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

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

#151

Post by brandall10 »

EvanAnderson wrote: post #61
peterangular wrote: post #35

Earlier quoted context omitted.

And this can really cause issues for people who are insured because 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. That is until you call the hospital and find out there's all sorts of "sliding" prices etc... I had a procedure billed for one of these drastically larger "insured" codes which got denied based on t…

> 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…

There are services you can use which will negotiate the rate back down to the neighborhood of what the insurer pays. They won't negotiate with you specifically, you have to retain one of these services to negotiate on your behalf. They have direct access to usual and customary charges insurers pay per region.

Was in a similar situation as you were, but unfortunately, what I'd have had to pay was still too much as it was clearly fraud on the part of an outpatient clinic - one side, the clinic, was approved by my insurer, the other side, the surgery center, was not, and they willfully lied about this distinction. I threatened a law suit and they demurred.

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

#152

Post by xur17 »

mullingitover wrote: post #118
trixie_ wrote: post #103

Earlier quoted context omitted.

I'm not a fan of the guy, but this is probably the most important/good thing he did with his presidency. Price transparency is the most fundamental first step to driving down health care costs. Once people get a taste of it, it will drive even more, better and accurate data. Start real conversations about costs and open the door to measureable improvement through innovation.

Price transparency is a pointless shell game designed to keep everyone strung along on the entrenched, failed system. When you're having a heart attack, the last thing you're doing is shopping around for the best prices on heart attack emergency treatment. The free market has no place in health care, because in the hands of the free market the first thing that will happen in a life-threatening emergency is for you to…

I agree that it's pointless for emergency surgery, but there are plenty of other cases where a consumer could shop around (colonoscopy, ACL repair, etc), and I'd argue these are actually the majority rather than the minority of cases.

To me it comes down to - if we are going to pretend we have a market based system for health care (that's what we say we have now), we need pricing transparency to have any hope of it working.

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

#153

Post by long_time_gone »

lotsofpulp wrote: post #75
jjoonathan wrote: post #45

Earlier quoted context omitted.

Every head of the insurance/drug/provider dog points at the other two heads when somebody accuses it of being the problem.

Voters not wanting to pay for comprehensive care for everyone is a 4th head. The current system of healthcare is great for allocating different amounts of healthcare to different classes of people, so that it is great for 20 to 30% of people, okay for 20%, and not good for 50%, and that is why it persists. There is no reason Medicare should be restricted to those over 65, or why Medicaid is implemented differently (a…

==We have at least 3 different taxpayer funded healthcare programs specifically so not everyone can get access to equal care==

Add in CHIP and the VA (Tricare). We've taken every vulnerable part of society (older, poor people, poor children, injured veterans) and given them government-paid, universal healthcare. This is around 100 million people.

Everyone left over is thrown into the private insurance pool. These people are typically working age population (18-60), making them both the richest and the healthiest. This is around 200 million people.

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

#154

Post by slownews45 »

avs733 wrote: post #58
Someone1234 wrote: post #10

Local hospital released this as an Excel spreadsheet (Chargemaster). They have a column called "Uninsured cash price." These prices are And, no, I don't think this was by accident as they have updated this Excel spreadsheet several times and only that one column is always set to 0 size.

You inspired me to look at the local hospital we just delivered our first child at. They release 'standard charges' which as far as I can tell means 'the range of charges for this particular diagnosis based on past data' as an excel file. But the price list is a text file delimited by pipes (vertical bars... |) which just seems unnecessary. They also do nothing to define the variables or column names they use...so th…

God, I used to work in medical billing, and people would think these file format issues were some kind of scheme. NO they are not. They deal with the obvious problem that clinicians are NOT always programmer friendly, and will put things like tabs in case notes, will use commas etc. At some point you use a delimiter that is much less likely to be used - | - is one of those, not a lot of clinicians use it and you can say, please don't use this.

A surprising amount of stuff (at least medical billing side) can be flat file moves, especially if you are billing into lots of different systems.

And yes, the idiot new person with a phD says, just quote every field with a ". Great - you program all this up, along with the required escape sequence handling, and then escapes for escapes. \ and / get used a fair bit sometimes already and we are dealing with tons of systems.

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

#155

Post by snarf21 »

Someone1234 wrote: post #10

Local hospital released this as an Excel spreadsheet (Chargemaster). They have a column called "Uninsured cash price." These prices are And, no, I don't think this was by accident as they have updated this Excel spreadsheet several times and only that one column is always set to 0 size.

This is why we need reference based pricing. You can't charge more than 1.2 * Medicare and if you pay cash, you get the Medicare price. This change alone would remove 25+% of unnecessary bloat from the US system.

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

#156

Post by cmollis »

r0m4n0 wrote: post #62

Seeing the price range you pay is interesting, but I'm not sure what we are supposed to do with it. My wife had her prenatal anatomy scan a few months ago at Stanford medical, $11000 for a 1 hour ultrasound. I personally was on the hook for around $500 and insurance paid $10500. End of the day, what say do we have as consumers? How did the insurance company negotiate a rate of $11,000? Does the insurance company real…

healthcare insurance is the best example of a state-sponsored scam I've ever seen.. and it just continues unabated. I can guarantee that almost no one involved in that transaction actually knows what the per-unit cost for a 1 hour ultrasound actually is.. and when I say 'cost', I mean how it costs the hospital. Health insurers, hospitals, doctors are so awash in money they probably can't believe they're still getting away with it after all this time. Just look at all of the new hospitals and care facilities that are getting built. You don't do that if you're 'squeaking by'.. Hospital lobby is full of shit. You can probably trace all of this back to the HMO model where insurers began to add a lot of distance between the caregivers (i.e. doctors, hospitals, etc) and the patients. Like wall street did (with basically every financial instrument), they add layer upon layer to the cost chain, which adds an equivalent number of money-takers, to the value proposition. Insurance companies amortize the total cost across their subscriber base and 'poof', you've got our ever increasing health premiums. Just ridiculous and so obvious.. but since they're 'doctors' and 'care givers', we automatically just assume they're not motivated by profit and therefore beyond reproach...um, wrong.

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

#157

Post by tibbon »

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…

Can you say more about why the information process isn’t automated, allowing for easier and faster determination of these things?

Doing it manually seems rife for error and to be awful toil

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

#158

Post by lotsofpulp »

haliskerbas wrote: post #136
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…

Reminds me when my dentist charged me $50 for a cup of fluoride (nothing too special about this fluoride). I asked why they said it would be covered. They said when they checked with insurance it says it’s covered, but for my age or whatever it’s not actually covered. So then I said why is it my fault that you gave me something you said was free but actually wasn’t because your check wasn’t thorough enough? They said…

The dentists peddle that nonsense because it is almost all profit for them. Insurance will not cover it because there is no strong evidence that it helps, assuming you are brushing your teeth regularly, have access to fluoridated drinking water, and otherwise have healthy eating habits.

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

#159

Post by wuliwong »

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…

Insurance isn't inherently a moral hazard.

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

#160

Post by KingMachiavelli »

EvanAnderson wrote: post #61
peterangular wrote: post #35

Earlier quoted context omitted.

And this can really cause issues for people who are insured because 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. That is until you call the hospital and find out there's all sorts of "sliding" prices etc... I had a procedure billed for one of these drastically larger "insured" codes which got denied based on t…

> 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…

I've had this thought as well. If insurance is negotiating with the provider then that should be the final say. What's the point in negotiating if the patient gets charged the difference?

I believe this is called 'balanced billing'. Some states prohibit it under certain conditions but it seems either the government or insurance should be prohibiting this practice.

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