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Started By
Message
re: Federal Judge Upholds Trump’s Hospital Price Transparency Rule
Posted on 6/24/20 at 11:54 am to Taxing Authority
Posted on 6/24/20 at 11:54 am to Taxing Authority
quote:
Insurance companies have used EOBs to scare people for decades. OMG that was $50,000 surgery,
Doesn’t the hospital submit their full fee? That’s what’s reported on the EOB. Then the discounted fee is placed next to the full fee?
1
Posted on 6/24/20 at 11:56 am to Auburn80
quote:See, that's the problem. The real customer isn't the patient. It's the insurance company.
The patients estimated cost can easily be determined without the patient knowing what the hospital gets reimbursed by the insurance company.
But they both pay for a portion of the service.
If you had a business partner.... 50/50 or even 20/80 and you're buying a building for the business. Would you be cool if your partner said "Your portion is $150,000", but he wouldn't tell you the total price for the building, nor how much he was putting in?
"I negotiated my own price" wouldn't be an answer I took for that purchase.
This post was edited on 6/24/20 at 12:00 pm
Posted on 6/24/20 at 11:59 am to roadGator
quote:Most of the time. ANd most of the time people only talk about the "big" number. Kinda like how people say "I got $15,000 off the sticker price!! I showed that dealer who is boss!" when they buy a car.
Doesn’t the hospital submit their full fee? That’s what’s reported on the EOB. Then the discounted fee is placed next to the full fee?
It's all part of the game.
People think if they don't have the Big Brother insurance to "negotiate" the price down, they'll have to pay the top-line price.
Posted on 6/24/20 at 12:03 pm to Taxing Authority
You can already get itemized billing statements with what the insurance actually paid, what you are required to pay and what the normal rate is. You just have to ask for it in the "correct" way. I had a $7k+ miscellaneous charge one time from being hospitalized, they were treating with a insulin drip so they had to check blood sugars every hour. They denied it because the hospital charged $69 for each blood sugar check. Once I got the itemized billing they were quick to take those charges off...
Posted on 6/24/20 at 12:04 pm to dbbuilder79
quote:
Which insurance company/medical provider do you work for???
I have been a hospital CFO for 32 years.
The problem with healthcare is that it's a 3 party transaction instead of the usual 2 party transaction. You could even call it a 4 party transaction because your employer gets involved in it too. You have the employer, insurance company, healthcare provider, and the patient involved in a transaction. Usually the patient gets caught in the middle of this because they are legally required to pay the bill. Many times it's not the hospital or the insurance company that is to blame. It's your employer with their high deductible and high co-pays along with special carve outs on certain items.
To be really honest here, I am a fiscal Conservative, but I am moving much closer to being OK with a single payer system. It wasn't very complicated until employers started jacking up deductibles and co-pays to save costs. Patients pay a tremendously larger portion of the bill now and hospitals have to collect it to stay viable.
Posted on 6/24/20 at 12:05 pm to Taxing Authority
Why do the providers submit the full fee if they never actually charge it? I’ve always wondered that.
Posted on 6/24/20 at 12:05 pm to bigblake
quote:
This is a false equivalency. Your example is a company paying for an intermediate part. This rule is for what the company is charging the end user. To use your example, it’s analogous to you buying a F150 and not knowing the actual price until a month after the transaction.
The rule is NOT for what they charge the end user. It's for what they've negotiated to charge on average for this service for certain classifications of users but only for services and not accounting for how complexity of care in any instance might lever on the price.
Thus, it would remain true, that the amount any end user would pay would be the result of the interaction of the specific contract the hospitals signed with a specific payer for the services rendered and the vagaries of that payer's contract with the end user. Also none of this takes into account fees associated with physicians which would remain outside of all of this disclosure.
The upshot is a onerous regulation on hospitals that won't benefit patients because patients won't understand what they're seeing if they knew where to look and they won't know where to look and if they did they probably wouldn't look.
Posted on 6/24/20 at 12:06 pm to Auburn80
quote:
Want to buy a Lexus? Too bad, you're getting a Yugo.
So you don’t want to pay for Lexus Tylenol when you could have Yugo Tylenol for 1/100 the price. Too bad...you are getting a Lexus.
I get that the system is fricked, but what would you suggest besides what Trump is offering? I don’t get the pushback for price transparency.
Posted on 6/24/20 at 12:06 pm to Magician2
Government regulations have made healthcare needlessly complicated.
Posted on 6/24/20 at 12:08 pm to roadGator
quote:Two reasons...
