Hospitals lift curtain on prices, revealing giant swings in pricing by procedure • Hacker News Board

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#231

Post by lowkey_ » Wed, Sep 22, 2021, 7:03 PM UTC

good8675309 wrote: post #204

loeg wrote: post #83

Earlier quoted context omitted.

You’re probably thinking of “healthcare ministries,” which are not insurance (they’re scams).

Scams? They paid for my $6000 colonoscopy which caught early cancer, my daughters stitches, my wife's allergy specialist, my son's rocky mountain spotted fever, etc. etc. $500/mo for our family of 5 and we've been on it for nearly 10 years. But yes, please tell me more how this service that is way cheaper than insurance, is a community of people helping each other, and covers way more than insurance, is a scam.

Can I ask what service you use? I'd be interested in checking it out.

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#232

Post by kube-system » Wed, Sep 22, 2021, 7:03 PM UTC

haliskerbas wrote: post #136

EvanAnderson wrote: post #61

Earlier quoted context omitted.

> if an insurance company decides not to cover something (very very common, even in-network) then the inflated price is what you end up getting billed for... Is there any reason why this kind of windfall shouldn't be illegal? I realize it isn't, but is sure seems like it should be. I was stuck with a charge from a doctor for 7x the price my insurance would have paid. My pre-ACA insurance refused to cover the procedur…

Reminds me when my dentist charged me $50 for a cup of fluoride (nothing too special about this fluoride). I asked why they said it would be covered. They said when they checked with insurance it says it’s covered, but for my age or whatever it’s not actually covered. So then I said why is it my fault that you gave me something you said was free but actually wasn’t because your check wasn’t thorough enough? They said…

Just take all of the money you'd otherwise spend on dental care and put it into a savings account or FSA.

I've never seen a dental insurance plan that actually makes financial sense. Most of them place significant limits on expensive and unlikely care, and cover routine care with little or no cost sharing. Insurance is a highly inefficient way to pay for expected expenses.

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#233

Post by fragmede » Wed, Sep 22, 2021, 7:03 PM UTC

danShumway wrote: post #148

jonathan-adly wrote: post #123

Earlier quoted context omitted.

The cost of the aspirin depends on these things lol. Look up 340B. There is a drug called Oncaspar. It's >$16,000 for one patient, and 5 cents for another (acquisition cost). Same drug, widely different acquisition cost.

When two pills coming from the same company are being made at the same time on the same machines, then they both cost the same. It's pretty obvious that the patient status changes nothing about that. However, the hospital's acquisition cost is variable because you're further down the supply chain and you're seeing the exact same kinds of arbitrary behind-the-scenes price swings that this article is talking about. It…

Under capitalism, a thing's cost to manufacture has nothing to do with the price of that something.

Read that again and work through your objections. Ideally something's price is higher than its cost so the company can make a profit, but there are so many obvious exceptions that its nice, but not necessary. Thus, who cares how much the pill coming down line costs to manufacture, unless you start hacking into the free market and set price controls, and say that pharmaceutical companies are only allowed to make 20% profit (or however much), Martin Shrekili's play, of buying pharmacutical companies and simply raising prices of drugs, is a legal move under capitalism, no matter how reprehensible that move may be.

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#234

Post by garettmd » Wed, Sep 22, 2021, 7:03 PM UTC

throwthere wrote: post #143

garettmd wrote: post #115

Earlier quoted context omitted.

This. It's telling that people working inside this system operate on a totally different set of rules for how to determine basic things like the cost of some input.

You're making the reasonable-sounding (but incorrect) assumption that the cost to the hospital of a drugs is the same for every patient. It's telling how people on the outside have no idea how complex the system is, as if there's one simple way to cost an item (hell, there's not even one simple way to cost an item with GAAP accounting for a widget). These lists are kind of worthless in the current iteration, but they…

How does the cost of a drug change based on who is consuming it? That's like saying the cost of a loaf of bread changes based on who is buying it.

The price you charge for the bread might change, but the cost is the same regardless of who is purchasing it. There's a difference between varying costs of an item based on accounting methods, versus varying costs of an item due to who is buying it. There seems to be huge disconnect here between people working in healthcare, and pretty much everyone else.

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#235

Post by stonemetal12 » Wed, Sep 22, 2021, 7:03 PM UTC

mullingitover wrote: post #94

derwiki wrote: post #76

Earlier quoted context omitted.

Is it illegal to state you don’t have insurance when you do? Or is this product not considered Insurance in the legal sense?

