4 ms·

Because the cost is unknown until treatment is over. Also, funny comparison, try to make it with software engineering.

thephyber 9y ago
> Because the cost is unknown until treatment is over. If you held a mechanic to the same standard, they "wouldn't know the cost" either. Maybe the doctor's office doesn't know your out-of-pocket cost, but they generally know (within a reasonable rage) how much they will bill the insurance company for. Perhaps an underlying problem is that a health insurance-medical pratcice contract prevents the medical practice from revealing the negotiated+contracted costs. In the case that the nurse/doctor/surgeon decides to change the prognosis/prescription during the visit, there are provisions for that type of action with auto mechanics, too.
- coldcode 9y ago
  Medical insurance reimbursement is based on correctly filling out a coded form (there are like 10,000 or more codes covering every type of service), waiting for some human at the insurance company to agree and provide payment, or often a protected argument about coding and necessity. Until a month or more later the doctor has no idea what the insurance will actually provide. The final cost will be determined by how many services are performed, how many interactions with various people occurred, how many supplies or drugs were used, tests run or ordered, etc. When you walk in and say I feel bad, it could be nothing or you are dying. Guessing what is wrong before they even see you is impossible. Try estimating software development costs with no idea what is to be written. With software at least no one will die, and probably no one will sue if you are wrong.
- conanbatt 9y ago
  > Maybe the doctor's office doesn't know your out-of-pocket cost, but they generally know (within a reasonable rage) how much they will bill the insurance company for We don't know either. In fact you have to build infrastructure just to know estimates, which will be cleared months later, and a result might be less or more price. It is not a transparent system for the provider either, specially when you are a small one. > In the case that the nurse/doctor/surgeon decides to change the prognosis/prescription during the visit, there are provisions for that type of action with auto mechanics, too. I honestly think the problem is fee-as-service, where you have to make very complex calculations based on how each thing is claimed. It would be very different if work was provided per-hour basis, or even per-result (complex, but market is leaning towards that right now). Figure a software engineer consultant charging differently per language, platform, stack version, LOC, cost of materials etc each time he works an hour. IF you are an engineer try to picture how that works. 1- You diagnose a problem to solve 2- You look into a list of 70k items to look for the corresponding code to that problem (C10.023 Turn iterative code to recursion) 3- You now write what you are going to do to solve it 4- Now you have to pick a billing code (CPT code 94102 -> Iterative on GC language to functional programming language ). You estimate 94102 will pay 50$, but are tempted to put 94103 which will pay 75$, from Iteractive non GC, because actually your custom language settings have GC turned off, but are unsure if the insurance company will believe or care 5- The client asks you how much will charge, considering he is personally liable for 20% of it because the actual client doesn't re-imburse everything. That was a single visit. Doctors get 12-16 a day.
- deleted 9y ago
  [deleted]
derekp7 9y ago
Car mechanics have "book hours" for each task. It may take them less time, or more, but they charge what is in the book. For example, changing a headlight is 1/4 hour, at $120.00 an hour, so they charge $30.00 plus parts. What I'd like to see for medical services, is something like an apendepticamy takes 1 hour to perform, plus 4 hours of prep, and 2 hours follow up spread over several weeks. The procedure uses one primary surgeon, one assistant, 2 nurses, an and anesthesiologist, each charging x per hour (depending on role / specialty). The hospital charges y per hour for the room, z for the supplies. All of this is known ahead of time. Yes, there can be complications. Just like a mechanic can run across rusted on bolts that take longer to remove. But going by book time for everyone works out in the averages. Heck, both dentists and optometrists work in this fashion for most of their services. Why can't the rest of the medical world get it together?
- jjeaff 9y ago
  Have you never looked at an itemized medical bill? This is exactly how all medical practitioners in the US that accept insurance do things. Every procedure, every Tylenol, every operating kit has a code and a price and that is all itemized and billed. Try calling up your mechanic and asking for a quote. Tell them your car is not working right and you don't know what's wrong, but you want a quote before bringing the car in. Now, if you call a medical practitioners and tell them exactly what tests or procedures you want, they can probably look that up for you.

