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How does this work exactly? I've heard of similar things offered via churches or other trust networks, but the practicalities seem difficult.
For example, let's say I get an MRI. Maybe the clinic charges me $5000, but then the insurance negotiates it down to $1000.
What price is the health sharing network paying?
Related, but I think one solution to the health care cost crisis is full cost transparency. If you charge Medicare $1000 for an MRI, you must charge all patients the same rate, and all costs must be disclosed up front. Imagine if the price for a hamburger at McDonald's was either free, 99 cents, or $37 dollars depending on who was paying. That's our medical system.
From my anecdotal experiences (which weirdly enough include specifically receiving an MRI as part of a health sharing system) you pay out-of-pocket and that price ends up being equal or lower to the negotiated insurance prices. You may have to do some negotiating yourself, but it’s usually as simple as calling the office and saying “this is unreasonable, give me the real price” and then they do. The $5000 price is there because they know insurance will haggle, and so they can charge the government systems exorbitant amounts, insurance pays the $1000 price, and if you pay out of pocket it’s more like $500, then health sharing reimburses you. The amounts aren’t accurate but the ratios are.
The $5000 price is part fraud, but realistically mostly just because they have to recoup the cost of all the non-payers who receive care and don’t pay for it. It’s basically just backdoor government-funded healthcare for the poor, scummy (has money just doesn’t pay or pays like $10/month), or undocumented. The only ways to bring the costs down are to not allow those people to receive maximum care, which the public doesn’t have the stomach for, or to address the elderly medical cost issue, which is politically untouchable, or address the supply cartel issues mentioned above.
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If everyone pays 100% of Medicare a lot of providers are going out of business. Commercial rates subsidized Medicare to some extent.
I won't accept that the only way the system can work is if the price is hidden. Consumers need to be able to make rational cost/reward decisions and to be allowed to shop around. Prices must be transparent.
oh I'm just saying if you set prices at 100% of Medicare. You can have transparent prices that are higher.
I know United (ironically) has been doing some work around varying copays such that the member is pointed towards providers with more favorable contracts with United. Maybe a little promise there.
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I don’t know what price the network pays. I know that it works on a reimbursement model- you get a big bill, and the network gives you the money to cover it.
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