6 ms·

This won't help consumers. The prices (both charges and what Medicare pays) are already effectively public: https://data.cms.gov/Medicare-Physician-Supplier/Med

by 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.
Cthulhu_ 8y ago
> It's a total mess and hopelessly complex for the average consumer. But not for insurance companies; it's in their interest to compare hospitals and get the best care for the lowest price. I for one hope this will trigger competition. On the other hand, it'll probably end up shafting the personnel instead of the ridiculous profit margins.
- kristopolous 8y ago
  The idea of effective competition in emergency services has always struck me as fanciful. The benefit that competition provides to incentivize lower prices and better services is a consumer's ability to easily deny someone their business and go elsewhere. What would this look like here? Would one be in the back of an ambulance doing price shopping on a tablet as they are fighting some terrible injury? Perhaps tie in different billing departments in a conference call as they bid over who will do the critically urgent surgery as the patient slides in and out of consciousness? Maybe decide to have a heart attack during a winter sale special or reach into their dresser to get a coupon out as they collapse to the floor? Or would someone be placed on a transportable life support system as they get ferried across a city deal hunting by having different procedures at different institutions, expecting them to talk to each other and string together piecemeal lab results for a coherent diagnosis? Maybe someone would do the work beforehand, search all the popular ailments and their procedures and then do price shopping in good health and prepare an execution plan if they fall ill? Maybe there's a non-absurd example, but I honestly can't think of it. The competition mechanism seems to be a completely unrealistic application.
  - tertius 8y ago
    Ambulance staff are incentivized by pretty nurses and free food/snacks. Ask any paramedic in a city with enough choice of hospitals and they'll tell you. What is the best answer to the "emergency care competition" that you've found? And what proportion of medical spending is on emergency vs. not?
    - kristopolous 8y ago
m1sta_ 8y ago
> It's a total mess and hopelessly complex for the average consumer. Sounds like something the people on this forum can help improve.
- pjc50 8y ago
  It's not a technological problem but a political one: the obfuscatory pricing is deliberate. Maybe you could have "fighting hospital billing as a service", but that's definitely going to need a chunk of human labour on top of whatever AI assistance you apply.
  - jmalicki 8y ago
    But technology can help patients unite against hospitals... Just like Yelp crowdsources the restaurant experience, or Glassdoor crowdsources salaries,and anotherss could collect crowdsourced medical bills and predict prices for procedures.
  - dig1 8y ago
    Is there any way this could be represented via interactive graph? We were able to tame much complex stuff than deliberate obfuscation by people not aware what tech can do. I guess there is not enough incentive ($$) to solve this problem.
    - willvarfar 8y ago
      The $$ is being made by the hospitals See https://www.vox.com/health-care/2018/12/18/18134825/emergency-room-bills-health-care-costs-america https://www.vox.com/health-care/2018/12/18/18134825/emergenc... to start digging into the mess
  - crispyambulance 8y ago
    I agree that the problem is political. While it might be nice in the short term to see some technological approaches to address the mess, the solution is ALSO political, NOT technological. Making the information public, however obfuscated, will enable journalists and activists to systematically expose this problem for what it is and that's the first step towards fixing it. The next thing that will happen is that many more people will be able to win massive lawsuits which is the only recourse the healthcare/insurance industrial complex understands.
cm2187 8y ago
In a way it's like if Apple was advertising the price of its individual electronic components rather than the all-in price.
- idontpost 8y ago
  It's far worse than that. It's like if Apple didn't have a price for an iPhone, but instead at the register it scanned the package and looked at which factories each part came from and which assembly-line workers in those factories worked on those specific parts, and which mines the minerals came from, etc. and then charged a different line item for every one of those factors. Sure, the average cost is $1000. But yours might be $5000.
sturgill 8y ago
I shared this experience before on HN, but I once cut my leg quite severely playing ice hockey. Ended up at the ER dripping blood everywhere. I went to the desk and asked if they took my insurance. Said I was only interested in treatment if my insurance would cover it. I was assured it was fine. Naturally the doctor assigned to me did not take my insurance... I got out of the out-of-network billing after hours of phone calls and lots of unkind words. But man was it just a terrible experience. And with insurance coming from work, it’s not like I could change providers. And with one hospital close to my house I didn’t have lots of options in an emergency. Nor would I expect any other hospital to treat me differently. My dad is a nurse and I grew up wandering hospitals. He complained as far back as the 80s that insurance was killing medicine. I didn’t understand it as a kid, but I see more what he was getting at as an adult.
- alehul 8y ago
  Just out of curiosity: have you tried calling your insurance to ask them where you should go? I haven't either, and have generally gone by your route of asking the hospital whether it will be insured, but I'd imagine calling insurance (if a feasible option?) would provide a lower rate of error.
  - PenguinCoder 8y ago
    The patient shouldn't have to call the insurance provider to see where it is accepted. This is adding to the problem. Do you have insurance, yes or no? Should be a good he only question not add-ons like, what provider, etc. It's stupid as hell that certain doctors are in network at a hospital while others are out of network, at the same damn facility. Ask me how I know this. American Healthcare insurance and billing is beyond messed up and needs to be fixed.
    - conanbatt 8y ago
      > The patient shouldn't have to call the insurance provider to see where it is accepted But this is actually the one that provides the service. You dont call the music band to ask about the prices ticketek charges. You should and can ask about the price without insurance and you might get an answer (though you wont like it).

by mwerd 8y ago

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.

