U.S. health care's widespread overbilling problem

Re:U.S. health care's widespread overbilling problem by Osiris on Monday July 10, 2017 @11:12AM (#14736613)

Health care is the only industry where you only find out how much something costs after you're already bought it.

Basic supply and demand theory depends on consumers having perfect information. A free market cannot work when a consumer has no information.

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Re:U.S. health care's widespread overbilling problem by cptskippy on Monday July 10, 2017 @11:23AM (#14736738)

A lot of trades give you estimates but you don't know the actual cost until the work is complete. Auto repair, construction, plumbing, electrical, etc. There are plenty of fixed costs that can be accounted for easily but there are a lot of unknowns that can't be seen ahead of time. That's why quotes and shopping around so prevalent because it allows for competition in price.

However in healthcare that's not an option, there is no competition. The cost of fixed cost procedures (e.g. lab work) are unknown. You can't shop around for surgeries or doctors. Everything is wrapping in mystery even after the fact, there is no final bill. Even if you pay everything you're asked to, you might still get a bill 2 years down the road for reasons no one can suitably explain.

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Re:U.S. health care's widespread overbilling problem by Johnny555 on Monday July 10, 2017 @03:02PM (#14738696)

One difference with auto repair: I expect the garage to call me before they do any work that exceeds the estimate. And I may very well decide not to do it. They may tell me that I need a $1000 timing belt replacement when I ask for a $200 water pump replacement, and I may decide not to do it. I can even ask them to put everything back together and tow the car somewhere else for repairs. If they tell me I need a $3000 engine replacement, I may decide to just scrap the car.

The same is not true with healthcare - you may go in for a $20K stent, but have a serious complication that needs $200K open heart surgery -- you don't really have the option to say "put everything back together and I'll live with it".

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Re:U.S. health care's widespread overbilling problem by mikestew on Monday July 10, 2017 @03:33PM (#14738936)

One difference with auto repair: I expect the garage to call me before they do any work that exceeds the estimate.

It's not just an expectation, it's the law in many places. When I was a pro mechanic in Indiana, anything over original estimate + 10%, and authorization from the customer is required. Well, not required I guess, since if you show up and the bill is 20% over, you just pay the original estimate. (Yes, in the worst case you might have to sue to get your car back. Personally, I've never known that to have happened, because most shops aren't looking to rip you off.)

But, as you point out, me being in the middle of a top end job is a little different than a surgeon who's working on a running engine when it comes to needed extra work.

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Re:U.S. health care's widespread overbilling problem by biomcgary on Monday July 10, 2017 @05:54PM (#14740037)

I've often thought this could be solved by requiring a doctor to carry "estimate" insurance. The patient's bill would be the quoted price and the doctor's insurance would cover any complications leading to additional costs. This would have the additional benefit of increasing the costs of doctors with frequent complications. This would only work for immediate complications from surgery (i.e., less likely to be impacted by patient compliance).

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Re:U.S. health care's widespread overbilling problem by cptskippy on Monday July 10, 2017 @06:32PM (#14740261)

It might also lead to doctors "missing" complications to avoid insurance premium increases.

Complications during surgery aren't necessarily caused by the surgeon or known ahead of time. The same is true of other things like home renovation where "we won't know until we open her up" is a common enough phrase.

Case in point, we want to remodel a bathroom that has a 7ft ceiling and my wife wants the ceiling raised to match all of the others. Why is it 7ft instead of 8ft? Can it be raised? Without significant cost? We won't know until we get in there.

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Re:U.S. health care's widespread overbilling problem by u801e on Monday July 10, 2017 @09:21PM (#14740930)

> The cost of fixed cost procedures (e.g. lab work) are unknown.

I don't think that's the case. For example, if you get a lipid panel, it's going to be coded under a given CPT. The billing department should be able to obtain the cash and insurance price. The problem is that they're not forthcoming with it (at least in my experience even when I had the CPT).

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