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Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

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Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#41

Post by toast0 »

maxerickson wrote: post #7
darkwizard42 wrote: post #4

Earlier quoted context omitted.

They will outright REFUSE to give you a quote...forget out-of-network, even IN network?! This is so astonishing cause you would assume they have NEGOTIATED the rate given its in network so there is little variability in what can be charged by the doctor and what can be thrust upon the customer. ex. if you charge $100K more than other in-network doctors, good luck, cause the insurance company is only paying the doctor…

They bill based on the procedures done and might not have that information until after the fact. I'm not saying it's a good way to do things. Opening a price list, it looks like one hospital charges ~$5000 for a knee replacement without major complications, and then the matching price for one with complications is $30000. So how do they quote that when the complications can be unpredictable? Which of course just says…

> They bill based on the procedures done and might not have that information until after the fact.

Quote a menu then. Something like:

If everything goes well, we'll do X, Y, and Z; which will cost $5million, plus an extra $200,000 for the Oxford comma.

Some potential complications are this and that and they cost even more, etc. All surgeries are risky, and you could require life saving interventions which will cost a stagering amount, and we won't be able to ask for consent.

The patient could say; well wait, I don't actually want an Oxford comma, please leave that out; and they could put that on the chart, and if it's added, it doesn't get billed.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#42

Post by Rickasaurus »

avgDev wrote: post #11

The US healthcare system is just a completely broken mess. When things go smooth, you are lucky! However, when you have a major procedure, life event or sickness things can get messy quick. We had a child 10 months ago, billing was screwed up by the hospital, then by insurance and we are still in process of getting it resolved. I have now spent at least 8 hours on the phone. I had a surgery, called insurance and veri…

Similar here. Had a baby 9 months ago, the doctor took the insurance, but it turned out later the hospital didn't. Bill was over 100K and it wasn't covered at all.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#43

Post by civilized »

maxerickson wrote: post #7
darkwizard42 wrote: post #4

Earlier quoted context omitted.

They will outright REFUSE to give you a quote...forget out-of-network, even IN network?! This is so astonishing cause you would assume they have NEGOTIATED the rate given its in network so there is little variability in what can be charged by the doctor and what can be thrust upon the customer. ex. if you charge $100K more than other in-network doctors, good luck, cause the insurance company is only paying the doctor…

They bill based on the procedures done and might not have that information until after the fact. I'm not saying it's a good way to do things. Opening a price list, it looks like one hospital charges ~$5000 for a knee replacement without major complications, and then the matching price for one with complications is $30000. So how do they quote that when the complications can be unpredictable? Which of course just says…

I don't buy that, because of the unpredictability of the worst case, we can't ever be told how much anything costs, no matter how routine.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#44

Post by Clubber »

axlee wrote: post #9

I thought "free markets" where supposed to facilitate fair value discovery?

Healthcare is an inelastic demand service. Also a free market requires an informed buyer. Lack of price transparency coupled with inelastic demand makes it highly resistant to traditional market forces. You've got other forces working on it like high barrier to entry to be a healthcare service provider, high upfront costs for equipment, very heavy (expensive) regulation, higher likelihood of legal costs, etc.

It's like food. If you're starving, you'll do or pay whatever you have to to get nutrients.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#45

Post by prepend »

maxerickson wrote: post #7
darkwizard42 wrote: post #4

Earlier quoted context omitted.

They will outright REFUSE to give you a quote...forget out-of-network, even IN network?! This is so astonishing cause you would assume they have NEGOTIATED the rate given its in network so there is little variability in what can be charged by the doctor and what can be thrust upon the customer. ex. if you charge $100K more than other in-network doctors, good luck, cause the insurance company is only paying the doctor…

They bill based on the procedures done and might not have that information until after the fact. I'm not saying it's a good way to do things. Opening a price list, it looks like one hospital charges ~$5000 for a knee replacement without major complications, and then the matching price for one with complications is $30000. So how do they quote that when the complications can be unpredictable? Which of course just says…

There are many industries that have this issue and deal with it in different ways.

I used to do consulting and fixed price estimates were common. Even when requirements were unclear. The way I mitigated this was with multiple clients.

Hospitals have lots of customers. They don’t have to perfectly estimate everything, they just have to be good on average.

