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Congress is set to ban most surprise medical bills

nytimes.com

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Re: Congress is set to ban most surprise medical bills

#171

Post by pxeboot »

andy_ppp wrote: post #133
bfieidhbrjr wrote: post #57

Earlier quoted context omitted.

There's no "market" in healthcare in the US. Long ago, it became illegal to open a hospital without a 'certificate of need' from the State. That's why so many towns have only one hospital - it's a government granted monopoly like cable companies in the 80s. Differential pricing is also illegal. You fly cheap on Sunday at 3am, expensive on Monday at 9am. Healthcare providers are not allowed to charge less when it's ch…

I find this idea interesting, but I'm extremely skeptical. If we are thinking about this as being a startup, how can we outsource the cost of building the hospital to the doctors and nurses? That way you might be able to build a billion dollar business by tricking people into owning all the downsides while you own all of the profits? I'm just joking of course... the idea that the market can optimise every problem is…

>how can we outsource the cost of building the hospital to the doctors and nurses?

This is almost reality in the US. Lookup "Ambulatory Surgical Center" investments.

Re: Congress is set to ban most surprise medical bills

#172

Post by tsjq »

kayodelycaon wrote: post #9

> Some private-equity firms have turned this kind of billing into a robust business model, buying emergency room doctor groups and moving the providers out of network so they could bill larger fees. If this doesn’t describe evil, I don’t know what else would.

MBAs, duhh

Re: Congress is set to ban most surprise medical bills

#173

Post by Frondo »

zbrozek wrote: post #134
annexrichmond wrote: post #118

Earlier quoted context omitted.

> and prices are hidden I believe the Trump administration is addressing this: https://www.hhs.gov/about/news/2019/11/15/trump-administrati... https://www.hhs.gov/about/news/2020/10/29/trump-administrati... > The rule requires that most health plans and health insurers not only provide easy-to-understand personalized information on enrollee cost-sharing for healthcare services, but must also publicly disclose the rat…

We still need up-front transparency on what codes will be billed to whom, from whom, and for how much. I want a comprehensible restaurant-like menu. And we need to break up regional monopolies so that there's actually a choice of provider. Further, agreements to pay whatever, whenever, before any diagnosis need to be banned as contracts under duress. If we want the free market approach to work, we need to make it pos…

Yes, we need price transparency, but the last time I had a surgery, it was an emergency surgery, in the sense of "get him to the nearest ER or he'll die."

By the time the anesthesiologist came around, I was drifting in and out of consciousness -- no way to ask if they were in-network. (They weren't, by the way.)

This isn't an uncommon scenario, and one where price transparency isn't really going to help.

Also, what am I supposed to do, decline the services of an anesthesiologist and request an in-network one? What if there isn't an in-network one on duty? What if they're busy? if I need a surgery now, what choice do I have?

Re: Congress is set to ban most surprise medical bills

#174

Post by pnutjam »

jsperson wrote: post #48
cdjk wrote: post #19

Earlier quoted context omitted.

The existing health insurance industry is far from free market. Try getting a price for a procedure or visit beforehand. Compare that to dental insurance. I’m always shocked when I get a treatment plant after 5 minutes that outlines exactly what the dentist needs to do, how much insurance will pay, and how much I will need to pay. Of course the set of possible treatments for dental work is a lot smaller, but it seems…

> The existing health insurance industry is far from free market. Try getting a price for a procedure or visit beforehand. Oh, I know. I've tried getting prices in the past. Traditional providers can't do it. One thing that has opened my eyes is using a Direct Primary Care (DPC) provider. I pay $75 a month for direct access to my doctor (email, text message, cell phone etc.). The access is great, but an unexpected si…

I see that alot in the stuff my insurance bills. $60 test they paid $3 for, another $180 test they paid $21 for or a $37 test that paid $2.80.

How can you shop around when prices are that distorted?

Re: Congress is set to ban most surprise medical bills

#175

Post by pnutjam »

jschwartzi wrote: post #128
mauflows wrote: post #112

Earlier quoted context omitted.

I've become more staunchly single payer after I had my first major medical hurdle of my adult life this year. I had switched insurance in January, but apparently my old insurance had a bug in their system. The effect was that they were accepting my claims, but then denying them. So I had to coordinate both insurances and get them on the same page. Then I had to call every one of my many providers, get them to underst…

Imagine having to do this every time you change jobs.

