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> “This stuff is such a black box,” he said. “You never really know how much your drugs cost you.” I tried a course of allergy injections (I didn't notice any

by csours 2y ago

> “This stuff is such a black box,” he said. “You never really know how much your drugs cost you.” I tried a course of allergy injections (I didn't notice any effect). I asked how much it would cost - NO ONE KNOWS. They have to submit it to insurance and then insurance spins a wheel and says a price. Health care is not designed for any human in the system. Almost everyone is having a terrible time. It's all for the shareholders.

ChadNauseam 2y ago
That doesn’t seem to quite explain it. I went to a non-profit hospital – which shouldn’t really have shareholders IIUC – and still got ripped off by confusing pricing and misleading estimates. My uninsured friend has a “good faith estimate” from a hospital that literally quotes the price as being “between $0 and $50,000”.
- csours 2y ago
  From the outside, a hospital seems like one thing; but it's really nothing at all like retail. Some doctors can bill separately, the pharmacy can bill separately, different departments can bill separately, different diagnostics can bill separately. One well-meaning hospital can't fix this; it's baked into everyone's expectations.
  - tartoran 2y ago
    Could be driven by Private Equity.
  - fakedang 2y ago
    Are the bigger hospitals like Mayo Clinic, university medical schools and MD Anderson like this too? I've only visited Mayo Clinic for the executive checkup plan which has a fixed and upfront sticker price (I'm in Europe).
- Amezarak 2y ago
  My hospital system, like many others in the US, is owned by the local government. My experience is the same as yours.
- davemel37 2y ago
  Some non-profit hospitals have for-profit management companies.
bena 2y ago
It's the reason why healthcare is so expensive in the U.S. because this is not just true for drugs, but for procedures as well. IIRC. I worked orthogonally to medical billing, but never did billing directly. Fee schedules don't get published. Because if providers know insurance is willing to pay $125 for a procedure, they're going to charge $125 rather than what it cost to do it. So if they want to know, they have to be deduced by the providers. So providers charge out the fucking ass for everything. Then submit that charge to the insurance. The insurance will say, "We'll only pay $75 of that $300 bill, the rest is patient responsibility". And often, what will happen is that the doctor will write off some or all of the remaining $225, because they weren't looking for that anyway. The charge is just to make sure they get the maximum from the insurance. The price is completely divorced from the value of the services provided. It's become this weird game.
- Spivak 2y ago
  I've been to doctors that refuse to treat you if you don't want to go through insurance and pay cash upfront for this reason. If they name their real price insurance can (apparently) go after them. I could understand maybe refusing if I don't have insurance to deal with rare but expensive complications but I do, I just know that it'll be a year long fight and I'll have to pay it all at the end anyway.
  - davemel37 2y ago
    If they take medicaid, they might not be allowed to accept private pay.
    - Spivak 2y ago
      Even from people not insured by medicaid? Fascinating.
eitally 2y ago
When my son was on Accutane a couple years ago it was a 7mo course. His prescription, from the same pharmacy with the same insurance, never cost the same amount twice.
- csours 2y ago
  Just insane

by csours 2y ago

ChadNauseam 2y ago

That doesn’t seem to quite explain it. I went to a non-profit hospital – which shouldn’t really have shareholders IIUC – and still got ripped off by confusing pricing and misleading estimates. My uninsured friend has a “good faith estimate” from a hospital that literally quotes the price as being “between $0 and $50,000”.

csours 2y ago
From the outside, a hospital seems like one thing; but it's really nothing at all like retail. Some doctors can bill separately, the pharmacy can bill separately, different departments can bill separately, different diagnostics can bill separately. One well-meaning hospital can't fix this; it's baked into everyone's expectations.
- tartoran 2y ago
  Could be driven by Private Equity.
- fakedang 2y ago
  Are the bigger hospitals like Mayo Clinic, university medical schools and MD Anderson like this too? I've only visited Mayo Clinic for the executive checkup plan which has a fixed and upfront sticker price (I'm in Europe).
Amezarak 2y ago
My hospital system, like many others in the US, is owned by the local government. My experience is the same as yours.
davemel37 2y ago
Some non-profit hospitals have for-profit management companies.

bena 2y ago

It's the reason why healthcare is so expensive in the U.S. because this is not just true for drugs, but for procedures as well. IIRC. I worked orthogonally to medical billing, but never did billing directly. Fee schedules don't get published. Because if providers know insurance is willing to pay $125 for a procedure, they're going to charge $125 rather than what it cost to do it. So if they want to know, they have to be deduced by the providers. So providers charge out the fucking ass for everything. Then submit that charge to the insurance. The insurance will say, "We'll only pay $75 of that $300 bill, the rest is patient responsibility". And often, what will happen is that the doctor will write off some or all of the remaining $225, because they weren't looking for that anyway. The charge is just to make sure they get the maximum from the insurance. The price is completely divorced from the value of the services provided. It's become this weird game.

Spivak 2y ago
I've been to doctors that refuse to treat you if you don't want to go through insurance and pay cash upfront for this reason. If they name their real price insurance can (apparently) go after them. I could understand maybe refusing if I don't have insurance to deal with rare but expensive complications but I do, I just know that it'll be a year long fight and I'll have to pay it all at the end anyway.
- davemel37 2y ago
  If they take medicaid, they might not be allowed to accept private pay.
  - Spivak 2y ago
    Even from people not insured by medicaid? Fascinating.

eitally 2y ago

When my son was on Accutane a couple years ago it was a 7mo course. His prescription, from the same pharmacy with the same insurance, never cost the same amount twice.

csours 2y ago
Just insane