[ Monday, August 06, 2007 ]


Misleading Headline: I caught the headline, "Healthcare information law set to go into effect in Texas" in a Healthleaders Daily News email this morning, and thought I'd missed something. But it's not a state HIPAA law; rather, it's a bill requiring hospitals, doctors and insurance companies to disclose their pricing information. It's part of a national trend toward "transparency," since in theory patients will be better served if they know how much things cost. Of course what things "cost" in healthcare is a pretty slippery thing, and I don't know how much most patients want to know or care, other than what their out-of-pocket is going to be. The big driver is "balanced billing," when an insured patient goes to an "in-network" hospital and finds out that the specialists there (particularly the hosptial-based specialists like radiologists, anesthesiologists and pathologists) are "out-of-network." The specialist bills the insurance company their "list" prices rather than their insurance discount prices (doctors sign contracts with insurance companies agreeing to accept lower rates in exchange for the insurance company sending them more business; if there's no new business -- typically generated by listing the doctor as "in-network" -- then the doctor has no reason to cut his prices). The insurance company doesn't pay the doctor's list price, but rather pays what the insurance company says is "reasonable." Obviously, the doctor's concept of a reasonable price and the insurance company's concept are substantially different. The doctor doesn't have to accept that limited amount from the insurance company; he can simply go after the patient for the "balance" between his "reasonable" list price and the insurance company's "reasonable" price. Somehow, this law is supposed to take care of that -- not make it go away, but make it so a patient can see the iceberg before he plows into it.

Jeff [9:33 AM]

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