Here’s a podcast from Econtalk with Dr Kieth Smith from Surgery Center of Oklahoma [0] where he explains how his hospital does it. Basically he estimate the cost for an average procedure and charge that, they are good at estimating and adjust each year. Sometimes extra stuff happens, sometimes less stuff happens. If the shit hits the fan during the procedure they have that rare event factored in.

It’s such an odd argument because they certainly could if they had to. But they don’t, so they don’t.

[0] http://www.econtalk.org/keith-smith-on-free-market-health-ca...

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#46

Post by ska »

bpodgursky wrote: post #34
quasirandom wrote: post #32

Earlier quoted context omitted.

\

I don't mean to blame you, but for the sake of anyone reading this -- you could absolutely have negotiated this down with the hospital by pleading financial hardship. I'm not trying to justify the system overall, but please don't take a $150k bill at face value, if you can't reasonably afford to pay it.

> if you can't reasonably afford to pay it.

It's true you can negotiate, but it's also true their bar for "reasonably afford to pay it" absolutely can include emptying your savings and other assets.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#47

Post by [deleted] »

kshacker wrote: post #14
avgDev wrote: post #11

The US healthcare system is just a completely broken mess. When things go smooth, you are lucky! However, when you have a major procedure, life event or sickness things can get messy quick. We had a child 10 months ago, billing was screwed up by the hospital, then by insurance and we are still in process of getting it resolved. I have now spent at least 8 hours on the phone. I had a surgery, called insurance and veri…

It is not a 'broken mess'. It is an 'engineered mess'. The difference is in intent.

[deleted]

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#48

Post by banana_giraffe »

avgDev wrote: post #11

The US healthcare system is just a completely broken mess. When things go smooth, you are lucky! However, when you have a major procedure, life event or sickness things can get messy quick. We had a child 10 months ago, billing was screwed up by the hospital, then by insurance and we are still in process of getting it resolved. I have now spent at least 8 hours on the phone. I had a surgery, called insurance and veri…

I have good insurance through a major company. My SO tripped, and hit their head on a curb on a busy road. I wasn't there, but by happenstance an EMT was there, witnessed the event, and came to offer aid. The EMT was concerned enough my SO ended up going to the hospital.

Several scans, and a few hours later, my SO was discharged.

I then got to spend something like 30 hours on the phone over the course of a couple of months fighting a bill for around $100k because of a typo during the admissions to the hospital.

That's bad enough on the face of it, but there were real Kafkaesque moments. Like where I was explaining to the insurance company that this was not an automobile incident just because there were cars nearby, not once, not twice, but five times, once with a form that asked for pictures of the intersection and made me describe why cars would be stopped at a red light.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#49

Post by Spivak »

civilized wrote: post #43
maxerickson wrote: post #7

Earlier quoted context omitted.

They bill based on the procedures done and might not have that information until after the fact. I'm not saying it's a good way to do things. Opening a price list, it looks like one hospital charges ~$5000 for a knee replacement without major complications, and then the matching price for one with complications is $30000. So how do they quote that when the complications can be unpredictable? Which of course just says…

I don't buy that, because of the unpredictability of the worst case, we can't ever be told how much anything costs, no matter how routine.

Because people will be mad if their bill is significantly north of what they were quoted.

And also because providers have genuinely zero idea what insurance will pay for and insurance has zero idea what a provider is going to bill for. You can get basically exact costs for specific codes but good luck assuming they’ll bill it that way.

Re: Hospitals lift curtain on prices, reveals giant swings for hips, knees and more

#50

Post by mindslight »

wdn wrote: post #2

Only in US that we don’t know the price of the health service we are redeeming. When I go get my car fix and I would go around to get an estimate for multiple body shop even if it is under insurance. But when it come to health care, you ask them for a cash price, they said they don’t know.

I feel like 80% of the healthcare logjam would be fixed if providers were required to 1. charge uniform prices for all payers and 2. present patients with written estimates based on said price schedule ahead of any non-emergency services, thus forming an actual contract.

Note that mechanics don't particularly know what they're going to have to do to any given car before they really get into working on it. Yet the market functions perfectly fine with estimates, agreements on hourly rates, phone calls for decisions on surprise situations, etc.

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