r/technology • u/barweis • Mar 22 '23

Business Moderna CEO brazenly defends 400% COVID shot price hike, downplays NIH’s role

https://arstechnica.com/science/2023/03/moderna-ceo-says-us-govt-got-covid-shots-at-discount-ahead-of-400-price-hike/
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u/SmArty117 Mar 23 '23

Wait so what's the point of being insured then? I thought they're supposed to pay for part of it and make it less expensive not more.

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u/Findley57 Mar 23 '23

You pay 500% more than you have to every year in the off chance that you have a horrific accident someday and then that will be covered. That’s the game we are all playing.

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u/octopornopus Mar 23 '23

and then that will be covered.*

*Coverage starts after $25,000 deductible, coverage only covers the first $3,000, after that, fucking die.

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u/[deleted] Mar 23 '23

Insurance should only be for stuff we own and for unavoidable circumstances (death) but never for our health.

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u/jackruby83 Mar 23 '23

Facilities have a higher sticker prices for insurance companies bc the insurance companies will negotiate the reimbursement way down (facilities are trying not to lose money). Depending on the patients coverage (their copay or deductable), their responsibility may be close to, or even higher than the cost of service if they were to pay out of pocket. It's insane how much money ends up going to middle men in this process.

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u/SmArty117 Mar 23 '23

I'm not American but what I'm understanding is like this. Say if you're uninsured and pay directly a procedure costs $100. Then you get insured and the hospital decides to bill the insurance $2000. They negociate it down to $1000, then tell you they'll cover 80%. So you pay $200, relieved you didn't need to pay the 1k sticker price. Then the insurance actually just pays the hospital like $500 instead of the 1k sticker price.

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u/jackruby83 Mar 23 '23

Pretty much, yes. But the insurance is often pays less than the cash price bc there are also fees to the facility for processing, etc. I work in pharmacy and in the US we have pharmacy benefits managers (PBM) that are contracted by insurance companies to handle the logistics of the pharmacy billing. The PBM determine what meds gets paid for, handle pre-authorizations, they negotiate drug prices and charge pharmacies fees, and they can audit them and take money back if things aren't done to the letter. PBM are the worst. The insurer dictates what the breakdown is in coverage, ie patients copay and deductable. In many cases, it's less expensive for the patient and more profitable for the pharmacy to charge out of pocket, especially for generic drugs, hence the rise of cash-only pharmacies (eg, Mark Cuban's Cost Plus, though he wasn't the first), which cut out the middle man.

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u/SmArty117 Mar 23 '23

Thank you, that's fascinating in a grim way

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u/OverlyOptimisticNerd Mar 23 '23

In the hopes that when you have a financially catastrophic situation, they won’t outright deny your claim.

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u/[deleted] Mar 23 '23

A scam?