One hospital that I use immediately takes 48% off the bill if you are uninsured without even being requested. As indicated elsewhere in this thread, this is not generally the non-insured price.

I'm afraid it is mostly irrelevant, but it is definitely the first step in the right direction. As somebody else said, it's more important to find out what real people ended up paying for a procedure after it was all said and done.

> As somebody else said, it's more important to find out what real people ended up paying for a procedure after it was all said and done.

Is there a bill-sharing website to cure this information from people voluntarily? Maybe someone on HN would want to start one up? Or would people be too reluctant to share details of procedures?

Several news organizations are collecting bills (and doing some great journalism with what they've collected thus far).

NPR / Kaiser: https://www.npr.org/sections/health-shots/2018/02/16/5855495...

Vox: https://erbills.vox.com/

This has been my experience as well. The one time I had to go to the hospital while uninsured, while in-between jobs, they immediately tried to negotiate a settlement with me.

This has made me wonder what the point of these high prices are if no one ever pays them. My guess has always been that it has something to do with tax write-offs for the services that they never recoup.

Legal reasons. They cannot collect more than advertised retail prices but may collect less.

Fair enough, so still maybe not actual price without insurance. In that case at least. Makes me wonder if all facilities do this or something similar? Maybe that facility is particularly generous, or in the financial position to do that without the patient having to negotiate themselves. Maybe this could be an interesting app to make where people could report what that paid in the end :)

No, it's not normal. But being able to get a discount if you are uninsured is normal.

I've wondered whether the facility is particularly generous or whether it just starts with insanely high list prices. Now I guess I can find out. :)

But I still won't know what the final bill would be for the same procedure at a different hospital.

I want to see that app.

I really wish routine procedures had fixed prices so you know exactly what you're in for. Obviously there should be some limits, but you should know what you're in for with a low chance of surprises.

If prices were fixed, you could shop around if your procedure wasn't urgent. This ability to shop around means that prices should stay competitive, which will benefit people who don't have that luxury.

> A̶n̶d̶ ̶i̶t̶'̶s̶,̶ ̶m̶o̶s̶t̶ ̶c̶e̶r̶t̶a̶i̶n̶l̶y̶ ̶a̶ ̶r̶e̶a̶l̶ ̶p̶r̶i̶c̶e̶ ̶i̶f̶ ̶y̶o̶u̶ ̶h̶a̶v̶e̶ ̶n̶o̶ ̶i̶n̶s̶u̶r̶a̶n̶c̶e̶.̶

Aside, I hope crossed-out-text generators don't become popular on HN. Maybe a trailing "(not)" will have the same rhetorical effect, though I don't think it added anything to your post.

It triggered my browser's "Do you want to translate from Vietnamese?" pop-up.

It was an edit, not meant for rhetorical effect, I don’t think.

Oops, yeah I it was a later update... never would have imagined. Good to know, I'll refrain from that in the future.

I am hopeful of these changes, too. But market alone won't have any influence in deterring hospitals from charging arbitrary charges. Market works best when there are range of options available, but in case of hospitals in US only few big players are hoarding all medicinal resources leaving patients with no choice.

That doesn’t seem true. I live in a small city and have three major hospitals within a 20 minute drive, plus half a dozen urgent cares.

Most of the urgent cares in my area (Rochester, NY) are being taken over by the local university medical system. Those that aren’t are closing as a new URMC urgent care opens up across the street.

They own several hospitals in the city. They’ve also bought up several formerly independent hospitals in the surrounding more rural areas.

My understanding is that this approach is becoming increasingly common.

Well said. In the Health IT community many have been quick to dismiss it as useless data, but data is data.

> but data is data.

No, data that doesn't have any coherent practical meaning is worse than no data (well, it's worth exactly the same as no data if and only if you recognize the fact that it has no coherent practical meaning and disregard it entirely.)

One of the classic bad-management failures is finding some easy to quantify it irrelevant to purpose number and optimizing around it because, hey, it may not be perfect “but data is data”.

The worst situation is to have high deductible insurance. Then you have to pay the prices the insurance negotiates out of pocket (at least if you want the costs to apply against that high deductible).

If you don't have insurance the hospital will take what they can get.

No, the worst situation is to have no insurance and develop a super expensive condition. A high deductible insurance is way better for most people than either expensive insurance (you're paying for care you're not receiving most of the time) or no insurance (bankrupt by bad luck).

If you have a high deductible insurance plan (mines pretty high at >$10k for my family), keep cash in your HSA so you're not put out if you max it.

Or just tell them you’re paying cash and ask for that price. It won’t count toward your deductible but it could be significantly cheaper. I’ve seen urgent care facilities that charge $50 for cash patients and $130 for those with insurance.

It can go both ways - often the insurance negotiated price is significantly cheaper.