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Hospital prices are about to go public in the U.S.

592 points by SQL2219 8y ago

mc32 8y ago
This is a start but will be useless unless how these published prices are arrived at are regulated so they can’t be gamed behind discounts, copays, deductions, insurer discounts, tacked on items, etc. It’ll be like buying a mattress and trying to do price shopping. The published prices will need to have a readily useful and predictable meaning and interpretation.
- moonka 8y ago
  Exactly. As it is, everytime we end up with a sizable bill I call and ask for a discount, and right away they tend to give a 10% pay in full discount. I've seen this through different providers and insurance plans. I would have never thought about it until someone suggested it to me.
  - Fjolsvith 8y ago
    Hah, yeah, I even pad my product prices so that when I run a sale, I still get my profit.
clavalle 8y ago
One way we could wheedle useful information out of this is how the published prices relate to other providers, especially if there are huge discrepancies. Telling me an average MRI has an average list price of $1000 at provider A tells me nothing. But if provider B says theirs is $10,000? That could be pointing to something important.
- caseysoftware 8y ago
  I think that one is a key point. Regardless of the insurance carrier-negotiated discounts, this kind of transparency should make people say "wth?" Especially as people start working and thinking of how to provide 1:1 comparisons between providers. That's the next step but we need the data first.
- jahbrewski 8y ago
  The ability to “shop around” for cheaper care sounds fantastic. But could that system actually work for healthcare? Is there anything intrinsic to healthcare that limits the ability of a free market in that arena (morally, economically, etc.)?
  - clavalle 8y ago
    >Is there anything intrinsic to healthcare that limits the ability of a free market Oh, lots (the biggest fundamental failing being that a person will generally pay anything to not die or be in pain -- its why extortion and robbery can never lead to an efficient market). But examining costs doesn't mean we have to apply a market-based approach to controlling those costs.
onetimemanytime 8y ago
List price $72,588.00 Insurance co pays $5600 OK, maybe I am exaggerating a bit but this is useless. Someone brought unconscious to the hospital should pay reasonable and common fees when they leave the hospital, not whatever the hospital dreams up. What the insurance companies pay the hospital for the procedure, maybe with a 20% increase should be it for everyone.
- pcurve 8y ago
  Sadly, I've seen worse billed/reimbursement ratio in reality.
gorbachev 8y ago
This is almost completely meaningless unless it's paired with some serious help in figuring out the total cost of a visit. Every service that offers this sort of price transparency I've seen so far lists the prices for single insurance billing codes at a time. A lay person isn't going to understand the total cost of the visit from that, because there's no way to figure out which billing codes are going to be make up everything that's been billed for different types of visits. An average price also means absolutely nothing, if the variance is significant or the medical care depends on circumstances and can, as an example, vary from a single day hospitalization to a 2 week hospitalization. While this is positive progress, I would really appreciate more effort put on actually reducing the prices themselves. I guess the more expensive hospitals could see patients choose less expensive hospitals, and forcing them to lower their prices, but I'm not too optimistic of that happening in any meaningful way.
- randyrand 8y ago
  that problem sounds like a market opportunity
  - theseatoms 8y ago
    it's that or deadweight loss
- pcurve 8y ago
  "A lay person isn't going to understand the total cost of the visit from that, because there's no way to figure out which billing codes are going to be make up everything that's been billed for different types of visits." Another problem is, for many, you won't even know what your ailment and treatments will be until after.
  - whatshisface 8y ago
    >Another problem is, for many, you won't even know what your ailment and treatments will be until after. Progress is progress, even if it's not perfect. Many people get diagnosed and treated on separate visits, and many more have long-term illnesses that they know relatively well. Soon there will be a proliferation of guides for common long-term illnesses like diabetes, detailing what billing codes you can expect. Eventually, I hope to be able to put a condition (say, pregnancy) along with some personal information into a computer, and get out the flow matrix telling me the probabilities of all possible futures and the costs of each. That's a long way off, but this is the first step. When medical costs are being discussed, the relatively rare situation of being rushed in to a hospital unconscious for doctors to do a series of completely unpredictable procedures on you tends to get focused on almost exclusively. In reality, a huge fraction of medical expenses go to (comparatively) predictable things like cancer treatments, where an operation will be scheduled out two weeks in advance. Even a day's notice would be enough time for price selection to happen, if all you had to do was look at a list of providers, prices and success rates.
refurb 8y ago
My guess is that eventually the govt will step in and start regulating prices if providers don’t. One interesting idea (not well thought out at all) would say that all prices need to be +\- 50% of what Medicare pays. Medicare pays $20,000 for stent placement? Great! You can charge whatever you want up to $30,000. A lot of effort goes into setting Medicare rates (and they are based on self reported costs across the country), so forcing providers to be in the ballpark of those might help. It wouldn’t solve the issue, but it would eliminate those ridiculous “why do you charge $10,000 for an MRI when the clinic down the street charges $1,000?”.
- pkaye 8y ago
  If you look at healthcare vs GDP, the US is way above the line compared to comparable countries. https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#item-relative-size-wealth-u-s-spends-disproportionate-amount-health https://www.healthsystemtracker.org/chart-collection/health-... I think scaling the average costs from other countries accounting for GDP would be a good way to set the rates.
  - AmericanChopper 8y ago
    This is one of those nice ideas that has some pretty serious hidden costs. You’d struggle to compare healthcare in the US to other countries, because the quality of healthcare available (talking about availability, not accessibility) in the US is generally superior to other countries. So you could end up simply eroding the quality of care in the US. Another thing people tend not to talk about when discussing healthcare in the US is how much the US contributes to medical research and innovation. No other nation on earth even comes close. If you adjust the system so much that you remove the incentive to carry out that research, then the quality of care in literally the entire world would suffer.
    - cazum 8y ago
      You're implying that both the quality of care and the amount of medical research done is a result of the profits of the medical companies. I'm not sure that this is the case.
surfmike 8y ago
Should be extended to require: * Prices _actually_ paid vs. list price for procedures * All-in prices for the ten most common/expensive procedures (e.g. all associated costs of a heart surgery).
kurthr 8y ago
Presumably, this is based on ICD10 codes... but there can be 30 different services tied to a code. You still won't know what code is being charged until after the service is rendered, and if it's rack rate you won't know the actual rate your insurance will be charged, until THEY tell you... because that is proprietary information (just like the reason why your treatment was denied coverage). Imagine you have diabetes and want to know which provider or insurance company will give you better endocrinology rates... it's the best case treatment knowledge scenario, but you can't figure anything out without knowing the secret negotiated rates for each possible coverage pair.
- Scoundreller 8y ago
  Are people really billed based on diagnostic codes? If true, it’s not what ICD-10 was designed for. Patient A can recover from the same procedure for the same diagnosis much quicker and with fewer interventions than Patient B. Would insureco get billed the same for both?
  - wslack 8y ago
    They aren't. Prices are based on the HCPCS codes (CPT for clinical charges). For example, a 99213 is a return office visit.
    - kurthr 8y ago
      Providers often enter ICD-10 codes (required by Epic) and do not know HCPCS or CPT... so how could they tell you what you will be charged? There isn't a way (that even educators know of to get those codes or the pricing)... the prices are handled by billing, which is a separate department and you can't reach them by phone. They will call you back (within 30days), but they do not leave messages. Clinic and hospital in the heart of silicon valley.
- gnopgnip 8y ago
  >Presumably, this is based on ICD10 codes... but there can be 30 different services tied to a code. You still won't know what code is being charged until after the service is rendered, This is not the case in CA. Chargemasters have already been public since 2011, and they list everything the hospital will charge for.
kozikow 8y ago
It's funny that co-pay I am paying for a service in the USA is comparable to a full private treatment with the same quality in Poland, where I grew up.
- Scoundreller 8y ago
  It can be difficult for a patient to determine quality of care. And difficult to compare country against country. Poland is similar to USA in cardiovascular care, but much worse in cancer : https://en.m.wikipedia.org/wiki/List_of_countries_by_quality_of_healthcare https://en.m.wikipedia.org/wiki/List_of_countries_by_quality...
  - TheDong 8y ago
