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Hospitals pledge to fight admin price transparency plan in court

• KukicAdnan 7y ago
  We need price transparency! Went to a quick care the other day because of a flu that would not go away, was seen and diagnosed with bronchitis in less than 5 minutes. The quick care billed my insurance $1,840, which they talked down to $300, and had me pay $115. What?
  • skolos 7y ago
    This kind of stuff is even more ridiculous with higher cost procedures: course of radiation therapy to treat cancer - in network hospital sends bill for more than $1m, insurance pays about $3k, bills nothing to patient.
  • swebs 7y ago
    Crazy, that's the price you would have paid at Minute Clinic without insurance. https://www.cvs.com/minuteclinic/services/price-lists https://www.cvs.com/minuteclinic/services/price-lists
    • KukicAdnan 7y ago
      Yep. I don't mind paying the $116, but the disparity in pricing is so ridiculous. It's like throwing darts at a board and saying "Pay us this much"
      • marklabedz 7y ago
        Which is why my first response to almost any medical invoice, is "Would you take ["total"]*0.5 to settle the bill?"
        • sobani 7y ago
          From what I've understood from /r/personalfinance, you can probably get away with an initial offer of 5-10% of the billed price.
      • vonmoltke 7y ago
        The "discounts" shown on my explanations of benefits are absurd. My current record is a 94% "discount" from list price for a particular test.
  • topicseed 7y ago
    From the UK. Health care cost stories in the US seem incredibly dreadful. Hard to grasp how a huge power like the US can't get itself around decently-priced healthcare.
    • madamelic 7y ago
      >Hard to grasp how a huge power like the US can't get itself around decently-priced healthcare. To be honest, it's not that hard to figure out. The US gov't largely believes itself is ineffective and needs to be privatized and ran like a business. Private businesses are held up as beacons of innovation and efficiency without the "red tape" the gov't has due to purposefully created checks, balances and regulations. Hence why we elected a CEO, albeit a massive failure of one, but a CEO regardless.
      • sol_remmy2 7y ago
        > The US gov't largely believes itself is ineffective and needs to be privatized and ran like a business. Private businesses are held up as beacons of innovation and efficiency without the "red tape" the gov't has due to purposefully created checks, balances and regulations. The medical system is really not private. It is a hybrid of a state-controlled system and a capitalistic system. Here are some ways of how the system is state-controlled: 1. Hospitals cannot be freely constructed. One must apply for a "certificate of need" to gain permission from the government to build a hospital. This is not a free market. 2. Credentialism is BAD in our medical system. There is only one group of people approved by the government to do prescribe most medications and perform most surgeries - doctors. This is not a free market and greatly increase costs. Doctors earn a median of 300k/year and are the highest paid profession in every state. This is not a free market. 3. Hospitals are legally forced to treat anyone who shows up at their door - even if they can't afford the treatment. This is not a free market. 4. Medicare/Medicaid are forced to nearly buy any drug, regardless of cost, if it could save a live. Even if a drug is 500k/year, the system is forced to buy it. This is not a free market and greatly increases costs.
        • deleted 7y ago
          [deleted]
  • wil421 7y ago
    My wife had a baby in September and had to return after one night home for high blood pressure. Total bill $55k. After insurance it was $6k. We paid $250 out of pocket.
  • refurb 7y ago
    I know the stories abound, but I had an MRI done at UCSF that they billed $18,000 for. I think insurance paid $15,000. There are multiple, standalone private MRI clinics in the US that will do the same MRI for $1,500. Really UCSF? You’re a part of the problem.
• mc32 7y ago
  Yes, hospitals, that’s the way to win hearts and minds. Fortunately both parties seem to welcome this idea, to lesser and greater degrees...
  • deleted 7y ago
    [deleted]
  • avocado4 7y ago
    Hospitals don't care about hearts, minds, or patient wellbeing for that matter. You will be brought there and they will extract $8000 for a simple procedure. That's all that matters for them.
• PunksATawnyFill 7y ago
  Incredible: Trump wants to do something positive. Wish he’d tweet about this daily instead of whining.
• throw1234651234 7y ago
  This is purely anecdotal, but I had a 15 minute (literally) ultrasound. Hospital "facility use" fee: $800. 15 minutes of technician's time: $250. Bill came down to $650 after adjustments. This is messed up. I imagine people with serious health problems just kill themselves or ruin their lives forever.
  • daveslash 7y ago
    I got 1 stitch at the ER (before I was aware that Urgent Care was a a thing). First hospital visit in my adult life. Some saline solution, an alcohol wipe, a shot of Novocaine, and 1 stitch. $3,200. I now avoid the hospital like the plague (ironically).
    • swebs 7y ago
      I hit my head a while back and had to get about 10 staples. Total cost was only $150 without insurance. This was at Penn Urgent Care in Philadelphia. Our combined anecdotes reveal how useful it would be for customers to be able to shop around.
