SoylentNews is people
SoylentNews
Amazon Health-Care Move May Be Next 'Home Run' Like Cloud Services
Amazon.com Inc.'s foray into health care won't be the first time it has disrupted an entire industry by starting with an effort inside the company.
Amazon Chief Executive Officer Jeff Bezos is teaming up with fellow billionaires Warren Buffett and Jamie Dimon to revamp health care for the 2.4 million workers and dependents of the companies they run. The move fostered widespread speculation the trio will eventually make their approach to medical care available to companies far and wide.
Bezos has a long, increasingly successful, record of starting new businesses on a small scale, often for the benefit of his company, then spreading them to the masses -- creating a world of pain for incumbents. Consider the ways Amazon is changing industries as varied as product fulfillment, cloud computing and even the sale of cereals, fruits and vegetables.
This is just a cheap excuse to follow up on the machinations of the world's richest human:
Amazon, Berkshire Hathaway, and JPMorgan Chase to Offer Their Own Health Care to U.S. Employees
(Score: 5, Insightful) by Justin Case on Thursday February 01 2018, @02:24PM (11 children)
I try very hard, before engaging any medical service (including prescriptions), to ask
What is this going to cost?
It is very hard to get an answer. Even when you do, it is probably wrong by several orders of magnitude. And then somehow I am supposedly obligated to pay an amount to which I never agreed.
This has to be fixed. How can you shop around for reasonable prices when everything is $Random[$Today]?
(Score: 1, Insightful) by Anonymous Coward on Thursday February 01 2018, @02:47PM (1 child)
I've gotten "we won't know how much it costs until we bill you" on multiple occasions. In what world is this a legitimate business model?
(Score: 2) by stretch611 on Thursday February 01 2018, @05:31PM
You are absolutely right.
However, despite not being able to give an accurate estimate, their computer is able to determine how much you owe as you are walking out of the office.
The only time this is not accurate is when the insurance company decides not to pay for everything because something is flagged as not covered. (and 90% of those times it is covered but you have to go through the insurance companies appeal process which is only designed only to delay your actual benefits until you give up being on the phone for hours.)
Now with 5 covid vaccine shots/boosters altering my DNA :P
(Score: 5, Informative) by bradley13 on Thursday February 01 2018, @03:42PM (2 children)
I assume you are in the US? I have a friend in the US, whose wife went to an "in network" hospital for treatment. Ought to be fine, right? In the course of things, various random doctors came in, looked at her chart, often said nothing at all, and left. When she gets out, her bill had separate entries for lots of those doctors: "consultation, not in network", "consultation, not in network". WTF?
I hope he has the balls to take the hospital to court. Either they are "in network" and in control of who wanders their corridors, or they aren't. Either way, it shouldn't be my friend's problem. And random consults just to chalk up another billable hour? Ought to get the both the physicians and the hospital sanctioned.
Everyone is somebody else's weirdo.
(Score: 3, Interesting) by Justin Case on Thursday February 01 2018, @03:55PM (1 child)
Yeah, that "in network" bullshit is one of the scams. "In network" doctor sends out some lab work. Lab is not "in network" => $ZAPPIE. Or if you choose the lab yourself, they send one of the tests to a "partner". If you ask the desk clerk "are you going to do this work in house or send it out" she gives a blank doe eyed stare that makes it clear she doesn't know and couldn't possibly care. "Check our web site." Web site says nothing. Send message to "customer service". No reply.
Then, those not-in-network charges are 10 to 100 times the real price the same places are willing to accept from insurance.
I'm about to the point of letting them take me to court, where I'll simply ask "show me the contract I signed agreeing to this price". Except, you know, binding arbitration clause in the EULA and stuff like that. Still, make them fight for it.
One company even used my stored credit card number (they promised not to store it -- haha) to fetch some extra cash out of my account. Must be nice. Want more dollars? Just grab them. Anytime is fine. As much as you want. Help yourself, no problem.
Canceled my card, disputed the charge... waiting to see whose side my bank takes. Any guesses???
(Score: 2) by Justin Case on Thursday February 01 2018, @04:08PM
#include SelfReplyApology
I just remembered their new trick this year: Tier One providers. You can save a lot of money by choosing only Tier One from the list on our website.
No, you don't save a damn nickel. What this really means is they will charge you double for any provider who is not "Tier One".
So you check the website when you make your appointment. Great, Tier One. You go there and get charged double anyway. "Yeah we're not Tier One any more." But you were last week? "Perhaps someone forgot to update the website." OK, so how is that my problem?
I have altered the bargain. Pray I do not alter it further. Now, just sign all these consent forms and I'll get my knives and go to work.