    I'm curious about the quality of that source actually. Based on the pdf linked from the OECD page [0] it looks like they're measuring the reported incidents of cancer based on medical records. The medical records for the US may be skewed because they only cover the well-off (after all, the poor can't afford healthcare), while in other countries, like Poland, everyone rich and poor receives care and are included in the statistic. Also, the numbers on wikipedia are stale, but they don't seem to have changed that much on the OEDC website. The ux is garbage so I didn't click around that much. [0]: https://www.oecd.org/els/health-systems/Definitions-of-Health-Care-Quality-Indicators.pdf https://www.oecd.org/els/health-systems/Definitions-of-Healt...
pcurve 8y ago
fyi, Medicare made their reimbursement data available some time ago, including billed vs reimbursed. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Inpatient2016.html https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta... CEDARS-SINAI MEDICAL CENTER in CA billed on average $2.8 mil for one heart transplant (nearly 50 performed) while Tufts Medical only billed $586k on average for similar number of procedures. They were reimbursed $345k and $280k per procedure respectively. Insurance companies should follow suit.
mikedilger 8y ago
I actually stiffed a doctor once because he refused to give a price up front and when I got the bill it was outlandish. I also made a huge scene in the intake/waiting room about this. I was leaving the United States at the time so I didn't really care about my credit record. To be slightly more honest: he wasn't the doctor assigned to me on intake, he was another doctor from another hospital across the street as a consultant IMHO trying to get onto my case so he could bill me.
- tehlike 8y ago
  most doctors in the US actually do not know about the prices of treatments as it changes based on insurance administrator/insurer, and then what the patient pays also have huge variability based on insurance administrator/insurer.
  - throwaway12iii 8y ago
    Most doctors in the US actually do know how pricing works.
    - homero 8y ago
      They know how it works but not the exact price of an aspirin. They can't exactly tell you to go to the pharmacy out of your hospital bed to get a $2 bottle vs a $50 pill from them.
      - benj111 8y ago
        Is it not reasonable for them to ask, if they don't know? Also should they not have a general ballpark idea? I'm British and would expect Drs to be aware of costs before advising treatment (ruling out cheaper to rule out things etc).
        jacobr1 8y ago
        No, because it will be different for every patient (for the same treatment) and will fluctuate widely from year to year. Also there is a general ethical sense of recommending the best treatment and dealing with cost as an afterthought.
stickfigure 8y ago
The next logical step is to require written estimates in advance, just like the auto repair industry.
- mindslight 8y ago
  s/the auto repair/every other/
- Scoundreller 8y ago
  That only works for non-urgent care and when estimates are cheap enough to encourage shopping around. Although even free estimates cost you time.
  - ams6110 8y ago
    Most health care is non urgent.
    - stickfigure 8y ago
      To underline this, the amount of money spent on emergency care (the kind where you might not have the opportunity to get an estimate) is in the single digit percentages, and may be as low as 2%. https://www.politifact.com/truth-o-meter/statements/2013/oct/28/nick-gillespie/does-emergency-care-account-just-2-percent-all-hea/ https://www.politifact.com/truth-o-meter/statements/2013/oct...
  - lostlogin 8y ago
    Could you explain a little further? Most industries are able to provide quotes, why shouldn’t healthcare facilities?
    - cheschire 8y ago
      Those industries probably bake the cost of estimating quotes into the manpower cost already. Hospital bills would ostensibly be even higher simply to provide quotes. But I believe his core point was up front. When your arm is off, you're not going to ask for, or even reject, a quote. I would anticipate though that once quotes are known, and posted to glassdoor-like services, one could develop an app where you point to your arm, select "it's fallen off" and then you are provided the cheapest hospitals for your issue and their ratings.
intralizee 8y ago
This is honestly something I look forward to witnessing. Currently it's hard to find detailed financial information for how much a person with whatever diseases ends up being covered per year with costs. I think transparency about coverage is necessary for people being unfairly handled by providers based on their condition being minuscule compared to another disease with a larger population that has better coverage because more advocacy.
dakom 8y ago
How about transparency of medical records - i.e. if I provide some credentials, can I definitively get a copy of my medical history so that I can easily take it with me to another country/hospital? By definitively I mean within some federal regulation or system that doesn't depend on an employee at a particular hospital getting around to it on their coffee break.
- trevyn 8y ago
  You certainly can under HIPAA, and I’ve done this several times without unreasonable delay. If you’ve had issues, I’m sure the “sternly worded letter from a lawyer” approach would get the gears turning.
  - dakom 8y ago
    Thanks! Are they all interconnected, so that if I use a service like https://www.medicare.gov/manage-your-health/medicares-blue-button-blue-button-20 https://www.medicare.gov/manage-your-health/medicares-blue-b... I will get the collected records from different doctor visits at different hospitals?
    - nradov 8y ago
      They are not all interconnected. Most providers have some sort of connectivity to a regional health information exchange network, but there are a lot of gaps and interoperability problems. Blue Button 2.0 is helpful but currently it only gives authorized providers access to your Medicare claims (if you're a Medicare beneficiary), which have limited clinical value. Getting a copy of your full chart requires going through other channels.
- maehwasu 8y ago
  Coral Health (in ios and play stores) lets you do this already for lots of hospitals.
txcwpalpha 8y ago
I take issue with this headline. Hospital prices are already, by law, public in the US. The new rule makes it required to post them online, whereas previously you might have to call/email the hospital to get the price list rather than looking at their website. This is an important distinction, IMO, because I have seen people saying that this is an important step because "insurance/patients can now negotiate easier with a set price list". The issue with this is that, like mentioned above, the public has already had access to these price lists, so this new rule changes nothing in that regard. The new rule might make it easier for insurance companies or those collecting pricing information to scrape the price data from the hospitals' websites, which is a good thing, but overall I think this new rule is being overblown in terms of the actual impact it will have.
- keerthiko 8y ago
  If the only access you have to a price list is through a private comms channel, what guarantee do you have that you are receiving the same prices and service for a given price as someone else? If the prices were available through a centralized third party (government health agency or similar) then sure, it's not much of a difference, but if the only way before was by directly contacting the hospitals, then it being available online is a big difference in the actual "public" nature of the information. Also, calling or writing snail mail to multiple individual hospitals for price lists is a barrier in 2018 that not only dissuades, but is possibly physically not viable for affected people. In my opinion, being posted online is rightfully the baseline for information to be considered "publicly available" (but probably not sufficient) today. My heuristic is if you can't find out a piece of information by visiting a public library within 5-10 minutes, it's not public information.
  - txcwpalpha 8y ago
    There's nothing in this ruling that requires the price list, even online, to fit within your heuristic. The hospital could choose to place the price list at a url of blahblahhospital dot com / 3424kjfksm34. And to get that URL, you have to call the hospital and ask for it. There is nothing in the rule going into effect on Jan 1 that says they have to plaster the price list on their front page or on Google. For that matter, they still could give separate price lists to different parties, as long as said price lists are 'online' (eg price list for you is at our_prices dot html, whereas someone else's price list is at our_other_prices dot html). And, beyond all of this, is the fact that even if you do get access to the price list, it is meaningless to you as a patient. The article discusses this. As a patient, if you want to know an actual realistic estimate of your costs, the only way to get that is to call/go into the hospital and ask, or to go through your insurance company estimator, both of which are already available and aren't changed by this new ruling. Your points are all legitimate and ones I agree with, but I just don't think this new HHS rule does anything to meaningfully address them.
throwawaywhynot 8y ago
I like to see when title mentions the country. National news websites typically don't include the name of the country, which is a definite inconvenience on global communities like hn and some subreddits
aj7 8y ago
There is a similarly useless drug price list. What is needed is crowd sourced discount pricing of the insurance companies, per hospital. Leaks would be welcomed.
___alt 8y ago
I'm so glad I live in a country with single-payer healthcare.
- yqh 8y ago
  Sometimes, reading this website makes me happy that I don't live in the US.
- assblaster 8y ago
  I'm so glad I live in the United States, arguably the greatest country in the history of the world.
  - ___alt 8y ago
    US is a great country for many things, but having any serious health problem putting you in financial jeopardy (or throwing you in an inextricable administrative maze to dodge high and cryptic charges) in ridiculous for a "great" country. Having a life-threatening condition is already scary enough that you don't also have to dread bankruptcy at the same time.
    - assblaster 8y ago
