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Comment by TallGuyShort | Hacker News Reader

Can't even find out what stuff costs beforehand either. I had to get a blood test. I had gotten burned before where my insurance said they covered a physical, but it turns out their definition of a physical didn't include the doctor's definition, which included blood tests. So before I had my blood drawn, I asked them to tell me what the tests would cost if my insurance didn't cover it. "It depends on how it's coded," they said. So I asked them to check how it was coded and tell me what the "code" cost. They looked it up. It was coded wrong, apparently. They would have to talk to the doctor and couldn't, so I would need to make a return appointment, or I could just let them draw my blood. Still don't know what the coding was or was supposed to be, or really what that even means. I just needed to get life insurance and get back to work. I found out the price once I was billed for it.

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'You should know the price before you agree to buy the product' seems like such an innocuous principle. Why isn't their broad-based support of it for medical care?

If you need emergency care then sure, there isn't time. The vast majority of interactions with the medical system aren't that type of emergency though. People have time to choose the better of two options. They can't decide on better if they don't know the price.

Yeah, this has baffled me before. I remember learning in my Family & Consumer Sciences class about the importance of being an informed consumer. Then, in college I had to get a dental procedure done and I called around to try to find out the price from different dentists and no one could give me any actual numbers. I ultimately just had to pick a place based on reviews and found out the price after the fact with no knowledge of how it compared t other places.

That's odd. Dentists, unlike doctors, will in my experience just give you a price if you ask for it... Maybe this varies state to state?

They used to but it's dwindling. A friend of mine is a dentist and he said when he first graduated from dental school some 15 years ago, his father and his practice dealt directly with the patient and had a list of all of their prices on their website and in their office. As customers increasingly wanted to have their insurance cover dental they had fewer and fewer people paying out of pocket and going through insurance. So prices went up due to increased complexity of the business.

At my dental office, they can tell you the total cost without insurance which is the maximum they would charge for any procedure. If you paid in cash in full, they would do a discount (for non-insured).

For those insured, it depended on the insurance you had but they would give you a rough estimate based on the plan you had (mostly because they can’t be 100% certain what the insurance will cover down to the exact dollar amount.

In my experience the estimate is often off but close enough that I am not worried I’d owe an insane amount afterwards.

The current federal administration has mandated the hospitals to publish their prices online since 2019.

I have no illusions, a person without a degree in accounting probably won't be able to decipher these prices, but that could be a step in a proper direction.

List prices are not the whole information: you want to know for your insurance, how much you will get charged. And that is a completely different question.

You can't find out the price on most things and procedures that are the highest value (cancer care, dialysis, sickle-cell, etc.) are usually those with the least flexibility in price.

> Why isn't their broad-based support of it for medical care?

IMHO, it is because folks are overly deferential to medical doctors.

While a lot of the problems are actually caused by the insurance industry (a constantly changing billing code system) rather than the doctors themselves, I think folks are growing tired of being yanked around by the system.

This deference is decreasing based on my limited experience (i.e., just talking to people about their medical experiences), and it may drop precipitously soon. My guess is that most/all of the good doctors going to "concierge" will be the breaking point.

> Why isn't their broad-based support of it for medical care

Because the American medical system is perhaps the finest example in the world of regulatory capture, ironically masquerading as an example of pure capitalism, while decrying the "socialism" in other countries.

Bravo, perfectly succinct description of the ground truth.

Because of insurance. It often leads the peculiar case that a healthcare provider might have no real clue about how much a person will ultimately end up being required to pay for some procedure they're undergoing. It has no clear connection to the price that the provider will bill the insurance for.

In many developing nations insurance is the exception, rather than the rule. This changes two big things. The first is that you're expected to pay for things that would have more than a negligible cost before these procedures are done. If you don't like the cost - you go somewhere else. Emergency care, like the US, is an exception - and nobody can be turned away, so you are billed afterwards.

But the really big thing this changes is that costs are such that people can actually pay them. For instance in one procedure I had a consultation, x-ray, and medicine. Total cost was about $20, and that's not government subsidized in any way - the hospital is making profit on that cost. And this is not a "hospital" with "doctors". Most of the medical staff are educated in the west and then come back home to work afterwards. As an aside, it also means they generally have great English. It's why developing nations are increasingly a destination for medical care - 'medical tourism'.

What do you recommend if it requires 2 months to get an appointment with a different specialist?

Its even more absurd because your health, well being, and potentially life is held hostage. Like, if the choice is "you pay this or you die", it's not exactly a choice. They can charge whatever BECAUSE OTHERWISE YOU'RE DEAD.

