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I had this same thing happen. My daughter was admitted via ER and it turned into a 6 day stay. At the end we received a bill for 40k for being out of network. L
by ydt 9y ago
I had this same thing happen. My daughter was admitted via ER and it turned into a 6 day stay. At the end we received a bill for 40k for being out of network. Luckily I have friends in the industry and it turns out if they fail to inform you within 48 hours that you're not in network you don't have to pay the out of network cost. We ended up paying just our deductible after a letter was drafted. Do not take what the hospital/insurance Co say at face value. Call an attorney.
- mistermann 9y agoCan someone knowledgeable on the subject comment on whether the "Obamacare movement" has been up front in acknowledging this aspect of the problem with health care in the US? My perception is that the problem is typically framed as a lack of insurance problem for financially challenged people, but the "abuse" on the billing side to me seems like at least as big of a problem. And if this is being conveniently ignored, it feeds my conspiracy thinking that the Democrats are actually largely indistinguishable from Republicans - they may wear a different mask, but their actions are only slightly different, in this case altering who is getting robbed.
- heartbreak 9y agoWell the progressives including President Obama pushed for single payer (or a public option) which would eliminate abuse on the billing side, at least to the insured.
- jazzyk 9y agoThe single-payer option was quickly dropped by the Democrats in Congress. Their sponsors (the health-"care" industry) did not like it.
- albinofrenchy 9y agoIt was dropped because it was politically impossible and it wasn't worth burning political capital on it. Even just the public option wasn't able to gain traction; single payer was never going to happen in 2009.
- jazzyk 9y agoStrictly speaking, it was politically possible - the Democrats had majority in both the Congress and the Senate. Public option is a great solution, because it does not prevent the people who prefer (and can afford) to pay for private services from doing so.
- albinofrenchy 9y agoNot really, they only had a filibuster proof majority for a very short period of time -- http://www.outsidethebeltway.com/did-the-democrats-ever-really-have-60-votes-in-the-senate-and-for-how-long/ http://www.outsidethebeltway.com/did-the-democrats-ever-real.... And that is counting Lieberman as a D; a person who backed McCain for president and who later personally killed the public option. I do think we will get to the public option at some point. It just makes too much sense not to and would strengthen the healthcare as a whole while allowing people more choice.
- enraged_camel 9y agoPublic option is unlikely to happen in the near future. Too many people start frothing at the mouth and yelling "socialism!" every time it is proposed.
- joe_the_user 9y agoI would just note that "...it was politically impossible" and "the Democrats were never serious in saying they wanted it" are two ways to frame the same reality. Both are true. Take your pick.
- albinofrenchy 9y agoI'm not saying any democrats at the time were willing to go all in on it, but the two statements would only be two ways to frame the same reality if democrats had the ability to make unilateral decisions in the senate. They never did.
- dankohn1 9y agoJoe Lieberman single-handedly killed the public option. He was able to do so because he was the 60th vote the Democrats needed. Source: http://voices.washingtonpost.com/ezra-klein/2009/12/the_death_of_the_public_option.html http://voices.washingtonpost.com/ezra-klein/2009/12/the_deat...
- joe_the_user 9y agoIf the democrats were serious, they could have deployed the "nuclear option" on this (suspend Senate rules). But of course there was more than one person's objection going on.
- dankohn1 9y agoThere are far less than 50 votes from either party to suspend the 60-vote filibuster rule because it gives more power to each individual senator. By contrast, Lieberman single-handedly killed the public option.
- joe_the_user 9y agoIpso facto there weren't enough votes to suspend the 60-vote in the health care case. But that's not always the case - Neil Gorsuch was confirmed by a vote to suspend the 60 vote rule. So the rule is available for things that a strong party consensus. https://www.nytimes.com/2017/04/06/us/politics/neil-gorsuch-supreme-court-senate.html https://www.nytimes.com/2017/04/06/us/politics/neil-gorsuch-...
- dragonwriter 9y ago> But that's not always the case - Neil Gorsuch was confirmed by a vote to suspend the 60 vote rule No, as your source accurately states, he was confirmed after a vote to abolish the rule for Supreme Court nominations.