      If you have any life threatening condition, go to the ER of any of your local hospitals and receive great medical care. If you didn't pay for insurance, you'll pay for the services rendered directly. People buy car insurance and home insurance and life insurance and disability insurance to pay for catastrophic incidents related to those things. Health insurance should similarly be for catastrophic events, but unfortunately it's come to be responsible for all care, even routine care. The introduction of third party payments is a root cause of pricing difficulties. Outside the United States in many of these "single payer" countries, you will have rationed care, whether that's in use of archaic procedures or medicines, or waitlists, or outright denial of service. At least in the United States you can get whatever you need without much waiting.
  - deleted 8y ago
    [deleted]
stuaxo 8y ago
Ah, always a surprise to entrenched businesses when freer markets are introduced.
yodsanklai 8y ago
Some anecdotes related in the comments are scary. I'm wondering, how is the situation for a software engineer working in a big company (say GAFA in silicon valley). Suppose you broke a leg skiing, and need surgery and various medical exams. How much are you expected to pay? what's the administrative overhead? same question for dental care.
- randomacct3847 8y ago
  completely depends on your insurance plan...something like this will definitely be covered, but how much you will pay depends on your deductible, how much you’ve already contributed to your deductible, what copay or coinsurance you need to pay once you meet it, and your out of pocket max (max you will pay for anything in a given year) I have supplemental “accident insurance” since I’m relatively young and healthy and the biggest reason why I’d end up in the ER is due to a physical accident. With this insurance it covers more of what I would pay in this situation than my insurance would alone.
  - iamgopal 8y ago
    How much I would pay is depend on insurance plan. How much is payable can be stated. Even insurance needs to publish their payouts for each of published data of hospitals.
  - lotsofpulp 8y ago
    Also if someone out of network walks into the room.
    - randomacct3847 8y ago
      Yeah that’s a big one. Also if you have an emergency and go to a in network facility your doctor might be out of network. Most decent insurance plans do say that in emergencies they treat in network and out of network care equally, but definitely not all plans work like that.
mwerd 8y ago
This won't help consumers. The prices (both charges and what Medicare pays) are already effectively public: https://data.cms.gov/Medicare-Physician-Supplier/Medicare-Provider-Utilization-and-Payment-Data-Phy/utc4-f9xp https://data.cms.gov/Medicare-Physician-Supplier/Medicare-Pr... The problem, as some other comments point out, is that they're way too complicated. The link I posted, for example, is just the provider charges. A hospital visit typically has a facility claim and at least one provider claim. Depending on the type of service received and the agreement between insurance and facility, the facility fees can be billed a variety of ways (diagnosis related groups, ambulatory payment classifications, or HCPCS). Each provider that sees you or performs labs, x-rays, etc can bill separately, and each could have a separate or no contract with your insurance. The latter is how surprise 'out of network' bills happen. It's a total mess and hopelessly complex for the average consumer.
- QuantumGood 8y ago
  As I noted below ($25 vs. $1400 for my sore shoulder), the range of ways providers can "code" what they charge you for is not sane. And how my inpatient bill in a different situation reached ~$45,000 was clearly because the hospital knew how to pad the bill.
  - xzel 8y ago
    And in fact I'd say medical coding is a boarder line predatory practice. There are a number of companies that specialize in padding / inflating medical codes against insurance companies for hospitals (or fighting them etc). It is just another inefficiency in the current system costing everyone more money.
    - QuantumGood 8y ago
      A friend's brother owned a construction and landscape company. One of their key philosophies was "You have to know how to write a bill." A wide range of equipment types, each with different hourly rates, can be used on any one job. Different procedures can be used. Figuring out the combinations that create the greatest "defensible" profit was a widely acknowledged goal of most companies in the space. I am also aware of training companies that do something similar. It's a common business mindset, unfortunately.
Dowwie 8y ago
EMR, Health Information Exchanges, teams of analysts organizing standards for information exchange, and mandates for upgrades should have set the stage for transparency beyond published fictional information by providers. Would someone please comment about these projects? The affordable care act gave more than a billion dollars away for people to work on the exact same, redundant projects in regions across the United States. Did these initiatives reach production and are they running today?
- nradov 8y ago
  Yes EMRs have been widely deployed, and the majority of providers are now connected to some sort of HIE. This has helped to improve care quality slightly by reducing medical errors and preventing the need for duplicate procedures. However it hasn't had much impact on billing or insurance issues; those will have to be addressed separately.
- mmirate3 8y ago
  Medical Records and Practice Management are often two separate pieces of software, with only the latter one dealing with billing and insurance.
SQL2219 8y ago
Now this is the way it should be: https://surgerycenterok.com/pricing/ https://surgerycenterok.com/pricing/
- assblaster 8y ago
  These prices seem reasonable, even though the cost is in the thousands of dollars. The question is what happens when you try to get your insurance company to pay this quoted price.
novalis78 8y ago
For someone who worked on price transparency in 2013 - I was personally affected with surprise billing - and spent long hours working on a price discovery / transparency tool called pricepain.com, this (first step of an) anti cartel measure brings tears of joy. While it won’t solve all issues at once, shining some light into the medical billing mess can only be a good thing, allow market forces to enter the picture somewhat. It’s rather sad, that it didn’t come from the industry itself - but I guess that speaks volumes already. Florida faced a dilemma with their incredibly broken public school system many decades ago and was stuck in a political gridlock as no party agreed on any measure the other would propose to improve the situation. Finally, the only item both parties did agree on, was to grade schools. Just a single simple letter, a search for more light. The result of a little bit more transparency caused a chain reaction of consequences leading to higher quality of service overall. I hope that similarly this move will spark a quality/performance re-orientation and help create more Surgery Centers of Oklahoma. It’s high time.
- epmaybe 8y ago
  Something I worry about, and that maybe you can help shed some light on, is what the ramifications of such a move would be. You mentioned the grading of schools leading to higher quality. Do we know if any metric suffered as a result? One guess I have is that teachers started teaching for the test rather than for the foundation. Take that same question and apply it back to the issue of hospital cost. If there's more transparency, the obvious conclusion is that there will be increased competition and an overall lowering of costs for patients. Does that come at the cost of quality of care? My gut says no, but my brain says that hospital administrators are incredibly talented at cutting costs. Maybe we have other safeguards such as HCAHPS to prevent the worsening of quality. And as my own comment on this situation - how does this move fit into the insurance realm? My understanding is that hospitals will display the overinflated prices, but not the individual insurance negotiated prices. So how does this increased 'transparency' help?
  - tachudda 8y ago
    I suspect that with teachers teaching to a test, it improves bad teachers and holds good teachers back a little.
bookofjoe 8y ago
Pro tip: I was a neurosurgical anesthesiologist at the University of Virginia Health Sciences Center for twelve years (1983-1995). Every now and then I'd get a call from our billing office that they'd received a letter from a patient I'd cared for who was too poor to pay what our department had billed (usually many thousands of dollars: I had NO IDEA what our charges were, BTW, nor did any of my colleagues in the department). Every time that happened, I'd go over to the billing office and — without bothering to read the letter — tell our billing chief to waive all anesthesia-related charges. In other words, by my initialing a form we had, their balance due us was 0. Try it, you never know, it might work for you.
- justaguyhere 8y ago
  by my initialing a form we had, their balance due us was 0 That is very nice of you. I hope others like you in positions of power do the same!
  - bookofjoe 8y ago
    As I recall, every fellow attending did exactly what I did whenever they received a letter like that. It happened so infrequently, and our department billed so many tens of millions of dollars/year, it wasn't even a ripple in the pond.
    - justaguyhere 8y ago
      it wasn't even a ripple in the pond. True, but it did make a difference to those people you helped! so yeah, kudos to you.
      - BigChiefSmokem 8y ago
        I'm up voting your comment, people on this site can be ridiculous.
  - loblollyboy 8y ago
    Like our elected officials for example
codingdave 8y ago
I'd be happier to see regulated business practices. While I agree that the prices are a problem, I've felt more pain from bills that keep coming in for more than a year after a major event. And when I go to complain, they say that someone made a mistake, the insurance took a long time to respond, or some other excuse. Give me a final bill with all charges within 30 days, then 30 more days to resolve any issues with that bill, and then let the billing end so we can move on with our financial lives without wondering if one more bill is going to show up next week, tied to my credit record.
- sturgill 8y ago
  I currently use hospital billing as an example when explaining the halting problem. You’re never sure if you’ve paid off an incident or if another bill will show up in a few months...
