> It also completely eliminates the incentive for insurance carriers to even bother creating a provider network.
This is extremely disingenuous.
The reason for the regulation was precisely because most physicians never bothered joining a provider network knowing that doing so would cap their income and the ability to hold the patient hostage.
Hey - it's ok to make money. But it's not OK to make it unethically.
You are extremely lucky that people dont think too deeply about the root cause of the outrageous costs of healthcare in U.S. and get quickly distracted, blaming insurance companies and the govt. about their crippling medical debt - because when they do actually run the numbers, look at the statistics, the invoices, the claims, they realize the root cause are the providers themselves.
It's very likely though, that some here in the HN crowd will come to this realization because they do think deeper.
There is 0 reason for an insurance company to charge more than absolutely necessary. The cheaper the premiums are, more volume they have.
Here are my thoughts:
Nothing stops a provider from telling a patient "Hey, I will cost you $10000 at most. Do you want me to treat you?".
The provider does not have to know what network the patient is in, what their deductible is. Whether the patient is employed or not.
All they have to know is that the maximum they have charged for stitching a cut, that this patient in front of them, has, is $10000 and that is what they inform them.
If a provider thinks that this question distracts them from providing the best of care, nothing stops them from joining an insurer's network and continue to do the good work.
Provider does not want to handle money at all? Fine - work at a hospital that has someone willing to do that. To have the numbers ready. Or even have an estimate printout in a new minutes.
Computers do that now.
Do you, personally, think this is a fair expectation?
No one is asking a provider to quote down to the last two decimal places what a visit might cost.
The expectation is to know, atleast, what the maximum financial liability could be:
$500? $2000? $10000? $50000?
Crickets. Indifference at best.
Instead - here's what providers have been doing: They explicitly try and stay OON to extract the maximal possible revenue from patients who were in a desperate situation with 0 leverage.
> It was no longer the individual physicians choice
The bulk of the individual physicians NEVER chose to be in network in the first place. Not when they were independent. Not now.
The American people are hurting from the thousands of dollars in medical debt foisted on them without them even being told what they are getting into.
Thousands of dollars in surprise bills from tens of different providers in addition to the tens of thousands of dollars from the hospital after spraining an ankle, dislocating an elbow, getting a cut.
I am not talking about blood gushing out of an open wound. I am not talking about a head cracked open.
Nickle, dimed and harassed by collection agencies that add on fees and interest rates multiples of prime if you can't settle in full.
I understand the medical education system in the U.S. is expensive and long but I, as your customer, should have the ability to know, UP FRONT, how much seeing you, might get me into debt so I can make a decision whether I should work with you or not. NOT after the fact.
Do you, personally, think this is a fair expectation?
Not a SINGLE doctor in the WHOLE of California has ever come forward to answer this question of mine, which at this point is more than 3 years old: https://www.quora.com/How-do-I-find-a-general-physician-in-S...
All this question asked (details can be found in comments for those logged in) was: Is there any general physician in San Diego that will provide an estimate (NOT a guarantee) of a visit planned weeks in advance with their staff.
I have found tens of doctors in Mexico who were more than happy to provide a quote down to the last two decimal places and they went beyond what was expected of them.
Yet, 0 responses so far from the WHOLE of California sans one extremely disingenuous, snarky Anonymous remark that stood up a strawman argument that I somehow wanted the estimate for free (which I did not and was more than happy to pay for)
Every regulation is a response to societal pain.
This pain has been cutting in too deep for far too long.