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snumbers76 karma

You're supposed to just lie on top of it.

snumbers33 karma

I'm a little confused by this. A lot of the discussion around inflated medical bills has demonized hospitals and healthcare providers, but a lot of cause of this seems to be based on historical negotiating practices by managed care plans, and gross charges aren't relevant to most of the population (true self-pay may be the exception, but in my experience there is a sliding scale or self-pay discount policy already in place for most facilities).

If the hypothetical ER visit statement was for charges, then almost everyone is by default paying less than that because your insurer has already negotiated that for you, and if you are true self-pay then there is almost universally a discount or sliding-scale policy already in place by the facility. Are you suggesting that patients should try to negotiate further?

snumbers2 karma

Multiple issues with this, there are some strides to change this, particularly in certain service lines (imaging, colonoscopy, etc).

  1. The actual out-of-pocket is not typically determined by the provider, but by the patient's insurance. This is called the negotiated rate or allowable or expected amount. So if you go in for a colonoscopy that procedure is one CPT code and the physician will have a fee for that, but your insurance will usually have a negotiated rate that is lower than the physician fee.

  2. For the colonoscopy example, most of these are performed in the ambulatory "surgery" center (ASC is also used for o/p surgery but colonoscopy centers are set up the same from a financial POV). The surgery center will also give you a bill. The physician typically has no idea what that fee will be. This separation is called facility (ASC) vs professional bill.

  3. Along with the negotiated professional rate, your insurance will also have a negotiated rate for the surgery center.

  4. Imagine all of these things for a simple, single-CPT code procedure, multiplied by 100 or 1,000 or 10,000 for a ED visit, short hospital stay, or extended hospital stay. There is no way to even guess how long you'll be in the hospital, what services you'll need, how many physicians will see you, etc etc etc.

For simple stuff like an x-ray, MRI, or a colonoscopy, many providers and hospitals are trying to get on board with transparency. But it's hard; it takes education for staff and patients, and it requires huge amounts of resources, just for this one procedure. Right now providers' only option is to say "you have to ask your insurance" and that's like chewing glass because insurers are right above cable companies wrt customer service and are literally only in business because we don't have a better option.

snumbers1 karma

But you need to take the historical context into account, it's much more nuanced than you imply. Until twenty five or thirty years ago everything was paid (by managed care plans) as a percent of cost, which incentivized healthcare providers to inflate "gross charges". Today we're in a situation where more people are un- or under-insured, and the hospitals and healthcare providers are now taking heat, while barely staying in the black. The real story is in the overhead expenses, which is difficult to quantify.

snumbers1 karma

HSAs paired with high-deductible plans are often beneficial to younger people and that's primarily how they are being promoted. Imagine though being a middle-age couple who has a $25,000 no-complication childbirth, or a $50,000 childbirth with complications, or a mid-50s patient with complex chronic disorders, etc etc. Insurance is intended to provide risk-sharing throughout life, which is why it was essential to get younger people to participate in ACA plans for it to be successful. Pay in more when you're younger, benefit later. This is why we all pay for Medicare. If high-deductible becomes the standard today what consequences are we going to sow twenty years from now? Less access, sicker patients, etc.