[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.