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Question for the techies here: Due to lack of political will and deep-seated corruption I believe a lot of issues in the US system are almost unfixable but I al

Question for the techies here: Due to lack of political will and deep-seated corruption I believe a lot of issues in the US system are almost unfixable but I always wonder why it has to be so convoluted (besides being hyper-expensive). Why can't the insurers have an app where the patient (or the provider) can type in the procedure codes they are planning to use and then the insurer returns the co-pay, co-insurance and other cost based on the plan the person is in? The insurer must have these systems already internally so why not mandate to give access to the calculations to patient? I had several occasions where I tried to figure out how much something would cost and the answer was "we can only tell you after the procedure was done". This seems to be totally doable to me.

patja 2y ago
In my experience this behavior is due to the fact that they don't really know on the insurance side how the care provider is going to code something until they have actually done the procedure and have submitted it with the coding. And there is a very high wall between the insurance/patient billing side and the care providers, even in a case like Kaiser where they're all employees of the same company.
nradov 2y ago
Insurers have an app where the patient (member) can type in a procedure code and see prices for local network providers. It's literally right there in every member web portal! Every health plan has sent out multiple notifications to their members! How are people still not aware of this? https://www.cms.gov/healthplan-price-transparency/consumers https://www.cms.gov/healthplan-price-transparency/consumers
- rqtwteye 2y ago
  I have never received anything.
HDThoreaun 2y ago
Trump actually forced hospitals to release their prices during his first admin. There are a few problems. First, quite a few hospitals refused and just took the fine instead. More importantly though, theres no standardization of codes. Your procedure might sound routine but there are usually quite a few different things being billed and there usually isnt a one to on relations hip between codes at different providers. Even if there was standardization a lot of the time unforeseen stuff comes up so you cant just get an out the door price before the procedure.

patja 2y ago

In my experience this behavior is due to the fact that they don't really know on the insurance side how the care provider is going to code something until they have actually done the procedure and have submitted it with the coding. And there is a very high wall between the insurance/patient billing side and the care providers, even in a case like Kaiser where they're all employees of the same company.

nradov 2y ago

Insurers have an app where the patient (member) can type in a procedure code and see prices for local network providers. It's literally right there in every member web portal! Every health plan has sent out multiple notifications to their members! How are people still not aware of this? https://www.cms.gov/healthplan-price-transparency/consumers https://www.cms.gov/healthplan-price-transparency/consumers

rqtwteye 2y ago
I have never received anything.

HDThoreaun 2y ago

Trump actually forced hospitals to release their prices during his first admin. There are a few problems. First, quite a few hospitals refused and just took the fine instead. More importantly though, theres no standardization of codes. Your procedure might sound routine but there are usually quite a few different things being billed and there usually isnt a one to on relations hip between codes at different providers. Even if there was standardization a lot of the time unforeseen stuff comes up so you cant just get an out the door price before the procedure.