    • maxk42 7y ago
      I got the same procedure at a cash-only walk-in clinic. (Eight stitches, actually -- a chunk of flesh was literally dangling from my finger.) $200. We will never get control of the insane cost of health care until we force medical facilities to actually compete with each other.
      • HarryHirsch 7y ago
        Normal countries do this by imposing price controls, and it works remarkably well to contain costs. Why can't the US do the same?
        • maxk42 7y ago
          Unfortunately, central planning stifles innovation. We have the best cutting-edge medical technology in the world for the few who would like it and can afford it. But by eliminating pricing transparency we've also eliminated the incentive to make those technologies cheaper and more accessible to the common man.
• aphextim 7y ago
  I don't think anyone who has had to pay hospital bills would agree with the hospital lobby's decision to fight this. The article's title makes it give the impression this is okay because, orange man bad, however regardless of the party pushing for transparency it is something everyone would benefit from (other than the heal care industry/insurance company's profits).
  • daveslash 7y ago
    I thoroughly dislike the bad orange man, but I will save my strongest words for a more appropriate forum. That said, just because you may dislike someone doesn't mean that you have to opposed everything they do. I do agree with this push for price transparency.
    • olliej 7y ago
      Right? I always find myself wondering why antitrust isn’t applicable? The hospitals clearly work together to ensure that consumers don’t have accurate or correct pricing information, which has always seemed like it should be classified as anticompetitive behavior.
      • bluGill 7y ago
        I don't think they are working together so much as the system is setup to reward their anti competitive behavior so they all have followed the rewards to the same end.
    • TurkishPoptart 7y ago
      I feel the same way about Trump, but as someone who's gone through many years of trying to eke out basic health care and gone through years of minimal insurance, I see this as the government doing the right thing to a giant, bloated, sector. In many ways, health care manifests itself like a racketeering operation in the country, despite the genuine well-wishing of the battalions of nurses, doctors, staff, and assistants who help us every day.
  • Angostura 7y ago
• legitster 7y ago
  The previous administration had a similar effort that failed. I hope that this effort is successful. >"For instance, it could allow one provider to follow and match the prices of the other provider (like two gas stations across the street from one another who face no other competition)," Garmon said. I understand this argument, but I think they underrate how much people are willing to shop around when they actually have prices to use as a metric. I would be willing to travel to get a cheaper hip replacement if I actually know what the local price is, rather than being surprised by it every time.
  • bluGill 7y ago
    I'd pay more for quality. If I knew hospital X is better at hip replacement I'd pay extra to go there. Of course how much extra I'm not sure, and I'm also not sure how you compare hip replacement quality like that. It is only emergency rooms where I don't get a choice - if you need an emergency room close is important.
    • legitster 7y ago
      Unfortunately, under the current system, price and quality of care are relatively uncorrelated. Which makes sense as we learn how arbitrary pricing is. But as I understand how medical billing actually works, if only a single patient uses an MRI machine in a year, they would pass on the entirety of the cost to the single patient. But a hospital that uses the MRI constantly spreads the cost across all patients. In the latter hospital, they would also have better outcomes since they have more experience and specialization in the procedure. This is also the opposite of how it would work in a market-based industry. In an auto-shop, I know how much I can charge for any service, and before buying equipment and personnel to expand my services, I determine if it is worthwhile to invest the capital.
    • sigstoat 7y ago
      > It is only emergency rooms where I don't get a choice - if you need an emergency room close is important. i feel like the folks on here peddling this line have not ever spent any time watching who comes through an ER. most of the people who go into an ER aren't dying, or screaming in pain. they've just got a problem that can't wait until urgent care opens up again in the morning. or they need something done that urgent cares aren't equipped to do (fancier diagnostic equipment; whatever). they've got plenty of time to consult with a hypothetical "find a cheap/good ER near me" app.
• braythwayt 7y ago
  Here in Canada, there is no price transparency whatsoever. Just when people are facing the stress and uncertainty of fighting a crisis like Cancer, they are given absolutely no inkling what their treatment will cost. When a physician makes an appointment for you with a plastic surgeon to discuss reconstructive surgery... No transparency about the cost. When they prescribe chemotherapy... No transparency about what the doses cost.* When they schedule surgery... You don't have any idea if they'll pull in another nurse or surgeon during the procedure, and again... No transparency about cost. --- I feel icky making jokes about this. But seriously, price transparency is a perfect example of the "XY Problem." America asks, "How do we make paying for health care an efficient and transparent marketplace," but the correct answer is, "If what you want is a functioning, civilized country, stop trying to make healthcare a marketplace." https://en.wikipedia.org/wiki/XY_problem https://en.wikipedia.org/wiki/XY_problem --- * Prescription drugs are still a quagmire in Canada. Basic chemotherapy is somewhat covered by various provincial drug plans, but if you're employed you usually rely on your employment benefits for prescription drugs much as Americans do. Many of the things covered by employment plans are more convenient than those covered by the public plans. For example, the public plan may require a dose a day, while the product that only requires a dose a week is only covered by an employment plan. But the bottom line is that if you aren't employed and can't afford chemotherapy, you will get treated.
