How much health insurers pay for almost everything is about to go public • Hacker News Board

Re: How much health insurers pay for almost everything is about to go public

#141

Post by dwringer » Fri, Jul 01, 2022, 8:17 PM UTC

bushbaba wrote: post #134

This will be huge! I’ve found that self paying can be 1/nth the cost of paying through my insurance. But you need to request self pay up front. Being able to better understand prices before hand will drastically help people reduce their healthcare costs.

I've seen the exact opposite of this - the self pay option would cost (for example) $300 while insurance would only get billed $150 for the exact same procedure. In the case I saw it, that meant the insurance paid out something like $12 and I was on the hook for the remaining $138. Which is roughly the same I would have owed if insurance had been billed the full amount and paid out the remaining $162.

Re: How much health insurers pay for almost everything is about to go public

#142

Post by bushbaba » Fri, Jul 01, 2022, 8:17 PM UTC

macksd wrote: post #67

I've lost count of all the problems I've had with medical billing. I can't understand an argument against public pricing because it seems like a clear win if you believe in free market dynamics or progressive reformation of the health care system. But it seems to me the system is just rotten to the core anyway. It makes even my Libertarian self want single-payer healthcare, but I have no expectation the set of people…

Don’t forget all that time spent on the healthcare side. Easily 10%+ of the cost of operation.

Re: How much health insurers pay for almost everything is about to go public

#143

Post by akira2501 » Fri, Jul 01, 2022, 8:17 PM UTC

elromulous wrote: post #94

ageitgey wrote: post #2

I'm one of the co-founders of Turquoise Health, mentioned in the article here. We've been downloading and parsing this data all day. It's a really big deal in the industry that the prices that insurance companies pay doctors are now being shared publicly. It will have all sorts of positive impacts over time, hopefully making rate negotiations more consistent and fair between different insurance plans. Right now, 10x…

Could this backfire - similarly to how publicly traded companies' CEOs disclosing their pay caused their pay to skyrocket?

That's an odd way to look at it, as a "backfire."

We're introducing more information into the market. If some prices went up as a result, isn't that an indication that the lack of pricing information was being used to artificially depress prices?

If so.. this isn't a "backfire" so much as an "obvious and necessary correction?"

Re: How much health insurers pay for almost everything is about to go public

#144

Post by tomrod » Fri, Jul 01, 2022, 8:17 PM UTC

ageitgey wrote: post #2

I'm one of the co-founders of Turquoise Health, mentioned in the article here. We've been downloading and parsing this data all day. It's a really big deal in the industry that the prices that insurance companies pay doctors are now being shared publicly. It will have all sorts of positive impacts over time, hopefully making rate negotiations more consistent and fair between different insurance plans. Right now, 10x…

Very cool work!

The article mentions that yall are working on hospital data. Is insurer data beginning to roll in?

Re: How much health insurers pay for almost everything is about to go public

#145

Post by InefficientRed » Fri, Jul 01, 2022, 8:18 PM UTC

karmanyaahm wrote: post #125

kstrauser wrote: post #57

Earlier quoted context omitted.

I'll admit, this is one thing, perhaps literally the only thing, he did that I think is excellent for individual Americans.

IPv6 mandate too

That has nothing on Al Gore, who invented the internet! And in much the same way as any other president doing something popular and uncontroversial: it would've happened almost no matter who was at the top.

(Point is, most legislation and XOs are largely bipartisan. Policy is driven much more by the machinations of hundreds of thousands of faceless/nameless actors than by the guy at the top. In both good ways and bad. The same is true in companies. The genius of leaders is mostly in their salesmanship.)

Re: How much health insurers pay for almost everything is about to go public

#146

Post by dimal » Fri, Jul 01, 2022, 8:19 PM UTC

I'm not a fan of Trump, but I have to admit, the executive order [0] that forced this disclosure looks fantastic, really fantastic. But if I'm reading it right, it seems like it's just an order to _enforce_ requirements ObamaCare that were intended to increase transparency.[1] Obama and Trump actually accomplished something _together_!

[0] https://www.federalregister.gov/documents/2017/10/17/2017-22...

[1] https://www.federalregister.gov/documents/2020/11/12/2020-24...

Re: How much health insurers pay for almost everything is about to go public

#147

Post by fragmede » Fri, Jul 01, 2022, 8:19 PM UTC

pkaye wrote: post #30

Next step is pharmacies. Find out which step in the chain is overpricing. The manufacturers, PBMs or local pharmacies, etc.

Hopefully this approach will help the situation: https://costplusdrugs.com/

Re: How much health insurers pay for almost everything is about to go public

#148

Post by nicoburns » Fri, Jul 01, 2022, 8:20 PM UTC

lotsofpulp wrote: post #61

NaturalPhallacy wrote: post #54

Earlier quoted context omitted.

IIRC, it's 15%, meaning that they can only have $675,000,000,000.00 in profits. That is $675,000,000,000.00 they can take from us and instead of using for healthcare or even healthcare administration, it's just additional money that they took.

> it's just additional money that they took. When did they take it? All the 10-Ks are showing me 5% or less profit margins.

They have low profit margins, but they massively overpay for the care, meaning that it's still incredibly inefficient.

Re: How much health insurers pay for almost everything is about to go public

#149

Post by sodality2 » Fri, Jul 01, 2022, 8:20 PM UTC

nicodjimenez wrote: post #111

kstrauser wrote: post #57

Earlier quoted context omitted.

I'll admit, this is one thing, perhaps literally the only thing, he did that I think is excellent for individual Americans.

Yep. That, and space force, and cheap energy, and renegotiating trade agreements, and not starting any new wars.

"Cheap energy" is not the boon you think it is. You have to consider other factors - deregulating the food industry and getting rid of the FDA would save millions of taxpayer's money, would lower prices of the supply chain and let consumers pay significantly less for food, yet would have drastic side effects. Cheap energy that requires deregulation, more alarming and precarious climate effects, etc might not be a net positive.

Likewise, "not starting any new wars" can be perceived as bowing to foreign nations by anyone who wants to frame it negatively, or vice versa as an amazing success for diplomacy.

Re: How much health insurers pay for almost everything is about to go public

#150

Post by kstrauser » Fri, Jul 01, 2022, 8:20 PM UTC

InefficientRed wrote: post #135

kstrauser wrote: post #63

Earlier quoted context omitted.

As the spouse of a doctor, this made me giggle. If her practice had 90% margins, my life would be a lot different than it is. Her actual net margin, as in what she brings home after paying all the bills, is closer to 15%.

A private practice owned by the MDs reporting relatively low net margins is meaningless without knowing what the MDs are taking out as income.

Her practice, as are most, is an S Corp. In other words, the net income is her take-home income.

Put another way, the rent, employee pay, supplies, malpractice insurance, etc. etc. etc. add up to about 85% of her gross revenue. That 15% difference is how much she personally makes.