(Score: 5, Insightful) by julian on Thursday February 01 2018, @04:41PM
When you're incapacitated? Delirious with fever? Gut shot? Oh and even if you are of sound mind at the time, you're not a doctor, and thus are ignorant of medicine and treatments anyway. So how can you shop around *when you don't even know what you're shopping for?*
You cannot run health care with markets efficiently OR fairly. It doesn't work; there's too much asymmetry between sellers and buyers in knowledge and negotiating leverage for it to ever be either efficient or fair. It's absolutely the wrong tool for the job but when you're a conservative that's all you've got in your tool box.
(Score: 4, Interesting) by NotSanguine on Thursday February 01 2018, @05:25PM (1 child)
I disagree in one respect. The "prices" aren't necessarily random, they're massively inflated, and there may well be some method to that inflation.
The issue, as far as I can tell, is that "prices" are set for the uninsured, especially those who have cold, hard, cash. Those "prices" have nothing to do with costs or reimbursements.
Case in point: About ten years ago I was briefly (three days) hospitalized and given strong IV antibiotics "just in case" I had MRSA [wikipedia.org] which, it turned out, I didn't have.
I received (as insurance companies generally do) a "detailed" explanation of benefits (EOB) for my hospital stay. it came out to be somewhere around US$14,000.00.
However, the EOB contained a number of grievous inaccuracies, of which the most ridiculous were:
I was, apparently, in two hospital rooms at the same time -- which would be a great trick, except I'm not entangled photons.
I also, apparently, had a Pap Smear [wikipedia.org], which is even more amazing, since, as a male, I have no cervix.
I called the hospital billing folks to find out what the story was with all this and was told, essentially, not to worry about it, as I wasn't paying anyway.
I protested, as even in 2008 (long before the ACA came into effect), premiums, co-pays and and other costs had been rising steadily, much faster than inflation, for decades. Not because I had to bear the full "cost," but because it certainly seemed that there was significant and blatant fraud on the part of the hospital, with apparent acquiescence by the insurance company.
Finally, after going back and forth with the hospital for a day or two, the billing folks at the hospital got me on a conference call with the payment folks at the insurance company.
They went back and forth, talking in jargon, and when I demanded to know what the real story was, the hospital and insurance company admitted that the EOB was irrelevant to their billing and payment, as the hospital's contract with the insurer mandated a US$1500.00/day reimbursement to the hospital, regardless of the actual services provided.
So, if you have insurance, the "prices" aren't real, and the "costs" aren't real. If you don't have insurance, then you are smacked with hugely inflated "prices" that (obviously) bear no relation to the actual costs of care.
I never did receive the pathology report on my pap smear. Fortunately, I'm pretty sure I don't have cervical cancer -- not having a cervix and all.
No, no, you're not thinking; you're just being logical. --Niels Bohr
(Score: 2) by darkfeline on Friday February 02 2018, @04:42AM
I suspect medical billing codes are just a very complicated mechanism for tallying up a bill.
Say the hospital wants $10,000 for your visit. They open up your insurance's billing catalog and go down the list.
"Let's take the dolphin bite for $1,000, two saline bags and an HIV drug for $6,500, skin rash for $1,500, and oh, let's see, the prostate exam for $2,000. How much is that? $9,500? Fuck, what's $500? Let's use this blood test."
Join the SDF Public Access UNIX System today!
(Score: 2) by All Your Lawn Are Belong To Us on Thursday February 01 2018, @08:22PM (2 children)
How can you get a reasonable price until you've been examined and the examiner has some inkling clue of what is actually wrong with you?
The reason you can't pin most physician offices down is because the office will charge based on the overall level of complexity of your visit. Take 5 minutes of the Doctor's time who then advises you to wait or hands you a simple prescription. low rate. Have ten co-morbidities and take up a half hour of the physicians' time who ultimately orders further diagnostic testing to make sure you're getting an effective treatment before he/she offers it... much higher rate. Spend fifteen minutes of the physican's time who decides you need to go to the ER and he then follows up with you in the hospital that afternoon.... still different rate.
You're asking for a fix for your body. The price will depend on just what the problem is, just like any other mechanism that breaks down and you need a repairman for.
That's already changing a little bit as things in healthcare shift from fee-for-service to value-based healthcare. But could the industry offer you a flat estimate rate? You pay X dollars until we either find out what's wrong with you or your problem takes longer than what it is? OK.
This sig for rent.
(Score: 2) by choose another one on Friday February 02 2018, @09:42AM (1 child)
This.
Call a plumber and say "my toilet won't flush, how much to fix it?".
Call an electrician and say "my electrics gone off, how much to fix it?".