  • bcrosby95 7y ago
    There are shades of bad. The US health care system with price transparency is better than the US health care system without it. The same procedure can cost 1,000x more if you go across town. It's been long reported that Hospitals mostly pull prices out of their asses. The health care problem in the US is not just a health insurance problem, it is also a health care provider problem. Even if you had a single payer system, pricing like this is insane.
    • braythwayt 7y ago
      What you say is true, but does not negate or discount what I said in any way. Again, with the XY problem... If someone asks for X, but really needs Y and there is a better way to get Y than to help them with X... Of course X is better than no X and no Y. But that doesn't change the fact that Y is much, much better than X. And in the case of health care, it is not even close. Price transparency may lead to each person paying a little less, or at least being less stressed, but it still won't fix the fact that America has the most expensive system, with the worst outcomes, in the developed world. So yeah, X is better than --X, and ++X even better than X, but that doesn't change the fact that Y is still the correct solution when you focus on the problem you really want to solve rather than making the incorrect solution slightly less incorrect. --- Also, IANAE, but I do not believe that in Canada, hospitals are permitted to have a 1000x variance in pricing. I think that for those things we socialize, the government sets the price.
• egdod 7y ago
  This is one thing Trump is doing that should get broad support. It probably won’t though, because some people are physically incapable of agreeing with him.
  • vernie 7y ago
    Right. I'm over here like WTF I love hospitals and insurance companies now?
  • sakopov 7y ago
    I honestly didn't even know this was in the works. It's amazing how much effort is put towards blocking out any positive news about this administration.
    • legitster 7y ago
      It was actually one of his campaign promises: https://www.politifact.com/truth-o-meter/promises/trumpometer/promise/1393/require-price-transparency-health-care-providers/ https://www.politifact.com/truth-o-meter/promises/trumpomete...
    • Brain_Thief 7y ago
      The simple explanation for the lack of positive news regarding this administration is that it's very hard to pay attention to the small list of broadly-beneficial policy proposals it has generated relative to the endless deluge of corruption and incompetence it is responsible for.
  • legitster 7y ago
    Absolutely! We should also give credit to the Obama administration for proposing the legislation in the first place and including it in the language of the ACA.
  • theandrewbailey 7y ago
    If people can understand that a bad person can do good things (and maybe help), there's still hope left for humanity.
• sharemywin 7y ago
  I would be awesome to see more sites like this: https://www.mdsave.com/ https://www.mdsave.com/ Wish it worked with insurance
• glofish 7y ago
  This is IMO the "simple solution" to healthcare - nothing will bring down healthcare costs faster than the following - be allowed to choose - know how much something costs - pay some of the cost themselves (co-pay, health savings account) etc.
  • triceratops 7y ago
    Americans already have co-pays, deductibles, coinsurance and whatever other terms the insurance industry has cooked up, with no visible effects on costs. In addition to your other changes the following would also help: - Allow competition. Don't give hospitals the power to veto new hospitals in their area. - Disallow regional consolidation of hospital systems and medical practices. Regional monopolies are bad. - Increase resident slots and supply of doctors. Make foreign degrees easier to transfer to the US. - Outright ban pharmaceutical advertising. Nothing whatsoever of importance would be lost and all the pharma companies would save millions every year.
    • eutropia 7y ago
      There's an argument to be made with respect to advertising to physicians, but not the general public. Doctors have limited time and they ought to know what meds are available somehow..
      • triceratops 7y ago
        I thought that was called pharma marketing, not advertising. That too has had corruption and perverse incentives in the past. However, I did mean banning advertising to the general public. Doctors have the knowledge and expertise to critically evaluate statements presented to them by marketing materials (whether they do so or not is a different story). The general public, modulo the odd autodidactic genius, largely does not. If someone from the general public wants this information, they are free to find it on the Internet. In fact maybe we could make it mandatory that any materials presented to doctors are also posted on the company's website for anyone to see.
      • authoritarian 7y ago
• XG6 7y ago
  Of course doctors and hospitals don't want price transparency. That would create pricing competition, which would drive down consumer prices, lower profit margins, and force them to become more efficient. Price transparency is one of the key elements of the highly successful Singapore healthcare system. Add in universal tax-free (or tax-deferred) Health Savings Accounts, and we could not only improve the US healthcare system but also help more Americans save for retirement and build wealth. There's no excuse not to try simple regulatory solutions before committing to a massive government takeover. I hope we get bipartisan support for price transparency.
