5 ms·

I used to be on a High Deductible Health Plan, which is designed to be just like the author suggests: only for catastrophes. For anything else, you use a Heal

by JPKab 13y ago

I used to be on a High Deductible Health Plan, which is designed to be just like the author suggests: only for catastrophes. For anything else, you use a Health Savings Account (a tax free account you put money into) and use it to just pay cash prices. IT WAS HORRIBLE. The concept of course, is great. But the problem is one of chicken and egg. Because the entire system is set up for 3rd party payment, NOBODY, and I mean NOBODY, has a clue what they charge for anything. Go ahead, take the challenge. Ask a receptionist or even a doctor how much they charge for a procedure. They have no idea. The effect was that going to any medical appointment was a crap shoot. I had no clue what I was going to be paying until AFTER treatment. The amount of friction in just getting a price was so painful that shopping around was impossible. Since "shopping around" is the whole basis behind "price clearing" in markets, the current system of HSAs implemented by Bush is bullshit. Had he gone all the way, and just forced every insurance company to only offer HDHPs, then it would be different. Medical providers would have been forced to share pricing information.

hayksaakian 13y ago
wasn't there a Show HN recently that solved this exact problem of exposing pricing of medical procedures and such.
- JPKab 13y ago
  No offense to the Show HN tool you are talking about, (I applaud anyone building anything) but it wasn't nearly as sophisticated as people think it was. It was just a pretty web app put on top of a DB loaded with data from a spreadsheet that was released by CMS.gov (Center for Medicare/Medicaid Studies) which is a breakdown for all of the major hospitals in the country, priced out by procedure code. It's a very cool dataset, and I recommend checking it out. Its also useless for anything other than stuff done in hospitals.
refurb 13y ago
It might have been your HDHP plan. I know the one my employer offers still have "networks". That is, the fees are pre-negotiated by the plan (you basically pay the same as for the non-HDHP plans). It's not hard to find out what they are either.
EvanAnderson 13y ago
My family is having exactly the same experience with our HDHP. I like the cost of the plan (and I'm saving every last red cent I can to cover future expenses) but I'm regarded like I'm crazy when I bring up cost to providers.
felideon 13y ago
Is it possible to pay cash prices without an HSA? I'm under the impression that if you have health insurance (high deductible or not) you are required to use it. The one time I asked for a cash price for a shot at a hospital, it was pretty quick for the receptionist to give it to me. (Incidentally, $150 cash vs. the $300 bill that came in the mail later, since I used my insurance. For a shot of Rhogam.)
- EvanAnderson 13y ago
  That depends. Some providers are contractually bound (and in some jurisdictions laws also apply) into "preferred provider contracts" that require the provider to bill your insurance and disallow them from taking cash.
  - ams6110 13y ago
    Yes. You can look for doctors that run cash practices. There aren't a lot of them, but they do exist.
- usefulcat 13y ago
  I could certainly be wrong, but I'm not aware of any requirement to always use insurance. However, if you pay for treatment out of pocket wouldn't you still need to involve your insurance company somehow in order for your payment to be counted towards your deductible?
  - mgkimsal 13y ago
    I don't think expenses count towards a deductible unless it was related to an insurance claim in the first place. If I have a $5k deductible, I could pay cash and claim it was $5k for anything, and that now the insurance companies needs to start paying their share. I'm sure they wouldn't like that.
deleted 13y ago
[deleted]
ams6110 13y ago
Since you mentioned Bush, how has Obama improved the situation? He wants MORE third party payment, in fact he wants exclusively that.
- JPKab 13y ago
  At no point was I touting Obama. My criticism for Bush, and Republicans, in general, is they are more focused on preserving the existing status quo (and the current beneficiaries of it) than they are in advancing free market principles. This is exactly why he did the half-ass measure of HSA's while still leaving the exsiting insurance industry absolutely unchanged. I think the notion of Obamacare representing what Obama, or even most people on the left, "wanted" is patently false. Obamacare isn't what they wanted. Its what they could get after the insurance lobby and the Republican establishment scared old people into thinking a single payer system would involve them being subjected to "death panels." Let's not forget the signs labelled "Keep the government off my Medicare". The Republican party once (correctly in my mind) opposed Medicare. Now they rely on its recipients to keep them in office, and even expand it (Bush). Which is proof to me that they are the political party of the "I am doing well in teh current system, so don't change anything!" crowd than the actual libertarian reformers they pretend to be.

