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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

#271

Post by codegeek »

nradov wrote: post #259
codegeek wrote: post #212

Earlier quoted context omitted.

I appreciate what you all are doing. We need people to try and really fix our Healthcare Industry. However, I do have a question. Are you trying to get rid of Insurance mafia at all for at least some things like basic preventive care etc because I am sure that drives costs up a lot if Insurance companies are always between a doctor and a patient. I really hope something can be done where I can just go to a doctor/hos…

Most healthcare providers are happy to accept cash payments from patients. You can sometimes even negotiate a discount. If you have a medical plan subject to the Affordable Care Act then most preventive care is already fully covered at no cost to the patient. https://www.healthcare.gov/coverage/preventive-care-benefits...

You could but without insurance, you are taking a big risk. The point is that I cannot just buy insurance that covers catastrophic stuff. It is binary. Either I buy insurance (crazy premiums) and then I might as well use it everywhere or I don't. If I don't buy insurance, good luck.

The point is that Insurance should be offered for catastrophic issues with caps and out of pocket limits and premiums should be much lower because the insurance should not cover basic stuff and for those, we should use cash thereby have price transparency AND market competition b/w various providers.

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

#272

Post by thaumasiotes »

snarf21 wrote: post #179
whatshisface wrote: post #165

Earlier quoted context omitted.

What's reference-based pricing?

The sibling is right but in this case we'd probably do something like Medicare + 20%, which is actually close to what most insurers do for some of the codes already. It just removes the cost of negotiation, brokers, out of network, etc. and actually lets you know the cost up front for most appointments. We also need to get rid of service levels for most appointments. It is just used as an excuse to up charge by havin…

> in this case we'd probably do something like Medicare + 20%, which is actually close to what most insurers do for some of the codes already.

But this is how Medicare sets its own prices - they pay a percentage of the minimum price you charge anybody else. You can't then have the non-Medicare parties charging a percentage of Medicare; that's a circular reference that could result in absolutely any price.

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

#273

Post by bequanna »

nradov wrote: post #259
codegeek wrote: post #212

Earlier quoted context omitted.

I appreciate what you all are doing. We need people to try and really fix our Healthcare Industry. However, I do have a question. Are you trying to get rid of Insurance mafia at all for at least some things like basic preventive care etc because I am sure that drives costs up a lot if Insurance companies are always between a doctor and a patient. I really hope something can be done where I can just go to a doctor/hos…

Most healthcare providers are happy to accept cash payments from patients. You can sometimes even negotiate a discount. If you have a medical plan subject to the Affordable Care Act then most preventive care is already fully covered at no cost to the patient. https://www.healthcare.gov/coverage/preventive-care-benefits...

> most preventive care is already fully covered at no cost to the patient.

Sigh. Someone has to pay and that someone is all of us.

Health insurance plays on the fallacy most individuals have that they will somehow beat the system and receive more services than they pay for.

So, it becomes a race to use as much as possible. Over prescribed meds for the sexy new illness you think you might have after seeing that commercial, unnecessary office visits, bloated testing.

Combine that with Drs who are scared shitless of being sued so they do whatever the patient wants, you have a the reasons for what we have today which is extreme over use of medical services. And that is precisely why insurance and care is so expensive.

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

#274

Post by indymike »

nradov wrote: post #259
codegeek wrote: post #212

Earlier quoted context omitted.

I appreciate what you all are doing. We need people to try and really fix our Healthcare Industry. However, I do have a question. Are you trying to get rid of Insurance mafia at all for at least some things like basic preventive care etc because I am sure that drives costs up a lot if Insurance companies are always between a doctor and a patient. I really hope something can be done where I can just go to a doctor/hos…

Most healthcare providers are happy to accept cash payments from patients. You can sometimes even negotiate a discount. If you have a medical plan subject to the Affordable Care Act then most preventive care is already fully covered at no cost to the patient. https://www.healthcare.gov/coverage/preventive-care-benefits...

> Most healthcare providers are happy to accept cash payments from patients. You can sometimes even negotiate a discount.

Actually, if you don't have insurance, you get the special cash price of $Maximum. /been there //tried that.

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

#275

Post by adventured »

indymike wrote: post #274
nradov wrote: post #259

Earlier quoted context omitted.

Most healthcare providers are happy to accept cash payments from patients. You can sometimes even negotiate a discount. If you have a medical plan subject to the Affordable Care Act then most preventive care is already fully covered at no cost to the patient. https://www.healthcare.gov/coverage/preventive-care-benefits...