  • noelsusman 7y ago
    In Singapore, the government forces you to deposit a percentage of your income into an HSA, and then they tell you what you can and cannot spend that money on. You're only allowed to use that money to buy government-approved drugs, for example, and it's not like the FDA where they're just testing for effectiveness and safety. Also, most hospitals are owned by the government, most doctors are government employees, and most hospital visits are mostly paid for by the government. Price transparency is a relatively minor part of what makes the Singapore health system work.
    • shantly 7y ago
      I'm not aware of a single advanced-economy state (I usually shorthand this "OECD" but Singapore's not a member, AFAIK) that doesn't use price controls, explicitly or de facto (monopsony), in their health care system. Price controls, non-profit status requirement for insurers, and a non-ruinously-expensive "public option" seem to be common factors in the most "free market" (relatively speaking) systems of our peer states. Despite Obamacare we've achieved zero of those, nor have we opted to go further "left" to mimic any other proven-to-control-costs-and-deliver-care system.
  • commandlinefan 7y ago
    > doctors and hospitals don't want price transparency Well, I do want price transparency - IF it works the way they promise. It’s hard for me, as a programmer, not to draw parallels to every employer’s expectation that I should be able to listen to them describe a software problem and quote them a timeframe on the spot (which, of course, they’ll then try to “negotiate” down). On the one hand, as a non-medical-professional outsider looking in, it seems to me that _of course_ they should be able to say ahead of time how much a cataract removal surgery should cost, they’ve done it hundreds of times (I hope). On the other hand, I know how much variability occurs in software projects and how little of that is trivially predictable. On the other other hand, I can’t for the life of me imagine any possible reason why they can’t say EXACTLY how much an MRI will cost before they do it.
• istjohn 7y ago
  I spent 45 minutes at the hospital where I was to get a lab test done, trying to get a quote for said test. Prescribing doctor didn't know the cost. Lab tech didn't know. Billing department told me I needed a procedure code. Lab tech who was ready to draw blood couldn't tell me the needed code even after spending five minutes at a computer looking for it. Prescribing doctor gave me the code. Called back billing. They will call me back in 2 to 5 days with a quote. Weeks later, I've yet to hear from anyone. This was at The Ohio State University Wexner Medical Center.
  • js2 7y ago
    From a Bogleheads topic titled “How to Minimize Your Emergency Care Expenses”: > Fifth, nobody you interact with at the hospital at the time of your visit has any idea how much anything costs. Part of that is the whole price transparency thing. Those who know the price don't want the front line workers to know it. Part of it is the fact that there are so many moving parts. Medicine gets inappropriately compared to aviation a lot, but it really isn't a fair comparison. Every one getting on a flight is basically getting the same thing. Medicine is like an airline flight where every row has its own flight attendant, every one on the plane is going somewhere different, and they all get a different movie and meal hand delivered to them. Imagine how much that flight would cost? Finally, despite the fact that there are hundreds of different products and services being sold, everybody pays a different price for them. This is due to dozens of different insurance plans each of which has negotiated a different price for every product and service, co-insurance plans, government plans, and various different levels of deductibles and co-insurance and different amounts of previously consumed care already in the year. (The full post is worth reading.) https://www.bogleheads.org/forum/viewtopic.php?t=238610 https://www.bogleheads.org/forum/viewtopic.php?t=238610
    • istjohn 7y ago
      Thing is, this was self-pay for a single routine lab test. It's the simplest possible scenario.
      • randall 7y ago
• bloopernova 7y ago
  I'm being offered $550 by my insurance in "gift cards" if I use certain facilities for any MRIs or other diagnostics. I think that shows just how wildly variable different locations charge, and how much they get away with. I'd love to see a published price list for standard procedures, because I think hospitals have become too used to being cash cows for administrators and CEOs. This isn't to say I think nurses or doctors are overpaid or underworked, or don't deliver good care. I just wish that people in the USA could get good healthcare without having to claim bankruptcy. I really miss the NHS and Bupa private insurance in the UK. NHS was great for so much stuff, but when I needed multiple surgeries on my leg metalwork, I chose to use private health insurance. This let me have the same consultant as the NHS hospital, same surgeons, but in a smaller "fancier" hospital that took really good care of me. What's funny to me is that extra private insurance was just a few pounds a month, and nothing at all like the thousands we spend here in the USA.
  • mywittyname 7y ago
    > This isn't to say I think nurses or doctors are overpaid The probably are. Clearly hospital executives and administrators are raking in most of the money, but we can't sit here and pretend that caregivers don't directly benefit from such an arrangement as well. There's a reason urgent care centers and small clinics pay their doctors less than most of us make, or skip employing doctors at all in favor of nurse practitioners, and their nursing staff makes ~1/3 what they would be earning in a hospital setting. Labor is expensive; specialized labor is even more so.