by JPKab 13y ago

hayksaakian 13y ago

wasn't there a Show HN recently that solved this exact problem of exposing pricing of medical procedures and such.

JPKab 13y ago
No offense to the Show HN tool you are talking about, (I applaud anyone building anything) but it wasn't nearly as sophisticated as people think it was. It was just a pretty web app put on top of a DB loaded with data from a spreadsheet that was released by CMS.gov (Center for Medicare/Medicaid Studies) which is a breakdown for all of the major hospitals in the country, priced out by procedure code. It's a very cool dataset, and I recommend checking it out. Its also useless for anything other than stuff done in hospitals.

refurb 13y ago

It might have been your HDHP plan. I know the one my employer offers still have "networks". That is, the fees are pre-negotiated by the plan (you basically pay the same as for the non-HDHP plans). It's not hard to find out what they are either.

EvanAnderson 13y ago

My family is having exactly the same experience with our HDHP. I like the cost of the plan (and I'm saving every last red cent I can to cover future expenses) but I'm regarded like I'm crazy when I bring up cost to providers.

felideon 13y ago

Is it possible to pay cash prices without an HSA? I'm under the impression that if you have health insurance (high deductible or not) you are required to use it. The one time I asked for a cash price for a shot at a hospital, it was pretty quick for the receptionist to give it to me. (Incidentally, $150 cash vs. the $300 bill that came in the mail later, since I used my insurance. For a shot of Rhogam.)

EvanAnderson 13y ago
That depends. Some providers are contractually bound (and in some jurisdictions laws also apply) into "preferred provider contracts" that require the provider to bill your insurance and disallow them from taking cash.
- ams6110 13y ago
  Yes. You can look for doctors that run cash practices. There aren't a lot of them, but they do exist.
usefulcat 13y ago
I could certainly be wrong, but I'm not aware of any requirement to always use insurance. However, if you pay for treatment out of pocket wouldn't you still need to involve your insurance company somehow in order for your payment to be counted towards your deductible?
- mgkimsal 13y ago
  I don't think expenses count towards a deductible unless it was related to an insurance claim in the first place. If I have a $5k deductible, I could pay cash and claim it was $5k for anything, and that now the insurance companies needs to start paying their share. I'm sure they wouldn't like that.

deleted 13y ago

[deleted]

ams6110 13y ago

Since you mentioned Bush, how has Obama improved the situation? He wants MORE third party payment, in fact he wants exclusively that.

JPKab 13y ago
At no point was I touting Obama. My criticism for Bush, and Republicans, in general, is they are more focused on preserving the existing status quo (and the current beneficiaries of it) than they are in advancing free market principles. This is exactly why he did the half-ass measure of HSA's while still leaving the exsiting insurance industry absolutely unchanged. I think the notion of Obamacare representing what Obama, or even most people on the left, "wanted" is patently false. Obamacare isn't what they wanted. Its what they could get after the insurance lobby and the Republican establishment scared old people into thinking a single payer system would involve them being subjected to "death panels." Let's not forget the signs labelled "Keep the government off my Medicare". The Republican party once (correctly in my mind) opposed Medicare. Now they rely on its recipients to keep them in office, and even expand it (Bush). Which is proof to me that they are the political party of the "I am doing well in teh current system, so don't change anything!" crowd than the actual libertarian reformers they pretend to be.