[ta1234567890]

It is crazy. Not a house, but friend had a baby in SF/Bay Area. Neither the hospital, doctor or insurance would tell them how much the delivery would cost, not even an estimate. It took a whole year after their hospital visit to get the bill, it was $85k for a c-section and 3 days at the hospital. Fortunately their insurance took care of most of the bill. But can you imagine getting a surprise bill for $85k a year after the fact? Or not having insurance? Terrifying!

[fmpwizard]

We have two kids (in NC, US)), both were c-sections, we had insurance on the first one, but because she was born in Feb, we had to pay the deductible twice, because even though it was the same pregnancy, it was "over two billing years". And even with insurance we still ended up paying the rest of the bill over 3 or 4 years. Second kid was with no insurance, I think we'll finish paying that one when he turns 10 years old. I don't know about other areas in the US, but around here you can at least setup a payment plan with the hospital and they are 0% interest rate.

[EE84M3i]

Don't get me wrong, I'm not a fan of insurance companies, but they seem pretty up front with the fact that deductibles are based on date of service rendered.

[jedberg]

They are, but it's still dumb. It puts extra demand on the medical system in December as people try to squeeze in their elective procedures in a year where they already paid their deductible, and it incentivizes you to not get care early in the year in the hopes that "it just goes away" and then sometimes it gets a lot worse and costs a lot more than if you had just gone in the first place.

Deductibles should be a rolling 12 month bill. If you have something major in December you should be good until next December. This would eliminate all of the issues with deductibles rolling over on Jan 1. It would even bring extra profit to the insurance companies because people might decide to stick with their provider another year since "I already made my deductible until November".

[refurb]

I narrowly avoided that issue when my kid was born late in the year. But yeah, you end up paying almost double for the same thing because of the deductible and out of pocket max resets in the new year.

That said, I was able to take advantage of it by making sure my surgery was scheduled before end of year. Ended up paying something like $200, rather than $1500 if it had happened in January.

[refurb]

Random comment - UCSF will now provide a billing estimate for procedures. They actually look up your coverage and figure out the out of pocket for you based on deductible, co-insurance, etc.

I did this and it was pretty close.

Of course, they don't make any guarantees that's it accurate. But hell, it's a start.

[elicash]

It's worse than this suggests.

If they couldn't provide an estimate because unexpected things happen and they can't predict all services that will be required, that'd be one thing. But they can't even provide a list like, "if you need an aspirin, that costs $X. And if you need..."

[cwhiz]

Well that is actually a pretty tough one. How are they supposed to predict how long the delivery will take or whether the mother will need a c-section? Even if the hospital were able to perfectly predict all of the procedures and line items they still would not be able to tell you what you, the individual, would ultimately pay. Even if they know your insurance information they still would not know how close you are to hitting your deductible or annual out of pocket max. There are a million different things that eventually go into figure out what the end "customer" will actually end up paying.

And just because they "billed" your insurance $85k doesn't mean they were actually paid $85. Billable vs allowable and all that mess.

However, if you went into the hospital and asked for the cash cost of a routine procedure they very likely would be able to give you a close approximation to what you would end up paying.

[ta1234567890]

> How are they supposed to predict how long the delivery will take or whether the mother will need a c-section?

In their case it was a scheduled c-section. In any case they can at the least give you a range: min-max.

Additionally, hospitals keep very accurate track of their c-section rates, so even if they are not able to predict yours in particular, they can definitely tell you what your odds are ahead of time.

And, there are other countries and healthcare systems in which they internally take care of the stats/metrics so that they make a decent amount while you pay a reasonable amount that they tell you before you choose to get the procedure.

The hospital doesn't tell you the estimate of anything because they are afraid of the liability (or maybe just accountability).

It's just lazy or maybe too convenient, to say it can't be done. I mean if already health insurance companies can give you a fixed monthly amount to pay, then they know very well how much it's going to cost them, why not tell us?

[dragonwriter]

> And, there are other countries and healthcare systems in which they internally take care of the stats/metrics so that they make a decent amount while you pay a reasonable amount that they tell you before you choose to get the procedure.

That's a difference in the financing system, which hospitals have about as much say in as consumers do.

The insurance companies (including government payers like Medicaid and Medicare) don't just control reimbursement, they control what providers can bill to customers, too. And that includes (by usual and customary charge rules) influencing what they can and need to charge to customers that aren't even being reimbursed by the payer in question.