I had an accident in late 2010 where I needed to stay in the NICU for 14 days. In January 2011 I had major neck surgery and spent another week in the hospital. SFGH charged me $100K for the NICU stay and $200K for the surgery (plus a separate bill for $1K from SFFD for my initial ambulance ride).
I had no job or insurance at the time and was in the process of moving out of my apartment.
Luckily, it was a slip and fall type accident and I immediately hired a lawyer when I saw the bills. I was also approved for MediCal after my surgery and they initially covered the bill. But they put a lien on my lawsuit. I learned a lot during all of this, but my biggest takeaway was that MediCal paid $20K for a bill that was charging me $300K! Less than 10% of what I was being charged!
That explains most of the bad pricing behavior in this space. For the law to have any real effect, it would need to force the hospitals to publish prices up front, and also ban discounting the charges after the fact.
(I get the distinct impression high-cost insurance plans get the best deals from hospitals, but could be wrong. Either way, I don’t thing conventional price discrimination is a thing in this US healthcare market.)
Don't get me wrong I do find it terrible that US healthcare pricing is incredibly opaque but it does not seem to immediately offer a lot of benefits. It will probably offer a good amount of indirect benefits as those who are paid to haggle will have more information to haggle with, but to me it seems like it wouldn't really force any of the changes needed.
The big troubling expenses are the emergency room visits where it turns out the guy who set your broken bone is now out of network and so you're billed some stupid price. Or as the above poster mentioned they were temporarily without coverage at that time and had an accident. In this case having the prices published ahead of time didn't really do you any good, as even the basic information of "is this doctor in-network or not" wasn't even able to be accurately looked up and compared.
And as for these stupid expensive list prices being published ahead of time making an impact to those without insurance, it probably doesn't change the math too much for the majority of those people. If they were unable to afford the crazy prices of insurance they're probably unable to pay the crazy non-insured list prices for non-emergency care, so they'll probably forgo it until their ailments get into emergency situations.
I'm still unsure how it actually helps. Can you fill me in on that?
https://www.wsj.com/articles/hospital-prices-healthcare-insu...
edit - I was initially paralyzed from the mouth down.
This is my experience as well.
Hospitals won't conform to this disclosure law without a proper stick to get them to. I wonder if companies fought the law in Colorado that stated all job descriptions need the minimum salary for a role to be listed. That's data that could advantage their competitors but I've seen it on Google job listings when looking at roles in Colorado...
It's a Micro-Economics 101 maxim that all students learn early is that efficient markets depend on as much price transparency as you can muster. When one or more parties have more pricing information than you they have a huge advantage.
"Ability to pay" might have been too narrow a phrasing though. Often as not it's instead essentially "ability to not pay", as with insurance companies using their bargaining power.
Now, will a law requiring prices to be posted prevent them from discounting the price? If only the powerless actually pay the sticker price it becomes a bit meaningless, so maybe? It would depend on the details of the law and its interpretation though, and I won't pretend to be knowledgeable there.
This is exactly how it works. Charge the max given the procedure, circumstance and insurance coverage. Let the consumer fight it out with our massively understaffed customer service department. Then, send it to collections anyway.
Insurance denied the claim.
They "applied a coupon" and the price magically became $35.
In this one transaction there's multiple layers of corruption most likely starting with the prescribing doctor.
Your post lacks information such as whether or not the specialty medicine would’ve been approved with the proper paperwork from the doctor, but what likely happened is that someone at the pharmacy put in the effort to find a manufacturer coupon for the medicine for you.
Interestingly the pharmacy doing that is generally forbidden in agreements with the insurance companies. That’s corruption imo.
The insurance PBMs forcing you to use their designated specialty pharmacies is part of the massive healthcare consolidation over the last couple of decades and it’s full of corruption as well.
> Have curious conversation; don't cross-examine.
> Please respond to the strongest plausible interpretation of what someone says, not a weaker one that's easier to criticize. Assume good faith.
This was all explained to me when we had to switch plans, ended up with Kaiser for a while, and needed to renew blood pressure meds for my wife.
She was in good control, no side effects, on meds for a decade. Those were not on the list. Rather than prescribe off list, that doctor increased her risk to benefit Kaiser, not her. And this was even made clear at the time! (maddening) Just to be ultra clear, it was that doctors "opinion" the various meds were all equivalent.
For a lot of reasons, none of which are medical, we went with it, and sure enough, she was not in good control, and had side effects.
Went back, got the meds that worked prescribed, (which cost me visit co-pays and some non trivial time and effort to basically demand the medication needed and proven) and found ourselves in the same "coupon" scenario above. Base cost of the medication was quite expensive, and a "coupon" was found to bring it roughly in line with the "on list" meds tried earlier. Of course, that all had to be done at another, outside pharmacy, due to the Kaiser one not carrying what they consider special order meds. That isn't a super big deal, but the whole mess involves bulk buying to gain price advantages, and the real worry point is cost being primary, with medical being secondary.
The whole thing caused me to very seriously question the strength of "medical opinion", given patient history, a routine request to simply continue proven treatment turned into a risk scenario for no reason other than the tangled mess of insurers, agreements, drug manufacturers, and the like all more focused on profit than they are patient health.