> Because the cost is unknown until treatment is over. If you held a mechanic to the same standard, they "wouldn't know the cost" either. Maybe the doctor's office doesn't know your out-of-pocket cost, but they generally know (within a reasonable rage) how much they will bill the insurance company for. Perhaps an underlying problem is that a health insurance-medical pratcice contract prevents the medical practice from revealing the negotiated+contracted costs. In the case that the nurse/doctor/surgeon decides to change the prognosis/prescription during the visit, there are provisions for that type of action with auto mechanics, too.

coldcode 9y ago
Medical insurance reimbursement is based on correctly filling out a coded form (there are like 10,000 or more codes covering every type of service), waiting for some human at the insurance company to agree and provide payment, or often a protected argument about coding and necessity. Until a month or more later the doctor has no idea what the insurance will actually provide. The final cost will be determined by how many services are performed, how many interactions with various people occurred, how many supplies or drugs were used, tests run or ordered, etc. When you walk in and say I feel bad, it could be nothing or you are dying. Guessing what is wrong before they even see you is impossible. Try estimating software development costs with no idea what is to be written. With software at least no one will die, and probably no one will sue if you are wrong.
conanbatt 9y ago
> Maybe the doctor's office doesn't know your out-of-pocket cost, but they generally know (within a reasonable rage) how much they will bill the insurance company for We don't know either. In fact you have to build infrastructure just to know estimates, which will be cleared months later, and a result might be less or more price. It is not a transparent system for the provider either, specially when you are a small one. > In the case that the nurse/doctor/surgeon decides to change the prognosis/prescription during the visit, there are provisions for that type of action with auto mechanics, too. I honestly think the problem is fee-as-service, where you have to make very complex calculations based on how each thing is claimed. It would be very different if work was provided per-hour basis, or even per-result (complex, but market is leaning towards that right now). Figure a software engineer consultant charging differently per language, platform, stack version, LOC, cost of materials etc each time he works an hour. IF you are an engineer try to picture how that works. 1- You diagnose a problem to solve 2- You look into a list of 70k items to look for the corresponding code to that problem (C10.023 Turn iterative code to recursion) 3- You now write what you are going to do to solve it 4- Now you have to pick a billing code (CPT code 94102 -> Iterative on GC language to functional programming language ). You estimate 94102 will pay 50$, but are tempted to put 94103 which will pay 75$, from Iteractive non GC, because actually your custom language settings have GC turned off, but are unsure if the insurance company will believe or care 5- The client asks you how much will charge, considering he is personally liable for 20% of it because the actual client doesn't re-imburse everything. That was a single visit. Doctors get 12-16 a day.
deleted 9y ago
[deleted]

derekp7 9y ago

Car mechanics have "book hours" for each task. It may take them less time, or more, but they charge what is in the book. For example, changing a headlight is 1/4 hour, at $120.00 an hour, so they charge $30.00 plus parts. What I'd like to see for medical services, is something like an apendepticamy takes 1 hour to perform, plus 4 hours of prep, and 2 hours follow up spread over several weeks. The procedure uses one primary surgeon, one assistant, 2 nurses, an and anesthesiologist, each charging x per hour (depending on role / specialty). The hospital charges y per hour for the room, z for the supplies. All of this is known ahead of time. Yes, there can be complications. Just like a mechanic can run across rusted on bolts that take longer to remove. But going by book time for everyone works out in the averages. Heck, both dentists and optometrists work in this fashion for most of their services. Why can't the rest of the medical world get it together?

jjeaff 9y ago
Have you never looked at an itemized medical bill? This is exactly how all medical practitioners in the US that accept insurance do things. Every procedure, every Tylenol, every operating kit has a code and a price and that is all itemized and billed. Try calling up your mechanic and asking for a quote. Tell them your car is not working right and you don't know what's wrong, but you want a quote before bringing the car in. Now, if you call a medical practitioners and tell them exactly what tests or procedures you want, they can probably look that up for you.