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

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

#201

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.

This is rapidly becoming a Monty Python sketch :)

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

#202
post #16

Wait till you find out how much it actually costs doctors/providers to render some of these services! Do you like 90% margins? Doctors sure do! :)

Spouse of a third year resident here. My wife has volunteered at several primary care (i.e. generic doctor) clinics in Manhattan and nearby area (Queens, Astoria, Brooklyn and even in Boundbrook, NJ). These are all owned by the doctors. She worked in all kinds of operations of a clinic from billing, sending prescription, taking patient history, etc. Back-of-the-napkin calculation based on my wife's experience -- if y…

There's no way a single assistant could handle 40 patients per day. At that volume, you'd have at least 2 assistants.

Malpractice insurance can be way the hell more expensive than that: https://www.nerdwallet.com/article/small-business/how-much-i...

Rent will probably be another $60K per year.

The receptionist will want to be paid, as will the biller. If you're lucky, one of them will have time to be the designated person to call and argue with the insurance companies every time they deny a payment because it was a waning gibbous moon that day, but realistically, if you have providers seeing 40 patients per day, that's another full time person.

The EMR system will be quite a few thousand dollars up front, plus another several thousand per year.

You'll have to provide health insurance for all of your employees, and worker's comp, and an office liability policy.

And finally, great insurance (from the billing physicians POV) will pay about 40% of the allowed amount. Really crappy insurance, like Medicaid, is basically a write-off. BTW, Medicare has decent reimbursement. Not great, but several times more than Medicaid will pay.

In my experience as being the one who's written the checks for medical practices in a couple of different states over the last 2 decades, you are grossly overestimating revenue and underestimating expenses.

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

#203
post #175

Earlier quoted context omitted.

Nah. Outside of the vision cartel you can get replacement lenses for any pair of frames < $100, with all the various coatings and special shit for low hundreds. Likewise, using insurance to just replace the lenses, if a plan includes that, is often $50 or less. It's just shopping at the vision cartel without insurance = huge sticker price.

Any tips for how to stay "outside the vision cartel"? (In the US, if that is relevant...)

zenni optical. I mostly use contacts, but I have several 'backup' glasses. You can get decent looks frame for like $11 shipped.

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

#204
post #64

Earlier quoted context omitted.

Can you elaborate on the regulations that you are referring to?

Can’t point to the source, but I think we all know that there is some sort of regulation requiring us to pay providers for services when those providers refuse to provide pricing information at before or during the time of service.

That sounds, among other things, like something entirely unrelated to the issue.

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

#206
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…

We really need to move to reference based pricing. We can cut so much waste out of the current system including brokers. Reference based pricing also get rids of the loopholes for things like anesthesiologists being "out of network" at a hospital/facility that is "in network". It also gets rid of the situation where if you offer cash you get one price but if you submit for the same code, it could be 3x or 10x or even…

Or we can have one network every doctor is in, and the state pays for everything. All doctors are independent contractors to the state. Everything is paid for. There's one price for everything. Everyone is covered. All this garbage just disappears.

Then there's one nice fee schedule like this, with all the prices on it, but it doesn't even matter, unless you're a physician doing your billing. [1]

[edit] As you can see from the PDF, a dermatology consult (A025) is $72CAD.

[1] https://www.health.gov.on.ca/en/pro/programs/ohip/sob/physse...

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

#207
post #8

This is regulation everybody should be able to get behind. How are these markets supposed to function efficiently with healthy competition if critical information like this is hidden away?

I don't think this will lhave much impact on health care cost. The cost is high because it is paid through employer and therefore it is hidden from you. If the law was to force employers disclose lost wages for employees due to health car, that would have bigger impact. The real impact will come if employers turn off the medical insurence coverage entirely and everyone has to cut the checks themselves.

Employer-provided healthcare is a solution for the problem that health insurance, unless it is mandatory, will tend to attract a self-selected group of expensive customers and, in turn, make health insurance (even more) unattractive for healthy people.

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

#208
post #162

Earlier quoted context omitted.

Another proof that more transparency decreases corruption and improves efficiency?

Once it's been shown to work it may be proof. The track record of healthcare reforms intended to cut costs is rather abysmal.

Does it really need to be proved?

I'd argue that it's a mathematical/logical truth in principle, and that the only thing that requires proof is whether this particular implementation is successful at what it aims to do.

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

#209

Earlier quoted context omitted.

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 genius of leaders is mostly in their salesmanship.

The topic of a couple Adam Curtis's documentaries IIRC.

Obama's first presidential campaign won marketing awards: https://www.theguardian.com/media/2009/jun/29/barack-obama-c...

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

#210
For anyone looking to download the data, here are a few links:

Empire Blue (Anthem): https://www.empireblue.com/machine-readable-file/search/

United Healthcare: https://transparency-in-coverage.uhc.com/

Aetna (Seems like the right page, but I don't see any download links — possibly because they haven't been posted yet): https://health1.aetna.com/app/public/#/one/insurerCode=AETNA...

Search keywords: https://www.google.com/search?q=machine+readable+files+trans...

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