    • devicetray0 7y ago
      > skip employing doctors at all in favor of nurse practitioners Hold up. I hope you're not being negative on hiring NPs. As someone who is in favor of NPs (and knows many NPs), they provide excellent primary care and hiring them can help bring down the overall cost of healthcare. I say we should teach and hire MORE NPs to provide cheaper primary and preventative care, not blame clinics for hiring them.
      • 7y ago
• rhacker 7y ago
  We have obviously routed out a LOT of fraud by forcing the auto repair industry to change its practices to inspect -> quote -> customer decision. I guess the question becomes this - is there so much fraud in this industry that we need to do this change? Even if it's NOT fraud, have hospitals simply become used to charging anything they want because they have no competition?
  • AlexandrB 7y ago
    The problem is you can't inspect -> quote -> customer decision with someone who's having a heart attack. Even if the person is lucid, they are unlikely to say no to any price if they're at death's door. No amount of competition changes the simple fact that health care is not a fungible service. CPR at facility A can't be exchanged for CPR at facility B if B is even a few minutes away. Combined with the emotional state most patients are in (something other industries, like mortuaries, prey on as well) and you have a recipe for gouging even under ideal competitive regulations.
    • rhacker 7y ago
      I don't see a problem with ambulance coming in -> charge them to the moon because if we don't do what we're going to do, they are going to die. There's a problem with applying that logic to - hey I have a pain in my hand because I was rowing a boat today without warming up. Take this 800mg Ibuprofen. 3 months later $800. (So that's a true experience with my wife and rowing a boat)
• _bxg1 7y ago
  Right now healthcare in the U.S. is the worst of capitalism (basic health is tied to income/employment, perverse profit-incentives) and the worst of anti-capitalism (anti-competitive monopolies/cartels) at the same time. I don't think improving its ability to function as a free market will ever be a real solution, but it certainly can't hurt.
• maerF0x0 7y ago
  > Transparency is not going to work where there is no competition, Emily Gee, a health economist at the left-leaning Center for American Progress, told Healthcare Dive. That's bs. I will drive to a further away hospital if it saves me $75 an hour of time spent... (edit: clearly I'm talking about non-emergency here)
  • bluGill 7y ago
    But it won't. Your insurance will pay for it either way, so you are spending an hour of your time to save your insurance $75 - which won't even be given back to you in form of lower premium.
    • maerF0x0 7y ago
      > Your insurance will pay for it either way This is an assumption based on a very good insurance package. Most have out of pocket co-pays . So yes, we have to gross it up by the co-pay percent and discount it by the Annual deductible limitt, but generally the point stands. If I can save enough money I might travel away from the monopoly. Until that data is transparently available I can't optimize that scenario w/ my own choices. > which won't even be given back to you in form of lower premium Systemically it will eventually if insurance companies are competing with eachother for your business
      • jonlucc 7y ago
        Sort of; in my experience, even with a high deductible health insurance plan, the insurance company's negotiated rates are still in effect. In other words, if a visit would be billed to an uninsured person at $200, but my insurance caps it at $100, then $100 is the price accepted by the doctor's office no matter if I'm paying because I haven't reached my high deductible or insurance is paying because I have a regular, not high deductible plan.
        • maerF0x0 7y ago
          right, but now you're talking about in-network vs out-of-network rates. I believe should disappear with price transparency...
• mullingitover 7y ago
  There should be a basic law of health care: no person is liable for a debt they incurred before they were presented with the price and had an opportunity to refuse. I'd give some amount of leeway for unconscious patients, but aside from that every single penny of expense should be agreed to up front. The absence of this policy explains a lot about how things have become so perversely broken.
  • Miner49er 7y ago
    Or we could just make healthcare a human right. No debt at all.
    • mullingitover 7y ago
      Oh, you're preaching to the choir, but I'm not optimistic about our country's chances of doing the right thing. If we're not going to follow the successful examples we've been presented with (because it's socialism! /s), and we're going to have capitalism, then we should have capitalism and engage in transactions where both parties have complete knowledge.
      • devmunchies 7y ago
        > and we're going to have capitalism, then we should have capitalism and engage in transactions where both parties have complete knowledge That's not capitalism, that's free market. You can have a free market by bartering chickens, you don't need capital for that.
    • AlexTWithBeard 7y ago
      It's an interesting question. Health care is a human right. Therefore it must be free. A prompt and fair trial is also a human right. Therefore legal help must be free. Moving around, staying warm and basic hygiene - a lot of stuff sound like basic human rights, but very few argue that transportation, heating and sewer draining services should be free. I think most people around don't mind paying for the service. They just want the prices to be reasonable and predictable.
• perseusprime11 7y ago
  You cannot do any good in this industry.
