Riddle Me This, Batman


Riddle Me This, Batman

I love a good riddle. The best ones make you think outside the box and stretch your imagination. Now try this one on for size:

  • I set it, but I don’t know how.
  • I discount it, but I don’t know why.
  • I enforce it, but I don’t know against whom.
  • Who am I?


The answer — Hospital Pricing.


Let me try to explain, not with a riddle, but with a real-world example.


  • Same Procedure – “Ear Tubes”
  • Same Insurance, Same Child, Same City, Same Outcome
  • No Complications
  • Left Ear Last Year – Right Ear This Year
  • 2012 Hospital A Charges – $1,560
  • 2013 Hospital B Charges – $5,260


Writing in The Courier-Journal, Laura Ungar sheds light on the riddle that is hospital pricing with the above case. No expert or hospital insider, quoted in this article, could offer a valid explanation as to the cost differential. Hospitals’ CFOs don’t know, the insurance companies don’t know.


Reading between the lines, there are several “subjective” influences that greatly impact pricing of particular procedures:

  • Hospital reputation (warranted or not);
  • Insurance company clout;
  • What the market will bear;
  • Financial health of hospital system;
  • Are the Feds involved?


Funny that “outcomes” never get mentioned in these pricing riddles.

Call us. We’re seldom stumped by riddles…and we specialize in “outcomes.”

William Faris, JD
Chief Executive Officer

Posted in OMCA