3 ms·

It's a decent start, but it doesn't really do a whole lot for "transparency", it simply caps the charges against some completely unknown and somewhat arbitrary

It's a decent start, but it doesn't really do a whole lot for "transparency", it simply caps the charges against some completely unknown and somewhat arbitrary number.

djrogers 8y ago
The important point for patients is that those charges - capped or not - would no longer be directly billed; instead the insurance companies would be responsible for paying them.
MBCook 8y ago
Hopefully the insurance companies would demand some transparency. At least when it comes to ERs transparency isn’t exactly useful. Most people don’t have time to go shopping around between them, all transparency does this let you know you’re being billed $1700 for a Band-Aid instead of billing code B736.21. This clearly isn’t a fix to the problems of the healthcare industry, but it certainly sounds like a nice step up. While I understand the logistics behind it, the idea that you can go to a place, pay your bill, then have eight different people bill you for the same service just feels like an absolute scam. Yes, one was the doctor, one was the lab, one was the hospital etc. and they may work for different companies and even in different buildings it’s just that they all HAPPENED to be in that one building that one day if that one time. But you don’t go to a restaurant and get separate bills from the establishment and the waiter and the cook and the group which buys ingredients. “We couldn’t have told you how much that Caesar salad would have cost, it depends on complex negotiations with your dietitian. Had it been at least 30 days since your last consumption of Californian arugula?”
- subhobroto 8y ago
  > At least when it comes to ERs transparency isn’t exactly useful. Most people don’t have time to go shopping around between them, all transparency does this let you know you’re being billed $1700 for a Band-Aid instead of billing code B736.21. Exactly! I link to an answer I wrote about this here: https://news.ycombinator.com/item?id=18108870 https://news.ycombinator.com/item?id=18108870 Direct link: https://www.quora.com/Would-a-completely-free-market-healthcare-system-with-zero-government-involvement-and-no-subsidies-for-anyone-work-better-in-the-long-run https://www.quora.com/Would-a-completely-free-market-healthc...
- nradov 8y ago
  Insurance companies do have negotiated prices with all their network providers for all applicable billing codes. And insurers do often provide those numbers to their plan members, at least partially. The trouble is that you can't always know in advance which billing code a provider will actually submit on the claim, and some providers are out of network without negotiated prices.
  - hakfoo 8y ago
    >The trouble is that you can't always know in advance which billing code a provider will actually submit on the claim, That seems like the billing system itself is conceptually faulty. Like a supermarket where the same gallon of milk costs different prices depending on which shelf you took it off of.
    - nradov 8y ago
      For a given customer, the "gallon of milk" costs the same regardless of which shelf it comes from. But if you come in to buy milk and end up buying champagne instead the price will be different. Billing amounts are calculated based on specific unique procedure and modifier codes. The coding is typically done by trained coders using the doctor's notes as a reference, and the coders select the most expensive codes that they can legally justify. Many doctors aren't even aware of their billing rates for various procedures. In some cases the doctor won't know which specific procedures will be needed until she gets into it and sees what's going on, at which point it's too late for price estimates. Payers (insurers) are trying to fix the billing system by moving away from the fee-for-service model and toward value-based care (payment for meeting care quality goals) or various forms of capitation (flat payment per patient per year regardless of which procedures are needed).
Nasrudith 8y ago
It is essentially a "don't be a complete dick" statistical cap. Whenever you hear somebody complaining about excessive regulations remember all of the other cases that resulted against past antisocial behavior like that.

It's a decent start, but it doesn't really do a whole lot for "transparency", it simply caps the charges against some completely unknown and somewhat arbitrary number.

djrogers 8y ago

The important point for patients is that those charges - capped or not - would no longer be directly billed; instead the insurance companies would be responsible for paying them.

MBCook 8y ago

Hopefully the insurance companies would demand some transparency. At least when it comes to ERs transparency isn’t exactly useful. Most people don’t have time to go shopping around between them, all transparency does this let you know you’re being billed $1700 for a Band-Aid instead of billing code B736.21. This clearly isn’t a fix to the problems of the healthcare industry, but it certainly sounds like a nice step up. While I understand the logistics behind it, the idea that you can go to a place, pay your bill, then have eight different people bill you for the same service just feels like an absolute scam. Yes, one was the doctor, one was the lab, one was the hospital etc. and they may work for different companies and even in different buildings it’s just that they all HAPPENED to be in that one building that one day if that one time. But you don’t go to a restaurant and get separate bills from the establishment and the waiter and the cook and the group which buys ingredients. “We couldn’t have told you how much that Caesar salad would have cost, it depends on complex negotiations with your dietitian. Had it been at least 30 days since your last consumption of Californian arugula?”

subhobroto 8y ago
> At least when it comes to ERs transparency isn’t exactly useful. Most people don’t have time to go shopping around between them, all transparency does this let you know you’re being billed $1700 for a Band-Aid instead of billing code B736.21. Exactly! I link to an answer I wrote about this here: https://news.ycombinator.com/item?id=18108870 https://news.ycombinator.com/item?id=18108870 Direct link: https://www.quora.com/Would-a-completely-free-market-healthcare-system-with-zero-government-involvement-and-no-subsidies-for-anyone-work-better-in-the-long-run https://www.quora.com/Would-a-completely-free-market-healthc...
nradov 8y ago
Insurance companies do have negotiated prices with all their network providers for all applicable billing codes. And insurers do often provide those numbers to their plan members, at least partially. The trouble is that you can't always know in advance which billing code a provider will actually submit on the claim, and some providers are out of network without negotiated prices.
- hakfoo 8y ago
  >The trouble is that you can't always know in advance which billing code a provider will actually submit on the claim, That seems like the billing system itself is conceptually faulty. Like a supermarket where the same gallon of milk costs different prices depending on which shelf you took it off of.
  - nradov 8y ago
    For a given customer, the "gallon of milk" costs the same regardless of which shelf it comes from. But if you come in to buy milk and end up buying champagne instead the price will be different. Billing amounts are calculated based on specific unique procedure and modifier codes. The coding is typically done by trained coders using the doctor's notes as a reference, and the coders select the most expensive codes that they can legally justify. Many doctors aren't even aware of their billing rates for various procedures. In some cases the doctor won't know which specific procedures will be needed until she gets into it and sees what's going on, at which point it's too late for price estimates. Payers (insurers) are trying to fix the billing system by moving away from the fee-for-service model and toward value-based care (payment for meeting care quality goals) or various forms of capitation (flat payment per patient per year regardless of which procedures are needed).

Nasrudith 8y ago

It is essentially a "don't be a complete dick" statistical cap. Whenever you hear somebody complaining about excessive regulations remember all of the other cases that resulted against past antisocial behavior like that.