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Related: I'd love an app or web site that lets me type in a medical procedure needed by someone close to me. After an AI chat conversation where I clarify the p

• thallium205 3y ago
  CMS publishes all their rates which is where almost all pricing is based off of (typically some multiple).
  • bardworx 3y ago
    Only issue is that you cannot get a bundled price. For example, you know what a colonoscopy costs but only the procedure and not all the addition care that may come with it. At least from my understanding.
• breadwinner 3y ago
  > I think millions of US citizens would subscribe. And why would millions of US citizens be interested in such a service? If they have insurance, insurance pays most of the costs. And this is the reason medical costs are on an upward spiral in the US: consumers are not incentivized to shop around.
  • wnolens 3y ago
    Many many people have high deductible plans, or need to use out of network providers. We cannot shop around as it is.
  • hathawsh 3y ago
    A lot of US citizens have moved to "high deductible" health insurance plans, which means they pay for most medical procedures up to some yearly maximum (such as $10k.) The advantage is the monthly premium is significantly less. Those people are very incentivized to shop around.
    • chatmasta 3y ago
      This is pretty much the default option for your average person who doesn't have employer-provided healthcare. And the "significantly less" monthly premium is still in the range of hundreds of dollars. It's outrageous.
      • zargon 3y ago
        It's also the default for very very many employer plans. If you do have a lower deductible option, it is even more hundreds of dollars on top.
  • EatingWithForks 3y ago
    I think the reason medical costs are on an upward spiral is not consumers not shopping around. It's that it's extremely hard to get a price for healthcare, that hospitals are being bought up by investment companies uninterested in improving outcomes but very interested in jacking up the price of service, and that it is perfectly legal to have the only cure for debilitating, potentially fatal illnesses like hepatitis C cost $24,000.
    • breadwinner 3y ago
      You should take a look at the prices of medical procedures not covered by insurance, such as plastic surgery. The prices are reasonable, and the reason is that when procedures are not covered by insurance, consumers shop around. When consumers spend out of pocket, they are very much interested in seeing the price before they do the procedure, and hospitals can't and don't hide the price.
      • ipython 3y ago
        I’d love to see the shopping around that you can do when you need urgent medical care. “Hold please 911, I need to first get three competing quotes for ambulance service”
        • NoZebra120vClip 3y ago
          You jest, surely, but keep in mind that one of the most financially significant decisions to be made is going to be the hospital which the ambulance transports you to. Some insurance plans charge a premium for mileage when it's not the "closest available", and you can imagine the damage if the chosen facility is "out of network" or not otherwise covered.
        • mindslight 3y ago
          Spoken like someone who has never sat waiting in an "emergency" room for hours. The sheer majority of medical services happen non-urgently.
  • Timon3 3y ago
    Why don't people in other countries have to "shop around" to keep healthcare prices at acceptable levels?
    • qwytw 3y ago
      Because prices are more or less regulated and controlled. e.g. the Swiss healthcare system is privatized to a much higher degree than the US one (no Medicare/Medicaid equivalents) but 'basic' insurance plan prices and deductibles are fixed so prices still remain reasonable.
      • Timon3 3y ago
        So logically it would seem that the US should introduce regulation instead of forcing its people to shop around, right?
        • qwytw 3y ago
          You can have both? Regulated minimum insurance coverage, maximum premiums/deductibles and transparent prices and an option to shop around for non emergency cases. You still want providers competing either on price and service quality (I don't see any issues with that as). The problem with fully public systems in Europe nowadays is that you end up with two tiers. There is public option with poor service and several month long queues for poor people. People with higher incomes can get reasonably priced private insurance which lets them skip the queue, shop around for "better" doctors/service etc.. In this case it still ends up being subsidized by the public because higher income = better than average health and the government still ends up paying the bill for high cost treatment for serious diseases or emergencies. A well regulated fully private system with income based subsidies just seems like the more fair and efficient option and it should be better at handling supply issues. The main issue US seems to have is massive inefficiency and IMHO both regulation and increased competition is the best (and most feasibly) way to solve this.
• moneywoes 3y ago
  Would they pay for it?
  • hathawsh 3y ago
    If that app works reliably, then yes, because it would regularly save people thousands of dollars under the current US health care system.
• nradov 3y ago
  Most large medical insurance companies already have some sort of cost estimator tool for their plan members. You can log into the member portal and search for common procedures to get estimates of what different network providers typically charge.
