mrnickel001

Many hospitals don't discount from their list price for self pay. Medicare pays ~10% of list price. So, for example, if there is an insurance rate set at "130% medicare" (common to have a coefficient between 1 and 2), then yes, you'd still see many cash rates that are 5x insurance. However, many hospitals also listed Managed Medicaid insurance rates. These are generally 3-5% of list price & look for similar to normal insurance plans. So, what you're seeing may also be comparing a Medicaid rate to a very high cash rate.

Will add 43284 & other gastro procs shortly. Thanks!

Generally, every hospital reported price is different. Many of the prices reported are "all in" service packages, but several also wouldn't include these ancillary charges. Forthcoming price transparency legislation puts more pressure on hospitals/insurance cos to quote these "all-in" bundles. On the Turquoise site, we'll be representing all inclusive bundles with a checkmark + explanation that the provider has verified with us the rate is inclusive of all professional/ancillary charges.

Exactly. Small payers are actually pretty hungry for this data. Generally, big payers are more privy to market rates (by paying for datasets, owning clearinghouses, etc).

Yeah, actually I can attest that a lot of our hospital clients have no idea what the hospital next door is charging / getting paid by insurance. So, a lot of price setting is guessing. It's often not cost-based. And often, negotiations will arbitrarily shift high prices over to one service type, eg Blue Cross will say: "Fine, if you want to get paid that much for knee replacements, we get a lower rate for bariatric surgery." So you'll find weird price discrepancies within the same provider.

Thanks for the feedback! We'll be improving our filter/sort here in the coming days and we'll take this feedback into our plan.

Yeah that's a generally interesting one because Kaiser's pricing is inflated assuming that all their patient's also have Kaiser insurance. But appendectomies do range quite a bit.

Hey man! This is a great comment. I work with Turquoise. We're actually building some stuff where patients can collectively bargain outside their insurance. But for now, it's most useful to people with insurance that see that one hospital down the road has a lower rate for their given insurance. (EG, the blue cross rate is better the next town over). We're going to make it easier to filter for insurance shortly.

Also, very useful for cash pay.