Hospital - Health Insurance Claims Processing: Barrier to Entry and Innovation??

The Fictitiously High Initial Billed Charges of a Hospital Prevent Any Rational Claims Processing Prior to Network Discount.

Processing a $275 Claim that Discounts to $15 Is an Effective Barrier-to-Entry for Companies Trying to Get into the Health Insurance Business.

Likewise, 'Discounting' a 2-Day Hospital Stay from $8,000 Down to $2,000 Prohibits Any Reasonable Adjudication without an Insurance Network.

Finally, 'Negotiating' a Doctor's Office Visit from $375 to $120 Prevents Any Patient without a Network from Accessing Care at the $375 Price.

NO Network Essentially Equals NO Way to Process Medical Claims. Until That Problem is Solved, all the other 'Solutions' in Healthcare Will Be BLOCKED by the Holders of the Network--i.e. the Hospitals and the Major Insurance Carriers.

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[julessantana]

It would be wonderful to see you roundtable with Peter Attia, Zubin Damania and Marty Makary on this. I recall Attia used a great phrase to describe this, "manufactured delta" between total charged amount and medicare allowed/payable. This also ties in well to your video on winners and losers, because any service that involves self-pay, or anything that activates a high deductible of $1000-$5000 towards those inflated rates is also very cost prohibitive to many households.

Due to the overwhelming concern on behavioral health and behavioral modification right now in the media, it'd be great to hear more your thoughts on the intersection between healthcare finance and social determinants of health. My biggest focus at the moment is public transportation as a SDOH. Great video as always.

[mrsbootsworkouts]

Hospital bill charges for those who pay are predatory unfortunately