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One of the last tweets was the most interesting - "Just looking at Stanford's 2011 vs 2020 data, you can see charges going up more than 300% in some cases" Tha

One of the last tweets was the most interesting - "Just looking at Stanford's 2011 vs 2020 data, you can see charges going up more than 300% in some cases" That is absolutely insane to me. I really don't understand how that's possible at all - I know no one really pays sticker price on any medical bills but still.

failwhaleshark 5y ago
Here, take this for-profit, inelastic demand service you need right now without seeing the prices. Trust us. You won't be bankrupt soon. Like, what are you going to do? Get up from the ER gurney and comparison shop at another hospital?
- geoduck14 5y ago
  My wife had a baby a while back. The hospital she went to did 50% of their business in delivery. Given 9 months of notice (the gestation period of humans), THOUSANDS of babies delivered every year, and professionals talking onthe phone - NO ONE could tell me how much it would cost to give birth. It blew my mind - how can you NOT know?
  - geerlingguy 5y ago
    6 months out, we're still getting random bills from our baby's birth. Only difference from first three is I know to expect it, so I'm numb to the insanity.
    - failwhaleshark 5y ago
      What other business in the entire world bills large, random amounts of money without explicit, informed consent? Also, does your insurance cover these random bills or is it copay/80%?
- atlasunshrugged 5y ago
  Lol right? Although I'm guessing even for non-emergency services there's still not a ton of comparison shopping going on. People probably trust their own doctor's referrals and don't know to comparison shop - with the new rules it seems a bit easier but I'm sure hospitals don't make it all that easy.
refurb 5y ago
That’s the kicker - almost no one pays these prices so when they get stupid nobody notices. Unless you’re uninsured then that’s the price they use. As someone in the healthcare field - the best way I can describe it is that providers and insurers fight it out however they can. The problem is is that patients get the shit end of the stick. I think calling out that both hospitals and insurers are fucking over patients is a positive change. Hospitals used to always get a pass, but they’re a huge part of the problem.
- caturopath 5y ago
  > Unless you’re uninsured then that’s the price they use. I don't think many uninsured people are paying sticker. Sometimes they automatically get charged with a discount, sometimes they have to call and get it. Some folks don't know to call, but these folks' bills are, I expect, not usually getting paid in full in the end anyhow.
  - refurb 5y ago
    True it’s not the price they pay typically, but it’s the price they start with. It’s “hey, well knock 50% off the cost if you pay now”. Which is stupid, since the price has no basis with reality. The insurance companies know this - when they negotiate, they look at $90k for stitches and say “yeah, we’ll pay you $1,200”. The uninsured get screwed because the hospital acts like their charge master prices have some basis in reality.
  - hasbot 5y ago
    In my case, there was no discount.
    - caturopath 5y ago
      You were charged the equivalent of 93k for stitches and paid it? That is exceedingly rare.
- atlasunshrugged 5y ago
  But do uninsured people actually really pay this? My impression was that you still can (and should) try to negotiate with hospitals/providers whenever possible and/or ask them to create a payment plan for you. But maybe that's not common knowledge? Since you're in the space, what do you think of the startup they mentioned in the thread, turquoise.health (or rather the idea behind it, not literally the startup)?
daniel-thompson 5y ago
> I really don't understand how that's possible at all The MBA-ization of healthcare - they realized they could, so they did. Mostly because the business processes around medical billing have become so convoluted, with so many layers of middlemen, that it's essentially impossible for a layman to understand and reason about.
- fukmbas 5y ago
  Literally happening in tech as well
JamesBarney 5y ago
I really think one of the lowest hanging fruits would be a law that forces providers to pick and share a sticker price for different services. How can anyone price shop without knowing any of the prices, and if no one is price shopping there isn't any pressure to lower prices.

failwhaleshark 5y ago

Here, take this for-profit, inelastic demand service you need right now without seeing the prices. Trust us. You won't be bankrupt soon. Like, what are you going to do? Get up from the ER gurney and comparison shop at another hospital?

geoduck14 5y ago
My wife had a baby a while back. The hospital she went to did 50% of their business in delivery. Given 9 months of notice (the gestation period of humans), THOUSANDS of babies delivered every year, and professionals talking onthe phone - NO ONE could tell me how much it would cost to give birth. It blew my mind - how can you NOT know?
- geerlingguy 5y ago
  6 months out, we're still getting random bills from our baby's birth. Only difference from first three is I know to expect it, so I'm numb to the insanity.
  - failwhaleshark 5y ago
    What other business in the entire world bills large, random amounts of money without explicit, informed consent? Also, does your insurance cover these random bills or is it copay/80%?
atlasunshrugged 5y ago
Lol right? Although I'm guessing even for non-emergency services there's still not a ton of comparison shopping going on. People probably trust their own doctor's referrals and don't know to comparison shop - with the new rules it seems a bit easier but I'm sure hospitals don't make it all that easy.

refurb 5y ago

That’s the kicker - almost no one pays these prices so when they get stupid nobody notices. Unless you’re uninsured then that’s the price they use. As someone in the healthcare field - the best way I can describe it is that providers and insurers fight it out however they can. The problem is is that patients get the shit end of the stick. I think calling out that both hospitals and insurers are fucking over patients is a positive change. Hospitals used to always get a pass, but they’re a huge part of the problem.

caturopath 5y ago
> Unless you’re uninsured then that’s the price they use. I don't think many uninsured people are paying sticker. Sometimes they automatically get charged with a discount, sometimes they have to call and get it. Some folks don't know to call, but these folks' bills are, I expect, not usually getting paid in full in the end anyhow.
- refurb 5y ago
  True it’s not the price they pay typically, but it’s the price they start with. It’s “hey, well knock 50% off the cost if you pay now”. Which is stupid, since the price has no basis with reality. The insurance companies know this - when they negotiate, they look at $90k for stitches and say “yeah, we’ll pay you $1,200”. The uninsured get screwed because the hospital acts like their charge master prices have some basis in reality.
- hasbot 5y ago
  In my case, there was no discount.
  - caturopath 5y ago
    You were charged the equivalent of 93k for stitches and paid it? That is exceedingly rare.
atlasunshrugged 5y ago
But do uninsured people actually really pay this? My impression was that you still can (and should) try to negotiate with hospitals/providers whenever possible and/or ask them to create a payment plan for you. But maybe that's not common knowledge? Since you're in the space, what do you think of the startup they mentioned in the thread, turquoise.health (or rather the idea behind it, not literally the startup)?

daniel-thompson 5y ago

> I really don't understand how that's possible at all The MBA-ization of healthcare - they realized they could, so they did. Mostly because the business processes around medical billing have become so convoluted, with so many layers of middlemen, that it's essentially impossible for a layman to understand and reason about.

fukmbas 5y ago
Literally happening in tech as well

JamesBarney 5y ago

I really think one of the lowest hanging fruits would be a law that forces providers to pick and share a sticker price for different services. How can anyone price shop without knowing any of the prices, and if no one is price shopping there isn't any pressure to lower prices.