Not to get political, but pretty sure this is thanks to one of Trump's last executive orders while he was in office. Correct me if I'm wrong
You are correct.
How much health insurers pay for almost everything is about to go public
281–290 of 370 posts
Re: How much health insurers pay for almost everything is about to go public
#282I'm one of the co-founders of Turquoise Health, mentioned in the article here. We've been downloading and parsing this data all day. It's a really big deal in the industry that the prices that insurance companies pay doctors are now being shared publicly. It will have all sorts of positive impacts over time, hopefully making rate negotiations more consistent and fair between different insurance plans. Right now, 10x…
Sorry, but the only thing that will help is Medicare for all. We need to get rid of insurance companies completely.
Lots of countries have great systems that aren't single payer.
Re: How much health insurers pay for almost everything is about to go public
#283Earlier quoted context omitted.
I have also been there and tried that, extensively. That's the opposite experience of what I encountered in paying by cash for more than a decade. Typically I'd pay around half price via cash for healthcare services (routine doctor visits, scans, et al.) versus what they charged if you had insurance. I never ran into a situation where they wouldn't negotiate steep discounts for paying by cash.
Yes, it works for routine stuff, but don't try to pay cash for abdominal surgery. You will get a very terrible, high price. After all, it's agree to our low price or die of appendicitis.
Not really. Its a matter of knowing where to find the place that can treat you.
For example, this surgery clinic will treat your appendicitis for less than the average patient's deductible + coinsurance. I'm including the flight + hotel stay in that estimate.
https://surgerycenterok.com/pricing/appendectomy-laparoscopi...
The problem is how you go about finding this information. Most ASC's and even independent doctors are extremely obtuse precisely to hide this huge liability from you. Hospitals will treat you like you are joking. Most hospital billing staff will prefer to do a cartwheel for you, instead of quoting you a price (insured or not). Or they will give you the super helpful range of 1,000 to...100k. Yes,I'm exaggerating to make the point. Heck, even if 1 out of 3 facilities do give you the estimate you seek, that's still 1 hour of time wasted for every 3 calls (avg call hold+time = 30mins) made.
For this reason, I recommend you go with a facility that is part of https://fmma.org/
Disclaimer: I don't have any relationship with OK Surgery or FMMA. Only a big fan, and also working with my startup to take out insurance out of regular healthcare choices.
Re: How much health insurers pay for almost everything is about to go public
#284Earlier quoted context omitted.
> most preventive care is already fully covered at no cost to the patient. Sigh. Someone has to pay and that someone is all of us. Health insurance plays on the fallacy most individuals have that they will somehow beat the system and receive more services than they pay for. So, it becomes a race to use as much as possible. Over prescribed meds for the sexy new illness you think you might have after seeing that commer…
I don't totally disagree with your broader point, but there's a decent case to be made that basic preventative care reduces costs by catching issues before they become expensive, chronic conditions (or worse.) The 'preventative care' that is 'free' is usually pretty basic: yearly physical, scheduled vaccines, and basic blood tests and cancer screenings at certain ages. I'd also question what health insurance plans st…
I doubt any preventative care can compete with a society that is approaching 50% obesity.
Re: How much health insurers pay for almost everything is about to go public
#285Earlier quoted context omitted.
Which price and who determines it?
Hospital is free to determine their prices, but they cannot give steep discounts to one channel of sales over other. They have to be consistent. Healthcare pricing should be based on cost+plus models for the hospitals rather than on value driven approach you see every else in any sales. We are not questioning their costs whatever they maybe, if the costs logically remain roughly same no matter how a particular patien…
But what's the cost? Complex hospital services have so many inputs that it's impossible to do cost accounting in a completely consistent way. Hospitals literally don't know what their costs are.
Re: How much health insurers pay for almost everything is about to go public
#286I work in healthcare.
Here is an exchange I had with a major hospital about standard surgery (one of those deemed "Shoppable services") earlier this year. This exchange was possible after I was able to get an email recipient, following a 30min conversation.
>>>> Hello!
I was told by the very helpful Ms. XXX, that you would be able to provide patient responsibility amount , related to CPT codes for XXX procedure. I am attaching front and back of my insurance card (Payor). The member DOB is MM/DD/YY
The specific 2 codes in question are : CPT 12345 CPT 01234
Can you please provide the total cost and patient resp. for the CPTs above?
