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>>> In Tampa, FL the a basic metabolic panel could cost you either $11 or $440 [paraphrased from a graphic in the article] No properly functioning market behav

>>> In Tampa, FL the a basic metabolic panel could cost you either $11 or $440 [paraphrased from a graphic in the article] No properly functioning market behaves like this.

nsxwolf 7y ago
We’ve been fighting a hospital on an overcharge that drained our HSA account. Every person we talked to has been utterly flabbergasted that we are complaining because “it says here you owe $0”. They can’t get it through their heads that the insurance paid them with our own money, and that we’d like to be refunded the overage. It’s just a confusing concept to these people. This is what happens when most people use someone else’s money to pay for things. Nobody knows or cares what anything is supposed to cost.
- dnadler 7y ago
  Your insurance has access to spend your HSA? That's certainly not how mine is set up, and I'm surprised that's even possible. Did you give them your account number and authorization to spend your money?
  - brians 7y ago
    Mine are run by the same company and bills pass through. The result has the same effects for me as a PPO with a weird sort of IRA attached, and lower premiums than my old BCBS Elite 100/80 PPO.
  - nsxwolf 7y ago
    Yes. I think the arrangement is technically called an “HRA”.
    - pishpash 7y ago
      That's just a fancy name for self insurance, i.e. no insurance. Somehow wrapping it in yet another siloed tax advantaged vehicle makes it sound better.
      - nsxwolf 7y ago
        You understand why I would have an interest in what my medical procedures cost then, yes?
        pishpash 7y ago
        Of course. Even with a run-of-the-mill HSA + HDHP, you're basically partially self-insured and tasked with the thankless job of insurance administration. You can see there is something scammy about these things (in practice if not on paper) when they are so enthusiastically pushed by the healthcare industry.
        nsxwolf 7y ago
        Seems to me like having a lot more people being interested in the prices of things could only be a benefit.
        mgkimsal 7y ago
        when I need something, I usually don't have much luxury to 'shop around', and whatever price shopping you may want to try to do is often still hamstrung by 'in network' vs 'out of network' price tables. I needed a procedure that was going to be ~$1500 at any one of a half dozen places within a 90 minute drive; some were a bit cheaper, but they couldn't see me for more than a month. There were a couple places that were ~$1100, but it basically would have been a whole day's enterprise for 2 people to get me there and back. To save maybe $400. $400 is not nothing, but I wasn't even actually 100% sure their pricing would actually be what we finally paid - no one could guarantee that. So we may have had 2 people take an entire day from earning on the partial chance of saving some money. Might even have been cheaper in another state, but then you've got travel/hotel costs to add as well.
        flowersjeff 7y ago
        "...no one could guarantee ..." Key phrase to be sure. Many people that I know talk about how people need to know how much something costs - but these systems themselves don't know how much anything costs. Furthermore, they know this and therefore unwilling to guarantee anything. Knowing prices is great, but I feel is a non-starter when thinking about how the system can be 'fixed'. Also, you can't price shop when you're having a stroke. All in all, we have to just acknowledge that the system for everyone is broken - beyond this, I haven't a clue as to the next step.
  - nicolethenerd 7y ago
    With my HSA, auto payment is apparently a setting you can turn on or off. I highly recommend having this turned off if your HSA allows.
- cosmodisk 7y ago
  Not suprised.We used to have customer purchasing our services on a credit provided by a finance company,then cancelling and demanding full amount to be translated to their bank accounts... It usually take a bit of time for people to get it...
- radium3d 7y ago
