4 ms·

Hey billing geeks, I have had this idea to compare US prices to the ones listed in the German GOÄ, which is the central price catalog negotiated with German hea

• c00lio 3y ago
  > Private insurance can be used as well, giving preferred access and treatment. Well, actually, the contracts doctors have with the public insurance carriers forbid giving preferred access. So handing out earlier appointments to privately insured people is verboten. But no doctor obeys this, and punishment is practically nonexistent. Differences in offered treatments are allowed, the catalogue that private insurance pays for is usually larger.
• nradov 3y ago
  US commercial medical insurers don't "get away with" pricing. They negotiate treatment prices with providers, who constantly try to raise prices. The most common way to handle pricing is as a multiple of whatever Medicare set. So if Medicare agreed to pay $20 (just making up a number) for CPT code 71045 (chest x-ray) then a commercial insurer might agree to pay 1.5× of that. The out of pocket amounts paid by plan members for insurance premiums and co-pays on employer sponsored group plans are largely under employer control (within limits imposed by the Affordable Care Act). There's nothing stopping your employer from giving you free insurance with $0 co-pays.
  • car 3y ago
    Thanks for the clarification. You are right, providers are the profiteers in the system. Often they’re set up as not-for-profits, avoiding taxes. Good examples are Stanford Health and Sutter Health. Their prices are extreme, and they expand like crazy. The profits are then ploughed into posh buildings and executive salaries. Edit: there was a Time article about this topic, which I can’t find. But this is another good one from them: https://time.com/198/bitter-pill-why-medical-bills-are-killing-us/ https://time.com/198/bitter-pill-why-medical-bills-are-killi...