(The medical provider also likely won’t be able to provide accurate all-in pricing at the time of service.)
I think we're only a few steps away from patients having to place limit orders on medication like they're on ETrade.
Edit: I double-checked and now at least it gives you an "estimated price". But.. what is there to estimate? Why is there a real-time market rate for perfectly generic prescription pills? https://imgur.com/a/grNPBUB
You end up having to place the order and the charge shows up a little while later. It's never 2x or anything of the sort, but it's also bewildering that they can't tell you what it will cost.
It was even sold in a ridiculous way. “We all know health care is broken, so if we just force everyone to sign up, and give them more guaranteed income streams then it will fix itself!!”.
I don’t want to hear about how Obama actually wanted single payer or X. He knew exactly what it was the whole time.
“Medical billing” is an industry probably larger than medical care.
I fully support Costco here, insurance is a scam.
The entire idea was using the threat of losing access to Medicare $$$ to force acceptance of all ACA plans by providers in order to drive down cost negotiations for individual payers.
Large companies get to leverage large group sizes, and the idea of the ACA was to effectively turn all government aligned plans including Medicare into a single giant "all or nothing" group.
But when the courts struck that down, instead it became the exact opposite, allowing for even more division and sub-grouping across ACA plans, which drives up the end payee costs because there's little to no consequences for providers telling ACA plans to get bent.
The ACA as designed was effectively a compromise, and then the courts reversing the key compromise meant the overall result was a hot pile of crap outside of finally ditching preexisting condition lock-in (which was still a win overall, but a much more minor one).
The only such parts I know of are the mandatory Medicaid expansion and some stuff related to covering contraception. (And the individual mandate penalty was reduced to zero by Congress in 2017.)
I was not aware of any part of the ACA that required insurers to carry certain plans, apart from the general regulations it introduced on health insurance plans in general.
It’s all a big scam.
hedge big losses with small investments, that's the idea behind insurances, isn't it?
In your case, they managed to negotiate such high prices that your co-pay is higher than the normal cost of the medical procedure. If you are on a Gold plan with a 20% co-pay, you can be sure that the money you paid is what went to the insurance company, while 4 times as much money went to funding healthcare!
You should be really happy about this, because this is a rule created to make sure your insurance funds hospitals, not Wall Street greed!
[1] https://www.washingtonpost.com/news/wonk/wp/2013/07/18/the-o...
> We saw the same doctor the same day, back to back. Got prescribed the same antibiotics.
> I had "good" health insurance, she had none. My bill AFTER insurance was higher than her bill without insurance.
> I'm really not sure the moral but it was frustrating as heck.
The moral is that any system which introduces price opacity will gradually increase the price of the product until the price is above what the market will bear.
Look at it this way - at the point of purchase, you are buying a product with absolutely no price information, because "the insurance will take care of it". With no price information to the consumer, there is no price discovery, and without price discovery the supplier will increase prices beyond what the consumer is willing to pay.
If all medical insurances were banned, the cost of medical will not exceed what the market will bear: it can't.
But that's extreme - how about a practical and workable solution: no private dealings between medical insurance suppliers and medical service suppliers.
You have medical insurance? Lovely - you will be forced to submit the claim yourself. When you visit the medical services supplier (doc, hospital, pharmacy, etc) for non-emergency services[1], you will be liable for the bill, and so you will have to lookup what that/those particular code/codes cost/s.
In this way the cost of medical services will actually come down, to what the market will bear.
We've seen the same thing with US tertiary education - free money introduced into the system by the government caused tuition fees to skyrocket, with all the profit captured by the providers. IOW, the price rose to what the market will bear, and since the government was the market in this case, the price rose to what the government was able to pay, which is perhaps 3x to 10x what an unemployed 18 yo is able to pay.
[1] For emergency care, obviously the claim will be submitted to you by the hospital, and you can then forward that claim to the insurance. Even better would be if all emergency procedures have state-backed insurance.
