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New health insurance “transparency data” looks suspiciously wrong

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Re: New health insurance “transparency data” looks suspiciously wrong

#161

Post by westmeal »

sl-dolt wrote: post #151
newjersey wrote: post #13

We should compel these companies to comply. There should be fine a 1% of annual revenue for every day these companies are in non compliance with prison for the ceo if they are non compliant for over thirty days.

Author here. The problem is checking compliance. By publishing these files, they seem compliant, but really aren't. Since the payors are the guardians of the data, it's very difficult to check that what they're posting is correct. That was the main thrust of the article.

Yeah these people are sketchy as hell, glorified middlemen trying to continue making billions for contributing nothing. Thanks for posting.

Re: New health insurance “transparency data” looks suspiciously wrong

#162

Post by chaxor »

The reasonable solution that people in the US arrive at is to avoid going to physicians at all costs. I recently found out that a simple blood test at the physicians office costs ~$600 (with insurance), along with all of the annoyance of dealing with setting up the appointments waiting for several months, waiting on insurance, the trouble and time off work to get there - all for a material that takes a few minutes to extract and few moments to run.

Due to the cost I was curious, and found out that I could literally purchase all of the FDA-approved* lab equipment for my house and run tests on myself for less cost than it was to go to a physicians office. The physician (i.e. expertise) is irrelevant here (almost always are) as the most input I've ever seen provided by one amounts to 'take an Aleve if you're hurting'.

Home labs are likely where the future is headed, and it's the fault of the medical industry being so utterly useless. I've been through most medschool (neurology-focused) courses, and most physicians or any medical professional uses essentially zero of that knowledge.

Re: New health insurance “transparency data” looks suspiciously wrong

#163

Post by gameman144 »

chaxor wrote: post #162

The reasonable solution that people in the US arrive at is to avoid going to physicians at all costs. I recently found out that a simple blood test at the physicians office costs ~$600 (with insurance), along with all of the annoyance of dealing with setting up the appointments waiting for several months, waiting on insurance, the trouble and time off work to get there - all for a material that takes a few minutes to…

My expectation is that costs for these simple tests will become competitive as physicians become more and more scarce -- if the person doing your blood test is no longer an expert, and is just feeding it into an off-the-shelf machine, then there's a lot more flexibility in cost-cutting.

(In fact, my local hospital has pretty great lab prices for this exact reason, so I'd assume this kind of price competition for simple tasks might already be a thing in some urban areas.)

Re: New health insurance “transparency data” looks suspiciously wrong

#164

Post by Alupis »

CraigJPerry wrote: post #111
Alupis wrote: post #98

Earlier quoted context omitted.

> That’s not how money works and until that fundamental misunderstanding is eliminated, learned helplessness will prevail. A country that issues its own currency cannot save money in its own currency. Ah, the so-called "Modern Monetary Theory"... the same one that told us governments can spend infinitely without consequences... and then runaway inflation and looming recession happened. Of course, not MMT's fault... I…

>> the same one that told us governments can spend infinitely without consequences you’re making a strawman argument. You’ve mischaracterised then proceeded to knock it down. Here’s Randall Wray, a leading MMT scholar on this topic in early 2020: https://www.levyinstitute.org/publications/covid-relief-and-... “The inflation worriers’ objection seems to be largely over the “stimulus checks.” While we prefer targeted s…

The MMT people always do this... bury people in bogus articles, references and walls of text to try to make people think everything known about economics was and is wrong.

Sorry... these are borderline crackpot theories. The devastation left in the wake of only a taste of MMT implemented is enough to drive MMT to bed, thankfully.

It's also rather interesting how one can tell a MMT'er is in their midst without much even being said.

Re: New health insurance “transparency data” looks suspiciously wrong

#165

Post by pwinnski »

ethbr0 wrote: post #77
candiddevmike wrote: post #3

Everyone assumed there would be malicious compliance here but it's definitely eye opening just how malicious they made it. Speaks volumes for the perceived risk releasing this data, IMO. Still waiting to hear about someone using this data to negotiate down a hospital bill, seems like it's just insurance companies that can weaponize this data for better rates.

> but it's definitely eye opening just how malicious they made it As someone familiar with insurer, provider, and facility IT systems, I'd offer an alternate explanation -- the data is bad because healthcare IT is understaffed (and often incompetent). These are businesses that have squeezed most costs out, and IT is definitely a cost. Imagine banking... if there were much less competitive pressure and an inability to…

They don't seem to have any trouble sending out bills, though.

