Everyone assumed there would be malicious compliance here but it's definitely eye opening just how malicious they made it. Speaks volumes for the perceived risk releasing this data, IMO. Still waiting to hear about someone using this data to negotiate down a hospital bill, seems like it's just insurance companies that can weaponize this data for better rates.
Imagine a world where one entity received all the peoples medical bills and was incentived to negotiate for the lowest possible rate from each provider. Imagine the savings alone from reducing a massively overly bureaucratic and complicated system down to just one entity negotiating and paying the health service providers. Just imagine in that world this article would have never needed to have been written.
So not only shouldn’t healthcare be a market good (moral argument), but healthcare profiteers are actively distorting the market and are not taking seriously efforts to provide a modicum of information to participants in this so-called market.
Whoever is doing this due diligence is truly helping millions and millions of people. Good luck. There are very few among us here that could pretend the same, and I'm not one of them.
If anyone is interested, the arm and a leg podcast covers how people leverage transparency data and other strategies to fight hospital bills. Most recently it was covered that so few people take hospitals to small claims court over their billing practices that hospitals can afford exorbitant teams of lawyers to establish more case law that their behavior is legal.<p><a href="https://armandalegshow.com/" rel="nofollow">https://armandalegshow.com/</a>
There are two problems here:
1) Hanlon’s razor
2) The author doesn’t understand health insurance data.<p>I’m not trying to excuse the other bad behavior, but within the data itself, he’s experiencing a combination of health insurers’ incompetence, the kludged up data models they’ve had to build to represent the output of the multiple generations of claims processing systems and other administrative processes, and the general mess that provider identifiers are. Every payor calculates values differently. Every payor uses different codes (beyond the standard CMS and CPTs). Every payor has different arrangements that are difficult to represent in standard schema, eg capitation in Florida, delegation in California, or the oddness that are Taft-Hartley plan.<p>There is a link in the article to a discussion with CMS. Another participant in the discussion works for IQVIA, a long-time claims data aggregator (and CRO and a bunch of other things), and clearly understands what’s going on. It would be extremely difficult to do this work at all without significant experience working with multiple payors’ data, which requires time and access, and pays well once you do have that specialized experience.
This could have been <i>much much</i> easier if they just required the medical equivalent of certificate transparency. Every insurance company is required to post publicly every single claim they receive, the full information of the provider(s), the name/code of the plan, the billing codes, whether it was approved or denied, how much the insurance was billed, and how much insurance actually paid (where paid doesn't mean discount, it means the literal dollars that left the insurance company's bank account), and the "patient responsibility" along with where the patient was with regards to their deductible and oopm. Every medical provider is required to do the same every time they create a bill.<p>Fine, "you don't know" how much things will cost. We can figure it out for you. No thoughts, head empty, just post and sign every bill you generate as it comes.
Seems like really important work that gains more value as more people hear about it. I hope that what you're doing will lead to better data and greater transparency.
This paragraph is missing the link at the end:<p>At DoltHub, where we build databases like codebases, we're running a data bounty, collecting rates for popular medical procedures for all US hospitals. Then we'll release the data under CC. Find out more here.
If you want to be a part of this battle while also not being a part of the "middleman" (e.g. price transparency venders), come join us at Yuzu Health. We are hiring for a senior engineer to help us build a modern health plan tailored to the needs of startups and their employees.<p><a href="https://yuzu.health/careers" rel="nofollow">https://yuzu.health/careers</a>
Name any other industry where neither transparent pricing exists nor government socialization exists.<p>The health insurance industry is quietly and uniquely one of the darkest markets in the world.
Just to throw out a possible next step to put pressure on the payors: consider reaching out to the CMS technology ombudsman to ask if you can CC him on a round of follow-up inquiry emails.<p>His nominal role is to assist with Medicare-related matters, but given that the ostensible goal here is to compare rates (and most payors define rates as a percent of Medicare), I think the request wouldn’t be too much of a stretch.<p>Similarly, might be possible to get some congressional offices to lend their weight. Happy to personally lend a hand with the outreach if there’s interest.
We should compel these companies to comply.<p>There should be fine a 1% of annual revenue for every day these companies are in non compliance with prison for the ceo if they are non compliant for over thirty days.
The reasonable solution that people in the US arrive at is to avoid going to physicians at all costs.
I recently found out that a simple blood test at the physicians office costs ~$600 (with insurance), along with all of the annoyance of dealing with setting up the appointments waiting for several months, waiting on insurance, the trouble and time off work to get there - all for a material that takes a few minutes to extract and few moments to run.<p>Due to the cost I was curious, and found out that I could <i>literally</i> purchase all of the FDA-approved* lab equipment <i>for my house</i> and run tests on myself for <i>less</i> cost than it was to go to a physicians office. The physician (i.e. expertise) is irrelevant here (almost always are) as the most input I've ever seen provided by one amounts to 'take an Aleve if you're hurting'.<p>Home labs are likely where the future is headed, and it's the fault of the medical industry being so utterly useless.
I've been through most medschool (neurology-focused) courses, and most physicians or any medical professional uses essentially zero of that knowledge.
The big problem with health insurance is that the people who buy it think that they are buying a health subscription.<p>The second big problem is that they are being forced to buy it.<p>So you have something that isn't what people want, but that they are legally obligated to "purchase"... Is it any wonder most people are dissatisfied with it?
Monopsonies require a single buyer with a stick to work. Economics teaches that to us since inception.<p>I am not sure why this is even a divisive topic. Sure discuss how a doctor decorates their office. Who cares. When you are dying or are in pain, nothing but treatment at any cost matters.
I've asked the author for a copy of a correct csv or xlsx file, I'll share it if the author responds.<p><a href="https://imgur.com/a/bTmfDEU" rel="nofollow">https://imgur.com/a/bTmfDEU</a>