> Most healthcare providers are happy to accept cash payments from patients. You can sometimes even negotiate a discount. Actually, if you don't have insurance, you get the special cash price of $Maximum. /been there //tried that.

I have also been there and tried that, extensively. That's the opposite experience of what I encountered in paying by cash for more than a decade. Typically I'd pay around half price via cash for healthcare services (routine doctor visits, scans, et al.) versus what they charged if you had insurance. I never ran into a situation where they wouldn't negotiate steep discounts for paying by cash.

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

#276

Post by briHass »

bequanna wrote: post #273
nradov wrote: post #259

Earlier quoted context omitted.

Most healthcare providers are happy to accept cash payments from patients. You can sometimes even negotiate a discount. If you have a medical plan subject to the Affordable Care Act then most preventive care is already fully covered at no cost to the patient. https://www.healthcare.gov/coverage/preventive-care-benefits...

> most preventive care is already fully covered at no cost to the patient. Sigh. Someone has to pay and that someone is all of us. Health insurance plays on the fallacy most individuals have that they will somehow beat the system and receive more services than they pay for. So, it becomes a race to use as much as possible. Over prescribed meds for the sexy new illness you think you might have after seeing that commer…

I don't totally disagree with your broader point, but there's a decent case to be made that basic preventative care reduces costs by catching issues before they become expensive, chronic conditions (or worse.) The 'preventative care' that is 'free' is usually pretty basic: yearly physical, scheduled vaccines, and basic blood tests and cancer screenings at certain ages.

I'd also question what health insurance plans still encourage 'using as much as possible'. Most are high-deductible plans, where you are paying $100-$150 for an office visit until you hit your deductible or OOP max. The days of $20 copay doctor visits are gone for most of us, unless you are on Congress' health plan.

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

#277

Post by foobiekr »

ch4s3 wrote: post #17
AdmiralAsshat wrote: post #9

Earlier quoted context omitted.

That would get in the way of unadulterated profit , you see.

Health insurers in the US have a cap on how much of premiums can go to profits.

The problem with this approach, even before the ACA was passed, is that if you have a maximum profit fraction, the way to maximize profit in absolute terms is to just charge more and spend more - it encourages absolutely the wrong behavior in terms of costs management.

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

#278

Post by indymike »

adventured wrote: post #275
indymike wrote: post #274

Earlier quoted context omitted.

> Most healthcare providers are happy to accept cash payments from patients. You can sometimes even negotiate a discount. Actually, if you don't have insurance, you get the special cash price of $Maximum. /been there //tried that.

I have also been there and tried that, extensively. That's the opposite experience of what I encountered in paying by cash for more than a decade. Typically I'd pay around half price via cash for healthcare services (routine doctor visits, scans, et al.) versus what they charged if you had insurance. I never ran into a situation where they wouldn't negotiate steep discounts for paying by cash.

Yes, it works for routine stuff, but don't try to pay cash for abdominal surgery. You will get a very terrible, high price. After all, it's agree to our low price or die of appendicitis.

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

#279

Post by nradov »

codegeek wrote: post #271
nradov wrote: post #259

Earlier quoted context omitted.

Most healthcare providers are happy to accept cash payments from patients. You can sometimes even negotiate a discount. If you have a medical plan subject to the Affordable Care Act then most preventive care is already fully covered at no cost to the patient. https://www.healthcare.gov/coverage/preventive-care-benefits...

You could but without insurance, you are taking a big risk. The point is that I cannot just buy insurance that covers catastrophic stuff. It is binary. Either I buy insurance (crazy premiums) and then I might as well use it everywhere or I don't. If I don't buy insurance, good luck. The point is that Insurance should be offered for catastrophic issues with caps and out of pocket limits and premiums should be much low…

High deductible health plans (HDHP) are widely available with relatively low premiums. Those do what you're asking for.

https://www.healthcare.gov/high-deductible-health-plan/hdhp-...

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

#280

Post by walterbell »

indymike wrote: post #278
adventured wrote: post #275

Earlier quoted context omitted.

I have also been there and tried that, extensively. That's the opposite experience of what I encountered in paying by cash for more than a decade. Typically I'd pay around half price via cash for healthcare services (routine doctor visits, scans, et al.) versus what they charged if you had insurance. I never ran into a situation where they wouldn't negotiate steep discounts for paying by cash.

Yes, it works for routine stuff, but don't try to pay cash for abdominal surgery. You will get a very terrible, high price. After all, it's agree to our low price or die of appendicitis.

This is provider-specific. Medical tourism exists, both internationally and within the USA. Some providers are happy to accept immediate cash and forego the pain of dealing with insurance company bureaucracy and delayed reimbursement.
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