Hospitals lift curtain on prices, revealing giant swings in pricing by procedure • Hacker News Board

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#91

Post by novok » Wed, Sep 22, 2021, 5:45 PM UTC

LurkingPenguin wrote: post #52

novok wrote: post #38

Earlier quoted context omitted.

Psychologists want to charge $200-$250/hr, but insurance only reimburses $120-$160/hr. You might think these are high prices, but chargeable hours isn't hours worked for psychologists, since they have to do notes for every meeting, manage the business, appointments, etc, which reduces their total take home to something below $200k/yr, which is below a typical bigtech Eng II with only a couple years of experience, pot…

> You might think these are high prices, but chargeable hours isn't hours worked for psychologists, since they have to do notes for every meeting, manage the business, appointments, etc, which reduces their total take home to something below $200k/yr, which is below a typical bigtech Eng II with only a couple years of experience, potentially not even going to college if they are clever and self motivated enough. Sili…

Any ambitious and smart enough American who wants to make a high income in exchange for working hard at prep has a choice of jobs they can go into. Many people who go into medicine are not necessarily the most passionate about medicine, but want a high paying, prestigious job.

So yes, it does effect the supply of future and even current psychologists and doctors. Supply is dictated partly by cost of that supply vs the demand in dollars for it, and the cost and barriers to med school and licensing is a big factor of supply costs.

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#92

Post by phkahler » Wed, Sep 22, 2021, 5:45 PM UTC

bazooka_penguin wrote: post #71

m0ngr31 wrote: post #39

Earlier quoted context omitted.

My local hospital offers a cash discount of nearly 50% if you pay at time of service.

That sounds pretty unreasonable. Most people can barely stay on top of payments with a payment plan, let alone paying everything upfront

That's why they're so eager to get the payment upfront that they'll give a heavy discount. Apparently a lot of people have trouble keeping up with their bills.

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#93

Post by Y_Y » Wed, Sep 22, 2021, 5:46 PM UTC

derwiki wrote: post #76

mullingitover wrote: post #73

Earlier quoted context omitted.

> These prices are There are some clever insurance companies whose entire model is "tell the hospital you don't have insurance, get the cash price, pay it with this debit card we give you."

Is it illegal to state you don’t have insurance when you do? Or is this product not considered Insurance in the legal sense?

I do this. Once my insurance company got upset that my procedure was so expensive and rang the hospital. The hospital immediately tripled the price. The insurance became even more upset and asked me to fix it. Still much cheaper than the equivalent procedure in the USA.

It's not illegal here, but in any case nobody asks, I just tell them I'm paying cash.

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#94

Post by mullingitover » Wed, Sep 22, 2021, 5:47 PM UTC

derwiki wrote: post #76

mullingitover wrote: post #73

Earlier quoted context omitted.

> These prices are There are some clever insurance companies whose entire model is "tell the hospital you don't have insurance, get the cash price, pay it with this debit card we give you."

Is it illegal to state you don’t have insurance when you do? Or is this product not considered Insurance in the legal sense?

I don't think it is. Sidecar Health is doing just fine on this model[1]

It's pretty perverse that you, an insured person, would have to lie about having insurance because the provider would charge you more for being insured.

[1] https://cost.sidecarhealth.com

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#95

Post by kurthr » Wed, Sep 22, 2021, 5:48 PM UTC

jonathan-adly wrote: post #63

I am one of the people responsible for making these lists. The fact that the general public as well as journalists think this data is accurate in anyway is really funny. This an exercise of futility that only increases the overall cost and provides job security for me :) No one working in a hospital knows how much do we acquire things for, or how much we get paid for doing things in advance. And only like 8 people ca…

That neither the people prescribing/providing the product, nor the customers/insurers can ever know the price before they are billed, shows that this is not a market, or certainly not anything like a free market.

The real scam is that the health insurers have convinced people they "fight for lower prices", when in fact they collectively profit from price hikes and the annual marginal increases fuel their growth as well.

