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PaperclipPerfector  9d ago (text post)   26394 thread views

Culture War Roundup for the week of December 30, 2024

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In my experience, hospitals are more than happy to screw over patients in billing as long as they don't complain too much after the fact. Surprise out-of-network anaesthesiologists used to be common (now prohibited), and I've seen hospitals try to tack on not-covered-by-insurance fees that show up much later and weren't disclosed in advance (not that they ever give straightforward billing answers in advance). Yeah, they'll "kindly" remove or waive those if you call and complain a bunch (probably marking it down as "charity"), but it's really annoying and not always worth my billing rate.

Yeah, they'll "kindly" remove or waive those if you call and complain a bunch (probably marking it down as "charity"), but it's really annoying and not always worth my billing rate.

IME you are significantly overstating how much of a hassle it is to get your hospital bill adjusted.

There are scum bags everywhere, for sure, but the perverse incentives start with the insurance companies. You can't pull a surprise out of network anaesthesiologist out of your pocket if there aren't any networks. It's the insurance companies who ban pharmacies and doctors from talking about the price of medication and offering cheaper alternatives. And it was insurance companies who instituted the policy of denying every claim first and forcing patients to pull teeth getting their claim covered.

It's the insurance companies who ban pharmacies and doctors from talking about the price of medication and offering cheaper alternatives.

This claim simply does not pass the smell test.

It's the insurance companies who ban pharmacies and doctors from talking about the price of medication and offering cheaper alternatives.

Can you provide citation/further reading on this? A brief search actually turned up basically the opposite complaint (in multiple articles that were clearly founded on pro-doctor propaganda advocacy), so I'm definitely interested if the surface internet has it all wrong and no one has been talking about these secret bans.

You're right (well, the opposite complaint would be that doctors and pharmacies are banning insurance companies from offering cheaper alternatives, but I think I get what you mean) I merged two problems in my head - the three big pbms (all owned by insurance companies) refusing to stock certain brands making it either expensive or impossible for doctors to prescribe them and insurance companies banning doctors from telling patients they could get their meds cheaper without using insurance.

the opposite complaint would be that doctors and pharmacies are banning insurance companies from offering cheaper alternatives, but I think I get what you mean

I chuckled. But anyway, what I meant (as you probably know) is the insurance company banning doctors/pharmacies from using more expensive alternatives. Dubbed "step therapy" or "fail first", the insurance companies were saying that you had to have the patient try a cheaper alternative first, and only if/when that didn't work would they cover the more expensive drug. I'm sure there are nuanced arguments on both sides of this, and I don't have a dog in that fight. Probably sometimes one approach is good; probably sometimes the other approach is good. Not worth getting involved from the outside.

insurance companies banning doctors from telling patients they could get their meds cheaper without using insurance.

I agree that lack of price transparency here was a problem. At a cursory look, I would agree with the goals of the Patient Right to Know Drug Prices Act that they cite, which fixed this problem. All we need to do is take that same name, swap in "Medical Services" for "Drug" in the title, and perhaps we can work out a text that can fix more of this price transparency nightmare.

I was kidding, but I appreciate the clarification anyway. But man the prkdpa didn't fix this problem any more than the anti kickbacks statute fixed the problem of doctors taking kickbacks for prescribing certain medications.

the prkdpa didn't fix this problem any more than

Well, of course it didn't fix all of the problems with pricing in the industry. The industry has amazing lobbyists. All they could do is fix the one very very narrow problem of insurance companies banning doctors from telling patients they could get their meds cheaper without using insurance. Similarly with the anti-kickbacks. The laundry list of exceptions is phenomenal, and it's questionable whether they even conceptualized the problem correctly in the first place.

I'm generally skeptical of regulation. It's usually ineffectual, produces unintended outcomes, and gets ground up by lobbying efforts to protect entrenched interests. It would be my last resort as a tool to improve price transparency in medical services. However, at this point, I'm pretty much out of other ideas for how to accomplish it. If you have any, I'm all ears. Absent that, I am at the point where I would support as minimally-scoped of a regulation as is possible to say some version of, "You just have to give them a good faith price estimate for services that you're planning to do before you do them (subject to the caveat of situations where informed consent is otherwise infeasible)."

The insurance companies want cheap alternatives. It's doctors and pharma companies who run advertising for big pharma, patients then demand treatments that are extremely expensive, then insurance has to pay for it.

Hold up, are you saying doctors want patients to spend more money on meds?

I'm saying that doctors often appear in drug advertising, sure.

Do you have a source for that? I'm currently watching football and while I've seen a ton of drug ads none of them have any doctors in them. I suspect if an advertisement for a Derm product appeared it would have a doctor, but I have no idea to what extent any of these people are really doctors (as opposed to actors) or practicing clinical medicine instead of working in industry.

Additionally while all Pharma companies are interested in people buying their products, a fraction of a fraction of one percent of doctors show up in ads. Why mention them at all?

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