In my case, the pharmacy was Walgreens and yes they signed me up for some plan or other, GoodRX or the like, handed me a card and said I needed to use it to get the much better price. Was on the order of a few hundred dollars being discounted to a few tens of dollars...
Have had similar experiences at CVS, Bi-Mart, Safeway... Indie pharmacies, usually niche places that offer things like compounding, are particularly good at this sort of thing and it's one of the ways they attract and keep patients. I used a good one for years, until I moved. Miss those people. They would do that automatically for anyone struggling with med costs of any kind.
The flip side of this is the "pharmaceutical representative" entire job description. Basically, your doctor has a wide range of words they use to describe how to treat you. Some of them wind up with the insurance company paying $15 for generic medication, while others wind up doing something like spending $400 on something under patent protection. Pharma's reps jobs are to talk to physicians and educate/convince them to use the expensive words instead of the cheap words out of force of habit.
Anyhow, that's why HMOs and insurers have approved medication lists - to push back against doctors writing down a $400 word instead of a $15 because a pharma representative said that FooBar XR treats Baz syndrome and the doctor wrote that down instead of the generic BarFoo.
Count me as a strong supporter for reform. I quite frankly, hate it.
Insurance companies are thrilled with high prices because they reinforce the idea that medical insurance is critical infrastructure. Liberal politicians love taking credit for throwing money at the problem they helped codify into law, and conservative politicians love being able to decry out-of-control, cradle-to-grave socialism at every campaign stop.
So yeah there are multiple layers of corruption there.
I remember reading several years ago reports that drug companies were favoring coupon distribution to doctors according to how often doctors prescribed the issuer's name-brand drugs instead of generics. That is, a doctor who prescribed a designer expensive drug, Foo, more often might get more coupons for name-brand but boring drug, Bar, for distribution to the doctor's indigent patients. I don't remember, however, if or which reforms were enacted as a result. Also, I'm not sure if it was nearly as big of an issue as actual kick-backs in the form of vacations, etc, which (AFAIU) were made illegal years ago. The opacity and overall baroqueness of the coupon system is precisely why there's not much opportunity for doctors to personally benefit from the scheme, yet why it works well as a tool for pharmaceutical companies to maximize profits while staving off political reforms.
Those coupon programs aren’t used for indigent patients since they reduce the co-pay/co-insurance the patient has.
Some not so great insurance plans will pay 90% of drug costs. Great when the drug is $300 per month. Not great when it’s $3,000. So manufacturers will directly pay an additional portion to cap the patients part at say $50 per month.
These companies are so massive and complicated in their roles and processes you and I cannot easily figure out specific actionable blame onto the specific administrators and processes involved.
Blame those who made the system. Doctors are forced to work 80 hour weeks for not as much pay as you're thinking. Clinical Doctors don't have the power to better their own conditions, how are do they have the huge power to reform the regulatory issue of medicine pricing?
Start blaming the source of the problem - the business executives whom made these decisions.
This makes NFTs and drug dealers look honest. Oh, wait, they kinfld of are drug dealers.
$300/day doesn't even begin to cover a single well-paid IT professional who can handle this project, let alone a team with resources.
It may seem trivial to HN audience to comply (hey, just do a SQL query and post the resulting CSV!), but hospital IT systems are oftentimes legacy dinosaurs, so a transparency project like this could cost millions of $ to undertake.
Why pay millions, when you can simply pay a measly penalty of ~$109,000 year after year?
Your point still stands though, even that is possibly not high enough
I don’t know how this wouldn’t act as de facto price discrimination but it is happening.
Several years ago I ended up in the ICU, no insurance, got a ridiculous bill that would have taken the majority of my lifetime to pay down. In the end I decided not to even attempt to pay because it was so ridiculously high, decided to just wait the seven years for it to fall off my credit.
If the price had been reasonable I would have paid outright or gotten on a payment plan.
However, it doesn't specify what treatment will be provided, so more likely, hospitals would use that sort of information to limit treatment to ER-level interventions and then recommend a wait-n-see approach as followup.
https://en.wikipedia.org/wiki/Emergency_Medical_Treatment_an...
As for other doctor's offices or planned procedures, I think they already can decide to not work with you if you don't pay them. Maybe there's something similar for general practice stuff related to Medicare/Medicaid as well but for exclusively private pay practices I can't imagine something forcing those providers to offer non-emergency services.
It doesn't, unless you are wealthy, otherwise you try and 'walk off' any issues until they become obviously life threatening, then you go to the hospital and if you have insurance, you hope the insurance will approve the operation you need, and if you don't have insurance you hope the cost wont bankrupt you.
Is it at all advisable to ignore collections and risk court appearance?
Next time they called I told them they had the wrong number and not to call again, and I never heard from them again, no letters, no calls, nothing.
Although I'm in Arizona, I don't know if laws are different in CA.
I haven't had that experience. That would be like a health dealership.
The tariffs of dentists do not follow the same pricing as those of surgeons in NL. The former is a mandated maximum based on cost price plus, the latter based on bargaining between hospital and insurer. Given the attention of private equity for the Dutch dentists I would expect the dentist to be more expensive although the team and capital requirements of the dental surgeon are probably larger.
I'll add that "discounts" aren't always very helpful nor is it something you can plan for if you have emergency surgery.