• arcticbull 7y ago
  Obligatory reminder socialized medicine exists, is cheaper [1], controls costs better [2] has better health outcomes [3], complete price transparency (for instance [4]) and no surprise billing. Also, a reminder that a majority of Americans want it [5]. And yet here we are, once again. [1] https://en.wikipedia.org/wiki/List_of_countries_by_total_health_expenditure_per_capita https://en.wikipedia.org/wiki/List_of_countries_by_total_hea... [2] https://www.healthaffairs.org/do/10.1377/hblog20110920.013390/full/ https://www.healthaffairs.org/do/10.1377/hblog20110920.01339... [3] https://www.oecd.org/unitedstates/Health-at-a-Glance-2017-Key-Findings-UNITED-STATES.pdf https://www.oecd.org/unitedstates/Health-at-a-Glance-2017-Ke... [4] http://www.health.gov.on.ca/en/pro/programs/ohip/sob/physserv/sob_master20191001.pdf http://www.health.gov.on.ca/en/pro/programs/ohip/sob/physser... [5] https://www.commondreams.org/news/2019/07/02/people-dont-insurance-companies-they-their-doctors-poll-shows-majority-voters https://www.commondreams.org/news/2019/07/02/people-dont-ins...
• sam36 7y ago
  My uncle wrecked his motorcycle once. He ended up in a ditch unconscious. Someone called 911. For what ever reason a life flight helicopter was then called and picked him up and took him to a local county hospital. He woke up there a few hours later. After they had already ran all kinds of tests. They had a large list of all the problems from busted spleen, broken bones, head concussion, etc. After a day of rest in the bed, the only thing wrong was a sore ankle and some deep scratches on his face. He checked himself out and we went and drove him home. They sent a bill of $16,000 the next month to him. He asked why it was so high since the only thing they did was give him a helicopter ride and a bed to sleep in (none of which he consented to but of course hard to consent when you are unconscious). He sent them a check for $16 which was the minimum amount required. He fully expected to pay $16 per month for the rest of his life, but they never sent another bill and he never asked... That was 15 years ago.
  • mehrdadn 7y ago
    Confused, so they flat out lied about broken bones? Something doesn't seem right.
    • sam36 7y ago
      I think the term they used was "fractured"
      • mehrdadn 7y ago
        Yeah, and my dictionary lists "bone break" as the 1st definition of that. I don't think it means anything else?
  • oh_sigh 7y ago
    Are individuals on the hook if they are unconscious and have things done to them without their consent for their own good?
    • lotsofpulp 7y ago
      In the US, yes.
• devinhelton 7y ago
  While publishing the negotiated prices for each procedure code would be interesting, I don't see how it would change much since it wouldn't necessarily be the price they would actually charge me, and it wouldn't help me know beforehand what sort of add-on procedure codes/bills were going to be part of my care. The policy I would like to see is that patients should only be legally liable for costs that they sign off on up front (at least for most elective care). It never ceases to bother me that every time I go to the doctor I have no option but to give the hospital a blank check and have to cross fingers that they will not hit me a month later with ridiculous charges.
  • cmiles74 7y ago
    Eventually the published price will be close to the amount you are being charged. I would expect health care providers to stick with their promise to post the highest possible cost but as people being to use these prices to shop around (both these numbers are exorbitant, but this one is less so, etc.), I am confident they will abandon this gambit. IMHO, it's kind of nuts they are even starting out with this argument.
• greggman2 7y ago
  An interesting interview this week on Econtalk about price transparency. The interview happened before Trump's price transparency plan was announced but the podcast just made it up this week. https://www.econtalk.org/keith-smith-on-free-market-health-care/ https://www.econtalk.org/keith-smith-on-free-market-health-c... Some guy has been running a non-insurance based surgery center for years, the surgeons make more and patients pay less or so he claims. All prices are listed on their website. They claimed they don't change prices. If a doctor misses something and needs to do extra work their policy is that's the doctors fault for not doing enough due diligence beforehand. He also claimed there are some perverse incentives like he claimed a hospital might bill an $100k but only receive $13k. But, they can claim a $87k loss which the government will partly reimburse. He further claimed that insurance companies often have contracts with employers where the employer is supposed to pay a percentage of the amount the insurance company saved for them. In other words, the insurance company will say "we managed to save you $87k on your $100k bill, pay us 20% of the savings" so they have an incentive to ask the hospital to charge more. Note: I have no idea how backed up this is. Just passing on the podcast, hoping to see more knowledgeable feedback.
• TurkishPoptart 7y ago
  This, IMO, is the best thing to happen under the Trump administration. Hospitals will have a hard time arguing on behalf of price-shrouding.
• selimnairb 7y ago
  This is why we need single payer and to abolish/greatly diminish private insurance. Hospitals and insurance companies continuously demonstrate the failed state of the healthcare market. Market-based healthcare will always be unworkable due to impossible to reconcile conflicting incentives.
• dantheman 7y ago
  I really hope this goes through - this one item will allow people to actually have educated discussions about care and ROI. It will allow people to compete, to specialize, to better serve those who are ill.
