[nshelly]

The amount an health insurance company pays is kept secret and we can assume is far less. Otherwise, insurance companies would find ways to open up more hospitals to compete with the large irrational ones, or face huge costs. The hospitals know they can get away these amounts on paper, so they do.

We should demand price transparency -- as we do for almost all direct-to-consumer purchases. Businesses can charge different amounts for volume purchases to other businesses, but it would be considered discriminatory if a restaurant didn't show their prices and then when you got your bill, it said -- oh, your company's not paying for it -- so it's $15,000 in extra fees.

[semerda]

No secret. It's all itemized on your insurance bill. What is secret is the deal insurance companies have with hospitals which allows hospitals to charge astronomical fees. That is then ultimately passed on to companies/patients through high premiums. And no one really chucks a stint over it with public shaming so the vicious cycle continues.

[nshelly]

You're right, patients get an itemized bill. The thing is the bill is pretty cryptic with CPT codes (and modifiers, ICD codes etc) practically unique to each payer as each payer interprets the AMA's guidelines differently. Payer A, say Blue Shield, asks for codes 99453 while Payer B (e.g. Aetna) wants code 92502 for the same procedure. So the patient is really clueless to know if 1) it's the right code, 2) they got charged too much, or 3) the insurance made a mistake in adjudicating the claim.

I know a company that was trying to help patients understand their medical bills, and for one bill, the hospital accidentally put down 10cc for an antidote for a snake bite, 10 times, when it should have been just once. The cost was in the tens of thousands instead of the thousands, and the hospital eventually fixed the claim and resubmitted, but the insurance company simply billed the patient.

[adrr]

Is it a secret? I get letters from my insurance company about how much they paid for medical treatment and even the provider sends me invoices with how much insurance paid. Last one was for blood tests were the provider(think was labcorp) charged $200 for a test and insurance paid $20.

[nshelly]

Good point. Prices for each CPT code accepted by by insurance company are kept secret, and the chargemaster published by a hospital is so inflated it's basically useless. For some diagnostic tests, it's pretty straightforward to understand, but for others like an ER bill where there can be dozens of claim lines and codes, it can be really hard to understand and the patient is relatively powerless to do anything about it after the fact.