Right now there is no motivation built into the system that gives the providers (hospitals/Doctors) to drop their prices. If a patient is told they need a heart surgery, they are scared and sign up for wherever their cardiologist tells them too. The insurance company doesn't have any motivation because if they start losing money, they just raise premiums. If the person qualifies, they just get subsidies from the government. The government has forced everyone to have insurance so their customer base just exploded.
This system SUCKS!!!
We have a wellness program in our company. Within that plan, if an employee needs that heart surgery, the wellness program will look at how much it is going to cost and then find comparable hospitals that will do it for much less. The patient/employee is not forced into using someone they don't want. They can then choose based on the cost. We will totally wave any deductible or co-pay if the employee decides on the lower cost facility. The wellness program also researches the quality of care at the facility so they are not sent to a place that won't do comparable work.
Something like this has got to be built into the system for everyone. We have an employee who had a procedure done at an office not physically within the hospital. When they received their bill, the hospital charged them a fee. When asked, the hospital said the doctor who did the procedure had an office within the hospital so they are allowed to charge a fee.....even though the patient never set foot in the hospital.
The cost structure and billing is totally screwed up to the point these places can charge whatever they want and get away with it.
Our insurance company is trying to get more providers signed onto contracts. What some providers will agree to is to charge insurance customers "medicare plus 100%" So, if a medicare patient would be charged $1000, the insurance patient would get charged $2000. Now, you may scoff at that, but a lot of providers won't do these contracts because they are charging insurance patients sometimes 10-15 times medicare.
Hospitals and doctors are NOT going to like being forced to charge less. But, there is no reason why a procedure should cost $80,000 in one place and $15,000 in another without the patient being informed.
good luck getting the government involved in that process.