster price is a fake dollar price resulting from a broken incentive structure and process. Here’s a setup:

A hospital is working out a negotiated rate for aggregate services with an insurance company. The insurance company wants to pay less, and they’re willing to put the hospital “in network” and bring their block of customers with them by doing it. But the negotiators on both sides aren’t going to sit and figure out the “right” price of every procedure. That would take forever (and there’s dinner at a Michelin starred restaurant to go to after this deal is done), so they agree that they will just pay some percentage of the chargemaster price, say, 50%.

Over time, the hospital administrators say “we need more money for this” and realize they have a lever. 95% of their customers are paying negotiated rates that are a percentage of the chargemaster price. The percentage is locked in stone, but the chargemaster rate? Yeah. They can change that.

The insurance company cries foul at their Michelin two-star dinner the next month, and the hospital agrees to lower the percentage a little in the next contract. Now the insurer is feeling flush, and the hospital is making about what they were doing before from that 95%. The remaining 5% who were uninsured are hanging upside down and getting shaken for loose change.

The cycle continues, and, eventually, the negotiated percentage drops to something comical, like 12%, but the chargemaster rates have soared. In the end, a pair of Advil “costs” $68 and uninsured patients have nosebleeds from being hung upside down for so long.

But there’s a new restaurant to try out, and someone else’s personal bankruptcy is a small price to pay for no-fuss managed care...

(Note: Marketing and administration accounts for more than a third of health care costs in the US, which is to say that health care bloat and weight due to a multi-player adversarial privatized system accounts for more than 5% of our GDP, so the chargemaster isn’t the only reason for sky high healthcare costs in America.)

One important piece of context here is that these rates are negotiated as part of a contract bundle where an insurer is bringing a pool of patients to the facility. Prices can vary widely procedure to procedure because they are associated with over or under representation of certain factors within that pool. For example, grossly simplified, I might have a particular service line, hip replacements (an ortho program). The insurer whose patient population is going to 'keep the lights on' in that service line is going to see a very different rate per service than a different insurer who rarely has patients that need it. Nothing about these prices shown are really reflective of the costs of doing the procedure such as pricing in a retail store.

I do think this transparency initiative will result in more consistent costs but not necessarily net lower costs.

Comparisons to other countries that are smaller than the united states are somewhat apples to oranges. There are a lot of factors that are glossed over when someone says "costs are 5x higher in the US than my country" including real estate, energy subsidy, and so on. Its a deep well.

I had this exact idea ~6 months ago but didn't know where to begin. I'm sincerely glad someone else built it. We're in such desperate need of justice when it comes to U.S. healthcare and this is a really good first step in holding the system just a little bit more accountable.