Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

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

khn.org

Post reply on HN
Print view View original

231–240 of 370 posts

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

#231

Post by spaetzleesser »

arcticbull wrote: post #206
snarf21 wrote: post #122

Earlier quoted context omitted.

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 se…

You don’t need to have the state pay. Make them charge the same price to all customers. Then you can have insurances compete. My body shop doesn’t charge one insurance $10/hr and another insurance $100/hr for the same work.

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

#232

Post by amluto »

arcticbull wrote: post #206
snarf21 wrote: post #122

Earlier quoted context omitted.

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 se…

I suspect we could do decently by requiring insurance to purely reimburse the patient (possibly without the patient needing to pay first). If an insurer pays up to $1k for an MRI, and a hospital charges $15k but an outpatient imaging center charges $700, there will be a strong incentive for patients to stop using the hospital’s MRI.

Combining this with an auto-service requirement for a binding estimate before services are rendered would be amazing.

(Dealing with actual emergencies in this model may be hard.)

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

#233

Post by spaetzleesser »

BurningFrog wrote: post #200
baby wrote: 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.

That may be true but the first prerequisite for functioning markets is price transparency for participants. Without that it will never work. There may be other problems but you absolutely need to know prices.

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

#234

Post by spaetzleesser »

vkou wrote: post #60
lotsofpulp wrote: post #21

Earlier quoted context omitted.

The fact that there are at least 5 large insurers competing nationwide and all have 5% or less profit margins means there is lots of competition, and if they are not providing the best prices, their customers will go elsewhere. See pharmacy forums as an example for all the pharmacists complaining about how independent pharmacies are so tough to operate due to ever smaller payments from insurance companies for the pas…

No, it means that Obamacare is working as written[1]. Insurer profit margins are set to the legally permitted ((medical bills) * 15%) - operating costs. If insurers want to make more money, they can either make medical bills more expensive, or reduce their own operating costs. Reducing the cost of medical bills does not increase the amount of money they make, unless it means they are capturing market share from a com…

“Will my workplace ever switch their insurer provider of choice? Almost certainly 'no'.”

They totally do that if they save money. They won’t do it to help you but for their own bottom line they will do it.

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

#235

Post by spaetzleesser »

treis wrote: post #176
31835843 wrote: post #164

Earlier quoted context omitted.

This seems so sensible to me that I’m curious why the hell it wouldn’t work.

Which price and who determines it?

The hospital determines a price and offers it to all comers. Most businesses work that way.

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

#237

Post by throwaway743 »

nope96 wrote: post #225
alanfriedman wrote: post #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.googl…

Blue Cross https://www.bcbsil.com/member/policy-forms/machine-readable-... So are there programs I can use to parse this? It looks like a json file with links to more gziped json files...

...it is unfortunately.

If you know a language you could run through it. Otherwise ypu might be able to find something like a json to csv converter online

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

#238

Post by alxhill »

db48x wrote: post #227
antisthenes wrote: post #171

Earlier quoted context omitted.

It's basically price-controls. A regulatory body looks at how much something "should" cost based on its history of reimbursement and the cost of its inputs and then sets a cap of say, cost + 20%. The problem is having an independent body that is free of influence of health insurance companies and hospitals, both of which have perverse incentives to continue profiteering.

Not to mention the fact that it will eventually cause a supply shortage.

Germany has reference pricing for their drugs system and doesn't seem to have a supply issue. Genuine question, is there something that makes you think that wouldn't be true for the US?

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

#239

Post by KyeRussell »

FollowingTheDao wrote: post #216
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…

Sorry, but the only thing that will help is Medicare for all. We need to get rid of insurance companies completely.

Non-American here: your healthcare system is so abysmal that you could stop short of implementing Medicare for all and still have a significantly improved system. You should obviously have Medicare for all, but let’s not kid ourselves about how far from that you are.

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

#240

Post by lotsofpulp »

nicoburns wrote: post #148
lotsofpulp wrote: post #61

Earlier quoted context omitted.

> 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.

How are you determining they massively overpay for the care?
Post reply on HN