  - mgr86 8y ago
    Before we were married my wife had an MRI. Having not met her deductible they sent her a bill for 1.5k. Not ideal but we were able to afford it and paid the bill. 364 days later we received another bill for roughly the same. We thought there was an error. After months of back and forth, even after they had told us for 2months that “they took care of it and we would not be charged” we ended up having to pay another $500. This whole process was beyond infuriating. The other bill apparently came from the Dr who read the MRI. The fun part was we were never contacted by that Dr about the results. She eventually left the hospital and she canceled our follow up appointment.
- lettergram 8y ago
  One thing that troubles me, is the hospital near me does the same thing, but "consoladates the bill". This literally is just a never ending fee that increases and they never list for what. Every single month I call and they give me the run-around. After 6 months of this, I have yet to pay the full bill until they mail me an itemized list and without fail it's wrong. I contact them, they remove two or three charges, I ask them to mail me the updated one. They do, then next month I receive a bill for those proceedures they removed the last time. Its to the point every month my bill now goes from $0 to ~$800, then back to $0 by the end of the month. Unfortunately, they now called and threaten the ~$800 "over due bill" to collection's. Luckily, I've recorded and documented everything, so I got it removed (again). However, I'm just waiting for this to go to collection's at some point, even though I owe zero at the end of every month. I'm 90% sure this is a bug in their system, but I can't seem to get around it. Having worked for a medical billing office, I hate to say it, but this is the norm. The billing office is often not officially the hospital or medical practice. Although we got all the records, we never really interacted and it was just files on a computer. I used to do write-offs, which was basically taking $10m a day and just clicking "don't need to pay". Usually it was dead people, poor, etc. At least that part of the job seemed somewhat nice.
karmelapple 8y ago
I was in a hospital in Singapore recently, and the prices for doctor consultation fees, staying in a room, and even certain tests were listed right at the front of the emergency room desk. After the patient I was with was stabilized, the nurse confirmed with us verbally what the rough cost should be for the rest of what the doctor prescribed, and asked if we wished to proceed. We could have said no and gone elsewhere if we wanted, since the patient at least was relatively stable and we knew what was wrong. I want this experience to be the norm in the USA.
- Holybeds 8y ago
  Where I live you know the cost before you go to the doctor since you will only pay a symbolic sum of 30 USD even if the visit ends up with something like a life long cancer treatment. If you need medicine you will pay at most 120 USD per year regardless of the costs. The idea that your access to healthcare should be linked to your own or your parents financial is crazy.
  - conanbatt 8y ago
    With the difference that a long-cancer treatment might cost hundreds of thousands of dollars in the US and simply bankrupt the hospital. Its easier to eat up cost if its a lot lower and has caps. The US has no apetite for those level of restrictions.
    - Holybeds 8y ago
      Not sure if you are joking but the hospitals are paid by the government for the provided services (via tax money). Obviously a life long cancer treatment will cost much more than 30 USD.
      - conanbatt 8y ago
        If the government has a final say, then it has to restrict supply to keep costs down. It cant say yes to everything.
sharemywin 8y ago
Now if we could just get some kind of all payer system in place. so everyone pays the lowest prices offered. but I guess its a start. The problem is there's not enough competition and not enough schools and we don't allow doctors from other countries to test to become a US doctor. with out basically starting over. https://innovation.cms.gov/initiatives/Maryland-All-Payer-Model/ https://innovation.cms.gov/initiatives/Maryland-All-Payer-Mo...
aceon48 8y ago
Its about damn time
phkahler 8y ago
One thing I advocate is fixed pricing. It's great to put prices online, but as long as insurance companies and such get to make deals there will be no real transparency or competition. The one downside I see to enforcing the prices is that it would ruin this ability to offer a break to people who need it. On the other hand, with enforce posted prices those prices would come down to levels similar to what insurance companies pay so the sticker shock to those uninsured would be significantly lower. Still, there will always be those in need.
- ethbro 8y ago
  It's a good goal, but this is a very complex system. For example, if published prices were brought down to slightly-above-insurance rates, fewer people would buy insurance. Consequently, insurers would have less bargaining power, further erroding their price advantage (and financial solvency). As an end result, absent regulatory mandate, non-high deductible plans would cease to be market viable. Providers, insurers, and patients are in a zero-sum competition for the same dollars. The ultimate question is -- do we want the US medical system to look like the US air travel system? On the whole, it seems like it would be better than what we've got. But I think we could do better (specifically: smooth boom/bust cycles, increase healthy competition)
  - pavel_lishin 8y ago
    > For example, if published prices were brought down to slightly-above-insurance rates, fewer people would buy insurance. Would they? I don't buy insurance so my doctor visits are only $20 - I buy insurance so that if something catastrophic happens to me, I'm not on the hook for hundreds of thousands of dollars. Even if the cost of (e.g., brain surgery, emergency appendectomy, resetting shattered bones) was the same as what insurance pays, I still wouldn't be able to afford it.
    - ethbro 8y ago
      I would hazard to say that both of us aren't in the demographic where $20 matters. But for a lot of people, $20 vs $250 is the difference between going to a doctor and not. Separate from that there's the catastrophic vs no coverage argument. If you're struggling to make rent at the end of the month, it's probably a smarter personal bet not to buy insurance. But patients without at least catastrophic are corrosive to our medical system, and what the ACA mandate was targeting. Personally, I think the ACA mandate for a catastrophic policy, with preventative care included, and direct cash subsidies to people at the poverty line (to cover routine care) is the best solution. I'd expect the ACA designers considered this, and only broadened the mandate requirements as a horse trade to insurers for assuming the risk of offering marketplace plans.
timtaco 8y ago
I was curious at what determines medical prices after recent stay in hospital, my bill was bizarre and it seemed that different hospitals charge substantially different amounts. So I wrote a medical pricing app to explore hospital bills and medicare reimbursement I still don't understand why pricing so different throughout the country, but at least there is a pretty app to visualize it https://itunes.apple.com/us/app/u-s-medical-prices/id1376580121 https://itunes.apple.com/us/app/u-s-medical-prices/id1376580...
mattferderer 8y ago
I wonder if the prices listed will be shown in a manner that is legible by the average citizen or if they will be so convoluted that no one will be able to make sense of them. Reading the article it seems as this will be the case. Hopefully that changes down the road.
hedora 8y ago
Just in time for end of year tax donations, and on a related note, I’m a big fan of RIP medical debt. They buy up medical debt for pennies on the dollar, then forgive it. It’s too late to prevent credit score dings, but at least it gets rid of collectors for someone. By law, when debt is sold to collectors, the person that owes the debt should have the option to pay the price offered to the collector. In the current system, hospitals are just paying shady crooks to borderline-illegally hassle people.
epsontmt88vi 8y ago
Can anyone recommend some resources to read up on the US healthcare system? I am looking to spend a good week studying the subject so I can have a more informed opinion on the subject.
- conanbatt 8y ago
  To have a truly informed opinion, I recommend The economics of Healthcare class on Coursera. Its only a couple of hours to understand why pricing is so complicated in the US, and why the problems people focus on are usually the wrong ones.
  - epsontmt88vi 8y ago
    Thanks.
SlowRobotAhead 8y ago
It’s funny how long it took me to figure out the rule, is being pushed through by Trump’s HHS appointee. Some of the only info I could find on him by name is how much of “a distaster” he would be published around the time he was appointed. I’m getting real sick of what constitutes professional journalism. I don’t like Trump, but when accomplishments are effectively hidden, and all speculation is unabashedly negative - there is a problem.
weliketocode 8y ago
It's hard to believe how little progress has been made with medical billing. My last standard annual physical was billed at $2.6k, had 30+ line items, and despite being covered my insurance left me with an out-of-pocket of $200+. I guess I'll take this as a win, albeit small.
deleted 8y ago
[deleted]
deytempo 8y ago
Why the hell would you allow automatic playing video ads that crash the mobile browser? What a shitty site
noddy1 8y ago
Has there been any precedent of patients saying to the hospital at the start of a visit "I agree to pay 1.5x the medicare reimbursement rate and no more, if you don't agree to this I will go to the next hospital"?
deleted 8y ago
[deleted]
ilaksh 8y ago
I work for a startup with two people and the other guy can't pay a real salary or benefits. So I can't really afford to live in nice areas of the US or really even afford the health insurance and medication for just me even after subsidies. If I needed to visit a hospital in the US without insurance, I know I would be bankrupt. So my solution is until business starts making money I am going to continue to live in Mexico and get Mexican health insurance.

