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Comment by social_quotient | Hacker News Reader

Why can’t insurance companies post the actual price they are paying and being charged by the hospital with proper billing taxonomies. They seem like they probably have these things well ironed out since they actually deal with various hospitals whereas hospitals only deal with themselves.

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The health insurance companies are now required to publish this and in fact the rule went into effect July 1 2022.

Look up price transparency by CMS (the data will be published in this format: https://github.com/CMSgov/price-transparency-guide)

Note: the data being published by payors in machine readable format (MRF) is MASSIVE - terrabytes of data. Example: https://transparency-in-coverage.uhc.com/

There is no actual price. Its rent extraction. They can change how much they charge you for 18 months.

I’m guessing you’re serious. Can you link me to more info on this specific thought?

Insurance companies have always given out prices. I have been able to type in CPT codes online and my insurance tells me the price on a map of all the providers in network in my area.

Before that, you could call and give them the code and they would tell you the price.

The problem is the doctor will not give you a code, and sometimes that makes sense since they do not know what they will be seeing or doing, so they cannot know the code in advance.

But I have also had doctors not give me codes for completely preventative services, which makes no sense.

Because they don't know it yet. They audit and review each claim a an office sends, which starts a negotiation process to see if each claimed item by the physician was warranted and done properly. All that information is codified then into a level of visit, which changes the amount it will be payed out.

It is grotesquely complex, but the core issue here is that patients want to consume their healthcare through insurance, because it is tax advantaged. Thus it is impossible to make a cash business that would cut through all this bullshit for the majority of healthcare.

Congress has been considering transparent, prior authorization legislation in the realm of CMS. I don't know much about it, but they did publish an RFI recently[0]. I hear it has bipartisan support (that's obviously hearsay, but a lot of this recent healthcare legislation that has been passed has not been divided along party lines, AFAICT)

[0] https://www.federalregister.gov/documents/2022/01/24/2022-01...

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