  It's a little different. It's more like hiring someone as personal buyer who buys for likely a large group of people. A majority of people don't actually use the $3600+ they spend per year on health insurance so the money adds up fast and the buyer doesn't have time to deal with individuals so they don't seem to question paying $$$ for a tissue paper. The amount of money they are authorized to spend is so large that a $$$ tissue paper is just an insignificant percentage of the total available cash. If hospitals and insurance companies are already tracking their income/expenses they should just be required to publish the anonymized data via a centralized API so we can all work on creating systems to analyze the average cost of the products. It will help insurance companies and patients as well as doctors and everyone in the end. Also, beyond the standardized API system which should easily cover all the standard financial points we can have multiple people / organizations analyzing the data. Say one particular health issue shows up in the system as costing a lot of the insurance cash pool, we would notice it right away and could funnel more cash into prevention. I'm not familiar with the industry so maybe there is already something similar available?
  - taurath 7y ago
    Also given their profits are capped, the only way to make more money (which is their primary function sadly) is to inflate prices and premiums.
  - flowersjeff 7y ago
    Whilst I can totally dig where you're going with this - love the idea of open API's... we know it aint a tech problem. How did Europe do this with that whole payment services directive (I think that this is what I'm thinking about) - the one that forced all payment systems to have open APIs and such?... How would we get something like this in the works? It would require a mandate from ??? Congress / the President / Bigfoot??? I can only imagine how these companies would not like this information out. Even if one were to explain that having this data would yield optimizations of their internal systems, saving them money, as the information would most likely make many within the organization look badly.
- HarryHirsch 7y ago
  Get a judgement, send it to collection. What's so hard?
- raving-richard 7y ago
  Small claims court if it's less than the relevant small claims amount. Otherwise, a strongly worded letter from a cheap lawyer. The legal system is often abused. But it sounds like you've got an actual legit issue, which is what the legal system is there for. Why not use it? If you don't want to pay for a lawyer, you can write your own strongly worded letter. Just be sure to stick to facts, and keep very good records. In your letter, explain the issue briefly but clearly. Explain how you've attempted to resolve the issue. Explain how if the issue is not resolved, you will be forced to take action. Address it to the hospital CEO, or whoever is in charge. Post it using registered mail. Your local library may have a subscription to LexisNexis or a similar legal database. This will have form letters and chunks of legal text that you can copy and paste. HN user patio11 wrote a thing about writing letters on this website that I can't just find. But find it, and read it. It also has helpful advice.
  - MrFoof 7y ago
    I think the reticence most people have with initially engaging with a lawyer is they're not only not free, but initially not cheap on account of the retainer fee. Yes, you'll get anything not used back, but the last time I needed a strongly worded letter I had to pay the $1500 retainer and finding a lawyer under $200/hour in my area is extremely difficult. I got my remainder back the following month, but the strongly worded letter cost $400 and tied up $1500 for about five weeks. The reality is the average person -- if we go off all the studies pointing out the large swathes of the population that can't meet a $500 emergency expense -- may not be in a position to tie up cash, even in markets where a lawyer is considerably cheaper. It's also a cost-benefit equation, and the value of that (regardless of the outcome) is different for everyone -- I'm someone who'll go tooth and nail to get $20 back on principle, but for some people that threshold might have to be $2000+ to care.