Call a mechanic and say "my car's stopped, how much to fix it?".
Same answer each time (after the laughter) - $x callout, $y per hour, plus parts, if it can be fixed.
But it's worse in medical, because even when they _think_ they know what's wrong and maybe how to fix it, there's still other stuff that can go wrong during the fixing that needs to be fixed too. This isn't stuff that goes wrong because the doctor or the hospital does something wrong, it's just the fact that we still know very little about how the body works and each and every body is different, and reacts differently. It's luck (or lack of) and being on the wrong side of the statistics (if someone tells you "this drug cures 90% of people with your condition with no side effects" the most important thing to ask is actually "what happens to the 10%").
If you go in for an operation and they say it should be 2 days recovery on the ward, but your body happens to react to the suture material leading to wound breakdown, bleeding, emergency re-op, crash, 5 days intensive care, etc., then what the hell _should_ the bill be?
"Hold the crash cart, we need to check if we quoted for a de-fib". Really?
(Score: 2) by All Your Lawn Are Belong To Us on Friday February 02 2018, @01:47PM
Plumbers, electricians, and mechanics generally don't have an insurance system which requires submission of discrete codes to categorize their work. They generally do not have to order diagnostic tests that others will perform for any given episode of care.
If they themselves deal with insurance at all (not likely, by the way, except for auto mechanics,) they price out an estimate and ship that complete estimate off. They don't get to tell the insurance company, "yeah, we'll charge somewhere between 3 and 5 hours to fix that plus $200." Auto mechanics, like physicians, have to tell the insurance companies exactly how much the bill will be before work commences.
It's relevant because your outpatient physician has a series of discrete codes they charge. For nominal office visits there are five levels of visit that can be charged. There are lots of rules of thumb about it, but it's basically what I said above - how much work will the physician (and other staff) go through for the care episode. All of this is necessary because of insurance. Doctors would LEAP at the chance to charge you a Level 5 visit every time, instead of having other people look at the work they did and assign a relative value. That won't happen, because the insurance companies won't let it.
Every repair industry has a process for what happens if other things go wrong and beyond their estimate of what's up. But it goes beyond just "we don't know how the body works entirely." It also works off the principal of doing the least amount of work *on average* to cure a given set of symptoms. You come in with an infection. The physician looks at it, checks temp and other vital signs, and makes a best estimate of your condition. He *could* order a culture to be taken (that has happened to me,) but most of the time he knows if he prescribes Antibiotic X (or gram postitive/negative combination antibiotics X+Y) his patient will get better 90% of the time.... or he suspects you may just have a virus infection and decides to not prescribe anything but OTC symptom control because he doesn't want to be wrong with the bacteria and make the possibility of creating a resistant strain. He doesn't order the culture because knowing exactly which organism it is very rarely affects the course of treatment.... the times when it does, he orders the test. Now if he'd ordered that test, he'd could definitively what he should do (though that may take hours to days to get a result)..... but then he's accused of ordering "unnecessary" tests. High quality, low cost healthcare is a game of average, not specific cases... which really sucks if you're the individual patient but few people care about that. Your doc could test if you'd be a candidate for a particular side effect, maybe, but again he won't unless that side effect is a fatal condition occurring in enough cases to be a problem.
So.... what the hell should the bill be IF you have that situation. Hospital billing is ENTIRELY DIFFERENT. Instead of charging on the services performed, a hospital will take the sum total of your diagnoses, issue a diagnosis-related Group code and bill based off that complex. "Aha!" you think - that's the ticket! But remember that we need to know your final diagnosis before that code is settled upon. Come in with a hangnail for observation... actually you'll get billed by the outpatient rules because reasons.... but once you're in the hospital unless you leave against medical advice you're going to be diagnosed as accurately as possible because the hospital will ultimately be paid based on what you actually had happen. Which is why hospitals have in-house labs and diagnostic services and all that. And if your condition worsens.... your diagnosis changes. Surgery is a little different because your surgeon will be their services as outpatient services (I did X, pay me for what I did) while the hospital still bills the diagnosis complex for their care.
Because of this, no they won't check if they quoted for a cardiac arrest. Come in with an infarction (or develop one) and your diagnosis codes change to handling the code. All the labor, materials, etc. are covered. And you pay a HELL of a lot more than if it happened at your Doctor's office, the medics come, and you're pronounced at the scene.
So, do you want the current system where it feels like you're being screwed, or do you want a system that doesn't operate on averages and you pay some multiple of that more? Because medicine ain't plumbing, or car repair, or electrical, and any system where you'd be paying flat quotes would drive the price up, not down.
This sig for rent.