- joe_the_user 9y ago
- protomyth 9y agoWell, if it works anything like IHS[1], then the system would run out of money before the end of the fiscal year and then you end up paying for it anyway or not getting the treatment. I find people who say "but it will be different for us" to need some proof from the US and not other countries. 1) Indian Health Service - the US agency tasked with providing and paying for Native American health care on reservations or "health service areas". http://www.richheape.com/american-indian-healthcare.htm http://www.richheape.com/american-indian-healthcare.htm
- mistermann 9y ago> which would eliminate abuse on the billing side, at least to the insured How does single payer fix that? If the hospital gives you a bill and won't negotiate down, how does the government "fix" this? Which is kind of what my question is: were specifics given in the ACA on how that problem will be fixed?
- heartbreak 9y agoWell since single payer typically refers to the government being the single payer, the bill goes to the government because you the insured are not the payer of the bill.
- mistermann 9y agoThe bill goes to the government, who gets its funding from the people. This in no way stops any systemic over-billing that may be occuring.
- kirrent 9y agoWell, in my country, the government would laugh, and then only pay a standard amount.
- ssambros 9y agoAnd unless they pay enough no providers will do the procedure unless you somehow force them.
- ceejayoz 9y agoYes, which is why single-payer systems generally do a tiny bit of research, pick a reasonable amount, and pay that.
- BurningFrog 9y agoSure, but if you're the single possible payer, you can push that number down quite low.
- maxsilver 9y ago> My perception is that the problem is typically framed as a lack of insurance problem for financially challenged people, but the "abuse" on the billing side to me seems like at least as big of a problem. If anything, the billing abuse is a much, much larger problem than lack of insurance. At least, that has generally been true since the ACA/"Obamacare" changes passed.
- hockley 9y agoIt was a problem before ACA; it's a problem now. The law didn't really change that aspect of the system.
- mistermann 9y agoThis is my uninformed impression of the matter as well, and if true (please, anyone with a rebuttal please weigh in), to me it is further proof that the true motive of the ACA is to line the pockets of health care provider donors, by spreading the costs over the entire population and get rid of the politically damaging stories of overcharges causing individual bankruptcy. Socializing this theft turns it into Just Another Crisis among the hundreds of others the US has.
- sethrin 9y agoHaving an expansive definition of theft merely serves to raise the noise floor. The "true" purpose of the ACA was to do something about spiraling health care costs. What was passed was a "compromise" where the people pushing for a public option got nothing and the most onerous restrictions on the monied interests were rolled back. This has not been an effective solution in many senses. I decline to further characterize the issue, however; this is extremely close to a political discussion, and those are ban-worthy here.
- hockley 9y agoThere were provisions that addressed cost containment (ACOs, Quality-Based reimbursement models for Medicare). In fact, medical cost inflation has come more in line with general inflation since about 2009/2010. But, you're right, the market based reforms like cost and quality transparency were left to fight another day. The ACA focused more on access to coverage than it did cost. I would not put too much weight on conspiracy theories though. The healthcare system is massively complex. It will take multiple reforms to eat this elephant.
- cookiecaper 9y agoThe insurance model is at the heart of the medical system's issues; it distorts the market by disconnecting prices from providers and consumers and severely disaligns their interests. The provider must set a high sticker price so that they can give the insurer the expected 60-80% discount to get in-network (and still tolerate underpayment and other shenanigans). The consumer is either intentionally misled or confused (usually both) about basically everything cost-related, and often won't learn the true out-of-pocket cost of a service until ~1 year after receiving it, when the billing process has (mostly) finished. Example: just yesterday I got a new bill for a routine lab test I received in December. It says that the insurance discount applied, but they never sent a payment, and thus I owe a balance of over $200 to the lab company. Now I have to call the insurer to figure out why they denied payment, which is sometimes due to an administrative error, sometimes a paperwork thing like signing a document that verifies there is no other possible insurance carrier whom may have been responsible for the bill, etc. Obamacare is thus anything but up front, because honestly working to fix the American medical system would involve excising market-breaking, paper-pushing leeches from the marketplace, but Obamacare props up this destructive apparatus by forcing every American to pay in or get fined.
