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

healthcaredive.com

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

#71

Post by bazooka_penguin »

m0ngr31 wrote: post #39
Someone1234 wrote: post #10

Local hospital released this as an Excel spreadsheet (Chargemaster). They have a column called "Uninsured cash price." These prices are And, no, I don't think this was by accident as they have updated this Excel spreadsheet several times and only that one column is always set to 0 size.

My local hospital offers a cash discount of nearly 50% if you pay at time of service.

That sounds pretty unreasonable. Most people can barely stay on top of payments with a payment plan, let alone paying everything upfront

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

#72

Post by peterangular »

mabub24 wrote: post #59
peterangular wrote: post #35

Earlier quoted context omitted.

And this can really cause issues for people who are insured because 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. That is until you call the hospital and find out there's all sorts of "sliding" prices etc... I had a procedure billed for one of these drastically larger "insured" codes which got denied based on t…

> Best insurance here is "don't get sick" Recent New Yorker article looking at the "Costa Rica model"[0] raised this point as well. America, by contrast to Costa Rica, has a very weak public health sector and infrastructure, and this leads to a real weakness when focusing on preventable illnesses and issues. [0]: https://www.newyorker.com/magazine/2021/08/30/costa-ricans-l...

Yeah I read that too - just cherry picking here:

> All adults have tests and follow-up visits to prevent and treat everything from iron deficiency to H.I.V. It’s all free. If people don’t show up for their appointments, she makes sure their team finds out why and figures out what can be done.

It's common sense why they have better results and outcomes than we do here... Our system is optimized for capitalistic profit. I've got insanely good insurance and I still have no idea how screwed I am if I go to the doctor or especially a hospital. Although I've only had one major billing snafu years back I have real anxiety about going to the doctor here.

And hell, even if I go my PCP is going to be stuck in an "all or nothing" mentality where it's either OTC or getting in their own conflict with my insurer... ie: "If I can't justify this test with your insurer..."

---

Costa Rica's model is better than America's. The reason for this is because it's not optimized for profit, it's designed from the ground up to optimize for patient outcome.

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

#73

Post by mullingitover »

Someone1234 wrote: post #10

Local hospital released this as an Excel spreadsheet (Chargemaster). They have a column called "Uninsured cash price." These prices are And, no, I don't think this was by accident as they have updated this Excel spreadsheet several times and only that one column is always set to 0 size.

> These prices are There are some clever insurance companies whose entire model is "tell the hospital you don't have insurance, get the cash price, pay it with this debit card we give you."

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

#74

Post by weaksauce »

EvanAnderson wrote: post #61
peterangular wrote: post #35

Earlier quoted context omitted.

And this can really cause issues for people who are insured because 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. That is until you call the hospital and find out there's all sorts of "sliding" prices etc... I had a procedure billed for one of these drastically larger "insured" codes which got denied based on t…

> 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…

> 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.

because our senators and congress critters are all on the buy for really cheap... it's not even hidden. something like medicare for all is the thing that makes sense but has a hard time finding traction because the people that it will negatively impact have the means to buy those politicians out.

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

#75

Post by lotsofpulp »

jjoonathan wrote: post #45
kindle-dev wrote: post #34

Earlier quoted context omitted.

But someone told me insurance companies are bad and are stiffing those poor, struggling doctors and hospitals.

Every head of the insurance/drug/provider dog points at the other two heads when somebody accuses it of being the problem.

Voters not wanting to pay for comprehensive care for everyone is a 4th head. The current system of healthcare is great for allocating different amounts of healthcare to different classes of people, so that it is great for 20 to 30% of people, okay for 20%, and not good for 50%, and that is why it persists.

There is no reason Medicare should be restricted to those over 65, or why Medicaid is implemented differently (and reimburses providers more poorly than Medicare). Or even Tricare. We have at least 3 different taxpayer funded healthcare programs specifically so not everyone can get access to equal care, but so that various classes of people can get healthcare proportional to their political power (which usually scale with money, but also votes in the case of old people).

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

#76

Post by derwiki »

mullingitover wrote: post #73
Someone1234 wrote: post #10

Local hospital released this as an Excel spreadsheet (Chargemaster). They have a column called "Uninsured cash price." These prices are And, no, I don't think this was by accident as they have updated this Excel spreadsheet several times and only that one column is always set to 0 size.

> These prices are There are some clever insurance companies whose entire model is "tell the hospital you don't have insurance, get the cash price, pay it with this debit card we give you."

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

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

#77

Post by bazooka_penguin »

kindle-dev wrote: post #34
Someone1234 wrote: post #28

Earlier quoted context omitted.

They make less that way. If they know you're insured they won't allow you to pay the cash price, only the much higher negotiated price.

But someone told me insurance companies are bad and are stiffing those poor, struggling doctors and hospitals.

Everyone says that. But it's pretty clear that healthcare services themselves just cost an obscene amount of money no matter who's paying.

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

#78

Post by topspin »

sxg wrote: post #64
vmception wrote: post #55

Great, now mandate that it is viewable via API Can even use the healthcare industry standard for EHR which is JSON and RESTful

Have JSON and REST been meaningfully adopted in healthcare? I thought most things still used the god-awful HL7 with hopes of migrating away.

HL7 FHIR is a counterpoint. A comprehensive, well specified REST API based on JSON.

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

#79

Post by elliekelly »

EvanAnderson wrote: post #61
peterangular wrote: post #35

Earlier quoted context omitted.

And this can really cause issues for people who are insured because 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. That is until you call the hospital and find out there's all sorts of "sliding" prices etc... I had a procedure billed for one of these drastically larger "insured" codes which got denied based on t…

> 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…

> It feels like an agreement, to me, when the practice takes on a patient knowing who their insurer is. I feel like the reimbursement rate that insurer has negotiated, regardless of whether the insurer ultimately covers any procedures, should act as a cap for the fees charged to the patient. It feels a lot like negotiating a contract, except that one party gets to unilaterally change the amount of consideration. How does that fly?

You aren't exactly talking about "balance billing"[1] but you'll be pleased to know the No Surprises Act[2] tries to address this situation with required cost (estimate) disclosures in advance of a procedure and capping the out-of-network amount that can be charged in the event of an emergency where there can't advanced disclosure. The HHS recently promulgated regulations[3] under the Act but the compliance date is January 2022. For some reason I think there is at least one (maybe two?) other proposed rules in the works but I can't recall what they address and I can't seem to find them.

Edit: The other proposed rule is relating to air ambulance services[4]

[1]https://en.wikipedia.org/wiki/Balance_billing

[2]https://www.congress.gov/bill/116th-congress/house-bill/3630...

[3]https://www.hhs.gov/about/news/2021/07/01/hhs-announces-rule...

[4]https://www.healthaffairs.org/do/10.1377/hblog20210913.57633...

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

#80

Post by jjoonathan »

EvanAnderson wrote: post #61
peterangular wrote: post #35

Earlier quoted context omitted.

And this can really cause issues for people who are insured because 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. That is until you call the hospital and find out there's all sorts of "sliding" prices etc... I had a procedure billed for one of these drastically larger "insured" codes which got denied based on t…

> 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…

Insurance has the worst moral hazard: the winning strategy is to sell a product that pretends to cover your customers but actually doesn't. Your customers give you money for nothing and they will only realize it once in a blue moon. You can probably buy off the few who are capable of causing actual blowback, and if that doesn't work just rebrand.

Until everyone becomes a contract lawyer capable of devoting weeks to insurance shopping every 6 months, the only good insurance market is a heavily regulated one, even though heavy regulation comes with its own gigantic bag of worms.

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