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It’s Time To Have A Black Friday Sale In Health Care

Black Friday Sale In Health Care

Black Friday is the best time to purchase a car. Have you ever wondered why there isn’t a President’s Day sale for colonoscopies in your area? Advertisements for knee replacements that come with a buy-one-get-one deal

In most cases, patients would not be able to receive a discount on their health care services if they were offered by a federal Civil Monetary Penalties Law or the Anti-Kickback Statute. These laws are intend to encourage patients to avoid unnecessary care and overuse services as if anyone would book a colonoscopy just for fun.

Every industry, from cars to shoes to reward customers with financial incentives or discounts, uses rewards programs and incentive programs. Both the seller and buyer benefit from them. A hospital could be subject to civil or criminal fines if it does this. Incentives that influence an individual’s decision to use a particular provider are prohibited by the law.

These laws are built into insurance companies’ contracts with hospitals, medical groups, and other providers. A breach of these agreements could be cause by the provider reducing or waiving a patient’s cost. This would indicate that the provider has overstated pricing.

There are laws that require providers to prove that the services they offer are medically necessary. Many laws already exist. There is a possibility of fraud if patients aren’t fully informed about the services they are receiving and whether it is necessary. Current laws that prohibit patient discounts and make it harder for patients to pay more for their care are not able to solve the problem. Americans could have some control over their health care spending by legalizing patient discounts.

The No Surprises Act attempted to solve the problem. A provision allows individuals to get a good-faith estimate before they receive any medical care. This requirement was enacte by the government because consumers need pricing information to “compare costs and make decisions about which provider they will use for care.” It must include all expected charges and a description of a provider’s “typical” discounted price. Providers cannot legally offer discounts or sales, so the “typical discounts” refer to the price that the insurance company would charge or the cash-pay patient.

What does the consumer end up paying? Patients won’t save any money if the provider’s “typically” discounted price is much higher than their copay deductible. However, the intention of helping patients save money by showing them a “healthcare version” of a price tag is a positive step.

It is time to remove the ban on patient discounts, and to empower consumers and health care providers to reduce costs. Providers could be competitive through pricing and not only through reputation or quality, if they had the chance to advertise lower out of pocket costs. Providers could also optimize their capacities by offering seasonal discounts during slow periods, or special pricing on new services.

Patients would be more inclined to pay ahead if they were informed of the discounted prices before waiting for their insurance claims to be processed. Patients would be able to pay less and providers would make more money. Providers would also be able to compete for price, which will benefit insurance companies.

Public policy that prohibits providers pricing competition for consumers is not in line with the free-market system of the United States.

Patients have been kept out of price negotiations by government rules and policies from insurance companies for far too long. It is time to change the rules so that patients can demand price competition in healthcare.

 

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