I'm one of the co-founders of Turquoise Health, mentioned in the article here. We've been downloading and parsing this data all day. It's a really big deal in the industry that the prices that insurance companies pay doctors are now being shared publicly. It will have all sorts of positive impacts over time, hopefully making rate negotiations more consistent and fair between different insurance plans. Right now, 10x differences in prices paid for the same healthcare service from the same doctor between insurance plans is not uncommon.

For anyone looking to download the data, here are a few links:

Empire Blue (Anthem): https://www.empireblue.com/machine-readable-file/search/

United Healthcare: https://transparency-in-coverage.uhc.com/

Aetna (Seems like the right page, but I don't see any download links — possibly because they haven't been posted yet): https://health1.aetna.com/app/public/#/one/insurerCode=AETNA...

Search keywords: https://www.google.com/search?q=machine+readable+files+trans...

> “What we’re learning from the hospital data is that insurers are really bad at negotiating”

Do the insurers have any incentive to negotiate well? Since their customers are not very price-sensitive (since they aren't marketing directly to patients or doctors), I would imagine they don't have a huge incentive to do anything but apply a markup to whatever prices the hospital tells them it costs.

I work in healthcare.

Here is an exchange I had with a major hospital about standard surgery (one of those deemed "Shoppable services") earlier this year. This exchange was possible after I was able to get an email recipient, following a 30min conversation.

>>>> Hello!

I was told by the very helpful Ms. XXX, that you would be able to provide patient responsibility amount , related to CPT codes for XXX procedure. I am attaching front and back of my insurance card (Payor). The member DOB is MM/DD/YY

The specific 2 codes in question are : CPT 12345 CPT 01234

Can you please provide the total cost and patient resp. for the CPTs above?

___________________________________________________________

Response:

Good morning,

>>>>>The hospital does not process estimates for patients with insurance coverage. However, our web portal contains charges under the Hospital Price Transparency link. I have included the link in the subject line for easy access. [comment: This link was broken. After much browsing.. I was able to find an alternate route. The linked file turned out to be a JSON. I couldn't figure that one out] As far as out-pocket responsibility, your insurance company is the best source for that information; they will advise if you have any copay for the encounter.

_______

Read the 1st sentence of the reply again. My blood still boils from that...

I'm curious if this is a first step towards hospitals being required to charge the same prices to everyone, insured or otherwise.

I'm not a fan of Trump, but I have to admit, the executive order [0] that forced this disclosure looks fantastic, really fantastic. But if I'm reading it right, it seems like it's just an order to _enforce_ requirements ObamaCare that were intended to increase transparency.[1] Obama and Trump actually accomplished something _together_!

[0] https://www.federalregister.gov/documents/2017/10/17/2017-22...

[1] https://www.federalregister.gov/documents/2020/11/12/2020-24...

Wait till you find out how much it actually costs doctors/providers to render some of these services!

Do you like 90% margins? Doctors sure do! :)

This will be huge! I’ve found that self paying can be 1/nth the cost of paying through my insurance. But you need to request self pay up front.

Being able to better understand prices before hand will drastically help people reduce their healthcare costs.

This would be great news in a world where healthcare company revenue (which never quite trickles all the way down to retail shareholders) wasn’t just a one-way wratchet.

More opaque: costs more. More transparent: costs more.

Want a better deal? Choose better parents pleb.

> Even after the pricing data is public, “I don’t think things will change overnight,” said Leibach. “Patients are still going to make care decisions based on their doctors and referrals, a lot of reasons other than price.”

Ah, but in the USA, there are a lot of uninsured people who end up paying cash for stuff. And there is a corruption problem in that individuals who pay for services and materials get ripped off compared to what insurance pays behalf of an insured patient.

I would expect that this will have an almost instant beneficial effect for some of the uninsured or under-insured. It will be harder to charge them $500 for something that insurance pays $250 for in plain view. People will go back and complain, asking for rebates even after paying.

Why nobody ever talks about how much doctors are overpaid and over valued in this country? Why always demonize insurance companies?

I was in an ER for 7 days, I only saw the doctor 2 times for less than 5 mins each. In the final bill, the most expensive line item was doctor consultation.

Question to somebody who might know as this seems like a relevant thread to ask in.

If a person wants to pay directly in cash/credit-card for services rendered by a doctor, do doctors' agreements with insurance companies generally prevent them from offering a cash discount to cash-paying patiences lower than the insurance company negotiated price?

This happened for hospitals too, and not much has changed. Cryptic billing codes will make this data hard to understand.

Now tell me about the relationship between health insurers and hospitals, and how they engage in pricing.

Next step is pharmacies. Find out which step in the chain is overpricing. The manufacturers, PBMs or local pharmacies, etc.

I've lost count of all the problems I've had with medical billing. I can't understand an argument against public pricing because it seems like a clear win if you believe in free market dynamics or progressive reformation of the health care system. But it seems to me the system is just rotten to the core anyway. It makes even my Libertarian self want single-payer healthcare, but I have no expectation the set of people currently working in the system would do anything but keep it rotten.

In the most recent case I tried to get a written quote for procedures because of past problems. I was given the run-around until all I could get was a verbal quote over the phone. But if that wasn't good enough, my only recourse was to delay getting a suspicious lump examined. I was then charged more than I was quoted, and I was even billed for procedures they didn't do. I actually heard one of the employees say "I added that because I thought he was using insurance". Still - hours of phone calls over several weeks before they would even bill me correctly without adding tests that they had no results from. And even then - more expensive than they told me because the person I was transferred to over the phone was in a different state than the clinic I called in the first place.

Absolutely rotten.

Very soon we'll have Congressional hearings after oil companies see profits climb 7000 percent over last year, and they'll look sad and do nothing.

I expect much the same from health insurance companies.

Not to get political, but pretty sure this is thanks to one of Trump's last executive orders while he was in office. Correct me if I'm wrong

Can anyone provide any hints on the search keywords to find this data at a given insurer's website?

Do you think this can have med to long term effect on revenues earnings and so stocks?

Thanks again President Trump!

I hope this becomes the norm all over

IMO, as a non-affected Canadian, this is one of the (very few) good outcomes of the Trump presidency.

Anecdote: I recently had my yearly glasses update. Cost was $188 to me + $20 of insurance copay, so the glasses provider charged $208 for the glasses.

That's not too bad, so I asked how much it would be to replace/update the lenses on my old frames, entirely at my charge.

It would've been $450. Just for the lenses.

I passed. I find it scandalous how much they can charge when just before they were perfectly happy to accept less than half that amount.

Instead I got another pair on EyeBuyDirect for $80.

It's not just the insurers themselves, but the whole system. Burn it all down.

This is regulation everybody should be able to get behind. How are these markets supposed to function efficiently with healthy competition if critical information like this is hidden away?

"Doctors hate this simple trick to reduce <illness>."

That's the strange spam message I could never understand.

Surely doctors would be delighted at any method to improve health?

So I always assumed the "trick" to be quackery with dangerous side effects. After all, why else would "doctors hate it"?

Eventually I realised these messages are exclusively US American, the only place on the planet where doctors could plausibly resent people improving their health at the expense of their profits (or at least that's the implication that seems to rest on an entrenched cultural cynicism).

Am I totally wrong?