592 points by SQL2219 8y ago

mc32 8y ago

This is a start but will be useless unless how these published prices are arrived at are regulated so they can’t be gamed behind discounts, copays, deductions, insurer discounts, tacked on items, etc. It’ll be like buying a mattress and trying to do price shopping. The published prices will need to have a readily useful and predictable meaning and interpretation.

moonka 8y ago
Exactly. As it is, everytime we end up with a sizable bill I call and ask for a discount, and right away they tend to give a 10% pay in full discount. I've seen this through different providers and insurance plans. I would have never thought about it until someone suggested it to me.
- Fjolsvith 8y ago
  Hah, yeah, I even pad my product prices so that when I run a sale, I still get my profit.

clavalle 8y ago

One way we could wheedle useful information out of this is how the published prices relate to other providers, especially if there are huge discrepancies. Telling me an average MRI has an average list price of $1000 at provider A tells me nothing. But if provider B says theirs is $10,000? That could be pointing to something important.

caseysoftware 8y ago
I think that one is a key point. Regardless of the insurance carrier-negotiated discounts, this kind of transparency should make people say "wth?" Especially as people start working and thinking of how to provide 1:1 comparisons between providers. That's the next step but we need the data first.
jahbrewski 8y ago
The ability to “shop around” for cheaper care sounds fantastic. But could that system actually work for healthcare? Is there anything intrinsic to healthcare that limits the ability of a free market in that arena (morally, economically, etc.)?
- clavalle 8y ago
  >Is there anything intrinsic to healthcare that limits the ability of a free market Oh, lots (the biggest fundamental failing being that a person will generally pay anything to not die or be in pain -- its why extortion and robbery can never lead to an efficient market). But examining costs doesn't mean we have to apply a market-based approach to controlling those costs.

onetimemanytime 8y ago

List price $72,588.00 Insurance co pays $5600 OK, maybe I am exaggerating a bit but this is useless. Someone brought unconscious to the hospital should pay reasonable and common fees when they leave the hospital, not whatever the hospital dreams up. What the insurance companies pay the hospital for the procedure, maybe with a 20% increase should be it for everyone.

pcurve 8y ago
Sadly, I've seen worse billed/reimbursement ratio in reality.

gorbachev 8y ago

This is almost completely meaningless unless it's paired with some serious help in figuring out the total cost of a visit. Every service that offers this sort of price transparency I've seen so far lists the prices for single insurance billing codes at a time. A lay person isn't going to understand the total cost of the visit from that, because there's no way to figure out which billing codes are going to be make up everything that's been billed for different types of visits. An average price also means absolutely nothing, if the variance is significant or the medical care depends on circumstances and can, as an example, vary from a single day hospitalization to a 2 week hospitalization. While this is positive progress, I would really appreciate more effort put on actually reducing the prices themselves. I guess the more expensive hospitals could see patients choose less expensive hospitals, and forcing them to lower their prices, but I'm not too optimistic of that happening in any meaningful way.

randyrand 8y ago
that problem sounds like a market opportunity
- theseatoms 8y ago
  it's that or deadweight loss
pcurve 8y ago
"A lay person isn't going to understand the total cost of the visit from that, because there's no way to figure out which billing codes are going to be make up everything that's been billed for different types of visits." Another problem is, for many, you won't even know what your ailment and treatments will be until after.
- whatshisface 8y ago
  >Another problem is, for many, you won't even know what your ailment and treatments will be until after. Progress is progress, even if it's not perfect. Many people get diagnosed and treated on separate visits, and many more have long-term illnesses that they know relatively well. Soon there will be a proliferation of guides for common long-term illnesses like diabetes, detailing what billing codes you can expect. Eventually, I hope to be able to put a condition (say, pregnancy) along with some personal information into a computer, and get out the flow matrix telling me the probabilities of all possible futures and the costs of each. That's a long way off, but this is the first step. When medical costs are being discussed, the relatively rare situation of being rushed in to a hospital unconscious for doctors to do a series of completely unpredictable procedures on you tends to get focused on almost exclusively. In reality, a huge fraction of medical expenses go to (comparatively) predictable things like cancer treatments, where an operation will be scheduled out two weeks in advance. Even a day's notice would be enough time for price selection to happen, if all you had to do was look at a list of providers, prices and success rates.

refurb 8y ago

My guess is that eventually the govt will step in and start regulating prices if providers don’t. One interesting idea (not well thought out at all) would say that all prices need to be +\- 50% of what Medicare pays. Medicare pays $20,000 for stent placement? Great! You can charge whatever you want up to $30,000. A lot of effort goes into setting Medicare rates (and they are based on self reported costs across the country), so forcing providers to be in the ballpark of those might help. It wouldn’t solve the issue, but it would eliminate those ridiculous “why do you charge $10,000 for an MRI when the clinic down the street charges $1,000?”.

pkaye 8y ago
If you look at healthcare vs GDP, the US is way above the line compared to comparable countries. https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#item-relative-size-wealth-u-s-spends-disproportionate-amount-health https://www.healthsystemtracker.org/chart-collection/health-... I think scaling the average costs from other countries accounting for GDP would be a good way to set the rates.
- AmericanChopper 8y ago
  This is one of those nice ideas that has some pretty serious hidden costs. You’d struggle to compare healthcare in the US to other countries, because the quality of healthcare available (talking about availability, not accessibility) in the US is generally superior to other countries. So you could end up simply eroding the quality of care in the US. Another thing people tend not to talk about when discussing healthcare in the US is how much the US contributes to medical research and innovation. No other nation on earth even comes close. If you adjust the system so much that you remove the incentive to carry out that research, then the quality of care in literally the entire world would suffer.
  - cazum 8y ago
    You're implying that both the quality of care and the amount of medical research done is a result of the profits of the medical companies. I'm not sure that this is the case.

surfmike 8y ago

Should be extended to require: * Prices _actually_ paid vs. list price for procedures * All-in prices for the ten most common/expensive procedures (e.g. all associated costs of a heart surgery).

kurthr 8y ago

Presumably, this is based on ICD10 codes... but there can be 30 different services tied to a code. You still won't know what code is being charged until after the service is rendered, and if it's rack rate you won't know the actual rate your insurance will be charged, until THEY tell you... because that is proprietary information (just like the reason why your treatment was denied coverage). Imagine you have diabetes and want to know which provider or insurance company will give you better endocrinology rates... it's the best case treatment knowledge scenario, but you can't figure anything out without knowing the secret negotiated rates for each possible coverage pair.

Scoundreller 8y ago
Are people really billed based on diagnostic codes? If true, it’s not what ICD-10 was designed for. Patient A can recover from the same procedure for the same diagnosis much quicker and with fewer interventions than Patient B. Would insureco get billed the same for both?
- wslack 8y ago
  They aren't. Prices are based on the HCPCS codes (CPT for clinical charges). For example, a 99213 is a return office visit.
  - kurthr 8y ago
    Providers often enter ICD-10 codes (required by Epic) and do not know HCPCS or CPT... so how could they tell you what you will be charged? There isn't a way (that even educators know of to get those codes or the pricing)... the prices are handled by billing, which is a separate department and you can't reach them by phone. They will call you back (within 30days), but they do not leave messages. Clinic and hospital in the heart of silicon valley.
gnopgnip 8y ago
>Presumably, this is based on ICD10 codes... but there can be 30 different services tied to a code. You still won't know what code is being charged until after the service is rendered, This is not the case in CA. Chargemasters have already been public since 2011, and they list everything the hospital will charge for.

kozikow 8y ago

It's funny that co-pay I am paying for a service in the USA is comparable to a full private treatment with the same quality in Poland, where I grew up.

