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Compare, if you will, the US system to the French system. In the US, if I'm going to an in-network provider (any provider), I have a defined co-pay. I could g

Compare, if you will, the US system to the French system. In the US, if I'm going to an in-network provider (any provider), I have a defined co-pay. I could go to the Mayo clinic, a family physician, or even urgent care. In France, I pay full price for the visit at the time of the visit. My insurance provider then reimburses me at 80% of the "reasonable and customary" cost of the visit. (This is changing, with French insurance companies creating networks and selling additional coverage that works more like the US system)

refurb 10y ago
Interesting! I didn't know that. I wonder if the US system worked like that (pay up front, get reimbursed later) it would have any impact on costs? I'm thinking it might for two reasons: (1) it pushes patients and providers to lay out costs before starting treatment [in non-emergency cases] and (2) it allows patients and providers weigh the economic costs relative to the potential benefit. Trying asking what something costs in the US before getting treated and most of the time you'll get a blank look from your doctor's office. Or, they tell you "about $1000" and you get a bill later showing the cost was $7000. It's impossible to weigh the economic costs because you never know them until after the fact.
- hx87 10y ago
  Paying upfront is different from having transparent pricing though--even if you pay first and insurance reimburses you later, you still might not know the price until you get the bill. In the end the two systems differ only in liquidity requirements, and perhaps counterparty risk (if insurance stiffs you). Otherwise the costs are the same, and since liquidity requirements affect primarily low-income people and those with little to no savings, it would disproportionately affect them.
  - coredog64 10y ago
    The French system grants special cards to low-income people that allows them to charge their outpatient visits directly to insurance.
- pmiller2 10y ago
  That's how some out of network providers handle billing. Essentially it offloads the entire claims submission process to the patient.
maxerickson 10y ago
Fight it. In the US, networks aren't used to manage costs, they are used to deny coverage. (As far as I can tell, insurance companies make an actuarial decision about accepting charges from a given area, they aren't negotiating shit with providers)

refurb 10y ago

Interesting! I didn't know that. I wonder if the US system worked like that (pay up front, get reimbursed later) it would have any impact on costs? I'm thinking it might for two reasons: (1) it pushes patients and providers to lay out costs before starting treatment [in non-emergency cases] and (2) it allows patients and providers weigh the economic costs relative to the potential benefit. Trying asking what something costs in the US before getting treated and most of the time you'll get a blank look from your doctor's office. Or, they tell you "about $1000" and you get a bill later showing the cost was $7000. It's impossible to weigh the economic costs because you never know them until after the fact.

hx87 10y ago
Paying upfront is different from having transparent pricing though--even if you pay first and insurance reimburses you later, you still might not know the price until you get the bill. In the end the two systems differ only in liquidity requirements, and perhaps counterparty risk (if insurance stiffs you). Otherwise the costs are the same, and since liquidity requirements affect primarily low-income people and those with little to no savings, it would disproportionately affect them.
- coredog64 10y ago
  The French system grants special cards to low-income people that allows them to charge their outpatient visits directly to insurance.
pmiller2 10y ago
That's how some out of network providers handle billing. Essentially it offloads the entire claims submission process to the patient.

maxerickson 10y ago

Fight it. In the US, networks aren't used to manage costs, they are used to deny coverage. (As far as I can tell, insurance companies make an actuarial decision about accepting charges from a given area, they aren't negotiating shit with providers)