  • brewdad 3y ago
    Admittedly, I haven't looked in a few months but the last time I used that tool it gave me some outrageous range like $2.000-10,000. Not particularly useful.
  • aquaphile 3y ago
    You can check ours out at https://providers.evryhealth.com/ https://providers.evryhealth.com/ Select the EPO plan, then select the "Cost Estimator" tile below the search box. We provide this for the most common ICD codes, and will be adding more in the future.
• WaitWaitWha 3y ago
  > Does such a thing exist? [...] I think millions of US citizens would subscribe. Yes, such thing exists. My friend just had an endoscopy & colonoscopy together. She was able to get a price estimate through her hospital's portal both with and without her insurance, prior to her procedures, requiring no special interaction besides picking the service she was interested in and if she wanted to see the price with or without insurance. The system seem to show her anything and everything she needed, from a routine office visit, these procedures, to delivering a baby. It not only includes the price at that facility but also a range from low to high, and where the facility fits. It also gives breakdown of the fees, although not deep enough. The service seems to be by a company called Epic (www.epic.com), based in Wisconsin.
  • zapdrive 3y ago
    > a company called Epic Epic is the biggest provider of hospital information systems in the US by market share. The hospital was probably using their software.
  • riceart 3y ago
    > The service seems to be by a company called Epic (www.epic.com), based in Wisconsin. Lol, that mom and pop shop. That’s the largest EMR vendor in North America and second in the world. They’re the provider of the patient portal frontend amongst other things but there’s a lot more behind the scenes that must be done (with varying levels of quality) that is institution specific. Just using Epic does not make this work.
    • brendanyounger 3y ago
      Exactly. IF you're a hospital system paying 10's of millions of dollars annually to Epic, and IF you want to pay for Epic's price estimation tool and offer it to consumers, then, yes, your patients can get a rough estimate of the cost of their elective surgery. I grew up in Madison, Wisconsin. Most of my graduating high school class works for Epic. Their campus rivals Google's. Fun fact, they bought all the farm land you can see to the horizon and rented it back to the farmers for below market rates just to ensure the view from their campus was unobstructed by new development. If you think anything about Epic is free or in the patient's best interest, check out their auditorium: https://cuningham.com/portfolio/epic-deep-space-auditorium https://cuningham.com/portfolio/epic-deep-space-auditorium You could host a Taylor Swift concert in there and have unused seating.
• HDThoreaun 3y ago
  There's a reason medical providers refuse to tell you the cost before a procedure. They honestly do not know, there are just so many complications and unforeseen events that can happen. While the Trump executive order forced some consolidation of medical codes there's still a massive difference between providers, so you can't even compare the lists of two hospitals since they're not charging for the same things.
  • maxerickson 3y ago
    If they can't predict a complication, shouldn't they be setting an ahead of time fee that will on average cover it? Why does the provider get to push the unpredictable risk onto the patient who has less control than they do? Like I shouldn't be billed extra if my surgeon is hungover and things don't go smoothly.
    • deleted 3y ago
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    • riceart 3y ago
      > Like I shouldn't be billed extra if my surgeon is hungover and things don't go smoothly. That’s what you think is the common root cause of complications? You clearly are not interested in a productive discussion. As for a fee for unpredictable occurrences - that’s what insurance is.
      • maxerickson 3y ago
        If the amount to bill the patient's insurance is determined after the complication, it's not an unpredictable risk, it's a fact. If it can't be predicted, then it more or less exists for each procedure, but that isn't reflected in the cost, the patient that has the bad experience gets charged extra for it.
        • deleted 3y ago
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        • deleted 3y ago
• gurleen_s 3y ago
  This is so insanely dystopian. You shouldn’t have to figure out where care is cheapest, especially in an emergency.
  • loeg 3y ago
    Everyone wants this for non-emergency scenarios.
  • bandrami 3y ago
    Emergency care is less than 3% of medical spending. Everybody loves to bring it up but it isn't really an issue. Of course nobody is suggesting you shop around for emergency care. The big issue is chronic condition care, and you really should be able to compare prices for that.
    • ipython 3y ago
      The problem for me is emergency care is where I’ve easily spent the most healthcare dollars. Providers already treat you with disdain and the back office in most doctors offices can hardly function as it is. When you ask how much something will cost, you will get somewhere between a blank look - if you’re lucky - to outright disgust that you could ask such a pedestrian question. You wouldn’t understand how complex medicine is and what could happen, you pleb. So how could we do something like give you a dollar amount?