Cthulhu_ 8y ago

> It's a total mess and hopelessly complex for the average consumer. But not for insurance companies; it's in their interest to compare hospitals and get the best care for the lowest price. I for one hope this will trigger competition. On the other hand, it'll probably end up shafting the personnel instead of the ridiculous profit margins.

kristopolous 8y ago
The idea of effective competition in emergency services has always struck me as fanciful. The benefit that competition provides to incentivize lower prices and better services is a consumer's ability to easily deny someone their business and go elsewhere. What would this look like here? Would one be in the back of an ambulance doing price shopping on a tablet as they are fighting some terrible injury? Perhaps tie in different billing departments in a conference call as they bid over who will do the critically urgent surgery as the patient slides in and out of consciousness? Maybe decide to have a heart attack during a winter sale special or reach into their dresser to get a coupon out as they collapse to the floor? Or would someone be placed on a transportable life support system as they get ferried across a city deal hunting by having different procedures at different institutions, expecting them to talk to each other and string together piecemeal lab results for a coherent diagnosis? Maybe someone would do the work beforehand, search all the popular ailments and their procedures and then do price shopping in good health and prepare an execution plan if they fall ill? Maybe there's a non-absurd example, but I honestly can't think of it. The competition mechanism seems to be a completely unrealistic application.
- tertius 8y ago
  Ambulance staff are incentivized by pretty nurses and free food/snacks. Ask any paramedic in a city with enough choice of hospitals and they'll tell you. What is the best answer to the "emergency care competition" that you've found? And what proportion of medical spending is on emergency vs. not?
  - kristopolous 8y ago

m1sta_ 8y ago

> It's a total mess and hopelessly complex for the average consumer. Sounds like something the people on this forum can help improve.

pjc50 8y ago
It's not a technological problem but a political one: the obfuscatory pricing is deliberate. Maybe you could have "fighting hospital billing as a service", but that's definitely going to need a chunk of human labour on top of whatever AI assistance you apply.
- jmalicki 8y ago
  But technology can help patients unite against hospitals... Just like Yelp crowdsources the restaurant experience, or Glassdoor crowdsources salaries,and anotherss could collect crowdsourced medical bills and predict prices for procedures.
- dig1 8y ago
  Is there any way this could be represented via interactive graph? We were able to tame much complex stuff than deliberate obfuscation by people not aware what tech can do. I guess there is not enough incentive ($$) to solve this problem.
  - willvarfar 8y ago
    The $$ is being made by the hospitals See https://www.vox.com/health-care/2018/12/18/18134825/emergency-room-bills-health-care-costs-america https://www.vox.com/health-care/2018/12/18/18134825/emergenc... to start digging into the mess
- crispyambulance 8y ago
  I agree that the problem is political. While it might be nice in the short term to see some technological approaches to address the mess, the solution is ALSO political, NOT technological. Making the information public, however obfuscated, will enable journalists and activists to systematically expose this problem for what it is and that's the first step towards fixing it. The next thing that will happen is that many more people will be able to win massive lawsuits which is the only recourse the healthcare/insurance industrial complex understands.

cm2187 8y ago

In a way it's like if Apple was advertising the price of its individual electronic components rather than the all-in price.

idontpost 8y ago
It's far worse than that. It's like if Apple didn't have a price for an iPhone, but instead at the register it scanned the package and looked at which factories each part came from and which assembly-line workers in those factories worked on those specific parts, and which mines the minerals came from, etc. and then charged a different line item for every one of those factors. Sure, the average cost is $1000. But yours might be $5000.

sturgill 8y ago

I shared this experience before on HN, but I once cut my leg quite severely playing ice hockey. Ended up at the ER dripping blood everywhere. I went to the desk and asked if they took my insurance. Said I was only interested in treatment if my insurance would cover it. I was assured it was fine. Naturally the doctor assigned to me did not take my insurance... I got out of the out-of-network billing after hours of phone calls and lots of unkind words. But man was it just a terrible experience. And with insurance coming from work, it’s not like I could change providers. And with one hospital close to my house I didn’t have lots of options in an emergency. Nor would I expect any other hospital to treat me differently. My dad is a nurse and I grew up wandering hospitals. He complained as far back as the 80s that insurance was killing medicine. I didn’t understand it as a kid, but I see more what he was getting at as an adult.

alehul 8y ago
Just out of curiosity: have you tried calling your insurance to ask them where you should go? I haven't either, and have generally gone by your route of asking the hospital whether it will be insured, but I'd imagine calling insurance (if a feasible option?) would provide a lower rate of error.
- PenguinCoder 8y ago
  The patient shouldn't have to call the insurance provider to see where it is accepted. This is adding to the problem. Do you have insurance, yes or no? Should be a good he only question not add-ons like, what provider, etc. It's stupid as hell that certain doctors are in network at a hospital while others are out of network, at the same damn facility. Ask me how I know this. American Healthcare insurance and billing is beyond messed up and needs to be fixed.
  - conanbatt 8y ago
    > The patient shouldn't have to call the insurance provider to see where it is accepted But this is actually the one that provides the service. You dont call the music band to ask about the prices ticketek charges. You should and can ask about the price without insurance and you might get an answer (though you wont like it).