Scoundreller 8y ago
It can be difficult for a patient to determine quality of care. And difficult to compare country against country. Poland is similar to USA in cardiovascular care, but much worse in cancer : https://en.m.wikipedia.org/wiki/List_of_countries_by_quality_of_healthcare https://en.m.wikipedia.org/wiki/List_of_countries_by_quality...
- TheDong 8y ago
  I'm curious about the quality of that source actually. Based on the pdf linked from the OECD page [0] it looks like they're measuring the reported incidents of cancer based on medical records. The medical records for the US may be skewed because they only cover the well-off (after all, the poor can't afford healthcare), while in other countries, like Poland, everyone rich and poor receives care and are included in the statistic. Also, the numbers on wikipedia are stale, but they don't seem to have changed that much on the OEDC website. The ux is garbage so I didn't click around that much. [0]: https://www.oecd.org/els/health-systems/Definitions-of-Health-Care-Quality-Indicators.pdf https://www.oecd.org/els/health-systems/Definitions-of-Healt...

pcurve 8y ago

fyi, Medicare made their reimbursement data available some time ago, including billed vs reimbursed. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Medicare-Provider-Charge-Data/Inpatient2016.html https://www.cms.gov/Research-Statistics-Data-and-Systems/Sta... CEDARS-SINAI MEDICAL CENTER in CA billed on average $2.8 mil for one heart transplant (nearly 50 performed) while Tufts Medical only billed $586k on average for similar number of procedures. They were reimbursed $345k and $280k per procedure respectively. Insurance companies should follow suit.

mikedilger 8y ago

I actually stiffed a doctor once because he refused to give a price up front and when I got the bill it was outlandish. I also made a huge scene in the intake/waiting room about this. I was leaving the United States at the time so I didn't really care about my credit record. To be slightly more honest: he wasn't the doctor assigned to me on intake, he was another doctor from another hospital across the street as a consultant IMHO trying to get onto my case so he could bill me.

tehlike 8y ago
most doctors in the US actually do not know about the prices of treatments as it changes based on insurance administrator/insurer, and then what the patient pays also have huge variability based on insurance administrator/insurer.
- throwaway12iii 8y ago
  Most doctors in the US actually do know how pricing works.
  - homero 8y ago
    They know how it works but not the exact price of an aspirin. They can't exactly tell you to go to the pharmacy out of your hospital bed to get a $2 bottle vs a $50 pill from them.
    - benj111 8y ago
      Is it not reasonable for them to ask, if they don't know? Also should they not have a general ballpark idea? I'm British and would expect Drs to be aware of costs before advising treatment (ruling out cheaper to rule out things etc).
      - jacobr1 8y ago
        No, because it will be different for every patient (for the same treatment) and will fluctuate widely from year to year. Also there is a general ethical sense of recommending the best treatment and dealing with cost as an afterthought.

stickfigure 8y ago

The next logical step is to require written estimates in advance, just like the auto repair industry.

mindslight 8y ago
s/the auto repair/every other/
Scoundreller 8y ago
That only works for non-urgent care and when estimates are cheap enough to encourage shopping around. Although even free estimates cost you time.
- ams6110 8y ago
  Most health care is non urgent.
  - stickfigure 8y ago
    To underline this, the amount of money spent on emergency care (the kind where you might not have the opportunity to get an estimate) is in the single digit percentages, and may be as low as 2%. https://www.politifact.com/truth-o-meter/statements/2013/oct/28/nick-gillespie/does-emergency-care-account-just-2-percent-all-hea/ https://www.politifact.com/truth-o-meter/statements/2013/oct...
- lostlogin 8y ago
  Could you explain a little further? Most industries are able to provide quotes, why shouldn’t healthcare facilities?
  - cheschire 8y ago
    Those industries probably bake the cost of estimating quotes into the manpower cost already. Hospital bills would ostensibly be even higher simply to provide quotes. But I believe his core point was up front. When your arm is off, you're not going to ask for, or even reject, a quote. I would anticipate though that once quotes are known, and posted to glassdoor-like services, one could develop an app where you point to your arm, select "it's fallen off" and then you are provided the cheapest hospitals for your issue and their ratings.

intralizee 8y ago

This is honestly something I look forward to witnessing. Currently it's hard to find detailed financial information for how much a person with whatever diseases ends up being covered per year with costs. I think transparency about coverage is necessary for people being unfairly handled by providers based on their condition being minuscule compared to another disease with a larger population that has better coverage because more advocacy.

dakom 8y ago

How about transparency of medical records - i.e. if I provide some credentials, can I definitively get a copy of my medical history so that I can easily take it with me to another country/hospital? By definitively I mean within some federal regulation or system that doesn't depend on an employee at a particular hospital getting around to it on their coffee break.

trevyn 8y ago
You certainly can under HIPAA, and I’ve done this several times without unreasonable delay. If you’ve had issues, I’m sure the “sternly worded letter from a lawyer” approach would get the gears turning.
- dakom 8y ago
  Thanks! Are they all interconnected, so that if I use a service like https://www.medicare.gov/manage-your-health/medicares-blue-button-blue-button-20 https://www.medicare.gov/manage-your-health/medicares-blue-b... I will get the collected records from different doctor visits at different hospitals?
  - nradov 8y ago
    They are not all interconnected. Most providers have some sort of connectivity to a regional health information exchange network, but there are a lot of gaps and interoperability problems. Blue Button 2.0 is helpful but currently it only gives authorized providers access to your Medicare claims (if you're a Medicare beneficiary), which have limited clinical value. Getting a copy of your full chart requires going through other channels.
maehwasu 8y ago
Coral Health (in ios and play stores) lets you do this already for lots of hospitals.

txcwpalpha 8y ago

I take issue with this headline. Hospital prices are already, by law, public in the US. The new rule makes it required to post them online, whereas previously you might have to call/email the hospital to get the price list rather than looking at their website. This is an important distinction, IMO, because I have seen people saying that this is an important step because "insurance/patients can now negotiate easier with a set price list". The issue with this is that, like mentioned above, the public has already had access to these price lists, so this new rule changes nothing in that regard. The new rule might make it easier for insurance companies or those collecting pricing information to scrape the price data from the hospitals' websites, which is a good thing, but overall I think this new rule is being overblown in terms of the actual impact it will have.

keerthiko 8y ago
If the only access you have to a price list is through a private comms channel, what guarantee do you have that you are receiving the same prices and service for a given price as someone else? If the prices were available through a centralized third party (government health agency or similar) then sure, it's not much of a difference, but if the only way before was by directly contacting the hospitals, then it being available online is a big difference in the actual "public" nature of the information. Also, calling or writing snail mail to multiple individual hospitals for price lists is a barrier in 2018 that not only dissuades, but is possibly physically not viable for affected people. In my opinion, being posted online is rightfully the baseline for information to be considered "publicly available" (but probably not sufficient) today. My heuristic is if you can't find out a piece of information by visiting a public library within 5-10 minutes, it's not public information.
- txcwpalpha 8y ago
  There's nothing in this ruling that requires the price list, even online, to fit within your heuristic. The hospital could choose to place the price list at a url of blahblahhospital dot com / 3424kjfksm34. And to get that URL, you have to call the hospital and ask for it. There is nothing in the rule going into effect on Jan 1 that says they have to plaster the price list on their front page or on Google. For that matter, they still could give separate price lists to different parties, as long as said price lists are 'online' (eg price list for you is at our_prices dot html, whereas someone else's price list is at our_other_prices dot html). And, beyond all of this, is the fact that even if you do get access to the price list, it is meaningless to you as a patient. The article discusses this. As a patient, if you want to know an actual realistic estimate of your costs, the only way to get that is to call/go into the hospital and ask, or to go through your insurance company estimator, both of which are already available and aren't changed by this new ruling. Your points are all legitimate and ones I agree with, but I just don't think this new HHS rule does anything to meaningfully address them.

throwawaywhynot 8y ago

I like to see when title mentions the country. National news websites typically don't include the name of the country, which is a definite inconvenience on global communities like hn and some subreddits

aj7 8y ago

There is a similarly useless drug price list. What is needed is crowd sourced discount pricing of the insurance companies, per hospital. Leaks would be welcomed.

