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Amen! I tend to be more Libertarian than either of the 2 major parties, but I would gladly pay personally for other people's health care if it was actually bein

Amen! I tend to be more Libertarian than either of the 2 major parties, but I would gladly pay personally for other people's health care if it was actually being done rationally. But I've had major problems every time I've seen a doctor my entire adult life, all related to the complexity of the billing, and it got to the point where my biggest health risk was the stress of fighting it. Go for an annual physical: $1200 bill for 2 physicals, blood tests I never got the results for, and a test they never performed. Not covered by insurance because the doctor's "wellness check up" wasn't the same as the insurance company's "annual physical". Time to resolve: 8 months. Resolution: I paid because the lawyer was going to be more expensive. That's not a system I'm willing to pay for, and it's got nothing to do with whether it's my social obligation or not.

xadhominemx 10y ago
Sounds like your issue is with your doctor's billing practices? Seems like a weird reason to let poor people die of treatable ailments.
- zerohm 10y ago
  It wasn't just his doctor it is the whole system which is somewhat unavoidable. We are lucky to have good health insurance, and a simple ER visit to get stitches or an X-Ray will invoke 5 pieces of mail from 3 different entities. You have to watch out for student Doctors who will send you a bill for being in the room. It's too much to think about when you should be focused on taking care of your health issue.
  - Para2016 10y ago
    Could you provide proof that you were charged because a student was in your room or in the operating room?
    - xtracto 10y ago
      What type of proof would be good for you?
      - Para2016 9y ago
        I'm a medical student, we are assured that the hospital can't bill for us. It would be enlightening to see an itemized bill showing that our presence is actually billed for. I've never heard of it happening so I think proof is warranted.
        zerohm 9y ago
        If I remember correctly, the hospital did not bill for him, he billed us separately, but the Hospital condoned this. I'm sure we agreed to it somewhere in the fine print. I'm not trying to vilify student doctors here, I understand 99% of the time they are not billing. But after this experience, we ask.
        Para2016 9y ago
        Ah gotcha. He wasn't a medical student then, most likely a resident. Residents are doctors though, if they perform a service such as anesthesia or other procedure they will likely bill. For example, an Anesthesia resident will perform all of the procedures and monitor the patient's vital signs and response to the general anesthetics or other drugs. The Attending physician only intermittently checks on the case if the resident needs help or the case becomes too complicated. If the resident doesn't bill for services performed, such as central line, placement, peripheral line placement, intubation, arterial lines, etc. I'm not sure who would do the billing.
  - TallGuyShort 10y ago
    >> It's too much to think about when you should be focused on taking care of your health issue. This is one of my biggest pet peeves. The biggest bill I've ever had get processed wrong is the only one where lawyers ended up getting involved, and what the other side's lawyers sent was a form my wife signed while in labor (was at an 8 when we got there) while I was out of the room agreeing to pay the bill however the hospital decided to bill it. They said that excused their mistake, and now that it was too late to bill insurance (had been over a year) we were on the hook.
- exclusiv 10y ago
  Poor people have always had access to health care and society has always paid for it. You don't get turned away at the ER and we have Medicaid ($545B) and Medicare ($646B) [1]. The people that get hosed the most are the ones with assets, like middle-class homeowners with some savings that have a major health emergency. It makes sense to try and force everyone onto health insurance before they need it, just like auto insurance; as it will cost a lot more to everyone if people are uninsured. But I agree that bringing down the cost should be a focus. Everyone gets a raw deal when doctors play billing games any chance they get, like giving x-rays for everything and keeping people overnight unnecessarily and charging insurance companies exorbitant multiples of the cash price. I actually know someone carving out a business going into healthcare centers and showing them how to make more money- by not playing admin/billing games and just serving patients. That's just crazy. [1] https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html https://www.cms.gov/research-statistics-data-and-systems/sta...
  - xadhominemx 9y ago
    Before the ACA, my uncle (lower-middle class, with two kids and a wife in a two bedroom apartment in Indiana), had to choose between between paying the gas bill and paying for his near-daily dialysis, which is not a service provided by emergency rooms. He had picked up Hep C as a young teenager and could not afford insurance in adulthood due to this pre-existing condition. The only "health care" he would have had access to was the ER when he inevitably suffered renal failure.
- deleted 10y ago
  [deleted]
- sctb 9y ago
  Please post civilly and substantively here. Part of both of those is reading other comments charitably before commenting.
  - xadhominemx 9y ago
    Respectfully, like 80% of HN comments, mine was not "nice", but it was neither uncivil nor unsubstantial - parent was literally an anecdote related to their billing grievances and their proposed solution was literally to let poor people die of treatable ailments. Unless you had an alternative reading? Totally understand how you could interpret my comment as uncivil if you believe I intentionally misrepresented his argument.
    - TallGuyShort 9y ago
      Actually my proposed solution would be single payer. Reducing political issues to "x wants to kill y" is never productive. FWIW my anecdote was from when I was living at approximately half of the poverty line and after ACA took effect. Similar things have happened to me in 3 different states. So forgive me for not having confidence that required insurance is really going to do much for me, or anyone. But let me know when you're voluntarily forking over all the money you don't need to survive to help save lives in third-world countries or something.
emjoes1 10y ago
Yes it seems the complexity of billing still has something to do with Who Pays. I had a similar issue where I was billed for a physical that my insurance provider would not pay. My wife suggested I have the Dr. office re-code the bill. Not sure what that is but I contacted the Dr. office and explained that it was not a wellness check up but an annual physical that my insurance should cover. After arguing for about 10 minutes they finally agreed to re-submit to insurance under that code... and it ended up being covered by insurance after all.
- SilasX 10y ago
  Now, imagine how much is being lost by most people having to go through that, most of whom aren't perceptive enough to notice this...
dv_dt 10y ago
The complexity of billing is strongly intertwined with who pays and how, and adding the third-party of your employer, who actually selects the health insurance company for many of us adds yet another layer on top of the already inefficient setup.
- TallGuyShort 10y ago
  And that's what swings me to single-payer, despite my other political leanings. The incentives system is just so screwed up. Consolidating is would make solving the remaining problems so much simpler.

