A Tough Negotiator Proved Employers Don’t Have to Pay So Much for Health Care

Oct 2018
Dan

As healthcare costs continue to rise, some are pushing back against the industry standards, proving that there is a way to decrease costs. ProPublica features one such story, of Marilyn Bartlett pushing back to save millions in healthcare costs in Montana. Medxoom allows employers and their employees to know the price and quality rating of a hospital procedure before deciding where to go.

From ProPublica:

In the illusory world of hospital billing, the hospitals typically charge a high price for a procedure, then give insurers in-network discounts. These charges and discounts might be different for each procedure at each hospital, depending on who has more leverage during negotiations.

The discounts, however, are meaningless if the underlying charges aren’t capped. When Bartlett looked at a common knee replacement, with no complications and a one-night hospital stay, she saw that one hospital had charged the plan $25,000, then applied a 7 percent discount. So, the plan paid $23,250. 

A different hospital gave a better discount, 10 percent, but on a sticker price of $115,000. So, the plan got billed $103,500 — more than four times the amount it paid the other hospital for the same operation.”

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