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#96

Post by phkahler » Wed, Sep 22, 2021, 5:49 PM UTC

jonathan-adly wrote: post #63

I am one of the people responsible for making these lists. The fact that the general public as well as journalists think this data is accurate in anyway is really funny. This an exercise of futility that only increases the overall cost and provides job security for me :) No one working in a hospital knows how much do we acquire things for, or how much we get paid for doing things in advance. And only like 8 people ca…

>> Cost depends on: 1. Are you an outpatient/Obsveration v. inpatient v. ED? 2. Are you on Medicaid? 3. Is the hospital a part of GPO organization or not? 4. Is contractual obligations of GPO includes/excludes Aspirin?

Those considerations aren't part of what anyone calls cost. How much does the hospital pay for aspirin? How much do they pay someone to administer it to a patient? That's cost. If it's very complicated to determine what the patient or their insurance pays, well that's part of the problem.

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#97

Post by minsc__and__boo » Wed, Sep 22, 2021, 5:50 PM UTC

breckenedge wrote: post #47

novok wrote: post #38

Earlier quoted context omitted.

Psychologists want to charge $200-$250/hr, but insurance only reimburses $120-$160/hr. You might think these are high prices, but chargeable hours isn't hours worked for psychologists, since they have to do notes for every meeting, manage the business, appointments, etc, which reduces their total take home to something below $200k/yr, which is below a typical bigtech Eng II with only a couple years of experience, pot…

FWIW I pay mine in cash from my HSA because he doesn’t accept any insurance due to the headaches involved getting reimbursed.

That's fair but for people without HSA they should still file a claim against maximum out of pocket.

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#98

Post by the-pigeon » Wed, Sep 22, 2021, 5:52 PM UTC

jonathan-adly wrote: post #63

I am one of the people responsible for making these lists. The fact that the general public as well as journalists think this data is accurate in anyway is really funny. This an exercise of futility that only increases the overall cost and provides job security for me :) No one working in a hospital knows how much do we acquire things for, or how much we get paid for doing things in advance. And only like 8 people ca…

I think this is the best argument for these lists that I've heard.

Forcing this stuff out into the light helps the system get fixed. This is a pattern I've seen in internal tools development for businesses over and over. When my solution increases visibility into a problem, suddenly people start solving the problem without my help.

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#99

Post by ipaddr » Wed, Sep 22, 2021, 5:52 PM UTC

jjoonathan wrote: post #80

EvanAnderson wrote: post #61

Earlier quoted context omitted.

> if an insurance company decides not to cover something (very very common, even in-network) then the inflated price is what you end up getting billed for... Is there any reason why this kind of windfall shouldn't be illegal? I realize it isn't, but is sure seems like it should be. I was stuck with a charge from a doctor for 7x the price my insurance would have paid. My pre-ACA insurance refused to cover the procedur…

Insurance has the worst moral hazard: the winning strategy is to sell a product that pretends to cover your customers but actually doesn't. Your customers give you money for nothing and they will only realize it once in a blue moon. You can probably buy off the few who are capable of causing actual blowback, and if that doesn't work just rebrand. Until everyone becomes a contract lawyer capable of devoting weeks to i…

Aren't insurance rates regulated meaning if they payout a smaller amount than expected the rates will go down next year?

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#100

Post by loeg » Wed, Sep 22, 2021, 5:53 PM UTC

lolpython wrote: post #43

missedthecue wrote: post #24

Earlier quoted context omitted.

Emergency care accounts for just 2% of healthcare spending. https://www.politifact.com/factchecks/2013/oct/28/nick-gille...

That is not a useful statistic here. We are talking about an individual’s financial obligations in a medical emergency. A $10,000 bill is not 2% of an individual’s yearly spending.

You’re missing the bigger picture. It’s worthwhile improving transparency around the vast majority of healthcare needs/spending. ER costs are also a problem, but it’s an orthogonal issue. Don’t let the perfect be the enemy of the good.