xadhominemx 10y ago

Sounds like your issue is with your doctor's billing practices? Seems like a weird reason to let poor people die of treatable ailments.

zerohm 10y ago
It wasn't just his doctor it is the whole system which is somewhat unavoidable. We are lucky to have good health insurance, and a simple ER visit to get stitches or an X-Ray will invoke 5 pieces of mail from 3 different entities. You have to watch out for student Doctors who will send you a bill for being in the room. It's too much to think about when you should be focused on taking care of your health issue.
- Para2016 10y ago
  Could you provide proof that you were charged because a student was in your room or in the operating room?
  - xtracto 10y ago
    What type of proof would be good for you?
    - Para2016 9y ago
      I'm a medical student, we are assured that the hospital can't bill for us. It would be enlightening to see an itemized bill showing that our presence is actually billed for. I've never heard of it happening so I think proof is warranted.
      - zerohm 9y ago
        If I remember correctly, the hospital did not bill for him, he billed us separately, but the Hospital condoned this. I'm sure we agreed to it somewhere in the fine print. I'm not trying to vilify student doctors here, I understand 99% of the time they are not billing. But after this experience, we ask.
        Para2016 9y ago
        Ah gotcha. He wasn't a medical student then, most likely a resident. Residents are doctors though, if they perform a service such as anesthesia or other procedure they will likely bill. For example, an Anesthesia resident will perform all of the procedures and monitor the patient's vital signs and response to the general anesthetics or other drugs. The Attending physician only intermittently checks on the case if the resident needs help or the case becomes too complicated. If the resident doesn't bill for services performed, such as central line, placement, peripheral line placement, intubation, arterial lines, etc. I'm not sure who would do the billing.
- TallGuyShort 10y ago
  >> It's too much to think about when you should be focused on taking care of your health issue. This is one of my biggest pet peeves. The biggest bill I've ever had get processed wrong is the only one where lawyers ended up getting involved, and what the other side's lawyers sent was a form my wife signed while in labor (was at an 8 when we got there) while I was out of the room agreeing to pay the bill however the hospital decided to bill it. They said that excused their mistake, and now that it was too late to bill insurance (had been over a year) we were on the hook.
exclusiv 10y ago
Poor people have always had access to health care and society has always paid for it. You don't get turned away at the ER and we have Medicaid ($545B) and Medicare ($646B) [1]. The people that get hosed the most are the ones with assets, like middle-class homeowners with some savings that have a major health emergency. It makes sense to try and force everyone onto health insurance before they need it, just like auto insurance; as it will cost a lot more to everyone if people are uninsured. But I agree that bringing down the cost should be a focus. Everyone gets a raw deal when doctors play billing games any chance they get, like giving x-rays for everything and keeping people overnight unnecessarily and charging insurance companies exorbitant multiples of the cash price. I actually know someone carving out a business going into healthcare centers and showing them how to make more money- by not playing admin/billing games and just serving patients. That's just crazy. [1] https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nhe-fact-sheet.html https://www.cms.gov/research-statistics-data-and-systems/sta...
- xadhominemx 9y ago
  Before the ACA, my uncle (lower-middle class, with two kids and a wife in a two bedroom apartment in Indiana), had to choose between between paying the gas bill and paying for his near-daily dialysis, which is not a service provided by emergency rooms. He had picked up Hep C as a young teenager and could not afford insurance in adulthood due to this pre-existing condition. The only "health care" he would have had access to was the ER when he inevitably suffered renal failure.
deleted 10y ago
[deleted]
sctb 9y ago
Please post civilly and substantively here. Part of both of those is reading other comments charitably before commenting.
- xadhominemx 9y ago
  Respectfully, like 80% of HN comments, mine was not "nice", but it was neither uncivil nor unsubstantial - parent was literally an anecdote related to their billing grievances and their proposed solution was literally to let poor people die of treatable ailments. Unless you had an alternative reading? Totally understand how you could interpret my comment as uncivil if you believe I intentionally misrepresented his argument.
  - TallGuyShort 9y ago
    Actually my proposed solution would be single payer. Reducing political issues to "x wants to kill y" is never productive. FWIW my anecdote was from when I was living at approximately half of the poverty line and after ACA took effect. Similar things have happened to me in 3 different states. So forgive me for not having confidence that required insurance is really going to do much for me, or anyone. But let me know when you're voluntarily forking over all the money you don't need to survive to help save lives in third-world countries or something.

emjoes1 10y ago

Yes it seems the complexity of billing still has something to do with Who Pays. I had a similar issue where I was billed for a physical that my insurance provider would not pay. My wife suggested I have the Dr. office re-code the bill. Not sure what that is but I contacted the Dr. office and explained that it was not a wellness check up but an annual physical that my insurance should cover. After arguing for about 10 minutes they finally agreed to re-submit to insurance under that code... and it ended up being covered by insurance after all.

SilasX 10y ago
Now, imagine how much is being lost by most people having to go through that, most of whom aren't perceptive enough to notice this...

dv_dt 10y ago

The complexity of billing is strongly intertwined with who pays and how, and adding the third-party of your employer, who actually selects the health insurance company for many of us adds yet another layer on top of the already inefficient setup.

TallGuyShort 10y ago
And that's what swings me to single-payer, despite my other political leanings. The incentives system is just so screwed up. Consolidating is would make solving the remaining problems so much simpler.