Hospitals and Insurers Didn't Want You to See These Prices. Here's Why.

[elleng]

'This year, the federal government ordered hospitals to begin publishing a prized secret: a complete list of the prices they negotiate with private insurers.

The insurers’ trade association had called the rule unconstitutional and said it would “undermine competitive negotiations.” Four hospital associations jointly sued the government to block it, and appealed when they lost.

They lost again, and seven months later, many hospitals are simply ignoring the requirement and posting nothing.

But data from the hospitals that have complied hints at why the powerful industries wanted this information to remain hidden.

It shows hospitals are charging patients wildly different amounts for the same basic services: procedures as simple as an X-ray or a pregnancy test.

And it provides numerous examples of major health insurers — some of the world’s largest companies, with billions in annual profits — negotiating surprisingly unfavorable rates for their customers. In many cases, insured patients are getting prices that are higher than they would if they pretended to have no coverage at all.'

https://www.nytimes.com/interactive/2021/08/22/upshot/hospital-prices.html

(Sorry to those with pay wall. I read my recent Medicare statement today; thank goodness for this program.)

[captain queeg]

1. I think I can share this article from NYT

https://www.nytimes.com/interactive/2021/08/22/upshot/hospital-prices.html?smid=url-share

Supposedly I can share a dozen articles per month. Or something. Hadn’t tried it yet.

[elleng]

2. Good. Thanks.

The differences between the carriers numbers are astonishing, and everyone should be aware.

[Hugh_Lebowski]

4. That URL has no link to your account personally, so ... no. That isn't going to give anyone access

based on your sharing it here.

[captain queeg]

7. I'll see if I still have the instructions somewhere

[captain queeg]

8. I don't know. Supposed to be a "gift" icon but I don't see it.

If anyone knows, let me know. Supposed to be able to do it with 10 articles per month.

[captain queeg]

10. Maybe try this

https://www.nytimes.com/interactive/2021/08/22/upshot/hospital-prices.html?smid=url-share

[Hugh_Lebowski]

12. Also not possible with that URL ... there would have to be something like a GUID that identifies

Your account (the sharer) in the URL.

Here is a typical GUID format:
20A2A231-BD67-4B20-AFBB-A47CE9CEFD93

Something in the URL has to tell the Web Server that's serving the pages of the article 'this is the account of the person who's shared it'.

Try sending yourself an invite via Email or text or whatnot. The URL will be much more complex than the one in this post. If it could be this simple, anyone could just tack on

?smid=url-share

to the end of the URL for a NYT article and get free access.

They wouldn't let that happen

[Hugh_Lebowski]

3. I hope they lay out the instances of the opposite, which I'm sure account for a lot of cases too

And it provides numerous examples of major health insurers — some of the world’s largest companies, with billions in annual profits — negotiating surprisingly unfavorable rates for their customers. In many cases, insured patients are getting prices that are higher than they would if they pretended to have no coverage at all.

I'd imagine this happens at times, but that is not what I've experienced for anything that's remotely big-ticket.

I'd guess that the insurer and hospital conspire to charge higher rates when you're under the deductible, split the extra profit ... then when you hit your deductible, the insurance company insists on paying way LESS than they would if you're under your deductible vs. what you'd pay as uninsured.

Haven't read the article but I'd wager that's the scam.

[cadoman]

5. people are going to learn that the spread on hospital pricing is astronomical

Hospital pricing is unlike every other price system you will deal with in your life. There is the posted price (astronomically high), but then there are a number of what in medical lingo are called "accepted prices".

So as an example, the posted price for an aspirin (what an uninsured patient sees) could be $400. The accepted price for Blue Cross could be $0.11, Medicare $0.10, and Medicaid $0.08. The dirty secret is that the hospital is perfectly happy to get $0.08. Why? Because by paying you are accepting services rendered, and it holds up as evidence in court if malpractice ever comes into play. Also, a lot of people just never pay at all so they're happy to have people actually pay.

What most people don't know is _you absolutely can haggle_ with hospitals. It is like a 3rd world bazaar. If you're dumb enough to pay $400 for the aspirin they're happy to take it, but they are expecting you to _haggle_. The best way to haggle is to simply ask them if they will pay on the Medicaid schedule (always the lowest prices).

Hopefully this new law will get us closer to uniform pricing. A perfect example of how things are getting better under Joe but for some reason the press has decided to throw him under the bus.

[Yorkie Mom]

9. I didn't know that.

Thank you!

[cadoman]

19. no problem! would be excited to hear from you if you decide to negotiate your next bill

Most of the time your insurance does this negotiation for you, but you can pay direct and do it or do it if your insurance doesn't cover something!

Basically you ask for the billing office (ideally before receiving service, but after is ok too) and ask if they accept the Medicaid or Medicare payment schedule. If they do, bam, you're in at the real market rate!

[NowISeetheLight]

6. Broken System

After 15 years in hospital finance before retiring last year I can attest the system is broken. Hospital chargemasters grossly inflate prices. Poor cash-pay patients are offered "discounts" of 25% which still requires them to pay way more than insurance companies do (hardly a break for the poorest people). We need a national healthcare system.

[ShazzieB]

16. What a weird coincidence!

We just had a person who recently posted about being an ex-Republican! Are there a lot of you out there? I sure hope so!

Welcome to DU.

[IbogaProject]

11. I hope Biden pushes this

I hope Biden pushes this, even if the former administration first implemented it. This type of disclosure and accountability is a big reason why big medicine hate the idea of single payer insurance. They also don't want a nice clear comprehensive list of all outcomes, so we can really see what works and get a handle on what is the best treatment value for the money.

[yaesu]

13. a decate or so ago I went to the er, got charged about 10 times more than insurance companies

pay for the same ultrasound.

[IronLionZion]

14. Hoping more news sources will cover this

unless big healthcare is paying them not to

It seems so weird that insurers would negotiate unfavorable rates. One would think they'd use their influence for lower rates.

[orleans]

15. this shit has been going on for years

my kid's father had insurance for her and it included eye check-ups and glasses.

it was a 500 deductible for that. her dad and i split the cost of deductibles & co-pays.

essentially we'd just have to pay for her eye care because it wouldn't exceed the deductible every year.

i turned over the insurance card that first year. (and we had to pay b/c we hadn't met the deductible)

the second year i told them we didn't have insurance.
holy shit!
huge discount!
the bill was over 100 dollars cheaper.

this was over 20 years ago

[PoindexterOglethorpe]

17. Health care costs are hugely variable.

There is simply not one cost for any one procedure, surgery, or whatever. Plus, each and every insurance company negotiates different prices for each and every procedure, surgery, or whatever.

[orleans]

18. a little humor to this piece? it made me smile (and shake my head)

As of July, the Centers for Medicare and Medicaid Services had sent nearly 170 warning letters to noncompliant hospitals but had not yet levied any fines.

Catherine Howden, a spokeswoman for the agency, said it expected “hospitals to comply with these legal requirements, and will enforce these rules.”

She added that hospitals that do not post prices within 90 days of a warning letter “may be sent a second warning letter.”

(i hope that second warning letter is 'strongly worded')