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The prices hospitals negotiate with private insurers for patient services

164 点作者 rafaelc超过 3 年前

21 条评论

smartbit超过 3 年前
<a href="https:&#x2F;&#x2F;archive.is&#x2F;6mgnc" rel="nofollow">https:&#x2F;&#x2F;archive.is&#x2F;6mgnc</a>
recursivedoubts超过 3 年前
Daily reminder that the US spends vastly more, per capita, in <i>government</i> heath expenditures[1], than any other country.<p>We pay for socialized healthcare, and then some, it&#x27;s just that most of us don&#x27;t get it.<p>I view the problem as impossible to solve until there is a collapse.<p>[1] <a href="https:&#x2F;&#x2F;en.wikipedia.org&#x2F;wiki&#x2F;List_of_countries_by_total_health_expenditure_per_capita#&#x2F;media&#x2F;File:OECD_health_expenditure_per_capita_by_country.svg" rel="nofollow">https:&#x2F;&#x2F;en.wikipedia.org&#x2F;wiki&#x2F;List_of_countries_by_total_hea...</a>
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zaroth超过 3 年前
I’m convinced that the single best way to improve the current private-insurance based system is that it should be illegal to charge two different patients a different price for the same test, drug, or procedure given at the same hospital.<p>I think implementing such a policy could be trivial for many things like labs and drugs and many procedures, and admittedly tricky to implement for complex &#x2F; one-off procedures, but that shouldn’t stop us from trying.<p>Price transparency is important but eliminating price discrimination is I think the key way to shut down so much of the bloat and corruption currently in the system.<p>The last step would be to make it illegal to do any kind of rebating where patients are billed more than insurance ultimately pays. Charging less for one procedure taken by Patient A in exchange for charging more for another procedure taken by Patient B similarly should just be banned.<p>You end up with a system where the insurance companies and benefits managers have a lot less that they are able to do. Perhaps they would claim they are “hamstrung” but that’s exactly what they should be in this regard.
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cascom超过 3 年前
I actually had this experience for an MRI, I called billing at the hospital at which my doctor was affiliated&#x2F;recommended I take my MRI - I was floored to learn that if I paid cash, it was ~$1k and if I ran it through insurance it was $1.5k<p>I actually ended up running it through insurance as I wanted the amount to be applied to my deductible…<p>When I asked the (very nice) woman in billing how this made any sense - she told me (paraphrasing) that it’s basically a super complex optimization problem where several thousand products&#x2F;services are being simultaneously negotiated, such that the hospital can maximize its gross margin, and the insurer can minimize its payments under insurance.
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coldcode超过 3 年前
US healthcare is a giant cash making scam, where patient health and open pricing are unimportant. If the Federal government actually cared to force the issue, we might find a preference for a national unified system, in which of course the insurers and healthcare conglomerates would lose their profit. So no doubt they spend a fortune ensuring that no matter what rules appear for political reasons, they are not really enforced, and thus don&#x27;t matter.
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cushychicken超过 3 年前
This story is revealing an important point about the health care system, but it only tells half the story. The other part of how broken the system is, and why pricing varies so wildly, is due to bad faith negotiations on the insurers&#x27; side.<p>Many insurers negotiate with a hospital by saying: &quot;We are only going to pay 25% any bill you send us.&quot; If the hospital doesn&#x27;t play ball, the insurer kicks them out of their network, and effectively denies the hospital customers. The hospitals that can&#x27;t afford to lose those customers is incentivized to quadruple their prices just to get the insurer to cover their costs.<p>However, if a second insurer comes along and negotiates the same way, but says they&#x27;ll only pay 50% of the hospital&#x27;s stated cost, the hospital makes a tidy profit on the insurer&#x27;s dime. (Remember: quoted price = 4 * cost. If insurer pays (quoted price * 0.5), then the hospital makes a 100% profit on that insurance transaction.)<p>What&#x27;s been created is effectively an endless positive feedback loop to negotiate prices upwards, fueled by rampant information asymmetry and profit motive.<p>We <i>desperately</i> need some kind of government intervention against this in the US. I&#x27;m convinced that single payer would fix this in a fucking jiffy.
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avnigo超过 3 年前
&quot;These prices&quot; being price comparisons between insurers, and &quot;here&#x27;s why&quot; because prices are sometimes much lower with other plans, or no insurance at all.<p>Aside from the clickbait title, this is interesting information.
KoftaBob超过 3 年前
