Hospital prices are about to go public in the U.S. • Hacker News Board

Re: Hospital prices are about to go public in the U.S.

#261

Post by jf » Thu, Dec 27, 2018, 4:40 PM UTC

blitmap wrote: post #257

bookofjoe wrote: post #172

Pro tip: I was a neurosurgical anesthesiologist at the University of Virginia Health Sciences Center for twelve years (1983-1995). Every now and then I'd get a call from our billing office that they'd received a letter from a patient I'd cared for who was too poor to pay what our department had billed (usually many thousands of dollars: I had NO IDEA what our charges were, BTW, nor did any of my colleagues in the dep…

After we establish transparent pricing across the board, we're going to have to deal with the reality that some folks seek care without having any ability to pay for services.

Some folks need care without having the ability to pay.

Re: Hospital prices are about to go public in the U.S.

#262

Post by SlowRobotAhead » Thu, Dec 27, 2018, 4:42 PM UTC

conductr wrote: post #111

StudentStuff wrote: post #103

Earlier quoted context omitted.

This type of billing practice causes a mess of winners and losers, essentially unless your insurer has good pricing with wherever you end up getting treatment (often not a choice you get to make in an emergency), you can end up holding the bag for the cash price, usually half of the $10k number you mention. Quite ridiculous when other insurers are paying less than half that price, smells of a scam.

My conspiracy theory is it was designed this way over time so that people “needed” insurance (before it was required).

Not too much of a conspiracy theory.

What’s ironic (?) is that by mismanaging a scheme to get everyone on private insurance they’re really working towards socialized insurance. Which good or bad, there is no going away from once you have it.

Re: Hospital prices are about to go public in the U.S.

#263

Post by ethbro » Thu, Dec 27, 2018, 4:42 PM UTC

pcarolan wrote: post #256

ethbro wrote: post #244

Earlier quoted context omitted.

Caveat: All hospitals not managed identically. I'm sure there's a lot of varying billing policy, hospital to hospital. And varying ability to financially write off care. As a gut guess, I'd expect rural hospitals to be the worst about this and suburban the best.

I'm sure this is true. We've (unfortunately) now experienced this at 4 different hospital systems. The customer service is alarmingly similar. Hospital: "Call your insurance company and ask for a break" Insurance Company: "Call the hospital and ask for a break" Also, 2/4 of these hospitals had outsourced their billing which means they can't even make decisions on behalf of the hospital (and have a disincentive to wri…

Was going to ask about outsourcing. I don't know the market on provider billing, but I'd assume there are some companies that manage a number of facilities.

And wow, does that search bring up a lot of astroturf: https://www.google.com/search?q=list+of+medical+billing+comp...

Re: Hospital prices are about to go public in the U.S.

#264

Post by conanbatt » Thu, Dec 27, 2018, 4:49 PM UTC

Holybeds wrote: post #210

karmelapple wrote: post #195

I was in a hospital in Singapore recently, and the prices for doctor consultation fees, staying in a room, and even certain tests were listed right at the front of the emergency room desk. After the patient I was with was stabilized, the nurse confirmed with us verbally what the rough cost should be for the rest of what the doctor prescribed, and asked if we wished to proceed. We could have said no and gone elsewhere…

Where I live you know the cost before you go to the doctor since you will only pay a symbolic sum of 30 USD even if the visit ends up with something like a life long cancer treatment. If you need medicine you will pay at most 120 USD per year regardless of the costs. The idea that your access to healthcare should be linked to your own or your parents financial is crazy.

With the difference that a long-cancer treatment might cost hundreds of thousands of dollars in the US and simply bankrupt the hospital.

Its easier to eat up cost if its a lot lower and has caps. The US has no apetite for those level of restrictions.

Re: Hospital prices are about to go public in the U.S.

#265

Post by conanbatt » Thu, Dec 27, 2018, 4:50 PM UTC

codingdave wrote: post #176

I'd be happier to see regulated business practices. While I agree that the prices are a problem, I've felt more pain from bills that keep coming in for more than a year after a major event. And when I go to complain, they say that someone made a mistake, the insurance took a long time to respond, or some other excuse. Give me a final bill with all charges within 30 days, then 30 more days to resolve any issues with t…

Think that a provider gets that billing cycle as well. Every patient that has insurance means the provider needs to collect from 2 different agencies: through the credit card in a copay and through the insurance, that fights the price.

