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U.S. health care's widespread overbilling problem

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Re: U.S. health care's widespread overbilling problem

#141

Post by [deleted] »

anigbrowl wrote: post #117
binarymax wrote: post #96

Earlier quoted context omitted.

Yes, hence the "transparent" in quotes and the overt sarcasm (apparently harder to detect than I intended). Of course patients shouldn't need to download a dataset and figure it out on their own! But please see my other response to see why it is tricky. Regarding pets, they are not beholden to hospital/insurance provider duality, and it follows that since it is out of pocket, you would not be able to afford a $60k se…

Tbh if I broke my own leg I think I'd rather have the vet do it. Every time I have had to bring a friend or family member to hospital I'm just appalled by it all.

[deleted]

Re: U.S. health care's widespread overbilling problem

#142

Post by wvenable »

jazzyk wrote: post #98
dboreham wrote: post #88

Earlier quoted context omitted.

Because Americans are selfish. Source: lived in US for 20 years.

I have lived in the US for 27+ years and I think Americans tend to be very generous, a lot of people donate their time and money to charities, churches, etc. They just don't want to give their money to a bunch of bureaucrats, who spend it mostly on themselves, and seem to multiply like rabbits.

So they pay for profit insurance companies owned by Wall Street investment firms. I don't understand why American's find that more palatable. The "government doesn't work" mentality is self-feeding. If you want government to work, you make it work. The alternative is just defeatist.

You won't find many conversatives in other countries who want to give up their socialized medical system.

Re: U.S. health care's widespread overbilling problem

#143

Post by beat »

projectramo wrote: post #4

I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price. On the 10th call, I finally got someone to tell me what the out-of-poc…

And yet, the idea that health care "consumers" would price-shop for the lowest-cost procedure is a dogmatic core of some American ideas about how to "fix" cost in health care.

Re: U.S. health care's widespread overbilling problem

#144

Post by DougWebb »

ashark wrote: post #111
drewbuschhorn wrote: post #89

Earlier quoted context omitted.

I had a hospital decide to restart the entire billing process on me after it was all paid for. Only time I've ever been glad for the insurance company (car, not health). I dropped it in their lap, and 3 mo later got an "our mistake" from the hospital, didn't have to lift a finger to fight it.

One of the more surprising things for me, watching major medical events from a distance and relatively close-up in my family, has been that hospital billing departments are at least as inconsiderate, incompetent , out-to-get-you, and generally shitty as insurance companies. And considering how much trouble I've seen/had with insurance companies that's saying something. The number of times I've seen a bill that made n…

I had a similar experience. My wife was hospitalized for several months when her liver failed and she got a transplant. I have no complaints about any of the care she received; everyone did their jobs very well except for the billing department. Overall the total cost was around $1.5 million, and my insurance company did a fantastic job weeding out all of the duplicate and invalid claims. Their numbers for amounts claimed, allowed, paid to the providers, owed by us (deductible, co-ins), paid to us to cover out-of-pocket expenses that exceeded our annual max, etc always added up. But when the hospital tried to bill us, the numbers didn't work. Their "itemized" bill included claims that were rejected, claims that were paid by insurance, was missing claims that went through the insurance, and had some things that didn't match up to insurance claims at all. Every month they'd resend the bill, and it'd have different items on it with a different total amount. We had money from the insurance company to use to pay for what we owed the hospital, but we refused to pay it until the hospital could produce a bill that matched what the insurance company said we owed. They never did. (I'm not sure what happened; my wife and I were separated before all of this, and the bills always went to her. I think they just stopped sending the bill.)

Re: U.S. health care's widespread overbilling problem

#145

Post by watwut »

EvanAnderson wrote: post #11
projectramo wrote: post #4

I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price. On the 10th call, I finally got someone to tell me what the out-of-poc…

An an anecdote: I've been on a high-deductible plan for nearly 13 years. I have been regularly met with shock and incredulity that I could possibly want to know the cost of a procedure. My wife and I have spent, collectively, hours on the telephone trying to get answers. It's particularly galling when we get "guilt trip" treatment for asking about costs for procedures for our young daughter. We have been met with bot…

In the long term, it is better for your daughter if you don't bancrupt and manage the price down. Especially if she is sick.

The guilt tripping of father of sick cold is pretty disgusting tactic.

Re: U.S. health care's widespread overbilling problem

#146

Post by Retric »

cmurf wrote: post #86
wlesieutre wrote: post #41

Earlier quoted context omitted.