Yup, last employer had me on a different plan then I signed up for. Went round and round with the employer and the insurer. Of course it was the others fault.

Finally talked to DoL guy and they told me it's absolutely the employers responsibility. They kept going back and forth with me. This was about and $1800 difference in out of pocket max, not in my favor...

Finally they fixed it, but only for my wife. Since she had the majority of the bills due to a surgery, the insurance clawed back a bunch of smaller stuff they had already paid. So that cost me about a $1k. I guess I'm going to have to sue in small claims, which is what the DoL guy recommended.

Re: Congress is set to ban most surprise medical bills

#176

Post by jimbob45 »

dr_orpheus wrote: post #143
jsperson wrote: post #13

That it takes such effort to pass a bill like this - 80% public approval, banning a clearly predatory practice, has turned me from a pure free market thinking into a believer in single payer healthcare. The free market just doesn't work when there is very little elasticity in consumption. I've been on the receiving end of a $15K air ambulance bill (thankfully covered by insurance) as well as the out of network specia…

The out of network care at an in-network hospital, is the absolute worst. In a similar vein, my wife's insurance was supposed to cover "out-of-network" ER visits. So one night that we had to go the ER we went to an out-of-network hospital ER because there wasn't an in-network one close by. Turns out that the coverage of the out-of-network ER visit basically just covers the cost of the bed in the ER, every treatment t…

Network scope existing at all baffles me. Insurance companies become the ultimate deciders of which hospitals are worthy and which aren’t instead of government certification agencies. Seems like an open door to malevolence.

Re: Congress is set to ban most surprise medical bills

#177

Post by octopoc »

thowawayyy wrote: post #170
calvinmorrison wrote: post #154

Earlier quoted context omitted.

That's probably true but a lot of medical cost is scheduled like follow up or specialist visits, surgery and things of the less urgent nature.

How is that solving the car crash situation?

It's not, but if 50% of your business cares about prices and 50% doesn't, that's still a lot of pressure to have competitive prices.

Re: Congress is set to ban most surprise medical bills

#178

Post by tehjoker »

rayiner wrote: post #142
WrtCdEvrydy wrote: post #81

Earlier quoted context omitted.

The biggest fuck you is that Medicare can't negotiate.. it's actually written into the law.

That's not true. Medicare can and does negotiate the cost of procedures and doctor's services. What the law says is that Medicare can't negotiate prescription drug prices. That's because Medicare doesn't directly pay for drugs, except what's used incidentally in the course of covered hospital stays. Medicare didn't provide coverage for prescription drugs until the adoption of Part D. That is structured differently th…

That's 1/10th of the military budget for drugs that can be often be manufactured for pennies (drugs with biological elements requiring glass column filtration and such are a different story but are far more rarely used).

A point in case is the Hep C vaccine: https://www.medicalnewstoday.com/articles/323767#drug-types-...

Re: Congress is set to ban most surprise medical bills

#179

Post by DangitBobby »

cpuguy83 wrote: post #61
jsperson wrote: post #48

Earlier quoted context omitted.

> The existing health insurance industry is far from free market. Try getting a price for a procedure or visit beforehand. Oh, I know. I've tried getting prices in the past. Traditional providers can't do it. One thing that has opened my eyes is using a Direct Primary Care (DPC) provider. I pay $75 a month for direct access to my doctor (email, text message, cell phone etc.). The access is great, but an unexpected si…

The annoying thing is, most people would agree that the whole system sucks... until you start talking about politics and suddenly you'd think a bunch of people have a love affair with their insurance company and healthcare providers.

"People love their insurance!" Is a dead giveaway that a politician is a sock puppet. Biden kept saying it during the primaries.

Re: Congress is set to ban most surprise medical bills

#180

Post by t-writescode »

octopoc wrote: post #177
thowawayyy wrote: post #170

Earlier quoted context omitted.

How is that solving the car crash situation?

It's not, but if 50% of your business cares about prices and 50% doesn't, that's still a lot of pressure to have competitive prices.

It sounds like this conversation needs a usage breakdown to see where most bills come from from a total price experienced perspective.

It seems like most people's greatest fear around hospitals is a surprise ER visit that blows through their savings.

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