>>> In Tampa, FL the a basic metabolic panel could cost you either $11 or $440 [paraphrased from a graphic in the article] No properly functioning market behaves like this.

nsxwolf 7y ago

We’ve been fighting a hospital on an overcharge that drained our HSA account. Every person we talked to has been utterly flabbergasted that we are complaining because “it says here you owe $0”. They can’t get it through their heads that the insurance paid them with our own money, and that we’d like to be refunded the overage. It’s just a confusing concept to these people. This is what happens when most people use someone else’s money to pay for things. Nobody knows or cares what anything is supposed to cost.

dnadler 7y ago
Your insurance has access to spend your HSA? That's certainly not how mine is set up, and I'm surprised that's even possible. Did you give them your account number and authorization to spend your money?
- brians 7y ago
  Mine are run by the same company and bills pass through. The result has the same effects for me as a PPO with a weird sort of IRA attached, and lower premiums than my old BCBS Elite 100/80 PPO.
- nsxwolf 7y ago
  Yes. I think the arrangement is technically called an “HRA”.
  - pishpash 7y ago
    That's just a fancy name for self insurance, i.e. no insurance. Somehow wrapping it in yet another siloed tax advantaged vehicle makes it sound better.
    - nsxwolf 7y ago
      You understand why I would have an interest in what my medical procedures cost then, yes?
      - pishpash 7y ago
        Of course. Even with a run-of-the-mill HSA + HDHP, you're basically partially self-insured and tasked with the thankless job of insurance administration. You can see there is something scammy about these things (in practice if not on paper) when they are so enthusiastically pushed by the healthcare industry.
        nsxwolf 7y ago
        Seems to me like having a lot more people being interested in the prices of things could only be a benefit.
        mgkimsal 7y ago
        when I need something, I usually don't have much luxury to 'shop around', and whatever price shopping you may want to try to do is often still hamstrung by 'in network' vs 'out of network' price tables. I needed a procedure that was going to be ~$1500 at any one of a half dozen places within a 90 minute drive; some were a bit cheaper, but they couldn't see me for more than a month. There were a couple places that were ~$1100, but it basically would have been a whole day's enterprise for 2 people to get me there and back. To save maybe $400. $400 is not nothing, but I wasn't even actually 100% sure their pricing would actually be what we finally paid - no one could guarantee that. So we may have had 2 people take an entire day from earning on the partial chance of saving some money. Might even have been cheaper in another state, but then you've got travel/hotel costs to add as well.
        flowersjeff 7y ago
        "...no one could guarantee ..." Key phrase to be sure. Many people that I know talk about how people need to know how much something costs - but these systems themselves don't know how much anything costs. Furthermore, they know this and therefore unwilling to guarantee anything. Knowing prices is great, but I feel is a non-starter when thinking about how the system can be 'fixed'. Also, you can't price shop when you're having a stroke. All in all, we have to just acknowledge that the system for everyone is broken - beyond this, I haven't a clue as to the next step.
- nicolethenerd 7y ago
  With my HSA, auto payment is apparently a setting you can turn on or off. I highly recommend having this turned off if your HSA allows.
cosmodisk 7y ago
Not suprised.We used to have customer purchasing our services on a credit provided by a finance company,then cancelling and demanding full amount to be translated to their bank accounts... It usually take a bit of time for people to get it...
radium3d 7y ago
It's a little different. It's more like hiring someone as personal buyer who buys for likely a large group of people. A majority of people don't actually use the $3600+ they spend per year on health insurance so the money adds up fast and the buyer doesn't have time to deal with individuals so they don't seem to question paying $$$ for a tissue paper. The amount of money they are authorized to spend is so large that a $$$ tissue paper is just an insignificant percentage of the total available cash. If hospitals and insurance companies are already tracking their income/expenses they should just be required to publish the anonymized data via a centralized API so we can all work on creating systems to analyze the average cost of the products. It will help insurance companies and patients as well as doctors and everyone in the end. Also, beyond the standardized API system which should easily cover all the standard financial points we can have multiple people / organizations analyzing the data. Say one particular health issue shows up in the system as costing a lot of the insurance cash pool, we would notice it right away and could funnel more cash into prevention. I'm not familiar with the industry so maybe there is already something similar available?
- taurath 7y ago
  Also given their profits are capped, the only way to make more money (which is their primary function sadly) is to inflate prices and premiums.
- flowersjeff 7y ago
  Whilst I can totally dig where you're going with this - love the idea of open API's... we know it aint a tech problem. How did Europe do this with that whole payment services directive (I think that this is what I'm thinking about) - the one that forced all payment systems to have open APIs and such?... How would we get something like this in the works? It would require a mandate from ??? Congress / the President / Bigfoot??? I can only imagine how these companies would not like this information out. Even if one were to explain that having this data would yield optimizations of their internal systems, saving them money, as the information would most likely make many within the organization look badly.
HarryHirsch 7y ago
Get a judgement, send it to collection. What's so hard?
raving-richard 7y ago
Small claims court if it's less than the relevant small claims amount. Otherwise, a strongly worded letter from a cheap lawyer. The legal system is often abused. But it sounds like you've got an actual legit issue, which is what the legal system is there for. Why not use it? If you don't want to pay for a lawyer, you can write your own strongly worded letter. Just be sure to stick to facts, and keep very good records. In your letter, explain the issue briefly but clearly. Explain how you've attempted to resolve the issue. Explain how if the issue is not resolved, you will be forced to take action. Address it to the hospital CEO, or whoever is in charge. Post it using registered mail. Your local library may have a subscription to LexisNexis or a similar legal database. This will have form letters and chunks of legal text that you can copy and paste. HN user patio11 wrote a thing about writing letters on this website that I can't just find. But find it, and read it. It also has helpful advice.
- MrFoof 7y ago
  I think the reticence most people have with initially engaging with a lawyer is they're not only not free, but initially not cheap on account of the retainer fee. Yes, you'll get anything not used back, but the last time I needed a strongly worded letter I had to pay the $1500 retainer and finding a lawyer under $200/hour in my area is extremely difficult. I got my remainder back the following month, but the strongly worded letter cost $400 and tied up $1500 for about five weeks. The reality is the average person -- if we go off all the studies pointing out the large swathes of the population that can't meet a $500 emergency expense -- may not be in a position to tie up cash, even in markets where a lawyer is considerably cheaper. It's also a cost-benefit equation, and the value of that (regardless of the outcome) is different for everyone -- I'm someone who'll go tooth and nail to get $20 back on principle, but for some people that threshold might have to be $2000+ to care.