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I analyzed hospital price lists so you didn't have to

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Re: I analyzed hospital price lists so you didn't have to

#311

Post by lotsofpulp »

legitster wrote: post #207
cycomanic wrote: post #182

Earlier quoted context omitted.

That's insane! Goes to show again that the solution in the US is "be rich" and then you'll be given additional benefits.

They're usually offered as an option for work-sponsored plans. You can get a low deductible plan that your work pays $1k a month for, or you can get a high deductible plan for $500 a month and the company gives you the other $500 into your HSA tax-free (oversimplified, of course). They actually make a ton of financial sense, but too many in the US would rather overpay for insurance rather than have to shop around.

Anyone can buy HSA eligible high deductible health plans on healthcare.gov too.

Re: I analyzed hospital price lists so you didn't have to

#312

Post by lotsofpulp »

caramelcustard wrote: post #66

Correct me if i'm wrong, but aren't some hospital bills/prices considered to be negotiable estimates? If so, wouldn't that skew the data? And yes, prices should be set in stone and be easily accessible, unless it's something that is hard to evaluate due to one reason or another.

Starting Jan 1, 2022, a healthcare provider has to provide an estimate and you are only liable for that estimate plus $400 in case of overage.

https://www.cms.gov/nosurprises/consumers/understanding-cost...

Re: I analyzed hospital price lists so you didn't have to

#313

Post by russnewcomer »

someoneFromWeb wrote: post #257
duffpkg wrote: post #65

Wrote Hacking Healthcare for O'Reilly, created ClearHealth/HealthCloud open source EMR, managed health systems for 15+ years, blah, blah, blah. It is very good there is are the transparency regulations. It is worth briefly explaining some of the reasons why many facitilities are having a hard time complying. There are some bad actors, absolutely true. However "Hanlons Razor" -- never attribute to malice that which is…

Have you ever heard about OpenEHR? https://www.openehr.org/

FWIW, pretty sure duffpkg was involved in the creation of OpenEHR, and therefore probably has heard of it.

Re: I analyzed hospital price lists so you didn't have to

#314

Post by lotsofpulp »

pishpash wrote: post #210
throw123123123 wrote: post #180

Earlier quoted context omitted.

You can do this with PPO insurance or paying cash.

No you can't. Some specialists are referral only. They do this to satisfy medical necessity requirements to make sure they get paid by insurance.

I have had PPO high deductible health insurance for 14 years, and I have been able to see whatever doctor I want whenever I want.

Obviously, I need to pay out of pocket until I meet the deductible, but it all counts toward the annual out of pocket max and I get the negotiated pricing between doctor and insurance company. After I meet the deductible, however, the insurance still pays for a consult for anyone I want to go see. Not necessarily for any procedure though, without justification. But that applies in any situation, PPO or not.

Re: I analyzed hospital price lists so you didn't have to

#315

Post by lotsofpulp »

social_quotient wrote: post #21

Why can’t insurance companies post the actual price they are paying and being charged by the hospital with proper billing taxonomies. They seem like they probably have these things well ironed out since they actually deal with various hospitals whereas hospitals only deal with themselves.

Insurance companies have always given out prices. I have been able to type in CPT codes online and my insurance tells me the price on a map of all the providers in network in my area.

Before that, you could call and give them the code and they would tell you the price.

The problem is the doctor will not give you a code, and sometimes that makes sense since they do not know what they will be seeing or doing, so they cannot know the code in advance.

But I have also had doctors not give me codes for completely preventative services, which makes no sense.

Re: I analyzed hospital price lists so you didn't have to

#316

Post by mindslight »

maxerickson wrote: post #120
mindslight wrote: post #113

Earlier quoted context omitted.

Wut? The service has already been rendered at that point. Without an upfront price, no contract has been formed, so there's no basis for the hospital to bill an unjustifiable amount. At best they could request reimbursement for cost incurred. eg $0.01 for an aspirin and not $60.

At which point? The hospital would stop providing services shortly after it was informed that it would not be able to bill for them. Also, I'm pretty sure you can write a contract that doesn't have an upfront price.