I came across Turquoise Health (<a href="https:&#x2F;&#x2F;www.turquoise.health&#x2F;" rel="nofollow">https:&#x2F;&#x2F;www.turquoise.health&#x2F;</a>) recently, they&#x27;re one of the early players that have built a search tool to look up the prices hospitals have negotiated with different insurance companies for procedures.<p>Many people&#x27;s first thought will be &quot;how does this help patients if they&#x27;re rarely paying the cash price, their insurance is the one paying&quot;. The effects (in theory) will be more indirect than that.<p>Now that insurance companies can see what prices a hospital has negotiated with other insurances, they&#x27;ll have hard, transparent data to show that those other insurance providers are getting a better deal, and can negotiate prices down.<p>This alone won&#x27;t be the magical solution to healthcare costs to patients, but this level of price transparency will no doubt have a big impact. It&#x27;s a great first step.
4e530344963049超过 3 年前
<a href="https:&#x2F;&#x2F;trimread.org&#x2F;articles&#x2F;288" rel="nofollow">https:&#x2F;&#x2F;trimread.org&#x2F;articles&#x2F;288</a>
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dls2016超过 3 年前
I don&#x27;t have anything to add, but I recently received a $701 bill for each my children&#x27;s covid tests ($1402 total). We took them to their pediatrician, part of a hospital. Insurance covered $0.<p>If the insurance can decide not to pay, guess who else has that option?!
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stefan_超过 3 年前
That guy actually paid the price of a car for a rabies shot. It was probably cheaper to take a vacation south and pretend to be bitten again.
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ttamk超过 3 年前
FYI, there is a similar effort going on that requires all health plans to host machine readable files containing negotiated rates by provider and procedure code by 2022-01-01: <a href="https:&#x2F;&#x2F;github.com&#x2F;CMSgov&#x2F;price-transparency-guide" rel="nofollow">https:&#x2F;&#x2F;github.com&#x2F;CMSgov&#x2F;price-transparency-guide</a>
coffeecat超过 3 年前
I think a healthcare system based on the following model could work great:<p>* Federal government provides public health insurance to all taxpayers. * Every healthcare provider submits a list of tests&#x2F;procedures they offer, and the price that they charge for each test&#x2F;procedure. The prices are public data. Providers can charge whatever price they want. * When you need a test&#x2F;procedure, you use a website provided by the public insurance system which looks up all providers within a reasonable distance (search radius would be algorithmically determined so that at least 3-5 providers are included in the comparison). The public insurance program covers the price of the cheapest option. Patients are free to choose any provider they want, but if they don&#x27;t choose the cheapest, they need to pay the difference out of pocket.
BrandoElFollito超过 3 年前
When going to the US from France, I always take an insurance because even a doctor visit is going to be bat crazy expensive.<p>When an American comes to France and sees a doctor, they will pay 25€.<p>I have the feeling we are being royally screwed. By ourselves.<p>We should have monster prices for people who are not part of the EU, with the understanding that tourists should come insured.<p>(One should always take an insurance because a heart operation is going to be costly in France as well, but my point is that for minor stuff there is z huge imbalance)
throwaway189q超过 3 年前
It is not the Doctors or nurses salaries, but the diagnostics costs are astronomical.<p>People are regularly billed for hundreds or thousands of dollars for something as simple as XRays. Other procedures are also almost 5-10 higher than what one would expect to pay anywhere else in developed world.<p>The emergency room charges are just out of the world. And extraordinarily large portion of the cost is not personnel costs.
throwawaygh超过 3 年前
<i>&gt; The agency plans to increase the fines next year to as much as $2 million annually for large hospitals, it announced in July.</i><p>Mass General&#x27;s annual revenue was 13.4 billion USD.<p>They&#x27;ll just not pay the fines. It&#x27;s literally <i>not even a rounding error</i> in their annual revenue!<p>The US healthcare system needs to be rebuilt from the ground up.
Ozzie_osman超过 3 年前
&gt; In many cases, insured patients are getting prices that are higher than they would if they pretended to have no coverage at all.<p>This is basically a racket
mensetmanusman超过 3 年前
I wonder how disruptive it would be if we let other countries set up health care centers in the US to compete.
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nickjj超过 3 年前
It would be neat if there was <a href="https:&#x2F;&#x2F;www.levels.fyi&#x2F;" rel="nofollow">https:&#x2F;&#x2F;www.levels.fyi&#x2F;</a> (anonymously submitted developer salaries) for anonymous hospital &#x2F; medical bills, complete with line items.
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nikkinana超过 3 年前
Thanks Trump for passing that executive order, now we get to see their prices.
ransom1538超过 3 年前
1) End all medical law suites. You enter care at your own risk.<p>2) Create more doctors. Stop the boards from restricting the total counts of doctors created. Flood the system full of doctors and nurses.<p>3) All practices and procedure costs should be made public and upfront.<p>4) End all drug patents. Flood university researchers with government money instead.<p>5) Expand medicare to insure everyone in the united states.
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