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Comment by olliej | Hacker News Reader

The issue I am dealing with currently isn't that my bill isn't transparent.

Knowing how much different procedures cost only matters if you have free choice of who is performing it. Which you don't.

Your insurance dictates a set of doctors and hospitals you can use. But then if you go to those doctors or hospitals they subcontract to other companies, but then .. don't actually subcontract, they pretend you have a relationship with the subcontractor, and let them bill you directly as if you chose them.

That's why a year after I spent a couple of months in hospital I am still getting random bills from an anesthesiology company. It's win-win for everyone except the patient: each player pretends you're getting a separate treatment, so each one has a copay (saving your insurance company money), and each one gets to give you separate bill, and if they're incorrect you have to fight each one individually, making the individual companies more money.

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I'd agree with that assessment.

Given this:

"The Hidden Fee Disclosure Act, HR 4508 , requires that providers give patients transparent cost data from price comparisons before providing treatment. The text of the bill explicitly addresses the role of pharmacy benefits managers, which play an integral role in the cost of prescription drugs."

We've known the role PBM's play in a government-endorsed organized crime scheme that shamelessly adds cost to what consumers pay out-of-pocket without insurance or a prescription for at least a decade.

Ask yourself, what is the point of insurance and prescriptions when I have access to deadly drugs like insulin OTC at Walmart without a prescription or insurance for $25 per bottle?

https://en.wikipedia.org/wiki/Claus_von_B%C3%BClow

I pay less than $10 per box for a box of a hundred new, name-brand, Becton Dickson insulin needles on Amazon without a prescription.

After this, Optum RX, United Healthcare's (UHC) wholly owned subsidiary PBM takes my doctor's 90 day script and charges me $40 for the same quantity. I'm pretty sure that's not what value-add means in business propositions.

You don't need a degree in forensic accounting to figure this out.

People laugh when I tell them I'm on a quest to reverse type 1 diabetes. Given insulin-dependence and its related costs accruing to technology, I don't know any better way to impact US healthcare.

A small item that doesn't make your pain any easier, but that you may wish to consider:

I'm an anesthesiologist. I practice at one hospital, and one hospital only. I am a partner in my group, which the partners collectively own. I don't work for the hospital. I don't work for a private equity firm. Our billing is done by a practice management company, who takes their cut, but we're all out of the same pool that paid for your surgery. In fact, the first entity to submit a bill to insurance under a claim has to collect the deductible (not copay, it's not an office visit), so we often delay our claims by a month or so and let someone else have that joy.

So, I'd encourage you to find healthcare from physician-owned groups. They are not as easy to find as they were twenty years ago, let alone forty, but we don't have a call center, and if you call us you will get a human being who lives and works in the US on the phone. How do I know? We have exactly two non-revenue-generating employees. It will be one of them.

The problem isn't that the hospital subcontracted for anesthesia. The problem is that hospital didn't simply bill me, but instead passed billing to the subcontractor, who billed me separately.

Why should I, as a patient, be exposed to the internal organization of the hospital? If, as the hospital claims, I have a personal relationship with the anesthesiology company why can I not choose who to use?

I really want to emphasize this fact: it is not the subcontracting that is the problem, it is the separation of billing.

The hospital doesn't employ me. They pay my group to cover call for them, but we are legally an entirely separate entity from the hospital.

And, as long as whoever you want to do your anesthesia has privileges at that hospital, you can use them. We're not the only ones who can work there; we're just the ones who have to take any case any surgeon who has privileges wants to do. (This creates its own set of headaches; there was an ENT surgeon who did all of his quick, easy, and profitable ear tubes and tonsils with a different anesthesia group in town, but if the tonsil bled at night, he would call us to do the much-worse-paying and unscheduled surgery to stop the bleeding.)

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