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Comment by wl | Hacker News Reader

Pricing is not even nominally transparent. By law, you can get access to the chargemaster, which is the list price that nobody actually pays. If you try to get access to the negotiated price your insurance company will pay, you'll quickly discover that it's confidential up until the point where the provider actually issues a bill. Medicare pricing is a special case, but you can't get that price without being on Medicare. Also, many providers won't accept Medicare because reimbursement is meager and often unprofitable.

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I wonder if there is a straightforward way to aggregate people's bills to estimate the cost of a procedure (eg appendectomy) at a given hospital. Eg pay people $1 to scan their bill. This would only work for common procedures I suppose.

HIPAA was passed largely to prevent this potential catastrophe for healthcare executives. b^)

So build it in Europe?

De-identified data and data contributed by people (read, not Covered Entities) is not covered by HIPAA. Someone could build a database of procedure cost comprised of these data sets, but price transparency isn't so easy due to the nuances of the problem (See Castlight Health).

That's a great idea because the codes are usually on the bill, too. The problem, of course, is keeping all of that volunteered data secure.

Replying to myself because I can no longer edit: California law requires public access to the chargemaster. This is not true in other states.

> Medicare pricing is a special case, but you can't get that price without being on Medicare.

As far as I recall, Medicare pricing is defined by law as a percentage of the lowest price the provider ever charges to anyone else. For the sake of this comment, call it 40%.

If Medicare pricing is public, you can look it up and try to negotiate for 250% or whatever of the Medicare price.

If you're uninsured and unable to pay you may be able to get the Medicare rate as a "I will pay you this amount to settle this in full, and I will pay it today" because that rate is still higher than they'd get from selling it to collections.

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