I mean, it's just the 'cost.' Not necessarily the 'cost to the patient.'
I understand that it's helpful to see for people who are under/uninsured, but for most of the people it'll just max out at out of pocket/annual deductible max (which for example is like $250 per annum for me).
Further, what hospitals charge to insurance is not necessarily the rate insurance pays either. My counselor charges my insurance $400 an hour, but insurance negotiates it to like $80, of which I pay $0.
The counseling office charges people who do not have insurance like $96 per session.
What hospitals charge is not necessarily cost to patient is all I'm saying.
Using insane prices and then marking them down to reasonable levels "as an insurance discount" only has a few possible purposes and none of them are good:
1. Ripping off anyone without insurance who doesn't realize they may be able to negotiate it
2. Misrepresenting the true cost of healthcare for anyone who goes off the "original price"
3. Establishing that insurance companies have to push for deep, 90%+ discounts on everything, meaning nobody can offer sane pricing because the insurance company will say "But <HOSPITAL> gives us 95% off!"
I recently had a genetic test done. They told me that if my cost after insurance was more than $200 they'd notify me ahead of time so I could decide how to proceed, one option was a simple pay-cash option for $250. Turns out the "Amount billed" to insurance was $ 25,000, which was then "discounted" by about $ 24,600 and they were paid $400 or something. So, this is a service the lab is happy to provide for $250 -- and they make money at that price, yet in some fantasy universe, $ 25,000 is in play. This is why people want to burn the US health system to the ground.
Curious question, if the amount 'billed' to your insurance was as you say, 25000, and if a patient went there and they were told without insurance they'd get charged say, $300 (slightly higher than with-insurance price), does it matter to that end user, or the users with insurance that the insurance is being charged $25 grand?
Ultimately the end user is paying $250/300. Eg, my counselor example.
The problem comes when insurance denies the claim for whatever reason. Now, the provider is going to try to bill you the $25,000. It's up to you to either get your insurance to cover the procedure properly or to negotiate it back down to something close to the $300 price. They won't just offer it to you after processing through insurance.
The inflated procedure costs help shape the premiums we all pay for (either directly, or through our employers, or though the overhead costs of business with employees where we shop and do business). It's just a sneaky way to extract as much value from society as they can get away with.
"What hospitals charge is not necessarily cost to patient is all I'm saying."
It is cost to the patient in the form of ever rising insurance premiums and deductibles (mine is $3000 and a lot of people have even higher deductibles).
Your counselor example also shows the insanity of US healthcare pricing. $400 vs $80 vs $96. How is anybody supposed to make economical decisions with such crazy pricing differences? There should be a regulation that providers charge the same price for the same procedure, no matter if they are insured or not or what insurance they have.
I mean, to an extent I agree. I just think that the current pricing structure is lack of competition and a result of overregulation (I may be wrong?) in how hard it is to get into healthcare market. If you make it insanely hard only certain companies will be able to get in and they can then charge whatever they want.
Which specific regulations could we remove to cut prices without seriously impacting care quality?
Generally the level of regulatory compliance necessary to enter the healthcare market is proportional to the risk of patient harm. If you want to sell healthcare analytics software not directly involved in patient care then there are basically no more regulations on vendors than in any other software market. On the other hand, if you want to start a new company to make implanted pacemakers then you'll have to spend years working through FDA compliance issues because a single tiny error can easily kill a patient.
The US still spends almost triple (per capita) what any other country spends on healthcare. Between the hospitals and the insurance companies, Americans are definitely getting a bad deal.
This is true only until insurance decides not to pay arbitrarily. In my case I was stuck with a $112k bill. Hospital offered 50% self pay discount. Now what?
Totally possible that it was an invalid denial, too. I don’t know if insurers face any consequences for just denying some percentage of claims initially, and then only paying out for customers who push back.
If they continue to accept the rate that the insurance company reimburses at, it is not reasonable to describe them as charging some other rate. They know what the insurance is gonna pay when they provide you the service.
Don't forget that they first send bills for that absurd amount to anyone who's uninsured, or anyone unlucky enough to go to an out-of-network facility. If you don't contact them and find a solution, like signing up for retroactive Medicaid or negotiate somehow, they will 100% sell your debt to a collection agency and can basically ruin your life. This does happen every day to people. I don't think it should be okay for prices orders of magnitude above what they actually accept from insurers, to be used to bill uninsured patients.
Insurance: "Look how much we saved you! (Don't question our value.)"
And maybe even the medical provider being able to write off the difference as a business loss or being able to say: "Look how much we discounted your service!"
This only matters to end user if they actually pay for insurance themselves. If their employer covers it (as mine does), I don't think they care that much how much their insurance 'saved' them if the net cost ends up being $0.
Very, very few employers offer an insurance plan without any employee premium. And I would be shocked if those insurance companies didn't highlight to the employer how much was "saved".
Even those employers that do pay 100% of the insurance premium could have paid more to their workers if the insurance costs were less.
Employers who pay less on benefits (pay less health insurance premium, pay fewer vacation days, pay less FICA, etc.) have more cash available. They could use that to pay higher salaries. I'm sure you've heard and that you actually do take into consideration the "full compensation package" when evaluating one job against another.
Also not trying to fight. "Could have paid you more" does actually happen in the right type of competitive environment -- though most employers are more likely to avoid direct salary increases to instead increase other parts of the "full compensation package". It's relatively much easier to later reduce those other things than it is to reduce direct salary, if things go sideways down the road.
https://www.england.nhs.uk/pay-syst/national-tariff/national...