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Comment by whatever1 | Hacker News Reader

I really don’t get why everyone involved is allowed to have hidden prices. It looks like a highway robbery.

I had a relative visiting from Europe and they had to go to the urgent care for some blood and urine tests and consultation. They received a $2,500 bill!

My relative told the hospital that they are leaving the country and offered to pay $250 or good luck collecting from abroad.

Then something magical happened. The hospital just told them that they found a special discount and the deal was closed at $250.

What a sh**show.

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I had to get a medication for a stomach bacteria called C. diff. It has bad relapse rates and its best to get it in check asap. What my doctor prescibed was the newest/best antibiotic for the issue, the other have worse recovery rates and way worse side effects.

I have very good insurance. The price of the medication without insurance was about $5000, the price with very good insurance was about $1300. After redditing i found a thread where you can find a manufacturers coupon on the manufacturers website. After knowing this seemingly secret hidden trick the medicine was $50. My doctor didnt know about that, my insurance didnt either. Absolutely insane. Absolutely arbitrary.

Well of course. In the USA, health insurance is legally required to spend at least 80% of premiums on medical care [1]. So, if they paid for only 50$ of care, they would only be able to make at most 62.50$ of revenue. The only way to keep revenue and total profits increasing is to increase costs.

[1] https://www.healthcare.gov/health-care-law-protections/rate-...

That’s a really important point. All the incentives are to increase cost.

The insurance still paid the $3700 or so, the rebate coupon is to remove the obstacle for the patient so that the larger payment gets made.

> After redditing i found a thread where you can find a manufacturers coupon on the manufacturers website. After knowing this seemingly secret hidden trick the medicine was $50. My doctor didnt know about that, my insurance didnt either. Absolutely insane.

This is GoodRx's business model in a nutshell. I used them when I didn't have insurance and saved a ton on medicine.

Some manufacturer coupons/copay programs work a little differently than GoodRx—specifically the ones that you can only use if you're insured.

Those ones work like this: HelpfulDrug costs $2000/month. Your insurance company will pay $1500/month, and wants to pass the remaining $500 onto you, but that's too expensive for you to pay.

The manufacturers of HelpfulDrug see this and would rather not lose our on a deal, so they make you an offer: as long as your insurance pays the $1500 as promised, they'll tell insurance to waive $450 worth of your portion. You only pay $50, and the HelpfulDrug manufacturer still earns $1500, most of which is pure profit anyway.

i just looked up the medication on goodrx [1]. still listed as ~$5000 when there is still a $50 coupon [2]

[1] https://www.goodrx.com/dificid

[2] https://www.merckconnect.com/dificid/coupon/

Interesting I Google'd this and it costs NHS in UK £1,350 GBP aka $1,719.22 USD for same 20 pills at same dosage (document dated 2019)

https://gmmmg.nhs.uk/wp-content/uploads/2021/08/Fidaxomicin-...

Manufacturers' discount coupons are a fairly common thing in the US. But if the patient is on any kind of government medical assistance program (Medicare & Medicaid being the two big ones), they're not eligible.

My bit of anecdata is the insured price of $1249/month for a drug whose manufacturer would sell me for $40/month - if only I weren't on Medicare. $14,988/year vs. $480/year. Sucks.

I needed an adrenalectomy.

I called before hand, trying to figure out what I would owe afterwards.

No one could give me a price. It’s all vague, we don’t know answers.

It’s absurd.

I basically got stern - eventually somebody is going to send me a bill with a number on it, so someone knows what this will cost.

Still never got a solid number out of them.

They can tell you what they'll bill (if they can't, they're idiots). They can't tell you how your insurance company will adjudicate it, which is what matters.

That doesn't change anything, but FYI it's not just doctor being shady.

I founded https://rivethealth.com to help providers estimate patient liability.

I had to get some bloodwork done. I sent emails and made calls until I found a provider who would actually tell me the prices.

Then the bill came and it was 3x higher. I wanted to know if it was the doctor's error or the lab's, so I asked for any paperwork requesting services submitted by the doctor, and they ignored me and sent it to collections, where it has been for the last 2+ years.

Even better, the hospital might use subcontractors for some services so for months you will be getting bills from random vendors.

In any case, best of luck with your surgery:)

My ex had surgery years ago. The hospital messed up something with billing so she had to go to 20 different companies to make them redo their bills. Took a year of almost full time work.

