New York Times Article on Hospital Price Transparency - Learn WHY Hospital Prices Are Kept Secret

The New York Times Posted an Article Explaining Hospital Prices for Patients on Private Insurance Plans Such as Blue Cross, United Healthcare, Cigna and Aetna.

The Article Rightly Points Out the Huge Variability in Hospital Prices:

1. Same Hospital, Same Procedure, Different Insurance Carriers - A Colonoscopy at the Univ. of Mississippi Medical Center with Cigna Costs $1,463 and with Aetna Costs $2,144.

2. Same Hospital, Same Service, SAME Insurance Carrier, Just Different Plan Type - An MRI at St. Luke's Hospital in Milwaukee with UHC PPO Costs $4,029 and with the UHC HMO Costs $1,092.

3. Same Insurance Carrier, Same Service, Different Hospital - A Rabies Prevention Treatment at Intermountain Health in Utah Costs $5,000 and at the University of Florida Medical Center Costs $10,000,

WHY? Why the Variability?

The NY Times Article Does Not Explain, But Here is Why...

Hospitals and Insurance Carriers Negotiate Total Annual Contract Value.

Each Individual Service (e.g. Colonoscopy, MRI, Rabies Treatment) Goes Through a Process of 'Horse Trading' to Come Up with a Total Contract that Has a Value of $X (e.g. NYU and United Might Come to a Total Annual Contract Value of $500M).

Each Hospital and Each Insurance Carrier Does Their Own Unique Horse Trading of Prices for Each Service, But It's the Total Contract Value That Matters to Both Parties... Not the Wild Swings in Individual Prices.

To Learn More, Watch the Video.

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[anujmalik]

I hope you never stop educating all of us. You are awesome.

[anujmalik]

You are my favorite US physician. I am a physician who is interested in all the issues you discuss. I watch your videos all the time. You rock Dr. Bricker.

[jdean]

Always, always, always, thankful for your input and points, Dr. Bricker.

[thSun]

They should just make a special bandaid that costs a billion dollars and give it to one person a year who has already met their deductible. That would fix everything.

[SpecialK]

I'm imagining the implications of what this same type of transparency requirement would have on other consumer-driven industries in our society where significant mark ups have made it nearly impossible to secure a purchase in an inflated economy...things like jewelry, furniture, automobiles, & now even the housing market, etc., ridiculously and unnecessarily over inflated & has unfortunately evolved into big game for actuarial gurus. These commodities are only worth as much as people are willing or able to pay.

[walterkeane]

This is huge regarding surprise and balance bills. Why? Because the legal theory to recover is quasi contract. Damages are "reasonable value " of the service. Sounds like U of U is the only hospital that would know that figure 🤔

[tannermurphree]

I appreciate your information and enthusiasm but to assume any health care financial administrator/executive would be transparent about any of this is a pipe dream.