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

#271

Post by [deleted] » Wed, Sep 22, 2021, 7:24 PM UTC

lotsofpulp wrote: post #267

peterangular wrote: post #237

Earlier quoted context omitted.

> Like at a previous job I had at a 250 employee company where premiums went up $150/m one year because the previous year had two families had a kid get (very different kinds of) cancer out of the blue. It's bad enough that I've heard office gossips complain about other employees leveraging their healthcare turning into higher premiums the year after. Like, as evil as complaining their coworker's kid got cancer. When…

>It's bad enough that I've heard office gossips complain about other employees leveraging their healthcare turning into higher premiums the year after. Like, as evil as complaining their coworker's kid got cancer. That is how it would have to work if the employer wants to restrict the risk pool to the company's employees. After all, money has to come from somewhere. But employers are welcome to participate in healthc…

[deleted]

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

#272

Post by rpmisms » Wed, Sep 22, 2021, 7:25 PM UTC

rconti wrote: post #239

rpmisms wrote: post #176

Earlier quoted context omitted.

I'm thankful the concession was made. The lower price of cost-sharing made it possible for my parents to keep eating while providing for the family.

That's great until the church decides your parents are sinners and refuse to cover anything, and have no consequences for stealing their money.

They're not church-run organizations. This is reductionist, inaccurate, and I would go so far as to say bigoted.

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

#273

Post by kube-system » Wed, Sep 22, 2021, 7:25 PM UTC

throwaway23438 wrote: post #248

kube-system wrote: post #240

Earlier quoted context omitted.

People show up at hospitals physically unable to identify theirselves all of the time. https://www.npr.org/sections/health-shots/2019/05/07/7207022... Hospitals that accept medicare do have a legal obligation to stabilize patients. But we're talking 'stabilize' as in 'you're not dying'. If you're alert and capable enough to be arguing with people and you're not a psych danger, you're likely stable enough to legally b…

I'm aware of that. That's different from refusing to identify yourself to avoid paying money to the healthcare racket. The discussion here is whether there is a legal obligation to identify yourself. If there is such a requirement, it would apply to someone who is fully capacitated but refusing to identify themselves. It would not apply to someone who is unable to identify themselves due to incapacity, because such a…

There is no legal obligation for you to identify yourself to any businesses that I'm aware of. Most businesses will refuse you services if you refuse to cooperate in paying, to the extent that they are legally able to do so. I think you can expect that a hospital met with this scenario will complete their obligations under the EMTALA and nothing more.

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

#274

Post by jimbokun » Wed, Sep 22, 2021, 7:25 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…

> The fact that the general public as well as journalists think this data is accurate in anyway is really funny.

If they are inaccurate, these hospitals should be sued into oblivion and replaced by trustworthy, competent organizations.

> 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?

> Reimbursement depends on: 1. Insurance 2. Group which you are under the insurance from 3. Contract language whether its a fee/service or bundled 4. Is the visit covered or not 5. how the visit/procedure was coded (most important and opaque factor)

Your convoluted process should not be the patient's problem.

Write an app that allows the user to input their provider and group, and search for the procedure to get a price.

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

#275

Post by neither_color » Wed, Sep 22, 2021, 7:26 PM UTC

SavantIdiot wrote: post #192

gfodor wrote: post #33

It will be fun to watch people be positive on this until they are reminded who we have to thank for it. Edit: CNN hasn't forgotten, notice the obvious negative spin, with literally zero argument of how this may be beneficial: https://www.cnn.com/2021/01/04/politics/hospital-price-trans...

You mean Bill Clinton in the early 90's? It was part of the Clinton health care reform. But maybe you're not that old. ;-) Every president has pushed for this except Bush Jr. Glad it finally happened even if it was under who I consider to be the worst president* in the last 100 years of US history. Doesn't mean I need to thank him. If you were being tortured in a Mexican cartel prison, would you thank the torturer fo…

I think it's sad that you can end a sentence with Bush Jr and then not call him the worst president in the next sentence. My vote for worst president in living memory is the guy who started two pointless trillion dollar wars, the latter of which took 20 years to close up in a humiliating retreat, but that's just me. This is not a defense of he who isn't being named here btw.

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

#276

Post by dllthomas » Wed, Sep 22, 2021, 7:28 PM UTC

Retric wrote: post #138

monocasa wrote: post #134

Earlier quoted context omitted.