      • sh34r 3y ago
        I think you might be taking it a bit too personally. I live in New England, and people are very blunt and straightforward here. I've gathered, asking if certain things are covered, that the office staff (and even moreso the providers), genuinely have no idea how any of this shit works. People are to the point here, so some of them will tell me as much, and I learn it's pointless to ask those questions at time of care. Wait for the garbage to go into the system, garbage comes out, and then we can maybe talk... Because this is totally how legitimate businesses operate, and bears no resemblance to how the mafia would determine what you owed in protection money. But arguing with the front desk staff would be rather pointless. You just go along with the madness, just like citizens of the USSR did when everything was falling apart around them, and hope the whole thing crashes and burns sooner than later. In other parts of the country, people are passive aggressive and it's extremely annoying. They won't admit they don't know, because it's all about appearances. Patients faced with such responses would become irate. What do you mean you don't know?! The workers hate themselves for not knowing, and they know this whole thing is a scam even better than you do. They hate themselves for participating in the scam, and so the cognitive dissonance manifests as rudeness towards you.
• brendanyounger 3y ago
  It might exist soon. There are a few other companies working with the hospital (and much larger payer/insurer) price data, but it's a _very_ small community. It's been said that you need a screw loose to really enjoy digging into the data. Even beyond just collecting and organizing the disparate files (which Alec has been doing a yeoman's job of with an all-volunteer force), you quickly realize that many of the quoted prices are just flat out wrong, or, at best, misleading. Even people in the business struggle to make sense of them. An example: you look at a hospital MRF to see the cost for a knee surgery on a BCBS plan and it just happens to be exactly 3.5x the Medicare rate. Then you look at all their other quoted prices in the MRF and realize they're _all_ 3.5x Medicare. Someone in the billing department was really lazy putting together that MRF! Then you look at the BCBS MRF and see a rate which is 1x Medicare. Definitely not right. So you ask the BCBS affiliate what gives and they say the hospital you're looking at is on the ancient APC billing codes which means the HCPCS code you were looking at for the knee surgery would never be billed by this hospital and all the rates you just looked at are complete bunk. Now, take that knowledge and make a simple-to-use, mostly correct user-facing website! Because if you quote the wrong $ amount, the internet will roast you alive. As I said, it might exist sometime in the next few years, but it will take a lot of behind the scenes effort to make it work. Some of the folks working on this problem: https://turquoise.health/ https://turquoise.health/ https://www.serifhealth.com/ https://www.serifhealth.com/ https://tynbil.com/ https://tynbil.com/ https://www.healthcostlabs.com/ https://www.healthcostlabs.com/
  • atourgates 3y ago
    This is absolutely right. And to complicate things even more: the hospital might actually bill 3.5x the Medicare rate to BCBS, but they’ll then expect to get paid some totally different number that they’ve negotiated separately with BCBS that’s somewhere between Medicare’s allowable and the ludicrous 3.5x they bill.
    • brendanyounger 3y ago
      Supposedly all these new laws around price transparency are aimed at exposing the "real" rate, not the inflated rate on the initial bill. 3.5x Medicare is actually somewhere around "reasonable" and is what a commercial plan like BCBS will actually pay. 10x to 50x is what would appear on the initial bill. It's hard to escape the conclusion that the whole thing is a massive protection racket (i.e. pay monthly premiums or get a shockingly large bill weeks after the fact that you have no way of negotiating down except making kissy faces to the billing clerk). The only reason it hasn't been litigated on those grounds is that there are too many entities involved so whomever you prosecute first will cry foul and blame the other guy.
• groby_b 3y ago
  It's only of limited helpfulness because the charging system for US healthcare is utterly bonkers. Might well be the actual care runs you $3500, but then you need to add $1000 for the aspirin they gave you, $800 for some gauze, and another $2500 for that MRI, because by jove it will be amortized. And at that point, you have a negotiable bill - because all health care bills in the US are open to negotiations. The insurance strategy to negotiation is usually a simple "yeah, we only cover that much, and you'll like it". The private strategy is reminding hospitals that they only make cents on the dollar if it goes to collection. Don't get me wrong, price transparency would be an enormous step forward for the US, but it's still just one step on a long road, and it won't be as useful as you'd hope.
• eli 3y ago
  All 3 of the health insurance plans I've used recently have a tool like this in their portal. They have the data; it's the average of what the providers have charged other members.
• newshorts 3y ago
  I did this a few years back using the .gov database and it never caught on. Will see if I can dig it up sometime and put it back online