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This is my wheelhouse, so let me back up and offer you some context: Hospitals are required to have a list of standard prices for all their procedures (usually
by wswope 5y ago
This is my wheelhouse, so let me back up and offer you some context:
Hospitals are required to have a list of standard prices for all their procedures (usually called a “chargemaster”). Hospitals can set these prices basically at their own discretion, but are legally barred from charging more than their chosen amount. Payors (read: insurance companies) often negotiate much better rates than the numbers on the chargemaster, but the hospital can never negotiate to have a payor exceed chargemaster rates. Unsurprisingly, this incentives hospitals to price their chargemasters stupidly high.
Each payor the hospital accepts will have their own negotiated rates, which incentives hospitals to be very secretive about their pricing (all they are required to publish is chargemasters, and that’s a recent development). If you want to keep going down the rabbit hole, you’ll likely have to start bugging your insurance to get more details about the negotiated rates.
However, you’re in a highly-populated area and seem to be looking to get an outpatient procedure done. Depending on the type of procedure, there’s a whole blossoming network of providers who avoid these issues by offering cashpay rates (whole nother rabbit hole I won’t get into for brevity) that can be much cheaper than your deductible, or in the case of surgical stuff, coinsurance. I’d highly recommend looking for one of them if it makes sense in your situation. Happy to offer guidance based on the general category of procedure you’re looking for.
Your experience is not abnormal, and the US medical industry is completely fucked. Hospitals spend billions annually on lobbying (more than big oil), and they’ve accomplished near-total regulatory capture.
- IG_Semmelweiss 5y agoUpdate: I went down the rabbit hole: Tried calling insurance, and the concierge 3rd party servicer was helpful. (Big factor: plan is "Platinum+" plan). After 1 hour on the phone, the concierge provided the best priced "negotiated" facility rates nearby. So now we know what is available. One price was 75% below the price quoted by the original facility after scheduling. However, now we need search the doctors with surgery privileges in the price-competitive facilities. I can't believe I am going to say this but I think at this point I'm ready to proceed with Cashpay. Can I email you for guidance ? (i don't want to disclose procedure here).
- wswope 5y agoI don’t know the NY area well enough to offer much pointed advice for surgical stuff in particular, but you’re welcome to shoot me a message at “<hn username>@pm.me” if you so desire. The two sites I personally use aren’t showing a lot of hits for the NY area, but I stumbled on this site, which should at least give you a baseline to determine if going cashpay over insurance is worthwhile: https://www.newchoicehealth.com/ https://www.newchoicehealth.com/. Hope this helps!
- IG_Semmelweiss 5y agoThanks: This also looks useful for cashpay. https://shophealth.fmma.org https://shophealth.fmma.org
- nojito 5y agoYou’re glossing over the fact that in OPs market(and others) hospitals are barred from disclosing what insurers reimburse for charges or else they will be bumped to a lower tier by the insurer and will lose referrals. You also ignore the fact that insurers lobby much much harder and more ruthlessly than hospitals do.
- wswope 5y agoTotally valid points, but outside the scope of op’s situation and how much information a single post should probably try to dump out IMO.