Why do the providers submit the full fee if they never actually charge it? I’ve always wondered that.
1/ Insurance companies love it. Otherwise it doesn't look like they "earned" the customer a "discount".
2/ if it goes to collections, the provider can expect just a few cents on the dollar. If they try to collect a $50,000 bill, and they get $0.10/dollar -- it's about right.
Posted on 6/24/20 at 12:08 pm to Magician2
What are the lefts arguments against this???? I’m sure they have one that is well thought out and makes logical sense.
Posted on 6/24/20 at 12:08 pm to Taxing Authority
quote:
See, that's the problem. The real customer isn't the patient. It's the insurance company.
The patient is the only customer. Insurance companies are just a 3rd party payer in the transaction looking to make money on it. Insurance companies could easily disclose to patients on the EOB what they paid it they wanted to.
Posted on 6/24/20 at 12:10 pm to Auburn80
quote:Nope.
The patient is the only customer. Insurance companies are just a 3rd party payer in the transaction looking to make money on it.
Posted on 6/24/20 at 12:29 pm to Auburn80
quote:
These are negotiated rates just like any other industry in the country does. Should Ford have to disclose to GM how much they pay for certain parts?
A hospital isn't like every other industry. If I go to a Ford dealership and don't like their prices, I can got to a Chevy dealership (assuming I was also gay).
If I am rushed to the hospital, I as a consumer, have zero leverage or negotiating power.
Posted on 6/24/20 at 12:32 pm to Taxing Authority
Gotcha. The collections part makes total sense.
Posted on 6/24/20 at 12:35 pm to theunknownknight
quote:
If I am rushed to the hospital, I as a consumer, have zero leverage or negotiating power.
That's true, but in most cases you are considered in-network if you are an emergency patient, so that helps.
Posted on 6/24/20 at 12:37 pm to Auburn80
quote:
4 party
I could even make an argument for 5th and 6th parties, which is what got me in trouble. Mostly from my first child. The hospital we went to laid out all their costs for my wife's delivery, but left out all the "specialist" who became involved because she was early and was labeled a "possible" high risk. Not a high risk, but the possibility that she might become that.
Her OBGYN brought in a few network friends, I mean specialist, who said our insurance would cover their costs because the pregnancy was deemed high risk, which it ended up being only early. They included one saying she had potential for having gestational diabetes, so we better put her on the special diets, which also needs a specialist for the diet and another for the diabetes. They were all under the same hospital letterhead as far as billing, but billing considered them outside of the network for that hospital
After our child was born, we found out that more than half of this guys patients had been diagnosed the same.
Her last 3 pregnancies (with a different OBGYN) never showed signs of gestational diabetes.
This was a great learning experience for me in how to navigate the medical maze. It only cost me $13,000 before we stopped paying. That's when the collection agencies came into play to collect for the specialists.
Posted on 6/24/20 at 12:41 pm to Auburn80
quote:
Totally agree with this. This ruling is not forcing the insurance companies to equally disclose information.
It does in a significant way; just not significant to the patient, but rather to other hospitals who, incidentally, are the only ones who are going to understand this stuff anyway. I'm not convinced this won't make prices go up. Right now, rates are pretty much a function of the leverage of each individual payer vs. each system/hospital in an area in terms of relative market importance plus the negotiating prowess of each entity. For big systems, everyone already knows everyone else's rates. But payers feast on small or unsophisticated hospitals from a rates standpoint. If rates are published, they're going to want fairer (higher) rates and they'll be in position to get them. In any situation, this rule is a pretty blunt instrument, 3 years post implementation, the big hospitals will definitely have outmaneuvered this rule.
This post was edited on 6/24/20 at 12:53 pm
Posted on 6/24/20 at 12:43 pm to jimmy the leg
quote:
I get that the system is fricked, but what would you suggest besides what Trump is offering? I don’t get the pushback for price transparency.
Much like everything else in this world, there isn't a simple answer. And it's an even bigger problem when you realize that the Government already controls well over 50% of the market thru Medicare, Medicaid, and the VA. Change can only come from the Feds, because they have made all the rules that have made it complicated.
If I had the power, my first step would be to ease a lot of the regulations in healthcare. The amount of documentation and paperwork (even if it is electronic) is tremendous in healthcare. It raises costs dramatically.
Posted on 6/24/20 at 12:50 pm to theunknownknight
quote:
anesthesiologist
A lot of anesthesiologists don’t contract so they can get higher out of network reimbursement despite the patient having no say in the anesthesiologist for their procedure.
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