Small and medium size practices have very few guarantees about how much they will get reimbursed for a procedure and the patient has no idea how much they will pay. It's truly insane.
Is anyone honestly trying to solve those problems right now?
OODA Health already has some major partnerships/investments from providers and payers. https://www.ooda-health.com/
Lumedic was acquired last year by Providence St. Joseph, a large hospital system. https://lumedic.io/
I'm not entirely sure if it would have the intended effect of reducing costs, but it would definitely add more transparency.
This is not true.
"There's a requirement to share how much a consumer needs to pay before procedures are done"
This is not true.
If I go in for a procedure at a medium sized specialist clinic they are going to take the fee schedule for this CPT, discount by my 20% expected contribution (or whatever), and then hope that the insurer pays them > 50% of the remainder.
A lot of the time my insurer will, but not always. Bigger systems negotiate their own fees and many doctors at larger clinics only track RVUs for each procedure (specifically because the clinics realize that paying based on insurance payout isn't fair or scalable, in that way RVU allocations act as a pool). But overall it's not a transparent system for the majority of people working within in.
Also, it is true that thier is a requirement for estimates. Granted, insurance companies can turn down procedures - but like I said, if it's a competent diagnosis than it works out.
But you can just ignore all the words in my post to be dramatic, that's fine.
I recently visited an Emergency Room and the whole process behind is really obscure.
Like for example, I got a bill from the health care provider for an owed amount and one letter from the insurance company saying that I owed the healthcare provider another different amount. They are not even close.
The whole experience in the ER was pretty fast and high quality but I feel they did a bunch of extra blood work and stuff just for the sake of getting more money out of the insurance and not necessarily because it was needed.
The way I see it the healthcare system in the US is just designed to squeeze as much as possible from the carriers and viceversa but without thinking too much who is the actual liable party which happens to be the sick individual.
I think this is how we ended up with a super expensive healthcare system that bankrupts people. All parties involved (insurance carriers, healthcare providers, healthcare product suppliers, pharmaceutical companies, doctors) think that the opposing party in any transaction is swimming in money so they optimize for squeezing the shit out of the other. That’s how you end up with ridiculous bill items like $1500 dollars for a simple fluids IV.