THE CONFUSION. THE MESS. THE UNFAIRNESS – HOSPITAL MEDICAL BILLS AFTER A CAR ACCIDENT (WARNING: CONTAINS OPINION)
A 50-inch-high-definition flat screen TV costs 85% LESS than it did in 2010. The price of a high-definition image from an MRI exam is 15% MORE than it was in 2010. Why has the price of one technology plummeted while the price of another has increased? The answer is free enterprise and competition or, in the case of the MRI, the lack thereof.
The manufacturers and retailers of high-definition TVs are competing in a brutal marketplace where each company tries to provide the highest possible quality television at the lowest possible price so as to maximize market share. The manufacturer and sellers of high-definition TVs know that the purchaser will be using the purchaser’s own money and that no government assistance or private insurance will be paying the tab. As a result, the manufacturer and retailers of the high-definition TVs know that the consumer will diligently shop, compare and analyze to find the best product for the best price. This has resulted in a dramatic downward slope to the price of high-definition TVs.
Why hasn’t this occurred in MRI imaging? The answer is socialized medicine and the lack of competition. Somebody else – like health insurance or the government is paying the tab. So, the consumer doesn’t price compare with health decisions. Diehl & Hubbell respectfully submits that medical care providers have gone to extraordinary lengths to prevent price comparison and shopping. Do you have to have a medical procedure or surgery? Good luck trying to figure out what the cost of that procedure will be. Both the hospital system and health insurers are guarding this information at all costs.
In 2018, Congress enacted the Hospital Price Transparency and Disclosure Act to require hospitals to disclose, up front, the cost of hospital services and to make this disclosure easy and simple to read. The hospital and medical care providers (in the opinion of Diehl & Hubbell) are taking every possible step to minimize the effectiveness of this Act. They are, in some cases refusing to provide the information, maybe claiming it is a trade secret or in other cases sending the information, but in a disjointed and incomprehensible format.
The medical providers are not the only entity preventing price competition. The health insurers are complicit as well. On multiple occasions, our office has requested private health insurance to disclose data regarding the negotiated rates the health insurer has with hospitals for reimbursement and other information about what the insurer will pay for various hospital services. In every case, the health insurance companies vehemently fight this the request. A closely watched Nevada lawsuit filed against United Healthcare involved considerable disputes about what information United Healthcare would have to divulge regarding reimbursement rates. Many hearings focused on a series of motions submitted by United Healthcare in its effort to withhold from the public what they claimed was proprietary information regarding reimbursement rates. In an effort to shield this information, United Healthcare argued that disclosure of its strategic business plan’s pricing, would infringe upon United Healthcare’s privacy interests.