Re: Hospital prices are about to go public in the U.S.

#266

Post by conanbatt » Thu, Dec 27, 2018, 4:52 PM UTC

sturgill wrote: post #190

mwerd wrote: post #133

This won't help consumers. The prices (both charges and what Medicare pays) are already effectively public: https://data.cms.gov/Medicare-Physician-Supplier/Medicare-Pr... The problem, as some other comments point out, is that they're way too complicated. The link I posted, for example, is just the provider charges. A hospital visit typically has a facility claim and at least one provider claim. Depending on the type…

I shared this experience before on HN, but I once cut my leg quite severely playing ice hockey. Ended up at the ER dripping blood everywhere. I went to the desk and asked if they took my insurance. Said I was only interested in treatment if my insurance would cover it. I was assured it was fine. Naturally the doctor assigned to me did not take my insurance... I got out of the out-of-network billing after hours of pho…

The collecting system is way too complicated for a provider to know. Nobody can reasonable assure you of that, the same way an accountant cant assure you you are compliant on all IRS codes, or even a doctor can assure you you will be healthy if you do a treatment.

But think what happens when you have a patient with insurance, bleeding right in front of you: would you turn them away because of this lack of assurance? its an unreasonable ask of a human being.

Insurance copmanies are the Ticketek of the health industry: they take the bad rep for the ones reaping the benefits.

Re: Hospital prices are about to go public in the U.S.

#267

Post by conanbatt » Thu, Dec 27, 2018, 4:54 PM UTC

phkahler wrote: post #218

One thing I advocate is fixed pricing. It's great to put prices online, but as long as insurance companies and such get to make deals there will be no real transparency or competition. The one downside I see to enforcing the prices is that it would ruin this ability to offer a break to people who need it. On the other hand, with enforce posted prices those prices would come down to levels similar to what insurance co…

IF you do fixed pricing in medicine, then as a provider you want to turn away care from expensive patients. They become huge money sinks, so you have to do everything in your power to turn them away.

Re: Hospital prices are about to go public in the U.S.

#268

Post by conanbatt » Thu, Dec 27, 2018, 4:59 PM UTC

Sacho wrote: post #97

tehlike wrote: post #56

Earlier quoted context omitted.

most doctors in the US actually do not know about the prices of treatments as it changes based on insurance administrator/insurer, and then what the patient pays also have huge variability based on insurance administrator/insurer.

I get why they might not be able to tell you how much you'll pay because of your specific insurer, but why would the overall price of the treatment change with it? That seems bizarre.

The cost for the provider is the same, but what the insurance pays is in someone elses hands. If you wished not to abide by the insurance, just pay out of pocket.

Insurance should really be only high deductible plans, so the patient really looks into pricing for his general care/periodic care.

Re: Hospital prices are about to go public in the U.S.

#269

Post by weliketocode » Thu, Dec 27, 2018, 5:01 PM UTC

It's hard to believe how little progress has been made with medical billing.

My last standard annual physical was billed at $2.6k, had 30+ line items, and despite being covered my insurance left me with an out-of-pocket of $200+.

I guess I'll take this as a win, albeit small.

Re: Hospital prices are about to go public in the U.S.

#270

Post by conanbatt » Thu, Dec 27, 2018, 5:02 PM UTC

refurb wrote: post #9

My guess is that eventually the govt will step in and start regulating prices if providers don’t. One interesting idea (not well thought out at all) would say that all prices need to be +\- 50% of what Medicare pays. Medicare pays $20,000 for stent placement? Great! You can charge whatever you want up to $30,000. A lot of effort goes into setting Medicare rates (and they are based on self reported costs across the co…

The specter of price controls.

They dont work, simply because if you limit payment then hospitals will stop doing the procedure, will fight against doing them, and will engage in high cost cutting to provide them. Please remember that about 60%+ plus of hospitals are non-profits: they only bask in the profits for their own salaries, but don't have the profit-based mentality usually accussed of.

You might want them to do that, but I doubt the market will agree with you on that one.