Its a tug-of-war between hospitals and insurers. One of the games we see get played is insurance companies asserting “We’ll pay X% of your billing rate and the customer pays the balance”, then deny claims on a bunch of line items in the bill by claiming they aren’t medically necessary. The hospitals respond by jacking up the billing rate for each exam, such that they can harvest more from the “X%”, then renegotiate the balance with the patient after the insurance pays out.

Consequently, fee schedules are an absolute joke. Nobody pays the fee on the fee schedule. Uninsured patients could never afford it and just end up negotiating the balance down or going to collections (where the hospital collects pennies on the dollar for the value of the claim). Insurers - public and private alike - always have their own schedules to argue a lower price.

I worked in medical billing for eight years, and the head of the insurance department joked about how much easier life would be if everyone was on Medicare/Medicaid. I remember her pointing to her back office and its 50 staff members, saying how four of these people work the Medicare book. Its so easy. They submit the claims under the Medicare fee schedule and Medicare pays and we get on with our business. The other 46 people exist to haggle with private insurers who have their own team of people digging through receipts to find an excuse not to pay. For any given patient, after all the haggling and write-offs and renegotiations, Cigna would pay around 85% of the Medicare fee for patient care while Aetna would pay closer to 80%. And these were the “In-Network” insurers. There were a bunch of other “Out-of-Network” carriers who were even more of a pain in the ass and had even worse payouts.

That’s not even to say whether the various procedures and their associated costs were a rip off. Maybe a hip replacement shouldn’t cost more than a car, idk. But I can tell you what the hospital I worked at actually did, in terms of delivery of services. They saw thousands of people a month and delivered a high quality of care. I have no idea what kind of service the private insurers were providing. You were just paying them to say “No” to you every time you called them to pay a bill.

A bewildering number of people ridiculously think it’s the doctors and pharmacists themselves ripping patients off.

Kinda like blaming the guy setting up your internet connection for your ISP ripping you off.

Fat Joe != Fatboy Slim

Do you want me to do so right about now, funk soul brother?

Oh sure, thanks for tracking me down to say that, but you don’t have anything to apologize for, it wasn’t a bad assumption if you didn’t know anything about me and made me realize how what I was doing could easily be misinterpreted and used in a way I didn’t want it to be, so I appreciated that original comment too. I’m definitely not above sticking my foot in my mouth and need people to point out when I’m doing that sometimes.

The other point from that thread is that the whole idea of having to price shop when you need care seems sadistic and inhumane to anyone from any other civilized country.

Even if pricing was transparent, it’s still the wrong way to manage it. Healthcare should be a utility, paid for by taxes, like it is anywhere else in the world that isn’t a capitalist dystopia like the US is.