___alt 8y ago

I'm so glad I live in a country with single-payer healthcare.

yqh 8y ago
Sometimes, reading this website makes me happy that I don't live in the US.
assblaster 8y ago
I'm so glad I live in the United States, arguably the greatest country in the history of the world.
- ___alt 8y ago
  US is a great country for many things, but having any serious health problem putting you in financial jeopardy (or throwing you in an inextricable administrative maze to dodge high and cryptic charges) in ridiculous for a "great" country. Having a life-threatening condition is already scary enough that you don't also have to dread bankruptcy at the same time.
  - assblaster 8y ago
    If you have any life threatening condition, go to the ER of any of your local hospitals and receive great medical care. If you didn't pay for insurance, you'll pay for the services rendered directly. People buy car insurance and home insurance and life insurance and disability insurance to pay for catastrophic incidents related to those things. Health insurance should similarly be for catastrophic events, but unfortunately it's come to be responsible for all care, even routine care. The introduction of third party payments is a root cause of pricing difficulties. Outside the United States in many of these "single payer" countries, you will have rationed care, whether that's in use of archaic procedures or medicines, or waitlists, or outright denial of service. At least in the United States you can get whatever you need without much waiting.
- deleted 8y ago
  [deleted]

stuaxo 8y ago

Ah, always a surprise to entrenched businesses when freer markets are introduced.

yodsanklai 8y ago

Some anecdotes related in the comments are scary. I'm wondering, how is the situation for a software engineer working in a big company (say GAFA in silicon valley). Suppose you broke a leg skiing, and need surgery and various medical exams. How much are you expected to pay? what's the administrative overhead? same question for dental care.

randomacct3847 8y ago
completely depends on your insurance plan...something like this will definitely be covered, but how much you will pay depends on your deductible, how much you’ve already contributed to your deductible, what copay or coinsurance you need to pay once you meet it, and your out of pocket max (max you will pay for anything in a given year) I have supplemental “accident insurance” since I’m relatively young and healthy and the biggest reason why I’d end up in the ER is due to a physical accident. With this insurance it covers more of what I would pay in this situation than my insurance would alone.
- iamgopal 8y ago
  How much I would pay is depend on insurance plan. How much is payable can be stated. Even insurance needs to publish their payouts for each of published data of hospitals.
- lotsofpulp 8y ago
  Also if someone out of network walks into the room.
  - randomacct3847 8y ago
    Yeah that’s a big one. Also if you have an emergency and go to a in network facility your doctor might be out of network. Most decent insurance plans do say that in emergencies they treat in network and out of network care equally, but definitely not all plans work like that.

mwerd 8y ago

This won't help consumers. The prices (both charges and what Medicare pays) are already effectively public: https://data.cms.gov/Medicare-Physician-Supplier/Medicare-Provider-Utilization-and-Payment-Data-Phy/utc4-f9xp https://data.cms.gov/Medicare-Physician-Supplier/Medicare-Pr... The problem, as some other comments point out, is that they're way too complicated. The link I posted, for example, is just the provider charges. A hospital visit typically has a facility claim and at least one provider claim. Depending on the type of service received and the agreement between insurance and facility, the facility fees can be billed a variety of ways (diagnosis related groups, ambulatory payment classifications, or HCPCS). Each provider that sees you or performs labs, x-rays, etc can bill separately, and each could have a separate or no contract with your insurance. The latter is how surprise 'out of network' bills happen. It's a total mess and hopelessly complex for the average consumer.

QuantumGood 8y ago
As I noted below ($25 vs. $1400 for my sore shoulder), the range of ways providers can "code" what they charge you for is not sane. And how my inpatient bill in a different situation reached ~$45,000 was clearly because the hospital knew how to pad the bill.
- xzel 8y ago
  And in fact I'd say medical coding is a boarder line predatory practice. There are a number of companies that specialize in padding / inflating medical codes against insurance companies for hospitals (or fighting them etc). It is just another inefficiency in the current system costing everyone more money.
  - QuantumGood 8y ago
    A friend's brother owned a construction and landscape company. One of their key philosophies was "You have to know how to write a bill." A wide range of equipment types, each with different hourly rates, can be used on any one job. Different procedures can be used. Figuring out the combinations that create the greatest "defensible" profit was a widely acknowledged goal of most companies in the space. I am also aware of training companies that do something similar. It's a common business mindset, unfortunately.

Dowwie 8y ago

EMR, Health Information Exchanges, teams of analysts organizing standards for information exchange, and mandates for upgrades should have set the stage for transparency beyond published fictional information by providers. Would someone please comment about these projects? The affordable care act gave more than a billion dollars away for people to work on the exact same, redundant projects in regions across the United States. Did these initiatives reach production and are they running today?

nradov 8y ago
Yes EMRs have been widely deployed, and the majority of providers are now connected to some sort of HIE. This has helped to improve care quality slightly by reducing medical errors and preventing the need for duplicate procedures. However it hasn't had much impact on billing or insurance issues; those will have to be addressed separately.
mmirate3 8y ago
Medical Records and Practice Management are often two separate pieces of software, with only the latter one dealing with billing and insurance.

SQL2219 8y ago

Now this is the way it should be: https://surgerycenterok.com/pricing/ https://surgerycenterok.com/pricing/

assblaster 8y ago
These prices seem reasonable, even though the cost is in the thousands of dollars. The question is what happens when you try to get your insurance company to pay this quoted price.

novalis78 8y ago

For someone who worked on price transparency in 2013 - I was personally affected with surprise billing - and spent long hours working on a price discovery / transparency tool called pricepain.com, this (first step of an) anti cartel measure brings tears of joy. While it won’t solve all issues at once, shining some light into the medical billing mess can only be a good thing, allow market forces to enter the picture somewhat. It’s rather sad, that it didn’t come from the industry itself - but I guess that speaks volumes already. Florida faced a dilemma with their incredibly broken public school system many decades ago and was stuck in a political gridlock as no party agreed on any measure the other would propose to improve the situation. Finally, the only item both parties did agree on, was to grade schools. Just a single simple letter, a search for more light. The result of a little bit more transparency caused a chain reaction of consequences leading to higher quality of service overall. I hope that similarly this move will spark a quality/performance re-orientation and help create more Surgery Centers of Oklahoma. It’s high time.

epmaybe 8y ago
Something I worry about, and that maybe you can help shed some light on, is what the ramifications of such a move would be. You mentioned the grading of schools leading to higher quality. Do we know if any metric suffered as a result? One guess I have is that teachers started teaching for the test rather than for the foundation. Take that same question and apply it back to the issue of hospital cost. If there's more transparency, the obvious conclusion is that there will be increased competition and an overall lowering of costs for patients. Does that come at the cost of quality of care? My gut says no, but my brain says that hospital administrators are incredibly talented at cutting costs. Maybe we have other safeguards such as HCAHPS to prevent the worsening of quality. And as my own comment on this situation - how does this move fit into the insurance realm? My understanding is that hospitals will display the overinflated prices, but not the individual insurance negotiated prices. So how does this increased 'transparency' help?
- tachudda 8y ago
  I suspect that with teachers teaching to a test, it improves bad teachers and holds good teachers back a little.

bookofjoe 8y ago

Pro tip: I was a neurosurgical anesthesiologist at the University of Virginia Health Sciences Center for twelve years (1983-1995). Every now and then I'd get a call from our billing office that they'd received a letter from a patient I'd cared for who was too poor to pay what our department had billed (usually many thousands of dollars: I had NO IDEA what our charges were, BTW, nor did any of my colleagues in the department). Every time that happened, I'd go over to the billing office and — without bothering to read the letter — tell our billing chief to waive all anesthesia-related charges. In other words, by my initialing a form we had, their balance due us was 0. Try it, you never know, it might work for you.

justaguyhere 8y ago
by my initialing a form we had, their balance due us was 0 That is very nice of you. I hope others like you in positions of power do the same!
- bookofjoe 8y ago
  As I recall, every fellow attending did exactly what I did whenever they received a letter like that. It happened so infrequently, and our department billed so many tens of millions of dollars/year, it wasn't even a ripple in the pond.
  - justaguyhere 8y ago
    it wasn't even a ripple in the pond. True, but it did make a difference to those people you helped! so yeah, kudos to you.
    - BigChiefSmokem 8y ago
      I'm up voting your comment, people on this site can be ridiculous.
- loblollyboy 8y ago
  Like our elected officials for example

codingdave 8y ago

I'd be happier to see regulated business practices. While I agree that the prices are a problem, I've felt more pain from bills that keep coming in for more than a year after a major event. And when I go to complain, they say that someone made a mistake, the insurance took a long time to respond, or some other excuse. Give me a final bill with all charges within 30 days, then 30 more days to resolve any issues with that bill, and then let the billing end so we can move on with our financial lives without wondering if one more bill is going to show up next week, tied to my credit record.