I don't think it is. Sidecar Health is doing just fine on this model[1] It's pretty perverse that you, an insured person, would have to lie about having insurance because the provider would charge you more for being insured. [1] https://cost.sidecarhealth.com

The same goes for pharmacies. Walmart advertises $4 generics. If your insurance has a $25 drug co-pay, then they will charge you the full $25.

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#236

Post by rconti » Wed, Sep 22, 2021, 7:07 PM UTC

hartleybrody wrote: post #196

loeg wrote: post #83

Earlier quoted context omitted.

You’re probably thinking of “healthcare ministries,” which are not insurance (they’re scams).

> (they’re scams). citation or story?

Here's a good start.

https://openargs.com/oa497-christian-health-sharing-is-a-sca...

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#237

Post by peterangular » Wed, Sep 22, 2021, 7:07 PM UTC

monocasa wrote: post #201

joshAg wrote: post #169

Earlier quoted context omitted.

Only to a degree because policies basically always have an upper limit on coverage. If the payouts are dropping because there's a massive reduction in claims, then there's a pretty decent chance that paying the policy maximum on each claim still won't be enough. Plus, profits don't come directly from the premiums anyway. They come from the investments the insurer makes with the premiums. So sure, they can try to conv…

> So sure, they can try to convince policy holders to increase coverage which allows them to charge a higher premium Or they just stone wall and increase premiums anywhere they can until they hit targets. Like at a previous job I had at a 250 employee company where premiums went up $150/m one year because the previous year had two families had a kid get (very different kinds of) cancer out of the blue. You'd think th…

> Like at a previous job I had at a 250 employee company where premiums went up $150/m one year because the previous year had two families had a kid get (very different kinds of) cancer out of the blue.

It's bad enough that I've heard office gossips complain about other employees leveraging their healthcare turning into higher premiums the year after. Like, as evil as complaining their coworker's kid got cancer.

When employees go through big health events it's hard to keep it under wraps in a work environment... especially in this "race to the bottom" society we happen to live in. You can bang on about privacy all you want, but people talk.

I guess I'm shocked it happened in an office of ~250 as I've always seen it happen at much smaller places.

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#238

Post by kwere » Wed, Sep 22, 2021, 7:07 PM UTC

itisit wrote: post #126

r0m4n0 wrote: post #62

Seeing the price range you pay is interesting, but I'm not sure what we are supposed to do with it. My wife had her prenatal anatomy scan a few months ago at Stanford medical, $11000 for a 1 hour ultrasound. I personally was on the hook for around $500 and insurance paid $10500. End of the day, what say do we have as consumers? How did the insurance company negotiate a rate of $11,000? Does the insurance company real…

The insurance most definitely did not pay $11,000 USD. They paid a percentage of an adjusted figure, and the balance was passed on to you. Billing and payment amounts usually differ by an order of magnitude.

So deducibiles are a sham?

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#239

Post by rconti » Wed, Sep 22, 2021, 7:07 PM UTC

rpmisms wrote: post #176

lotsofpulp wrote: post #137

Earlier quoted context omitted.

Is there evidence that Obama wanted those religious exemptions and bullshit cost sharing plans? I would be willing to bet that was a concession to other politicians in Congress in order to get ACA passed.

I'm thankful the concession was made. The lower price of cost-sharing made it possible for my parents to keep eating while providing for the family.

That's great until the church decides your parents are sinners and refuse to cover anything, and have no consequences for stealing their money.

Re: Hospitals lift curtain on prices, revealing giant swings in pricing by procedure

#240

Post by kube-system » Wed, Sep 22, 2021, 7:08 PM UTC

throwaway23438 wrote: post #129

peterangular wrote: post #60

Earlier quoted context omitted.

There's police around hospitals constantly and if they get a whiff that you have a fake ID they're going to be talking to law enforcement sooner or later. Also this isn't going down to your corner liquor store and flashing your drivers license... that thing is going to get scanned etc. --- Actual protip: If you're uninsured and need care they legally can't turn you away at an ER. They have to provide the healthcare t…

I've often wondered what would happen if you went to the ER, carried no identifying documents, and just refused to identify yourself. Just hope nobody recognizes you there. Giving a fake name is fraud, and people have been arrested for doing that at the ER. (Fuck America.) But I don't know that there's any legal obligation to give any name at all. If you don't give them a name, you're not lying to them, and oops, loo…

People show up at hospitals physically unable to identify theirselves all of the time.

https://www.npr.org/sections/health-shots/2019/05/07/7207022...

Hospitals that accept medicare do have a legal obligation to stabilize patients. But we're talking 'stabilize' as in 'you're not dying'. If you're alert and capable enough to be arguing with people and you're not a psych danger, you're likely stable enough to legally be thrown out on the street.