Informed by who? Hospital performs services, sends out a "bill" 30 days later, patient responds "due to the lack of published pricing as per federal reguation, no contract was formed and thus this bill is invalid". Are you saying the hospital would then react by stopping providing care to all patients from then on? Why wouldn't they react by you know, complying with the law to stay in business?

A contract has to have defined consideration, otherwise it is not a contract. Time and materials (hourly rate + cost/plus) is another standard form of financial consideration, but "we'll charge you whatever we feel like at some later time" is not.

Re: I analyzed hospital price lists so you didn't have to

#317

Post by throwaway0a5e »

twicetwice wrote: post #186
throw123123123 wrote: post #173

Earlier quoted context omitted.

It's not the same regulation.

Yeah. A lot of flamewars have happened: "regulation bad!" vs "no, regulation good!". But in reality, good regulation is good, and bad regulation is bad. It sounds silly written out because it's a tautology, but if more people internalized it we could have much more productive conversations. Instead of going back and forth on whether regulation is good or bad, we should try to figure out which regulations are good and…

>But in reality, good regulation is good, and bad regulation is bad.

No one brick in the road to hell is bad. But you can definitely pave a road to hell with the accumulation of "positive" changes. People tend to define positive over too short a timeline or too narrowly.

Re: I analyzed hospital price lists so you didn't have to

#318

Post by dham »

bsimpson wrote: post #106
Someone1234 wrote: post #13

When High Deductible Insurance was introduced the supposed concept was to "give employees a stake in their costs, and therefore lower them for both employer and employee." However, even today doing so is very challenging, and before laws like this it was essentially impossible. There's no way to shop around American healthcare, with the system itself working against you at every turn (e.g. doctors prescribing named b…

I broke my foot recently. Calling around and asking for quotes ranged from a straight up "I don't know" to "Here is the cash price. We won't know your HDHP insurance price until after we bill them, which could be good for you or could be bad. It will probably be bad, because there are more middlemen." I tried paying the cash price. They inadvertently billed my insurance anyway. Turns out, I actually saved like 33% us…

Broke my finger and did the whole CD thing to. I accidentally laughed on the phone when they told me what I had to do. Felt a little bad. I had to drive to the urgent care to get the CD and then drive it to the orthopedic specialist days before the appointment. As I was driving I just thought to myself, here is everything that's wrong with the medical industry, synthesized in a 700Mb metallic disk I'm holding in my hand.

Re: I analyzed hospital price lists so you didn't have to

#319

Post by rmbyrro »

el_jay wrote: post #238
duffpkg wrote: post #65

Wrote Hacking Healthcare for O'Reilly, created ClearHealth/HealthCloud open source EMR, managed health systems for 15+ years, blah, blah, blah. It is very good there is are the transparency regulations. It is worth briefly explaining some of the reasons why many facitilities are having a hard time complying. There are some bad actors, absolutely true. However "Hanlons Razor" -- never attribute to malice that which is…

Interesting, thank you. One remark: > Modernization is hard, time consuming and very expensive. These regulations are a good driver for all that, but it takes time. Having been in some of these boardrooms there is not typically a cartel of evil executives figuring out how to screw patients. A lot of the time it is a group of relatively normal people trying to hold up a technological and business process house of card…

Richest Country - RiCo for shorter - is not a sentient being that sees and controls all...

What you refer to is actually a collection of hundreds of millions of individuals, with all sorts of interests, sentiments, ambitions, sometimes conflicting ones.

Re: I analyzed hospital price lists so you didn't have to

#320

Post by formerkrogemp »

From an accounting and compliance perspective, not complying might make sense depending on the cost of upgrading systems. Hospitals and healthcare networks are going to upgrade their systems piecemeal and hodgepodge as their funding allows and pay the fines in the meantime. It'll be a good time to work in healthcare IT consulting. I'd imagine revenue will increase as EMR and so on require updates due to changes in regulation, assuming that we continue this trend.
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