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My understanding (not an expert by any means) is that we basically have two tiers of negotiation - the fed. govt. has way more leverage but also some amount of
by e_i_pi_2 4y ago
My understanding (not an expert by any means) is that we basically have two tiers of negotiation - the fed. govt. has way more leverage but also some amount of corruption that goes into pricing, then afterwards individual hospitals and "networks" of providers will negotiate with the insurer - sometimes after the procedure has already happened - to figure out the final price.
The end result is that you might end up with an individual doctor having to work with the insurance company for pricing, so the same procedure can cost vastly different amounts at hospitals down the road from each other providing the same level of care. To make it worse we also have laws preventing healthcare providers from providing prices upfront, out of a fear that people will forego necessary care they can't afford.
Edit: seems like this changed 01-01-2021, now we do have some price transparency laws - https://www.cms.gov/hospital-price-transparency https://www.cms.gov/hospital-price-transparency
- celestialcheese 4y ago> To make it worse we also have laws preventing healthcare providers from providing prices upfront, out of a fear that people will forego necessary care they can't afford. What are these laws? This seems so backwards - I know personally I have put off medical care in my past because I had high deductible insurance, and no guarantee that the bill I'd get wouldn't wipe me out, and no way to price shop. Paralysis of unknown.
- e_i_pi_2 4y agoAh thanks for making me look this up! Seems like it did change recently (Jan 1, 2021) https://www.cms.gov/hospital-price-transparency https://www.cms.gov/hospital-price-transparency Now assuming the hospital is compliant the information should be available. To be fair my understanding of the argument for the old law was that you didn't want a hospital with a big sign out front saying "Broken arm repair: $10k" and having people not go in for it when there might be some financial aid they could get afterwards
- willcipriano 4y agoI'm sure the real reason is that the hospital up the road will set up a sign "Broken arm repair: $9k" to compete and that isn't something the lobbyists want.
- bombcar 4y agoWhat I see around here are billboards with the current emergency room wait time on them in digital LEDs. Which often struck me as kind of weird - the rooms with shortest wait time are probably most expens
- elliekelly 4y agoIt’s not the case. The No Surprises Act requires a good faith estimation for most procedures. Although IIRC it doesn’t apply to people who don’t have insurance, which seems kind of backwards as those people would likely be the most price-sensitive and have the least amount of bargaining power in the market. I guess they also tend to have the least amount of political power, too...