Related to 1 and 2, people on high deductible health plans are paying everything out of pocket until they hit their yearly cap (then insurance kicks in). It's not even whether you have insurance or the insurance company wanting to reward you, it's trying to save your own money like any other purchase. High deductible health plans are becoming more and more common, from what I gather.

Mine's $5500. The monthly premiums are ~$300. It's an obscenity for someone who's healthy, runs, bikes, or swims pretty much every day. But it gets worse. Recently I went to a doctor for a minor problem, but did not get pre-authorization. I knew exactly what it was going to cost for the visit, and knew it would not be covered by insurance. What I did not know is, due to lack of pre-authorization, it also would not be…

You generally can't really directly associate specific cases of disease with specific lifestyle choices.

EX: Some non smokers get lung cancer, so a percentage of smokers would have gotten cancer either way.

Re: U.S. health care's widespread overbilling problem

#147

Post by psyc »

jazzyk wrote: post #98
dboreham wrote: post #88

Earlier quoted context omitted.

Because Americans are selfish. Source: lived in US for 20 years.

I have lived in the US for 27+ years and I think Americans tend to be very generous, a lot of people donate their time and money to charities, churches, etc. They just don't want to give their money to a bunch of bureaucrats, who spend it mostly on themselves, and seem to multiply like rabbits.

I've lived in the US for 40 years. I'd estimate that less than 5% of all the people I've ever known ever donate time. A substantially higher number donate money to the millionaire operators of charities and "ministries".

Americans aren't generous. Americans are preoccupied with moving money. The more it moves, the faster it accumulates to the top of the economic pyramid.

Re: U.S. health care's widespread overbilling problem

#148

Post by Shivetya »

projectramo wrote: post #4

I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price. On the 10th call, I finally got someone to tell me what the out-of-poc…

I am always dismayed when I get back "it depends". depends on what? I want a pure cash price. however it has been this way for decades having listened to my grandfather back in the nineties trying to by his wife a wheelchair only to be told he could not buy one and no they would not give him a price. so he did what anyone of his generation did, goodwill, salvation army, and finally found one at a garage sale. he just didn't think it right someone had to pay for what he needed for his wife but damn if the system stymies people at every turn.

the new billing fun I have is required visits for prescription refills on some medicines and that to me is just overbilling in a different form. I didn't need to visit other than to get permission to refill; no it does not necessarily need to be a controlled substance

Re: U.S. health care's widespread overbilling problem

#149

Post by beat »

projectramo wrote: post #4

I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price. On the 10th call, I finally got someone to tell me what the out-of-poc…

The core difference between the American health insurance model and the Japanese model (which costs half as much and has better outcomes) is fixed pricing. In Japan, a government commission sets prices for every medical product and procedure, tuning the prices to insure profitability, while preventing profiteering.

In America, price negotiation is done between providers and insurance carriers. This has a few obvious effects. First, it gives us the in-network/out-of-network distinction. Second, it introduces complexity in the math sense to pricing - providers aren't charging one price, they're charging a wide array of prices, although those prices don't really vary much.

The network thing also has the effect of reducing consumer choice in providers. I can use whatever doctors/facilities my insurance has in-network, unless I'm willing to cough up the difference out of my own pocket.

Of course, fixed prices would be that wicked socialist government control we're told is ruining everything.

Re: U.S. health care's widespread overbilling problem

#150

Post by sparky_z »

DougWebb wrote: post #137
projectramo wrote: post #4

I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price. On the 10th call, I finally got someone to tell me what the out-of-poc…

Price transparency is probably not feasible, most of the time. For the software developers, here's an analogy: asking your doctor how much it will cost to treat you is akin to a product manager asking you how long it will take to implement a feature. You might have a rough idea, but until you get into the requirements, do some design work, and dig into the details you can't even come up with a precise estimate. And y…

Well, in some sense that's true of most businesses, right? Some customer interactions take up more overhead and resources than others. The trick is to aggregate that uncertainty over your customer base and come up with a price that incorporates your expected average costs. There are a lot of businesses that do this successfully because they have to in order to participate in the market. The reason health care providers don't seems to me because that are isolated from competition by heavy regulation. (I'm not saying the regulation in the health care space is necessarily a bad thing on balance, but it means that change can only come through additional regulation rather than depending on hamstrung market forces.)
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