- dv_dt 9y agoNot only the insurance model, but the encouragement of health insurance as an employer benefit. It adds one more aspect of indirection to an already complex health system.
- thephyber 9y agoAlmost any politician will tell you that taxing employer-sponsored health insurance is a "3rd rail". Almost any economist will say this is one of the largest problems with US health care costs and employment mobility.
- dv_dt 9y ago> Almost any politician will tell you that taxing employer-sponsored health insurance is a "3rd rail". Every employer outside of the health insurance and drug industries should be furious at the price they pay to pay their employees health benefits. Besides having a distraction that operating businesses in other nations don't have, they're likely paying more than double than what they need to in this area to maintain competitiveness against other nations. It's even worse for startups.
- maxerickson 9y agoIt's well enough understood that the cost side is also a problem. http://www.cnbc.com/2015/11/20/obamacare-architect-high-deductible-plans-overdone.html http://www.cnbc.com/2015/11/20/obamacare-architect-high-dedu... The previous administration was working to move to different payment models to try to address it (it's not clear that the different models will have much long term impact): http://www.reuters.com/article/us-usa-healthcare-reform-idUSKBN0KZ1ZV20150126 http://www.reuters.com/article/us-usa-healthcare-reform-idUS...
- burkaman 9y agohttps://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act#Delivery_system_reforms https://en.wikipedia.org/wiki/Patient_Protection_and_Afforda...
- mistermann 9y agoThank you, looks like some initiatives were underway.
- deleted 9y ago[deleted]
- tptacek 9y agoThe fact that the problems addressed by the Democratic health care bill are orthogonal to some other problem you care deeply about is not, logically, evidence that the Republicans and Democrats are "indistinguishable" when it comes to health care. The status quo ante of the ACA was a system in which millions of people were locked out of insurance by fiat due to pre-existing condition bans. For those people, all providers were "out-of-network".
- mistermann 9y agoRight, which increases revenue for the medical establishment, while also helping some people (and harming others) in the process. For me to consider the Democrats as the true party of the people rather than a tool of corporations, I'd want to see the cost side of health care addressed as well. My question is: was it?
- ComradeTaco 9y agoObamacare only reduced the growth of healthcare costs, it did not stop the growth. The approach that most democrats believe would reduce cost is single payer or Medicaid for all.
- 0xbear 9y agoAs far as I can tell by looking at my premiums, it actually significantly sped up the growth of costs. I don't know how anyone could argue otherwise with a straight face.
- tptacek 9y agoThat's not the cost we're measuring! We're measuring cost on the macro scale, in terms of the percentage of the economy spent on health care and, in particular, the percentage of the federal budget spent on health care entitlements. That's the cost curve we're talking about bending, because the pre-ACA projections were literally prima facie untenable. Any number of effective cost-saving measures could be passed that would have the effect of increasing your premiums.
- Mz 9y agoThe problem isn't abuse on the billing side per se. The problem is that insurance is about risk management. In laymen's terms, it amounts to taking a bet. When you insist that private insurers cover people with pre-existing, incurable, chronic conditions, there is no "bet" to take there. It is all downside for the insurer. It amounts to charity. This fact then seriously distorts the business model, driving up costs for everyone in a big way. It has to be covered somehow. We need a single payer system because, at the societal level, it makes sense for government to make sure people get their healthcare needs met for the same reason it makes sense for government to provide police and fire protection. But forcing all Americans to get private health insurance makes no sense and indicates a fundamental misunderstanding of what the insurance industry does. Direct Primary Care, single payer and wellness programs all have a good track record of genuinely getting people healthier while bringing down costs. Obamacare cannot do any of those things and just runs expenses up. Source/qualifications: Among other things, I worked in insurance for over five years. I have a certificate from a technical college in life and health insurance, paid for by my former employer.
- dboreham 9y agoYes there were attempts made in the ACA to control costs (hence the first 'A'). However 1. the clock ran out on the bill drafting due to people voting for republicans in mid-terms and 2. Corruption.
