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Comment by BeetleB | Hacker News Reader

It's nice they succeeded, but a word of caution: Medicare is not a good standard - it's often lower than what it costs them to provide the care. If everyone paid Medicare rates, lots of providers would go out of business.

The usual benchmark is the "usual and customary" charges for a procedure. You can look it up for a procedure for your area. You then go to the hospital and point out these charges. My guess is they're much more likely to agree with this than the Medicare rates.

It's also the rate your insurance will use if you go out of network. So if your insurance pays 40% out of network, and you get billed $1000 for a $100 procedure, your insurance will pay only $40 (4%).

(Although by all means, you can start your negotiation with whatever is lower).

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I broadly disagree.

Yes - Medicare is typically lower than private insurance plans, but if you can't deliver care for the reimbursement that Medicare offers as a health system/plan/office/provider, you're probably overcharging.

More than that, Medicare is the de facto starting place for most reimbursement negotiations between providers and payers. One of its benefits is that it's transparent and readily available. Blue Cross isn't gonna tell you what it's contracted to pay an individual provider (and that individual provider often won't know what they'll be reimbursed untill after they submit a bill) - but with Medicare the data's out there.

I know a good number of private clinics that'll offer cash pay discounts that effectively mirror Medicare or even slightly below Medicare, since you're saving them the trouble and expense of going through the medical billing process.

> One of its benefits is that it's transparent and readily available.

So is the usual and customary rate - I think it's been available since before Obamacare.

> Blue Cross isn't gonna tell you what it's contracted to pay an individual provider (and that individual provider often won't know what they'll be reimbursed untill after they submit a bill)

You'll find out when you get the bill :-) The bills I get have:

- Cost the provider is charging (e.g. $1000)

- Agreed upon cost with the insurance company ($600)

- Amount due ($60 assuming 10% and deductible met).

I don't know if they publish it transparently, but for common procedures, it's easy to find out. They're not going to prevent you from posting your bill online.

Give me a break.

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