Re: New health insurance “transparency data” looks suspiciously wrong

#166

Post by BizarroLand »

chaxor wrote: post #162

The reasonable solution that people in the US arrive at is to avoid going to physicians at all costs. I recently found out that a simple blood test at the physicians office costs ~$600 (with insurance), along with all of the annoyance of dealing with setting up the appointments waiting for several months, waiting on insurance, the trouble and time off work to get there - all for a material that takes a few minutes to…

I know it's even stupid for me to say this, but capitalism should have no place in hospital health care.

It's lives on the line. In a somewhat realistic ideal world, any monies that exchange hands at that level should be to cover costs plus a moderated profit.

The lack of moderation and accountable oversight on the profit centers of healthcare is a real issue that we could solve, but too many people would rather have a 0.00000001% greater chance of becoming a millionaire in their lifetimes rather than put checks on unchecked capitalism.

Re: New health insurance “transparency data” looks suspiciously wrong

#167

Post by ethbr0 »

m463 wrote: post #132
joe_the_user wrote: post #97

Earlier quoted context omitted.

They received a mandate. They tried to respond in the way that required the least amount of effort. From someone in the industry, it's entirely plausible this is the best they can do. Assuming this is true for the sake of argument, saying that this sort of thing isn't malicious compliance is a sad kind apologistics for bad behavior that seems to regularly appear on HN.

I agree. How can these kinds of companies optimize their charge codes to get the max for the procedures, optimize their taxes to pay the minimum possible, and then do a poor job on these existential crisis kinds of things? I think they know what they're doing in all cases.

I've known at least a few insurers who have automated running test claims through their systems, because it's the quickest way to find out what will actually happen.

It's not rocket science! But it is decades of code on top of decades of code. There's a reason they still pay COBOL programmers...

Re: New health insurance “transparency data” looks suspiciously wrong

#168

Post by lostlogin »

lelanthran wrote: post #134
lostlogin wrote: post #61

Earlier quoted context omitted.

I have both, and the wait at the paid clinic is long, as is the wait at the free clinic. It’s not whether the cost is socialised or not that decides how long the wait will be. It also doesn’t help that the private system is incentivised to undermine the ‘free’ system at every turn.

> It also doesn’t help that the private system is incentivised to undermine the ‘free’ system at every turn. By competing on ... what? Can't be price (because "free" wins). The only other option is competing on quality. Your statement doesn't sound correct.

Staff, including very senior staff often work in both systems. They then hire staff from the public system into the private one. This runs down the public system. There are accusations that they don't work fast or efficiently in the public system, leading to inefficiency. Senior staff with roles or even ownership of private facilities arrange contracts for outsourcing of work to private facilities. I have worked in both systems and currently work in the private setting.

Re: New health insurance “transparency data” looks suspiciously wrong

#169

Post by axutio »

logicallee wrote: post #133
axutio wrote: post #49

Earlier quoted context omitted.

What does this mean? Having read the article, I don't understand what it is you're asking the author for.

Article says "contracted rates that are wrong, mislabeled, or missing" so I want to see what a correct, properly labelled example looks like according to the author. I want to see what they think correct data looks like.

But that's entirely dependent on the data - if you read the article, you'll see that the author is pointing out how different datasets are reporting different values for the same healthcare service. A correct, properly labeled example is just that - a document where values are accurate rather than misreported.

If you want to get a sense of what a correct, properly labeled example might look like, you should visit the CMS's guidance [1]. Health insurers should be providing documents that follow the format described there, and most importantly, reporting values that are accurate.

[1] https://github.com/CMSgov/price-transparency-guide

Re: New health insurance “transparency data” looks suspiciously wrong

#170

Post by vianneychevalie »

relaxing wrote: post #140
elzbardico wrote: post #57

Earlier quoted context omitted.

The reality is that both systems suck, and I say this having lived in systems with universal public healthcare. They just suck in different manners, different countries have different degrees of "suckness" and so on. And then there's the big problem beyond the question of who is paying: How much is being paid. Healthcare costs in the US are absurdly high both on relative terms (things are way more expensive) and on a…

> Healthcare costs in the US are absurdly high both on relative terms (things are way more expensive) and on absolute terms (more of the same things is needed because the American population is relatively too unhealthy for what you'd expect in a developed country with similar demographics). You need to ask why relatively inexpensive stuff like insulin is so much expensive in America than say, Germany or the UK. Must…

I know you're joking here, however, increasing marginal costs products are well-know and studied in microeconomics.

https://www.investopedia.com/terms/l/lawofdiminishingmargina...

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