• imgabe 7y ago
  What an excellent way for hospitals to help convince everyone to switch to a single-payer system.
• soneca 7y ago
  The Econtalk podcast latest episode is about a surgery clinic in Oklahoma that has full price-transparency policy. I am outsider to US healthcare system, but after listening to it, it seems hardly controversial what would be the right thing to do here: https://www.econtalk.org/keith-smith-on-free-market-health-care/ https://www.econtalk.org/keith-smith-on-free-market-health-c...
  • wswope 7y ago
    Texas Free Market Surgery offers a near identical business model based out of Austin. Green Imaging (who I used to work for) offers cash-pay imaging services for all modalities across Texas, and are in the process of expanding nationally. Because they contract with existing imaging facilities, they don't post prices publicly to avoid poaching patients, but if you call in or message them through the website, they'll give you an up-front price for any service they offer. For family practice/general medicine, there's a business model called "Direct Primary Care" that offers you unlimited primary care services, usually for a cost of $50-80/month, and most big cities will have a few providers following this model. A lot of progress is being made in terms of transparent/affordable outpatient and day surgery services, but it's hard to get spread the word because the current healthcare model is so entrenched.
    • AtlasBarfed 7y ago
      The South is almost a total loss when it comes to medical fraud. Combined with the more unhealthy population, it is just a boondoggle. There's a reason the Tricare South contract is so coveted.
• xrd 7y ago
  I'm surprised there is no startup that sells you membership in offshore healthcare. If you want to do anything, you just jump on a short hop flight to a man made island in international waters and get healthcare. Or, coupled with a trip to Thailand. It would be disruptive and cheaper. My wife is a doctor and last night she tried to renew her credentials at a major hospital network here. She could not, despite clear instructions, open the PDF locally to add her signature. I inspected the web view in chrome tools and see it is an awful Microsoft product behind the scenes. This is the reason this attempt by Trump will never happen (I'm supportive even though I despise Trump). My wife's incentives and the hospital incentives are aligned, even though no one will admit it. Even if hospitals are forced to give price transparency, they will just go and buy a shitty solution from Microsoft (I'm using Microsoft as a placeholder, but it can be any large tech company who wants in on the action), who will be happy to certify it for the law. It won't work and the hospitals can blame Microsoft. Microsoft will lobby politicians to water down the law so they won't pay anything but a pittance if things don't work. Consumers will get continually screwed. The doctors and the hospitals will continue to make great money because they will still not have to admit pricing this way, with zero transparency, is the golden goose of healthcare and why costs are insane in the US.
• carapace 7y ago
  (EXPLETIVE DELETED! I try to avoid low-content comments, i do, but goddmnit it pisses me off to hear them say, "Oh the poor patients will be so confused!")
• jimbob45 7y ago
  The most salient issue is insurance providers being able to proclaim arbitrary hospitals as "in-network" and "out-of-network". My significant other claims that hospitals are now hiring contractors, who are always by definition "out-of-network". This hurts the career prospects of the contractor and lowers the level of care received. And for nothing! Insurance should not be certifying which doctors you can and cannot see. That's for the medical boards to decide.
  • jonlucc 7y ago
    Yeah, if I go to an in-network facility, then they have an out-of-network provider walk into my room, how am I supposed to know? The same is true of labs. My wife had her blood drawn and sent to a lab every couple of years without issue until one year they sent it to a different lab unbeknownst to her. It was out-of-network and cost $800.
    • AnimalMuppet 7y ago
      I've had good luck arguing with the insurance company on that kind of thing. It's worth a phone call.
      • jonlucc 7y ago
        It's been way too long now, but thanks for the tip. We called insurance and the doctor's office several times each to no avail. Insurance's answer was that we should sit in the exam room with an insurance representative on the phone to ask where each vial of blood is going and what for, then relay that to the insurance representative to give a verdict.
• greenimg 7y ago
  The problem with transparency at the hospital level is the CPT coding system, for which all medical entities including the govt pay the AMA millions of dollars to use, which splits up exams and procedures into components. So even though the knee MRI might cost $1600 (ridiculous but typical), that does not include the radiologist's interp, billed separately by the rad group, or the $300 orbit xray to screen for metal. Also anesthesia is paid based on time, cannot predict that. It is all a sham. And, they can get out of it for a $300 a day fine....well worth it to most of them.
• bootlooped 7y ago
  I called a pharmacy once and asked how much a vaccination would be. I had insurance. They told me they couldn't tell me how much it would be until after I got the shot.
  • frankharv 7y ago
    PBS has an excellent report about flu vaccinations and the widely varying prices. Millions of shots given every year and prices from free to $85. I wonder what the actual vaccination vile costs in this whole scheme compared to the overhead. https://www.pbs.org/newshour/health/the-hidden-costs-of-free-flu-shots https://www.pbs.org/newshour/health/the-hidden-costs-of-free...
