I don’t understand how it’s legal to charge $900 for an X-ray you are happy to take $56 for from an insurance company (actual bill from last month). Seems like illegal tying of products or price discrimination. I would be for a rule that you can not charge more than 30% more than the average you accept for a line item. So if 90% of your customers pay $56 around $80 would be the max you can charge.

So this is geared more towards making them accountable to the non-insured vs anything to do with insured patients?

I would assume the transparency will help in a lot of places.

Right now the system feeds itself. The higher the bills for the uninsured vs insured the bigger a risk you take not getting insurance so it drives sign ups and what it’s worth to you to avoid being unisured. The bigger the discounts the more companies value health insurance negotiated discounts. Also the more hospitals can write off on unpaid bills. So both insurance companies and hospitals benefit from this gap- which it probably why it has grown so much in the past 5 years. It used to be a discount but not this rediculous level.

So this gap feeds the system. Yet if it was visible that a hospital is willing to take $56 for an X-ray instead of $900 I think that changes a lot of negotiations and will bring on change in the system. The insurance companies have an oligopoly on affordable health insurance and with a lack of transparency they are able to exploit that which benefits both them and the hospitals.

If this gap was not being exploited there is no way to explain a 1700% mark up over acceptable payment.

From just an efficiency of billing perspective it makes no sense.

I also think it’s probably tax fraud. If I donated 10 sweaters with a market value of $56 and claimed they were worth $900 each I’d probably get in trouble.

Can you come up with a legitimate reason for the billing gaps?