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Totally. A few years back I asked both my doctor and insurance company how much a procedure would cost in advance. They both knew this answer and both flat refu

Totally. A few years back I asked both my doctor and insurance company how much a procedure would cost in advance. They both knew this answer and both flat refused to tell me until I got the service. How would that possibly fly in any other sphere? A friend of mine that works in health care admin and IT described walking into a doctor’s office ‘like walking into a used car lot.’ It seems to be one of those few holdout areas where the information economy hasn’t affected. Maybe it’s even perverted it, by enabling data holders to optimize inefficiency for their own benefit.

jrs235 8y ago
Walking into a doctor’s office is like buying a timeshare. You have no idea or control over how much the fees will be.
maxerickson 8y ago
They know how much a particular code costs in advance. They are less certain whether a particular course of treatment will be coded in one way or another. It's probably not a good payment model, it doesn't make any sense for the insurance company to be taking on risk that the provider should be bearing, but here we are.
- reilly3000 8y ago
  That makes sense. ICD9/10 is certainly byzantine, and widely abused, but it seems reasonable to not quote something that isn't coded yet. I did some research for a company once on Medicare reimbursements. That data is all publicly available via data.gov, sorted by code and much more. The private insurance market could follow suit, and providers could also publish that information if agreements didn't forbid it. The data simply needs to be price per code per insurance policy. I understand providers may not want people bickering over what codes are used, but they ought to be able to produce that report easily.
  - pauljurczak 8y ago
    That's where it gets even more bizarre. Some states legally protect health insurance companies for not disclosing their price list. Highly paid lobbyists pushed that one through legislation on trade secret/proprietary data doctrine. You can't inconvenience the holy "free" enterprise in America.

jrs235 8y ago

Walking into a doctor’s office is like buying a timeshare. You have no idea or control over how much the fees will be.

maxerickson 8y ago

They know how much a particular code costs in advance. They are less certain whether a particular course of treatment will be coded in one way or another. It's probably not a good payment model, it doesn't make any sense for the insurance company to be taking on risk that the provider should be bearing, but here we are.

reilly3000 8y ago
That makes sense. ICD9/10 is certainly byzantine, and widely abused, but it seems reasonable to not quote something that isn't coded yet. I did some research for a company once on Medicare reimbursements. That data is all publicly available via data.gov, sorted by code and much more. The private insurance market could follow suit, and providers could also publish that information if agreements didn't forbid it. The data simply needs to be price per code per insurance policy. I understand providers may not want people bickering over what codes are used, but they ought to be able to produce that report easily.
- pauljurczak 8y ago
  That's where it gets even more bizarre. Some states legally protect health insurance companies for not disclosing their price list. Highly paid lobbyists pushed that one through legislation on trade secret/proprietary data doctrine. You can't inconvenience the holy "free" enterprise in America.