I feel like whenever I hear crazy stories like this about healthcare it usually involves these weird in or out of network issues. I'm certainly not an expert on healthcare, but is there no way to attack the problem from this angle?
If you have a hospital with a certain list price for a particular procedure, why is it legal for them to charge one insurance company 5% of that price and charge another insurance company or someone without insurance full price? It seems like exactly the kind of scenario that price discrimination laws are meant to prevent.
Similarly for the insurance plans themselves, why can you sell basically the same plan to employees of a large company for much cheaper than you sell it to employees of a small company? (This one might need to be a new law specific to insurance companies, because clearly there are many other products that give group discounts when selling to large companies, but I think health insurance should be treated differently).
I'm sure I'm missing what some of the downsides might be, but it seems like making these kinds of backroom network-based deals illegal in health insurance would go a long way in making prices more understandable/predictable, and that might allow for more fair competition on price to emerge.
> I feel like whenever I hear crazy stories like this about healthcare it usually involves these weird in or out of network issues. I'm certainly not an expert on healthcare, but is there no way to attack the problem from this angle?
Because hospitals, and physicians, have decided that, for the most part, it is better for each of them for physicians to be "independent contractors", so the situation of "your hospital is in network, but your physician was not".
Or for me, most recently, going to my doctor for a checkup on my hypertension at an Urgent Care/Family Practice hybrid. Facility? In network? Physician/Assistant? In network? Lab in the same building (to be clear, it wasn't a multi-tenant complex, this was a medical practice) that they sent me for CBC draws? Out of network. Boom, hundreds of dollars in lab bills.
Prices, more and more, are negotiated between very few providers and customers. It's like there are 3 fruit stands and 3 buyers of fruit, and those three buyers of fruit are willing to buy huge quantities of fruit (provide a hospital business with lots of patients) as long as the fruit stand meets their price demands. The fruit stand can take it our leave it. If they leave it, they lose out on 1/3 of their potential sales. They go through this kind of negotiation with each of the three fruit sellers every so often.
If you have a hospital with a certain list price for a particular procedure, why is it legal for them to charge one insurance company 5% of that price and charge another insurance company or someone without insurance full price? It seems like exactly the kind of scenario that price discrimination laws are meant to prevent.
Similarly for the insurance plans themselves, why can you sell basically the same plan to employees of a large company for much cheaper than you sell it to employees of a small company? (This one might need to be a new law specific to insurance companies, because clearly there are many other products that give group discounts when selling to large companies, but I think health insurance should be treated differently).
I'm sure I'm missing what some of the downsides might be, but it seems like making these kinds of backroom network-based deals illegal in health insurance would go a long way in making prices more understandable/predictable, and that might allow for more fair competition on price to emerge.