
Using Medicare and Medicaid data for uninsured to price shop medical care - firedup
https://www.reddit.com/r/datascienceproject/comments/cu2a3a/using_medicare_medicaid_data_for_uninsured_to/
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xphilter
I have some experience with these datasets and this topic (and anecdotal
experience with physicians) and I don't think this will provide anything
useful. Essentially, physicians are still incentivized to bill the code that
provides them with the largest reimbursement. And, the physicians are
incentivized to bill for any possible code they can. What I think the dataset
will provide, then, is a good look at negotiations between the physician and
the government--not "what will it cost to heal me?"

In addition, health centers may very well have a policy to simply charge
uninsured more for every procedure. That may be because they "negotiate with
insurers for better rates" or "know that the uninsured are more risky and
won't pay, so we should charge more."

The "best" thing to do, unfortunately, is call around _. For a recent cut to
my head, I had to call a dozen places to find the best price. I was "insured"
but hadn't met my deductible yet so I'd be paying cash. Ranged anywhere from a
quoted price of $850 to $120. Pays to call around.

_Calling around, of course, won't be helpful if the agent misquotes you, your
insurance company screws up your paperwork, or it's actually out of network.

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sjb554
If this is the billed data I think it is, then this data is super unhelpful. I
have done a few different projects for providers (I am an actuary) and I could
never find a good use for this data. Billed charges are a made up number, you
really need the discounted data (varies between each payor and provider), and
need to know what market you are in (employer, ind, Medicare, Medicaid, some
kind of ACO or other agreement).

Also, a lot of what the reddit OP wants already exists in various forms (some
of them you have to pay for, such as truven data). 'Bundled payments' have
been picking up steam for the last five years or so, and there are public data
sets that describe things like knee surgery costs in different geographic
areas. I think CMS has a website that already visualizes this data as well.

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avgDev
I remember some years ago when I had surgery, the surgery was pre-authorized.
After the surgery I received a bill for $20k. Insurance refused to pay the
surgery place and eventually both parties settled it. I ended up speaking to
someone at the insurance company that I went to school with. She said that for
this procedure and amount of time for operating room the max they pay is $2k.
So, there was no way that company would see $20k.

I also refused to pay as patient is responsible. Few years later I received a
proper bill for $300. It was long after they could collect, so I told them to
beat it.

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thechao
I've been trying to figure out if there's an alternate ... game that could be
played in order to find _actual_ pricing for procedures _ex post facto_. My
original (and I know this doesn't work) thought was some sort of competitive
billing procedure. It would work like this:

1\. After a procedure K is performed & the payee sends a request to billing
for $M;

2\. The payer can request "co-bids" from other sources;

3\. The co-bidder "X" that bids the least/best _gets the money_ (say, $N <
$M);

4\. But! "X" now guarantees to accept $N for that procedure K for the _next_
(or some single future) procedure K they perform.

Obviously, a co-bidder could bid $N for procedure K with no intention to ever
perform procedure K again, amongst other nefarious things.

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mrfusion
Sounds like a way to translate the billing codes to normal vernacular would be
really useful for them.