• deleted 7y ago
  [deleted]
• fbanks 7y ago
  Additional anecdata: Enjoyed an extended honeymoon through Thailand, Singapore, and Malaysia in 2016 and my wife was bitten by a stray dog in rural Thailand early on -> 7 medical interactions involving post-exposure prophylaxis and rabies shots in all 3 countries over that next month. (She's fine BTW!). Price transparency was really amazing in all these places and I think it might be a single reform that's broadly ameliorative of the max-friction / painful experience of US healthcare. In each country, we basically called around, asked "do you have this shot and how much is it" and got a more or less straight answer, despite having some language issues everywhere but Singapore. Whole experience cost ~ $1k, including some visits for 2nd opinions to high-end private clinic in Singapore and we just gave up bothering with it on our US insurance b/c of deductibles and hassle.
• mriguy 7y ago
  Plug for Econtalk episode on exactly this topic - transparency in prices for healthcare: http://files.libertyfund.org/econtalk/y2019/SmithKhealthcare.mp3 http://files.libertyfund.org/econtalk/y2019/SmithKhealthcare...
• mriguy 7y ago
  Plug for an Econtalk episode on exactly the topic of transparency in healthcare prices. http://files.libertyfund.org/econtalk/y2019/SmithKhealthcare.mp3 http://files.libertyfund.org/econtalk/y2019/SmithKhealthcare...
• TurkishPoptart 7y ago
  My dad, who is in his late 60s, has about $200k to live off of in his retirement. Provided I outlive him, I have a sneaking suspicion that his savings will not only be siphoned out by whatever hospital system inevitably treats him, but that _I_ will have to cough up the remainder! Granted, this isn't a discussion he and I have had. Just goes to show that if you have some terminal condition in this broken country, it's better to just be hit by a bus or drown, than be "treated" comfortably in a hospital bed for $5k+ a night.
• soapboxrocket 7y ago
  I think the bigger scam is how they break apart the hospital/doctors offices into separate companies. Now I'm not complaining how I go from one building to get blood drawn and a different building for the emergency department. I'm complaining how I walk across the hallway in my doctors walled garden inside the building but when I enter that room, in his area, and get an x-ray that is a completely different company that bills me separately and I have to pay a different co-pay to.
• naveen99 7y ago
  Insurers must have data on pricing. You can call up some already before having imaging procedures for some guidance on cost. Maybe they can expand price transparency as a differentiator to their competitors.
• fzeroracer 7y ago
  Price transparency is a losing battle. Let's say they make prices transparent. You ask them about the cost of getting an X-ray done and they quote you $Number. You go and get an x-ray done and you're billed for $number plus a few extra thousand for any number of unknown costs. Hospital billing is a lot like getting billed for internet/phone/cable etc. They'll throw all kinds of bullshit charges, ding you for not using certain things and more. Then you have to waste energy calling them up to talk with someone whose job is to get you off the line. That's assuming you can even shop for your needs. If it's an emergency then you're screwed either way. The only change this would cause is that insurers and hospitals would adapt and figure out other ways to sneak in charges. If you want to fix this problem at the core, then trying to make it more of a free market won't work. You need stronger oversight and control to keep things in check.
• Wh1skey 7y ago
  Surprise, state monopoly wants to keep their monopoly.
• 7532yahoogmail 7y ago
  I dislike the Trump admin a lot. But I like this a lot. The federal government ought to make this step 1 in a strategic effort to make a consumer report campaign for patients. 100pct consumer driven all about where the money goes, why, by whom, how prices are assessed, how they differ geographically, and outcomes to money spent. Put the consumer in charge of their money
• burke_holland 7y ago
  > Instead of helping patients know their out-of-pocket costs, this rule will introduce widespread confusion, accelerate anticompetitive behavior among health insurers, and stymie innovations in value-based care. So people are too dumb to understand prices, and unlike any other economic system to ever succeed, knowing the value of a thing will DECREASE pricing competition. I was waiting for the good argument on why this is a bad idea. Instead we got _that_.
• greenimg 7y ago
  Doctors' wages have grown minimally ocer the last 20 years. Increased costs go to big pharma, 'not for profit' hospitals, and insurance companies, the "cartel". Meanwhile, the expense and number of years of training for high end docs increases. I am 57 and still did 4 years undergrad, 4 years med school, and 5 years postgrad. I did not do the 1 or 2 year fellowship now required for many radiology positions. Read the Proscan law suit about what happens when undertrained folks read imaging exams. It is not the shortcut needed to save healthcare. We can pay docs fairly if we get 80 percent of care away from hospitals where it costs 3 times more than it does elsewhere. Because hospitals employ or subsidize 70 percent of docs, most care happens there. That is really a huge part of the problem.