Medical providers have inflated prices because contracts with insurance providers say the medical provider must provide them with discount. There's a secret cash price which often is cheaper than what insurance pays. Everyone is ripping each other off.

Here's a good example. Duexis is a combination of two over the counter drugs except medical providers bill $2500 a month for it even though it contains less than $5 worth drugs.

https://jamanetwork.com/journals/jamainternalmedicine/articl...

I'm type 1 diabetic, so I have a lot of medical costs. I'm legitimately traumatized by decades of navigating the US healthcare system, and one of the biggest problems is never having a real idea what things are going to cost, what will be covered, or when my insurance will randomly stop covering one of my medications, or take one of my doctors out of network.

I've had the experience of buying a prescribed medication in an EU country without local insurance, so the pharmacist had to charge me full price (and sincerely apologized for doing so) yet the full price was less than my co-pay would have been in the USA.

Technically speaking, there's supposed to be an available price sheet of services posted somewhere where patients can find it. IIRC this was a law passed during the first Trump administration.

The way that healthcare companies have been dealing with this is to post indecipherable price lists in a place that's buried within their websites. [0]

[0] https://arstechnica.com/science/2019/01/new-hospital-price-l...

That doesn't help, because it doesn't tell you what insurance will or will not cover

The other only way a price based system will work is if providers are required to show the bill ahead of time, with full insurance coverage and noncoverage clearly laid out, that is binding to the hospital and the insurance company.

That must be signed off by a conscious capable representative.

Yeah how does that work for emergencies and other situations?

It doesn't! Just like hospitals unable to or refuse to disclose prices.

The system isn't working, it's a steadily sinking ship that the four pigs of medical care: doctors, insurance companies, drug device makers, and trial lawyers feast at while they can.

With political parties in realignment, you'd think that Republicans who are pro working class under trump (allegedly) and Democrats who are pro poor (allegedly) could enact real reform, but I stead the chaos of current politics means corporate even more control

Because corruption is definitely up on both parties since the advent of trumpism.

> Just like hospitals unable to or refuse to disclose prices.

Yep or they give an estimate which explicitly says it can change based on the procedure's outcome and then your real bill is 3x the estimate even though you have signed paperwork from a doctor saying nothing out of the ordinary happened so you call your insurance company and mention this and they immediately deny your grievance form and say you're responsible for the full amount that's not covered.

Then you bring this up with the hospital and they say "an estimate is what it is, there's nothing we can do" and then you ask for them to assign you to someone who can walk you through the itemized bill which says stuff like "Code 0234 Unknown" and explain why it costs $6,354 dollars and they don't comply.

This is all after you've called half a dozen departments ahead of time to try and get an accurate price quote but were denied by everyone. It's no surprise that bills get sent to collections.

For anyone out there in the US, I highly encourage you to record every single phone conversation you have with anything medical related. It will save you.

It's funny that if you talk about the top issues Americans worry about, health care is one of them.

What are the top issues as perceived by Republicans and Democrats? They range from gender equality, race, immigration, crime, trans issues - basically anything controversial.

Healthcare is less controversial. And there's big buy-in for change by Americans. So what's happening? Are the two parties so bribed by lobbying efforts that democracy is canceled on this topic?

It's not surprising because everything you just listed for the top issues are wedge issues

Those are the issues that will drive votes either distinctly, Democratic or Republican.

Neither are the Democrats or the Republicans are actually interested in healthcare because the powers that be and their funders don't want it to change

Travel insurance is cheap, effective, and available for europeans to purchase in their contry of residence. Using the health services of another country and refusing to pay in an asshole move.

People don't like price gouging. If you get into a taxi where somehow there's a misunderstanding about the price or opaqueness when you get in, and suddenly when it's time to get out there's some crazy price the driver is requesting, that makes you feel cheated, well you'll feel like not paying or going to the police. These things happen all the time when traveling. Why do health services somehow get a free ticket to cheat? The numbers, thousands of dollars, are astronomical and never is there an attempt to rationalize it. It just is.

> Why do health services somehow get a free ticket to cheat?

In the vast majority of western countries, a tourist would need to pay more than 250usd to receive the services described by GP. Even when a country has UHC it rarely(never?) covers tourists. A quick google suggests prices in the 1000-3000usd range for Canada, the UK, and Germany, for example (an ER visit with blood tests + follow up).

It's just expensive to provide urgent care and tests. Not having travel insurance (fairly cheap!) and then refusing to pay for services is, indeed, a dick move.

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