___________________________________________________________
Response:
Good morning,
>>>>>The hospital does not process estimates for patients with insurance coverage. However, our web portal contains charges under the Hospital Price Transparency link. I have included the link in the subject line for easy access. [comment: This link was broken. After much browsing.. I was able to find an alternate route. The linked file turned out to be a JSON. I couldn't figure that one out] As far as out-pocket responsibility, your insurance company is the best source for that information; they will advise if you have any copay for the encounter.
_______
Read the 1st sentence of the reply again. My blood still boils from that...
Re: How much health insurers pay for almost everything is about to go public
#287For anyone looking to download the data, here are a few links: Empire Blue (Anthem): https://www.empireblue.com/machine-readable-file/search/ United Healthcare: https://transparency-in-coverage.uhc.com/ Aetna (Seems like the right page, but I don't see any download links — possibly because they haven't been posted yet): https://health1.aetna.com/app/public/#/one/insurerCode=AETNA... Search keywords: https://www.googl…
Blue Cross https://www.bcbsil.com/member/policy-forms/machine-readable-... So are there programs I can use to parse this? It looks like a json file with links to more gziped json files...
> It looks like a json file with links to more gziped json files
Yup! Should be pretty easy to whip up a parser, it's just JSON and HTTP, you could do it in shell if you cared to. The challenge is what are you parsing it _to_. That is to say, what's your data model. I'd choose that first, then worry about parsing.
Re: How much health insurers pay for almost everything is about to go public
#288For anyone looking to download the data, here are a few links: Empire Blue (Anthem): https://www.empireblue.com/machine-readable-file/search/ United Healthcare: https://transparency-in-coverage.uhc.com/ Aetna (Seems like the right page, but I don't see any download links — possibly because they haven't been posted yet): https://health1.aetna.com/app/public/#/one/insurerCode=AETNA... Search keywords: https://www.googl…
Thank you thank you thank you!
Here's Cigna: https://www.cigna.com/legal/compliance/machine-readable-file...
UCLA Health keeps theirs: https://uclahealth.s3-us-west-1.amazonaws.com/price-transpar...
But sadly, still can't find my insurance company's download links.
I can't wait to lose a weekend doing something with this data, it's a dream dataset and a perfect example of a very narrow type of project I love doing.
Is there a canonical list of the major insurance companies?
Re: How much health insurers pay for almost everything is about to go public
#289Earlier quoted context omitted.
Yes, it works for routine stuff, but don't try to pay cash for abdominal surgery. You will get a very terrible, high price. After all, it's agree to our low price or die of appendicitis.
Not really. Its a matter of knowing where to find the place that can treat you. For example, this surgery clinic will treat your appendicitis for less than the average patient's deductible + coinsurance. I'm including the flight + hotel stay in that estimate. https://surgerycenterok.com/pricing/appendectomy-laparoscopi... The problem is how you go about finding this information. Most ASC's and even independent doctor…
> this surgery clinic will treat your appendicitis for less than the average patient's deductible + coinsurance. I'm including the flight + hotel stay in that estimate.
Are there really people flying to avoid overpaying for an appendectomy?
Re: How much health insurers pay for almost everything is about to go public
#290Earlier quoted context omitted.
Insurers are incentivized to pay higher prices for claims. The Affordable Care Act enforced that insurance companies must have at least an 80% "medical loss ratio." Meaning that insurance companies must make at least 80% of their total spend on actually paying out medical claims. This law was put into place because insurance companies would spend huge amounts of money on advertising and giving execs bonuses, all paid…
>The Affordable Care Act introduced the newer perverse incentive of insurance companies tolerating higher prices. Because if you can only pay your execs bonuses based on 20% of your total spend, insurance companies can pay execs more if the underlying claims they're paying cost more. 20% of a $1,000 MRI isn't as juicy to your C levels as 20% of a $10,000 MRI. If this perverse incentive were true, then you would expec…
Having no idea what the real trend is, couldn't any other factors counteract the perverse effect, making both parent's and your observations true at the same time ?
For instance rhe sustained efforts that lead to ACA peobably didn't stop there, and more effort surely were made to reduce healthcare cost from there. If ACA could be passed in the first place, it wouldn't be surprising if other effective actions were also passed as well ?