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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

#291

Earlier quoted context omitted.

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

I don't think it would work well. Hospitals are not a free market in most of the US. You have to get a Certificate of Need to set up a new one. Given the near monopoly they have in the local area, regulation is probably going to be required if nobody gets to negotiate.

Why can't a hospital charge the same price for the same procedure? I can see that different hospitals may charge different prices from each other. But a single hospital should charge the same no matter if uninsured, insured or whatever.

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

#292
post #241

Earlier quoted context omitted.

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.

So many don't realize that this is entirely because Medicaid pays less than the cost of treatment. So hospitals make it up by charging other customers more. If you actually wanted this then your taxes would go up because Medicaid expenses go up dramatically. Maybe it's worth it - but at least be aware of what you are asking for.

"So many don't realize that this is entirely because Medicaid pays less than the cost of treatment. So hospitals make it up by charging other customers more."

I would like see an accounting of that. I bet they charge way more than they have to if they want to make up for Medicaid.

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

#293
post #227

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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?

" Genuine question, is there something that makes you think that wouldn't be true for the US?"

The US is too big, too diverse, too whatever else, blablabla for things that work perfectly anywhere else in the world. Nothing can be learned from other countries unless it makes capitalists richer.

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

#294

Earlier quoted context omitted.

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.

Not really. Its a matter of knowing where to find the place that can treat you. For example, this surgery clinic will treat your appendicitis for less than the average patient's deductible + coinsurance. I'm including the flight + hotel stay in that estimate. https://surgerycenterok.com/pricing/appendectomy-laparoscopi... The problem is how you go about finding this information. Most ASC's and even independent doctor…

1000 to 100k? How about zero to infinity? Hospital refuses to give any price range for a colonoscopy, wouldn't quote a cash price because I had insurance. Insurance can't say if it is covered. Won't know until the claim is submitted. Says it might be fully covered as preventative care, or partially covered, or not covered at all. Might not even go against the out of pocket max. Spent a week on the phone trying to get a straight answer. Final bill 3k.

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

#295

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.

I can never get them to tell me what it would cost if insurance were to cover it. Either pay a definitive amount of cash today, or insurance will cover some unknown arbitrary portion of a similarly arbitray and unknown amount tomorrow, and pay the difference.

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

#296

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…

I’ll admit I haven’t thought of all of the potential consequences, but this seemed like a good idea.

Medicare collects cost data from hospitals and uses it to set their DRG payments. They have the data.

You could make some law saying providers can’t charge more than X% of what Medicare rates are. You could even make it 200% (lots of room for higher reimbursement) and it would be a massive change. You won’t have one hospital charging $2000 for an MRI and another $15,000 (actual numbers I’ve seen - the payment insurers made!).

That would force hospitals and insurers to at least keep price somewhat closer to reality and they’d need to stop the game of “ill take an insurance payment below cost for X-rays but make it up in MRI reimbursment” which is what a lot of hospital do - they look at line of service finances not procedure costs (so they don’t care if X loses money if they make it up on Y).

Problem is, most hospitals have no clue what things cost (a friend worked at a major hospital and said they’ve never calculated what it costs, all in, for say an MRI).

It would be massively disruptive for a while but eventually contracts would be renegotiated and you’d end up with bills that are at least in the ballpark of actual costs.

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

#297
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…

“Right now, 10x differences in prices paid for the same healthcare service from the same doctor between insurance plans is not uncommon.” Makes me wonder how things got to this point. How can a business perform any planning if they sell their services with such big differences between prices charged to customers?

The honest answer is because that’s what insurer negotiation had led to with hospitals having using their negotiating position.

If you’re a hospital in an area with standalone MRI clinics the negotiation pressure is high, insurers can say “ill send patients elsewhere”, so you give on price, maybe below cost.

But that same hospital is the only cath lab in 100 miles. Great! We’ll just tell the insurer “we’re charging 300% the normal cost of a cath procedure, take it or leave it”. So the insurer takes it because how can you offer insurance and tell customer they have to drive 100 miles for a heart procedure?

Hospital is happy because they’re profitable overall. Insurer just lives with paying 3x for cath procedures in that area.

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

#298

Earlier quoted context omitted.

Thank you for saying so. Flooding the market with cheap, low-quality crude would drop the price of gasoline, but it'd be horrid for the environment.

Go to the gas station and tell the struggling families how good for the environment it is that they have to choose between essentials and going to work.

The current high gasoline prices have little to do with environmental regulation. They are up because the global price for crude oil is way up, due to production cuts that had nothing to do with environmental factors couple with a sharp increase in demand due to recovery from the pandemic.

First, in 2020 the US told Saudi Arabia that the US might cut weapons sales and military aid if the didn't cut production. In response to that OPEC agreed to a big cut production for 2 years.

Second, Russia invaded Ukraine which led to more disruptions in the global oil market.

Some like to try to blame it on the current US administration cancelling sales of new oil leases on Federal lands, but the oil companies already have a ton of existing oil leases on Federal lands that they can put into production but are choosing not to. They aren't choosing to because they know that the aforementioned reasons for the current high prices are temporary and putting those leases into production would just lead to a glut later and low prices, making it unlikely they would come out net positive on those leases.

I've also heard some try to blame it on cancelling Keystone XL, but Keystone XL would not have increased supply. It would have just made it cheaper for some Canadian producers to get their oil to refineries. Because the oil market is a global market, costs rising or falling for those Canadian produces wouldn't have a measurable affect on the market price of oil. It just would affect how much profit those producers could make on their oil.

To so called "war on oil" that people have been accusing anyone who tries to promote clean energy of since Obama was elected, if it even exists, is about the least effective war in the history of wars on things, as any examination of global oil production by year will show.

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

#299
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.

Should Europe get rid of their insurers too?

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

#300
post #4

> “What we’re learning from the hospital data is that insurers are really bad at negotiating” Do the insurers have any incentive to negotiate well? Since their customers are not very price-sensitive (since they aren't marketing directly to patients or doctors), I would imagine they don't have a huge incentive to do anything but apply a markup to whatever prices the hospital tells them it costs.

Insurers are incentivized to pay higher prices for claims. The Affordable Care Act enforced that insurance companies must have at least an 80% "medical loss ratio." Meaning that insurance companies must make at least 80% of their total spend on actually paying out medical claims. This law was put into place because insurance companies would spend huge amounts of money on advertising and giving execs bonuses, all paid…

Kind of but not really.

Insurers compete for customers, typically corporations buying group plans.

My employer switched insurers all the time to get the same or better coverage at a lower price.

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