But the mere fact that you can go get a surgery, and not only will you not know what it will cost, you don't even know who you're doing business with: you're going to get bills from the doctor, from the hospitals, from the nurses, from the anesthetist, and god know what else from, for the next 6 months. You don't even know if you're done paying all your bills or not!

Its completely absurd.

> They can charge whatever BECAUSE OTHERWISE YOU'RE DEAD.

Just like when you buy food! Or heating! Or water!

> You should know the price before you agree to buy the product' seems like such an innocuous principle. Why isn't their broad-based support of it for medical care?

This is not a probleam of health-care as much as it is of insurnace. If you paid doctors cash you will get straight up pricing.

Thing is the market is like 95% insurance.

I believe this will change in the near future. High-deductible plans and DPC's will bring back some sane price sensitivty into the system. But while patients with great PPO plans pay 20 bucks for a 300 dollar visit, its not going to get fixed itself by "posting prices somewhere"

I think of this every time someone acts like U.S. healthcare is a market in any positive sense: our son had his first birthday before we got the last hospital bill (they were hoping we’d gift them money beyond their negotiated rate with our insurance company) while nobody I know from another country has ever had any experience with that.

That may be so-called "balance billing". It is illegal in some states.

The billing for health care in the USA is also rediculous. Last week I got a bill from the doctor's office for a visit back in November that my insurance company decided not to pay. What other business takes 4+months to send a bill?

Oh it can get even more ridiculous... yesterday I got yet another $300 bill for an ER visit from October 2017. Now I have figure out whether it will cost me more in lost billable hours than to just pay this bill, knowing that contacting my $1700/mo insurance company to help sort things out will prove to be fruitless.

My partner works for a large hospital network dealing with insurance payments. Their department is not even able to figure out how much bills "should be," which prevents them from being able to prioritize their work based on total costs.

When the process is voodoo for the people who actually deal with insurance payments, normal people stand zero chance because it's unlikely you'll ever find a person to talk to who can find this information out.

I was at the dentist today because I managed to chip a tooth yesterday, and needed it fixed. Before the procedure, they asked if I wanted an estimate, I said sure, and got one in a minute.

The dental industry works the same as the medical, I have a half-useless insurance that covers too little, and out-of-pocket expenses are always higher than you expect. But if they can do estimates before a procedure, why the hell can't the medical industry do the same?

Just to put my cautionary experience in on that, I woke up after some oral surgery about ten years ago to find out that my estimate was worthless and the actual cost was twice what was estimated. I was fortunate enough to have recently gotten a good paying job and could cover it, but it was certainly a shock.

Dental insurance isn't insurance in the normal sense. It's more a way to prepay dental expenses with pre-tax dollars.

In the US those estimates can often be wrong.

Yeah I was able to get an estimate on the birth of my child, too. But then lawyers had to get involved between me and Banner Health a year later, over a bill from an anesthesiologist they said didn't exist, with contact information at which no one said I owed any money, that was never billed to my insurance company, for an epidural that ended up being done quite poorly. In the end it was considered to be my responsibility because of a paper my wife signed while in hard labor agreeing to pay the bill. Fuck the whole industry. That's not even my worst experience - just the most recent. I basically don't visit doctors or dentists anymore because the biggest health threat I see in my life is the massive surge of blood pressure I get at the mere mention of insurance companies.

I agree this is all a huge pain. I've been burned on "this test cost you x because of the facility it was done in and if you had gone to one of our partner labs (which you'd have no way of knowing without calling us), you could have had it done in <dedicated, partner lab> for 1/4x".

I recently learned that there are 2 different codes involved and that it's the combination that matters.

1. The diagnostic code - the reason why you need that test

2. The procedure code - what the test is

My insurance tells me that their coverage (as in whether they cover a service or do not) is different for the same procedure code with a different diagnostic code. I'm not sure if that implies that their coverage price for the same procedure code also varies by the diagnostic code.

Your doctor can give you both codes for the test they're prescribing. In theory, your insurance company can tell you what they'll pay for the combination, and then you can contact each lab / hospital / service provider to get an estimate for what they'd bill. It's unclear how much recourse you have if the bill turns out to be significantly different than the estimate… that is once the bill actually arrives, sometimes 30–60 days later. I'm not sure if the service provider's bill varies for the same procedure code with a different diagnostic code.

Admittedly this is all a huge pain and with my insurance company at least, cannot be done online, you must call and wait. It's all such a time sink that I usually just get the service done upfront and hope. Sometimes the end consumer cost is practically free, sometimes it's hundreds of dollars or more.

It should be more feasible for us to know a rough estimate for a procedure across providers upfront.

Just had all the blood tests done here in Japan. Walked out paying a total of $80. Had I been employed by a Japanese employer, it would have been free. They told me the fee up front.

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