![[personal profile]](https://www.dreamwidth.org/img/silk/identity/user.png){kind=small}
Entry tags:
Our wacky health care system, continued
In this post and others, I remarked that the "list price" of most medical procedures is a fiction, applicable to hardly anybody, because every insurance company negotiates deep discounts for its own customers, as a kickback for steering its customers to this particular health care provider.
According to this Times article, the reality is even weirder than that. Not only are list prices dramatically different for the same procedure at different providers in the same area, not only are the discounted prices dramatically different between insurers for the same procedure from the same provider, but many "discounted prices" are actually higher than the price to uninsured patients. Depending on the contract between insurer and employer, the insurer may get paid a percentage of the billed amounts as an administrative fee, so it's in the insurer's interest to negotiate a higher billed amount!
And, not surprisingly, despite the law passed last year with rare bipartisan support requiring health care providers to publish their negotiated price lists, almost none of them have actually done so. They also refuse to tell a patient even the negotiated price for that patient's own procedure, with that patient's own insurer, until after the procedure is done, presumably to prevent people from "shopping around" the way a free market is supposed to work. In some cases the contract between insurer and provider contains a gag rule forbidding either party to divulge the negotiated prices; in other cases they just don't want the public to know, and would much rather pay a trivial $100,000/year fine instead. That is, if the Federal government ever gets around to imposing those fines; so far they've sent warning letters, and ominously threatened non-compliant providers with a second warning letter.
According to this Times article, the reality is even weirder than that. Not only are list prices dramatically different for the same procedure at different providers in the same area, not only are the discounted prices dramatically different between insurers for the same procedure from the same provider, but many "discounted prices" are actually higher than the price to uninsured patients. Depending on the contract between insurer and employer, the insurer may get paid a percentage of the billed amounts as an administrative fee, so it's in the insurer's interest to negotiate a higher billed amount!
And, not surprisingly, despite the law passed last year with rare bipartisan support requiring health care providers to publish their negotiated price lists, almost none of them have actually done so. They also refuse to tell a patient even the negotiated price for that patient's own procedure, with that patient's own insurer, until after the procedure is done, presumably to prevent people from "shopping around" the way a free market is supposed to work. In some cases the contract between insurer and provider contains a gag rule forbidding either party to divulge the negotiated prices; in other cases they just don't want the public to know, and would much rather pay a trivial $100,000/year fine instead. That is, if the Federal government ever gets around to imposing those fines; so far they've sent warning letters, and ominously threatened non-compliant providers with a second warning letter.