So that encourages greater payouts more or less synced with greater premiums in order to increase year over year real profits. And given that the payouts are very nearly a function of how hard the insurance company can negotiate, they can simply choose to call off the negotiations when they reach their target amount.

Only up to a point, they still accept or recheck claims arbitrarily to get closer to their targets. Worse they have incentives to decrease efficiency by increasing paperwork etc. Private medical insurance in the US is a horridly inefficient system. Separating the claims process from insurance companies hands might help, but their incentives are never going to line up with consumers.

> Worse they have incentives to decrease efficiency by increasing paperwork etc.

Money spent on paperwork comes out of the same pile as profit. The MLR cap preserves incentive to reduce paperwork, wherever premiums and payouts sit.

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

#277

Post by good8675309 » Wed, Sep 22, 2021, 7:29 PM UTC

hartleybrody wrote: post #196

loeg wrote: post #83

Earlier quoted context omitted.

You’re probably thinking of “healthcare ministries,” which are not insurance (they’re scams).

> (they’re scams). citation or story?

I think instead of using a blanket statement and calling them all scams, the OP should have said that some are scams. That goes for pretty much any service out there. Here's a site with over 900 reviews of different health sharing communities. Some there are clearly scams by the terrible reviews.

https://healthsharingreviews.com/

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

#278

Post by peterangular » Wed, Sep 22, 2021, 7:29 PM UTC

wuliwong wrote: post #270

peterangular wrote: post #206

Earlier quoted context omitted.

I know that any anti-capitalism comments get immediately downvoted here but yeah... The privatization of healthcare is a conflict of interest which is a product of our hyper-capitalistic society. You can't make a profit center out of human services without dehumanizing it in the process - the very nature of profit/capitalistic societies means someone has to lose and I see no place for these interests in healthcare or…

>the very nature of profit/capitalistic societies means someone has to lose If by 'profit/capitalistic societies' you mean those allowing for voluntary exchanges between its people, I would disagree. As an adherent to the subjective theory of value, I think it is common that both parties in an exchange would consider themselves 'winners.' [0] [0] https://en.wikipedia.org/wiki/Subjective_theory_of_value

I'm in the Jim Camp school of thought where, in negotiation, there is no "win-win" situation.

https://www.forbes.com/sites/jimcamp/2013/03/11/revisiting-w...

The reason I am firmly in this school of thought is that I've made the absolute mistake of a decision to try for "win-win" situations in a capitalistic society, specifically in regards to contract negotiations and ultimately pricing/billing.

When I'm making sure that the person on the other end of the table "wins" I'm putting myself at a capitalistic disadvantage; and - if both parties "won" then didn't both ultimately lose?

I get your ideal, but when money is involved I find that the "win-win" is very much that: just an ideal. And, anecdotally over the years I've found many business experts write on the topic of why "win-win" is a losing position which validates my position on this.

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

#279

Post by omgwtfbyobbq » Wed, Sep 22, 2021, 7:29 PM UTC

codegeek wrote: post #199

r00fus wrote: post #128

Earlier quoted context omitted.

Did you have a HDHP (high deductible plan)? In that case, you have no co-pay or anything until your deductible is used up. Employers typically contribute a good amount towards this deductible (or even more than) using an HSA. It's still crazy that the bills were so completely divergent.

That's not the point. Your explanation is exactly what the issue is. Why is cash price cheaper than insurance price ? And in that case, why do we even need insurance for most of these visits.

In my view, the amount you pay for stuff before you hit your deductible is just another type of premium. If the cash prices you can pay for what you reasonably think your care will be in a year are less than your deductible, then it can save you a little money to do that. If you happen to be wrong, you'll have still have to pay for your deductible.

I pay for a specific medication OOP with goodrx because it's not covered by my insurance, and paying for it through them would be nutty ($1600/year versus $90/year). But other things I just lump in b/c I use a fair bit of insurance every year.

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

#280

Post by kube-system » Wed, Sep 22, 2021, 7:29 PM UTC

lotsofpulp wrote: post #244

kube-system wrote: post #232

Earlier quoted context omitted.

Just take all of the money you'd otherwise spend on dental care and put it into a savings account or FSA. I've never seen a dental insurance plan that actually makes financial sense. Most of them place significant limits on expensive and unlikely care, and cover routine care with little or no cost sharing. Insurance is a highly inefficient way to pay for expected expenses.

Dental insurance via employer is mostly just a way to pay for dental healthcare via pre tax dollars.

And FSAs do that without the insurance company overhead.