Ah yes. Because I, the lay person, know exactly what all those codes mean and their actual costs.
> IOW, the price rose to what the market will bear, and since the government was the market in this case, the price rose to what the government was able to pay, which is perhaps 3x to 10x what an unemployed 18 yo is able to pay.
Strange how this didn't play out in (most of) Europe.
Why would you need to know?
Serious question - how does it help to know what all those codes mean and their actual costs?
All you need to know is $INSURANCEPROVIDER only covers $100 of a bill for $CODE. What do you care what the "actual cost" of $CODE is for $MEDICALPROVIDER?
> Strange how this didn't play out in (most of) Europe.
Because what the government was able to pay was a lot less than what the US government was able to pay, because the US government provided the money (with basically no controls on cost) and then made the student liable for paying it back. This way the state didn't actually care what the purchase price was, they were always going to get it back anyway.
My understanding is that in Europe (e.g. Germany), the tuition was paid for by the state! It's not a loan, the state is not getting that money back, and so there's pressure on the state to limit what it will pay for tuition.
Who is "you" then in this quote: "You have medical insurance? Lovely - you will be forced to submit the claim yourself. When you visit the medical services supplier (doc, hospital, pharmacy, etc) for non-emergency services[1], you will be liable for the bill, and so you will have to lookup what that/those particular code/codes cost/s."
> know exactly what all those codes mean and their actual costs.
Why would you need to know? How does it help knowing the actual cost vs what your out-of-pocket expenses?
You get $FOO as the code and $BAR as the cost. That lets the market discover, over time, which providers are charging $BAR+$EXTRA, which insurances only cover $BAR-$uncovered.
You can't have price discovery if the purchaser is not able to determine what the price is at the point of payment. If you have a better proposal for determining what the market will bear, lets hear it.
I'm not sure where you're going with this line of questions, but the impression I get from your comments are "People will find it too confusing to know how much they are are purchasing something for - let them only discover the price of the purchase after they have already bought it".
TBH, it's never a good idea to reveal the purchase price of something only after the purchase is made. There is no justification for it.
The problem with this view is that it assumes providers have relatively few SKUs and relatively static pricing, and that providers are relatively static over time. In reality:
- medical providers have an incredibly long list of SKUs, which can have adjustments (e.g. quantity).
- pricing changes frequently
- staff changes frequently. A bill is typically not a provider charging $BAR+$EXTRA, it's more like provider A working at facility B on procedure C has Price 1, but that same provider working at facility D on the same procedure has a different Price. And all the prices are affected by the patient's insurance, and the specific contracts that were in place between the provider, the facility, and other parties at the time of service. (I'm simplifying this, in reality pricing is more complex).
It's entirely possible for Provider A to be the cheapest option in town (for a given patient-insurance combination) when a procedure is done at Facility 1, where they work Monday-Wednesday but the most expensive in town for that same patient when a procedure is done at Facility 2, where they work Thursday & Friday. This relationship can change frequently. Worse, this relationship can be subject to the specific service codes that end up being performed (all of these may not be knowable before the service begins).
I want to especially highlight the "over time" aspect as it assumes the relationships between any of these items are relatively static. In truth, it's entirely possible that your insurance carrier has a great deal for a given service this year, but next year has a terrible deal for that service at the same facility (possible because one of the underlying providers has changed). Second, it highlights the opacity in all of this. Even if you had the ability to digest all of the raw data, it's likely the outcome would not be very predictive at all for a given individual who needs to make a purchase today.
> If you have a better proposal for determining what the market will bear, lets hear it.
The market needs a lot more regulation. Think more like electric utilities instead of software.
We saw the same doctor the same day, back to back. Got prescribed the same antibiotics.
I had "good" health insurance, she had none. My bill AFTER insurance was higher than her bill without insurance.
I'm really not sure the moral but it was frustrating as heck.