[wdn]

Only in US that we don’t know the price of the health service we are redeeming.

When I go get my car fix and I would go around to get an estimate for multiple body shop even if it is under insurance. But when it come to health care, you ask them for a cash price, they said they don’t know.

[darkwizard42]

They will outright REFUSE to give you a quote...forget out-of-network, even IN network?!

This is so astonishing cause you would assume they have NEGOTIATED the rate given its in network so there is little variability in what can be charged by the doctor and what can be thrust upon the customer. ex. if you charge $100K more than other in-network doctors, good luck, cause the insurance company is only paying the doctor $5,000 no matter what and the customer will be on the hook for X% of that (outside of deductible and other math required to quote a price)...

[emkoemko]

how is that legal? you are telling me you won't know how much sometime costs until you have to pay for the service? is that not illegal? reminds me of Chinese scam of foreigners where women lure men to restaurants on the take and give you a massive bill at the end telling you it does cost that much but since you can't read Chinese its your fault.

[darkwizard42]

I don't know why it is legal but that is entirely how it works. They can't quote you an exact price on any procedure. They always hem and haw about something could change, negotiated rates vary, all sorts of BS even when you have specified the doctor, the procedure codes, the hospital, the jurisdiction and basically removed nearly every variable from the equation.

[PragmaticPulp]

They have to reveal their prices now. It's part of a bill that the Trump administration passed in 2019: https://www.cnbc.com/2019/11/15/trump-releases-rule-requirin...

From the article:

> As of Jan. 1, hospitals must publicly reveal the negotiated rates reached with insurers for services, a landmark shift in the sector notoriously opaque when it comes to pricing. The data offer a peek behind the curtain, exposing prices long kept a secret.

The catch is that they can't guarantee what services you'll receive. If you have complications after your inpatient surgery, the price is going to be higher than the estimate due to additional services.

[gzer0]

The Affordable Care Act laid the framework to allow for this to happen, under the “Sunshine Provisions”

[1] https://www.commonwealthfund.org/blog/2014/affordable-care-a...

[refurb]

Your article talks a lot about data but nothing about the negotiated rates with insurers.

[spaetzleesser]

The Affordable Care Act had some good intentions but they had no courage to make the hard decisions.Trump was terrible for health care in many ways but forcing hospitals to open up their pricing was a very good thing.

I am just a little afraid that they will find other ways to obscure things quickly.

[OgAstorga]

Please don’t make this political.

[caslon]

How is that political? I found it interesting to see the (long) process to get where we are.

[darkwizard42]

I don't think that applied as broadly as people think. I had to remove screws and a plate from my leg in NYC at a fairly large hospital so I went through what I thought was a pretty straightforward process.

1/ Got the procedure codes from the doctor

2/ Got the doctor's estimated billing for those codes

3/ Reviewed my insurance information and in/out network status and then called up the insurance company to confirm the amount they would reimburse for those codes

They REFUSED to give me a clean $ number on how much they would pay of the bill that the doctor would give me. The bill from the doctor was high so naturally I wanted to know the true cost that I might be stuck with and the insurance company just wouldn't give a straight answer.

Naturally if there are complications and you have to have new procedures then it makes sense to me the price could go up, but for a straight procedure code to price transparency there doesn't seem to be any change in my personal experience

[maxerickson]

They bill based on the procedures done and might not have that information until after the fact.

I'm not saying it's a good way to do things.

Opening a price list, it looks like one hospital charges ~$5000 for a knee replacement without major complications, and then the matching price for one with complications is $30000.

So how do they quote that when the complications can be unpredictable?

Which of course just says that maybe people shouldn't be put in the situation of trying to figure it out for themselves.

[prepend]

There are many industries that have this issue and deal with it in different ways.

I used to do consulting and fixed price estimates were common. Even when requirements were unclear. The way I mitigated this was with multiple clients.

Hospitals have lots of customers. They don’t have to perfectly estimate everything, they just have to be good on average.

Here’s a podcast from Econtalk with Dr Kieth Smith from Surgery Center of Oklahoma [0] where he explains how his hospital does it. Basically he estimate the cost for an average procedure and charge that, they are good at estimating and adjust each year. Sometimes extra stuff happens, sometimes less stuff happens. If the shit hits the fan during the procedure they have that rare event factored in.

It’s such an odd argument because they certainly could if they had to. But they don’t, so they don’t.

[0] http://www.econtalk.org/keith-smith-on-free-market-health-ca...

[maxerickson]

Right, they bill on what Medicare/insurers (apparently) want, and then are unable to quote cash because of that.

Not sure why describing what they do is being treated as a defense of it.

[toast0]

> They bill based on the procedures done and might not have that information until after the fact.

Quote a menu then. Something like:

If everything goes well, we'll do X, Y, and Z; which will cost $5million, plus an extra $200,000 for the Oxford comma.