- tunetine 9y agoWere there attempts very early on because I remember them drafting a bill no one even had time to read. Republicans were going to vote anything down and it seemed like Dems waited out the clock so it would be forced in at the last second, either way.
- chasing 9y ago> it feeds my conspiracy thinking that the Democrats are actually largely indistinguishable from Republicans Have you been watching anything that's been happening with the healthcare debate over the past, oh, 25 years? The Democrats have been trying with varying degrees of success to inch this country in the direction of a more sensible healthcare system and the Republicans have pitched a generation-long hissy fit about it.
- kobeya 9y agoTake your politics elsewhere.
- chasing 9y agoThat's more of a history lesson than a political one. Democrats and Republicans have wildly different perspectives on healthcare. Democrats tend to believe it's a universal human right. Republicans seem to think whatever solution the free market decides is the right solution, even if it means not everyone gets access to healthcare. It's been that way for decades.
- hkmurakami 9y agoFrom my observations, neither side has done much to reign in the cost of the cost of hospital services and doctor/nurse compensation, which are out of line with our developed world peers. On the coverage side, the two parties have contrasting stances. Healthcare and Health Insurance are related but distinct topics.
- chasing 9y agoObamacare does include a bunch of tools to help keep overall healthcare spending down. As far as I'm aware, they have helped. But there's a long way to go. I'm actually not sure the BHCA or AHCA or whatever it's called now has much in it besides slogans and major spending cuts which aren't aimed at making care less expensive -- they're aimed and reducing the overall amount of care provided by shifting costs to those less capable of bearing them. That's a pretty big contrast.
- eatbitseveryday 9y ago> Luckily I have friends in the industry and it turns out if they fail to inform you within 48 hours that you're not in network you don't have to pay the out of network cost. Curious, can you perhaps provide evidence of this? Seems like a good thing to know. > Call an attorney. This is itself a cost, and maybe only makes sense if you owe ≥ $10k but for procedures billed as $1k when they should be $400 I don't think warrants the cost and time of an attorney; what other recourse is there except to pay?
- patrickg_zill 9y agoA consultation with the lawyer will be free or low cost. Paying even 200 to save 600 seems like a good idea.
- ydt 9y agoI have no evidence other than a person that works in claims for an insurance company looked at my claim, drafted a letter citing relevant statutes and the bill went away. I agree that an attorney only makes sense if you're facing a significant bill. On a smaller bill I would go to the hospital billing department and negotiate.
- dungle6 9y agoIf you have excellent credit you can simply not pay and make them do the work. I had a $1500 dispute. I was getting tired of wasting time. When it went to collections I drafted the standard leave me alone. The funny thing is now the collection company has screwed up twice on some things. It is their prerogative to sue. I doubt they will. If they do it, it will be annoying but I can respond in kind with a countersuit. Oh and the credit score? Dropped about 40 points into the upper 700s. Annoying, but not worth just rolling over and paying. You can of course negotiate as well.
- e59d134d 9y agoAgreed, this is just part of business for hospitals. We as honest people feel ashamed if we cannot pay bills. But I make an exception medical bills and other unpredictable broken industries (if any). If someone bought a car or house, they knew their obligations exactly. If they declare bankruptcy, I would lay some fault with them, if not all. But with medical billing, you cannot get a straight answer. If they cannot tell you what a simple procedure would cost you, then you don't owe them anything. Also hopefully if enough people don't pay surprise bills, then medical industry would have motivation to simplify their systems.
- seppin 9y ago> Do not take what the hospital/insurance Co say at face value. Call an attorney. What a terrible industry.
- stronglikedan 9y agoThat applies to any and all insurance - especially mandated insurance policies. The main job of the insurance company is to collect your premiums and the find any way to deny your claims.
- thephyber 9y agoAs cynical as it sounds, I think I agree with this sentiment even though it's being downvoted. The employees at an insurance company have an ethical responsibility to the company to deny any claims that do not perfectly align with the policy they sold. I don't think every insurance company is the antagonist in The Rainmaker or the car company in Fight Club, but insurance companies will try to reject as many claims as they can, straddling the line of losing reputation with consumers.