sturgill 8y ago
I currently use hospital billing as an example when explaining the halting problem. You’re never sure if you’ve paid off an incident or if another bill will show up in a few months...
- mgr86 8y ago
  Before we were married my wife had an MRI. Having not met her deductible they sent her a bill for 1.5k. Not ideal but we were able to afford it and paid the bill. 364 days later we received another bill for roughly the same. We thought there was an error. After months of back and forth, even after they had told us for 2months that “they took care of it and we would not be charged” we ended up having to pay another $500. This whole process was beyond infuriating. The other bill apparently came from the Dr who read the MRI. The fun part was we were never contacted by that Dr about the results. She eventually left the hospital and she canceled our follow up appointment.
lettergram 8y ago
One thing that troubles me, is the hospital near me does the same thing, but "consoladates the bill". This literally is just a never ending fee that increases and they never list for what. Every single month I call and they give me the run-around. After 6 months of this, I have yet to pay the full bill until they mail me an itemized list and without fail it's wrong. I contact them, they remove two or three charges, I ask them to mail me the updated one. They do, then next month I receive a bill for those proceedures they removed the last time. Its to the point every month my bill now goes from $0 to ~$800, then back to $0 by the end of the month. Unfortunately, they now called and threaten the ~$800 "over due bill" to collection's. Luckily, I've recorded and documented everything, so I got it removed (again). However, I'm just waiting for this to go to collection's at some point, even though I owe zero at the end of every month. I'm 90% sure this is a bug in their system, but I can't seem to get around it. Having worked for a medical billing office, I hate to say it, but this is the norm. The billing office is often not officially the hospital or medical practice. Although we got all the records, we never really interacted and it was just files on a computer. I used to do write-offs, which was basically taking $10m a day and just clicking "don't need to pay". Usually it was dead people, poor, etc. At least that part of the job seemed somewhat nice.

karmelapple 8y ago

I was in a hospital in Singapore recently, and the prices for doctor consultation fees, staying in a room, and even certain tests were listed right at the front of the emergency room desk. After the patient I was with was stabilized, the nurse confirmed with us verbally what the rough cost should be for the rest of what the doctor prescribed, and asked if we wished to proceed. We could have said no and gone elsewhere if we wanted, since the patient at least was relatively stable and we knew what was wrong. I want this experience to be the norm in the USA.

Holybeds 8y ago
Where I live you know the cost before you go to the doctor since you will only pay a symbolic sum of 30 USD even if the visit ends up with something like a life long cancer treatment. If you need medicine you will pay at most 120 USD per year regardless of the costs. The idea that your access to healthcare should be linked to your own or your parents financial is crazy.
- conanbatt 8y ago
  With the difference that a long-cancer treatment might cost hundreds of thousands of dollars in the US and simply bankrupt the hospital. Its easier to eat up cost if its a lot lower and has caps. The US has no apetite for those level of restrictions.
  - Holybeds 8y ago
    Not sure if you are joking but the hospitals are paid by the government for the provided services (via tax money). Obviously a life long cancer treatment will cost much more than 30 USD.
    - conanbatt 8y ago
      If the government has a final say, then it has to restrict supply to keep costs down. It cant say yes to everything.

sharemywin 8y ago

Now if we could just get some kind of all payer system in place. so everyone pays the lowest prices offered. but I guess its a start. The problem is there's not enough competition and not enough schools and we don't allow doctors from other countries to test to become a US doctor. with out basically starting over. https://innovation.cms.gov/initiatives/Maryland-All-Payer-Model/ https://innovation.cms.gov/initiatives/Maryland-All-Payer-Mo...

aceon48 8y ago

Its about damn time

phkahler 8y ago

One thing I advocate is fixed pricing. It's great to put prices online, but as long as insurance companies and such get to make deals there will be no real transparency or competition. The one downside I see to enforcing the prices is that it would ruin this ability to offer a break to people who need it. On the other hand, with enforce posted prices those prices would come down to levels similar to what insurance companies pay so the sticker shock to those uninsured would be significantly lower. Still, there will always be those in need.

ethbro 8y ago
It's a good goal, but this is a very complex system. For example, if published prices were brought down to slightly-above-insurance rates, fewer people would buy insurance. Consequently, insurers would have less bargaining power, further erroding their price advantage (and financial solvency). As an end result, absent regulatory mandate, non-high deductible plans would cease to be market viable. Providers, insurers, and patients are in a zero-sum competition for the same dollars. The ultimate question is -- do we want the US medical system to look like the US air travel system? On the whole, it seems like it would be better than what we've got. But I think we could do better (specifically: smooth boom/bust cycles, increase healthy competition)
- pavel_lishin 8y ago
  > For example, if published prices were brought down to slightly-above-insurance rates, fewer people would buy insurance. Would they? I don't buy insurance so my doctor visits are only $20 - I buy insurance so that if something catastrophic happens to me, I'm not on the hook for hundreds of thousands of dollars. Even if the cost of (e.g., brain surgery, emergency appendectomy, resetting shattered bones) was the same as what insurance pays, I still wouldn't be able to afford it.
  - ethbro 8y ago
    I would hazard to say that both of us aren't in the demographic where $20 matters. But for a lot of people, $20 vs $250 is the difference between going to a doctor and not. Separate from that there's the catastrophic vs no coverage argument. If you're struggling to make rent at the end of the month, it's probably a smarter personal bet not to buy insurance. But patients without at least catastrophic are corrosive to our medical system, and what the ACA mandate was targeting. Personally, I think the ACA mandate for a catastrophic policy, with preventative care included, and direct cash subsidies to people at the poverty line (to cover routine care) is the best solution. I'd expect the ACA designers considered this, and only broadened the mandate requirements as a horse trade to insurers for assuming the risk of offering marketplace plans.

timtaco 8y ago

I was curious at what determines medical prices after recent stay in hospital, my bill was bizarre and it seemed that different hospitals charge substantially different amounts. So I wrote a medical pricing app to explore hospital bills and medicare reimbursement I still don't understand why pricing so different throughout the country, but at least there is a pretty app to visualize it https://itunes.apple.com/us/app/u-s-medical-prices/id1376580121 https://itunes.apple.com/us/app/u-s-medical-prices/id1376580...

mattferderer 8y ago

I wonder if the prices listed will be shown in a manner that is legible by the average citizen or if they will be so convoluted that no one will be able to make sense of them. Reading the article it seems as this will be the case. Hopefully that changes down the road.

hedora 8y ago

Just in time for end of year tax donations, and on a related note, I’m a big fan of RIP medical debt. They buy up medical debt for pennies on the dollar, then forgive it. It’s too late to prevent credit score dings, but at least it gets rid of collectors for someone. By law, when debt is sold to collectors, the person that owes the debt should have the option to pay the price offered to the collector. In the current system, hospitals are just paying shady crooks to borderline-illegally hassle people.

epsontmt88vi 8y ago

Can anyone recommend some resources to read up on the US healthcare system? I am looking to spend a good week studying the subject so I can have a more informed opinion on the subject.

conanbatt 8y ago
To have a truly informed opinion, I recommend The economics of Healthcare class on Coursera. Its only a couple of hours to understand why pricing is so complicated in the US, and why the problems people focus on are usually the wrong ones.
- epsontmt88vi 8y ago
  Thanks.

SlowRobotAhead 8y ago

It’s funny how long it took me to figure out the rule, is being pushed through by Trump’s HHS appointee. Some of the only info I could find on him by name is how much of “a distaster” he would be published around the time he was appointed. I’m getting real sick of what constitutes professional journalism. I don’t like Trump, but when accomplishments are effectively hidden, and all speculation is unabashedly negative - there is a problem.

weliketocode 8y ago

It's hard to believe how little progress has been made with medical billing. My last standard annual physical was billed at $2.6k, had 30+ line items, and despite being covered my insurance left me with an out-of-pocket of $200+. I guess I'll take this as a win, albeit small.

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deytempo 8y ago

Why the hell would you allow automatic playing video ads that crash the mobile browser? What a shitty site

noddy1 8y ago

Has there been any precedent of patients saying to the hospital at the start of a visit "I agree to pay 1.5x the medicare reimbursement rate and no more, if you don't agree to this I will go to the next hospital"?

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ilaksh 8y ago

I work for a startup with two people and the other guy can't pay a real salary or benefits. So I can't really afford to live in nice areas of the US or really even afford the health insurance and medication for just me even after subsidies. If I needed to visit a hospital in the US without insurance, I know I would be bankrupt. So my solution is until business starts making money I am going to continue to live in Mexico and get Mexican health insurance.