r/HospitalBills • u/Old_Glove9292 • 12d ago

A $101,000 knee replacement? Why hospital charges vary so much.

https://www.usatoday.com/story/money/2025/08/18/why-hospital-charges-prices-vary-cost/85656566007/
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u/tlit1357 11d ago

Pharmacist here. Insurance companies are absolutely one of the causes of rising healthcare costs. They reimburse less and sometimes even under acquisition cost for drugs. You bet costs for everything will inflate to cover their under-reimbursement. Also when they don’t want to cover the anticoagulant that the hospitalist prescribed for patient’s dvt/pe/afib at the pharmacy, that patient is going to wind up back in the hospital for probably the same thing that put them there in the first place.

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u/Old_Glove9292 10d ago

Insurance companies contribute to costs, but they're not the main driver as has been demonstrated in multiple sources that I've shared in this thread. While your statements hold some truth, they're only a tiny fraction of the story, and your argument seems tailored to exculpate providers of any ownership over their share of the cost equation (which is enormous)

On a side note, why mention that you're a pharmacist? Do you think that adds to your credibility on this topic somehow? I guess I'm curious, because it's amazing to see how many med and med-adjacent people style themselves as experts on anything and everything that touches healthcare-- finance, economics, business management, information technology, politics, etc -- when in fact, their knowledge on those subjects is very narrow and their understanding doesn't generalize at all to the rest of the world, which renders them incapable of making any sort of meaningful assessment or critique of those functions within their own industry...

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u/tlit1357 10d ago

I add that I’m a pharmacist for context. I have direct experience in the industry. Do you?

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u/Old_Glove9292 10d ago

Right. That's exactly my point. You're under the impression that you "industry experience" elevates your ethos on this topic somehow, but it doesn't. That's like a cashier at CVS flexing their experience in a conversation on GLP-1 agonists.

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u/Dwindlin 9d ago edited 9d ago

You are aware that most physicians are responsible for their own billings right? We do actually have to understand the business side of healthcare.

On that note there is a huge lack of context in this article. Surgery isn’t a fixed cost, even within an institution. Using knee replacement as an example. Is it a primary? Revision? Robotic? What kind of implants are needed? Length of surgery (again these are humans not machines so it isn’t always exactly the same) changes cost. Is the anesthetic straight forward or do they have conditions that make it more challenging. Did they need blood or other specialized medications? Were they healthy enough for outpatient or did they have to stay a few days? These all matter when you’re taking about the cost of any procedure.

Comparing claims from procedure codes submitted to insurance is a worthless endeavor, there is never going to be enough context there to make any kind of real comparisons.

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u/Old_Glove9292 8d ago

Why do you think that understanding billing codes in the context of one industry equips someone with anything more than a cursory understanding of the "business side" of healthcare? Let alone giving them the tools to conduct a comparative analysis across industries and provide meaningful contributions to discussions on reform? I stand by my point. Clinicians are dangerously overconfident about their knowledge across a whole swath of topics that brush up against healthcare including but not limited to finance, accounting, economics, law, and technology. They think they know a lot, but they don't... and the overconfidence that they bring into conversations well outside their scope of knowledge is just embarrassing...

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u/Dwindlin 8d ago

This is one big ad hominem, you don’t actually point out anything that I said that was incorrect. And it’s pretty fucking clear that YOU’RE the one out of their depth here. Considering ALL of the articles you’ve linked are doing exactly that, looking at codes submitted and comparing them to actual bills. That’s a worthless endeavor, because, as has been pointed out to you several times, there is a MASSIVE amount of missing information.

You cannot just fucking set a price point for things in medicine. People aren’t widgets, even something simple like medications can have extreme amounts of variability.

You want to standardized the way billing is reported? Fine. But the article specific dealing with stents, I know for a fact that the Cleveland clinic number is JUST the physical stent, whereas the one they are comparing it to is for the entire fucking procedure. Doesn’t really seem like a fair comparison does it?

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u/Old_Glove9292 8d ago

Whatever helps you sleep at night... The "complexities" of healthcare aren't any more complex than other industries, but people like you think everything in healthcare is unique and special and only people in the industry can understand. That's just a load of bullshit. The ongoing commoditization of healthcare will undermine the value of clinicians, but ultimately benefit patients through cheaper, more predictable, and higher quality care. I'm sorry to break this to you but healthcare is not special, and you're not special by extension.

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u/Dwindlin 8d ago

Okay. So the economics of healthcare are either so complex the likes of mere clinicians can’t understand it, or it’s not complex at all and the clinicians are making more difficult than necessary? Which is it, because you seem to be arguing both at this point, so maybe pick a premise for your argument.

If this is reference to the actual taking care of patients, well then by all means fucking step up. If it’s so easy I’ll leave you to it. I could use some time off.

Also, you STILL have actually addressed any actual argument I’ve made. Just more straw-men, ad hominem, and goal post moving.

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u/Old_Glove9292 7d ago

I'm sorry this is difficult for you to understand, but my point is just that clinicians like you don't understand business management, accounting, finance, economics, law, or tech nearly as much as you think you do. And, when someone calls you out, you get defensive and start projecting about bad faith arguments when your whole worldview is built on poor, self-serving assumptions that you were likely taught while growing up and that were reinforced in your training, and so the only arguments that you're capable of constructing are those in bad faith, because your ego doesn't know how to live in a world where you're not the expert... Look, I know this isn't going to convince you, and you will spin this around in your head and vomit out some more defense bullshit, but I'm not your therapist and it's not my problem. Just know that there are people out there with actual education and experience in these subject areas who will call you out. Medicine doesn't have to be complicated, but apparently, clinicians do...

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u/Dwindlin 7d ago

lol. Another long winded response where you’ve said absolutely nothing. I should have scoped out your comment history before even attempting. You clearly have some sort of axe to grind. All of your comments are exactly this, long winded but ultimately making no argument or point, other than to claim the other person doesn’t know what they’re talking about.

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u/cel22 7d ago

You sound a lot more like industry talking points than a neutral critic. Insurers and administrators love to say doctors “don’t understand the business side” because it justifies why they get to skim off 25–30% of healthcare spending in overhead. Meanwhile in countries like Germany or Sweden, most of that money goes directly to patient care. Blaming doctors just keeps the middlemen safe.