Some potential complications are this and that and they cost even more, etc. All surgeries are risky, and you could require life saving interventions which will cost a stagering amount, and we won't be able to ask for consent.

The patient could say; well wait, I don't actually want an Oxford comma, please leave that out; and they could put that on the chart, and if it's added, it doesn't get billed.

[koolba]

> So how do they quote that when the complications can be unpredictable?

Then they should be ones buying “price insurance” to compensate them potentially exceeding the quoted costs. That also has the pleasant effect of aligning incentives so they can keep their costs accurate.

[civilized]

I don't buy that, because of the unpredictability of the worst case, we can't ever be told how much anything costs, no matter how routine.

[Spivak]

Because people will be mad if their bill is significantly north of what they were quoted.

And also because providers have genuinely zero idea what insurance will pay for and insurance has zero idea what a provider is going to bill for. You can get basically exact costs for specific codes but good luck assuming they’ll bill it that way.

[darkwizard42]

Yeah but I didn't ask for a FULL quote. I simply gave them X Y Z procedural codes and then asked what the responsibility to me would be. I also know what the doctor was going to bill and I want to know how much I would be stuck with.

Even a car mechanic gives you a detailed quote of what he EXPECTS and then you sign off knowing there is a caveat that more work could be needed.

[bcrosby95]

Our local hospital tried to quote us for a routine fertility related procedure because we thought insurance wouldn't cover it. It took several hours on the phone before they figured it out. Day of the procedure they told us they forgot to factor something in and they gave us the wrong price.

They said it was fine though because insurance would actually cover it.

But they were wrong on that account too.

In comparison, the actual fertility clinic we went to was upfront and told us the price of everything ahead of time.

Everytime I've had to deal with a hospital the billing experience has been a nightmare. Fuck hospitals.

[PeterisP]

Giving out quotes and sticking to them is obviously not an unsolvable problem since the private health industry in so many other countries manages to do that.

[mindslight]

I feel like 80% of the healthcare logjam would be fixed if providers were required to 1. charge uniform prices for all payers and 2. present patients with written estimates based on said price schedule ahead of any non-emergency services, thus forming an actual contract.

Note that mechanics don't particularly know what they're going to have to do to any given car before they really get into working on it. Yet the market functions perfectly fine with estimates, agreements on hourly rates, phone calls for decisions on surprise situations, etc.

[dumpsterdiver]

I'm not disagreeing at all (I'm not familiar enough with the system to disagree), just curious about your reasoning on uniform pricing for all payers?

The reason I'm curious is because using your car analogy, if I was a barely competent mechanic then management would probably be fine letting me perform oil changes, but when a classic Rolls Royce comes in with all original parts, management isn't going to let me touch that, right? They'll need to call in the big guns, whose rates are definitely higher than my "oil change" rate. I know that doesn't directly map with how medical procedures play out. I guess my real question is when and how does that balance out?

[mindslight]

The reasoning is to make pricing transparent and grokkable as in every other industry, end the severity of this in-network out-network divide, and eliminate this ridiculous dance based around providers sending fraudulent bills to patients.

In the car analogy, there are natural differentiators between levels of service, namely completely different shops that Rolls Royce owners go to. Even so, the same shop could have a price list specifically for Rolls Royces, using Rolls Royce certified mechanics.

And the residual where a shop is willing to pay for damage caused by barely competent mechanics on less expensive cars, but only becomes concerned when that liability grows? It seems like that should fall on the business.

[BeetleB]

> But when it come to health care, you ask them for a cash price, they said they don’t know.

As with everything, "it depends".

You often can get an idea from your insurance company, who will often provide you with what's called the "usual and customary" rates for a given procedure (in-network). Depending on the procedure, though, it may be hard to pin down. The procedure you want may actually consist of 3 things, and you need to look at all 3 up.

Also, if you call some private practices, and if it's a standard procedure (ultrasound, etc), you will often get a quote if you tell them you'll pay cash without involving insurance (some people ask for the "uninsured rate"). Often that will be less than the insurance negotiated rate. The down side is that whatever you pay will not count towards your deductible.

[hoka-one-one]

According to the law they have to provide a price list, you're probably just asking for the wrong thing. No one's going to go through the price list and translate what you're looking for into medical jargon. My experience has been that you can usually find a list of direct-to-consumer prices online.

[Spooky23]

Only in the US among developing countries do you care.

My experience getting a COVID vaccination was eye opening. I walked into a large facility, provided ID, was asked screening questions, consulted with a provider about a medical issue and got the shot.

I work for an employer with a legacy PPO. I suffered a back injury, had a major surgery and 8 weeks of physical rehab. My out of pocket was a few hundred bucks. I didn’t lose a days pay because of sick leave at half pay and short term disability insurance. The people I was in rehab with were losing jobs, selling cars, facing complete ruin.

The lack of ethical standards and focus on profit over the general welfare of the people is gross.