9 ms·

At least in US you get the medical treatment first and then they hand you a large bill to pay. In poor countries the hospitals will turn you away until you pay

At least in US you get the medical treatment first and then they hand you a large bill to pay. In poor countries the hospitals will turn you away until you pay a significant sum in advance (not exaggerating it has happened to me).

chimeracoder 9y ago
> At least in US you get the medical treatment first and then they hand you a large bill to pay. A large bill which, if you're uninsured, you can almost always negotiate down to 10% or less of the original. Of course, most people don't know this, but those large bills aren't what the hospitals expect uninsured patients to pay. They just legally have to present them the same initial bill that they present private insurers.
- chromanoid 9y ago
  This is a good way to sort out the ones who can't negotiate. They have no place in a capitalist society anyway. /s
  - nothrabannosir 9y ago
    I think you make a good point, downvotes notwithstanding. A "market society" inherently rewards people who are good at "the game." Which is fine for most things: worst case scenario you pay too much for a shit car. But having to play that damn game when you life is on the line is inhumane. There's no time out zone.
    - chromanoid 9y ago
      Yeah, it's wonderful how you can make it in such a system. Just imagine - a self-employed blue-collar worker slips with his car on a wet road. He loses his wife, his unborn child and his leg. He sells his house to pay the bills of the hospital and the mortician. His parents also pay some bills because he still had not enough. And then after a year or so on the street somebody tells him how negotiable these bills were. The American dream...
  - BookmarkSaver 9y ago
    I hate negotiating for shit where my own identity is economically irrelevant. I suck at it, so if I go and buy a car I'm basically subsidizing people that are better at haggling.
- gknoy 9y ago
  > you can almost always negotiate down to 10% or less of the original. How does one do this? Where do you learn it? Is there a book you suggest? The fact that I'm even asking this feel weird (I'm insured).
  - chimeracoder 9y ago
    > How does one do this? Where do you learn it? Is there a book you suggest? The fact that I'm even asking this feel weird (I'm insured). You can't do this if you're insured, because then the terms of your insurance apply. You can still get bills reduced, but the reasons are different and it's a bit more involved. If you're uninsured, it's simple. You literally just tell them, "I have no insurance. I can't afford $45,000. It would take me years to pay that, and I'd probably default on the bill beforehand. However, if you reduce the billed amount to $500, I can pay that in full today, in cash.". Substitute appropriate values in as needed, but that's the general idea. It's actually not all that different from what private insurers do, except they do all this up-front in bulk, so their rates are set in long-term contracts.
    - ska 9y ago
      I don't disagree with the general message that these things are negotiable, but I'd love to see a citation showing real research on the effective rate. 10% seems way too low from my limited experience. I've known people to successfully negotiate to 40-50% of original bill, usually with proof of (lack of) assets. Maybe if you really are basically broke, they'll write you off rather than carry it on their books until they sell the debt. On the other hand if your bill is 45,000 and you have even meager assets : say a couple of cars and equity in a house, I'm guessing their going to try hard to see a good chunk of that.
      - uberduber 9y ago
        There are businesses that are medical bill negotiators and charge you a percentage of the bill. In general, they only negotiate hospital bills because they are the only bills large enough. I would say that the typical final negotiated rate they get from the hospital is about 3-20% of the billed amount. It depends on how high the original bill is, and it also depends on whether you need to make payments and how long the series of payments is. Hospitals will certainly claim that you need to send in the proof of assets, usually you have to refuse about 6 or 7 times and they will relent. However, things have changed in the last few years and professional medical bill negotiators have told me certain hospitals are completely unreasonable and refuse to negotiate. They advise these people to file bankruptcy.
- emidln 9y ago
  Of course then you get taxed on the remaining 90% as income.
  - chimeracoder 9y ago
    > Of course then you get taxed on the remaining 90% as income. What? No, that's not how it works.
  - AnimalMuppet 9y ago
    No, because it wasn't income. When you find something on sale, you don't pay income tax on the difference between the sale price and full price.
    - emidln 9y ago
      That depends on if they are willing to negotiate with you before considering it a debt. If they send you to receivables with a 100k bill and you negotiate down to 10k cash, they are well within their rights to write off the 90k as debt forgiven. If they do so, you will be taxed on it. Good luck finding a 90% off coupon for a surgery prior to the event.
  - vonmoltke 9y ago
    What? You do not get taxed on anything. Discounts are not income.
    - oconnor663 9y ago
      Hmm, forgiving a debt is considered income. I wonder if the situation with hospitals depends on a lot of technical details.
      - chimeracoder 9y ago
        > Hmm, forgiving a debt is considered income. I wonder if the situation with hospitals depends on a lot of technical details. It doesn't. It's not a debt yet. You don't have to pay taxes on the difference.
- bitshiffed 9y ago
  Have you ever done this? Where did you hear this? Where have you seen it? I have never had health insurance. Where I live many people don't have health insurance. I have never heard of this happening. I've seen peoples, my own included, wages garnished before this will happen. I currently have a $20k bill for an emergency appendectomy I had 4 weeks ago. The hospital will seriously take payments for 30 years before they'll lower any cost. If you want to negotiate, you'll have to wait until the collection agency has their account removed from your credit report 7 years after the first reporting. Any time before that you are in no position to negotiate with anybody. EDIT: Unless your income is less than 1.5x the poverty level. In which case you qualify for aid in paying your bills.
  - uberduber 9y ago
    Not the op, but I have done this on behalf of friends. Some with significant assets. Did you admit to having assets or significant income? If so, it might be very difficult to negotiate. Google for medical bill negotiation services or "lower my hospital bill" and you should be able to find some professionals near you. The consultation is always free. Be aware that some hospitals have become completely unreasonable in the last few years and would rather you file bankruptcy and collect nothing than negotiate. The initial consult with the negotiation service is always free and they will tell you if this is the case.
13of40 9y ago
> poor countries It happened to a friend of mine who was hiking in Canada a year or two ago. Her son cut a big gash in his foot and they couldn't get online, so I had to call around to find an emergency room they could go to. The local emergency room basically said in lieu of proof of (internationally-accepted) insurance they would need $800 up front if he wanted to be seen. I think they wrapped a towel around it and drove back to the US.
- Kluny 9y ago
  As a Canadian, I find that difficult to believe. Even more difficult to believe that your friend didn't get travel health insurance and carry proof of it while hiking. That's pretty reckless.
  - testvox 9y ago
    Do you really find it harder to believe a tourist wouldn't have travel health insurance? I've never heard of anyone buying that for a day trip to Canada. And just generally it's rare in my experience for people to buy insurance unless it's required in some way. Maybe that is an American phenomenon though.
    - Kluny 9y ago
      By contrast, I know few Canadians who would set foot in the USA for one day without travel health insurance. We've all heard the story about the Canadian couple who went to Hawaii on their honeymoon and delivered a baby (prematurely) there, and it cost them 1 million in hospital fees because their coverage wasn't sufficient. And they did have insurance, it just didn't cover baby deliveries.
      - 13of40 9y ago
        https://www.today.com/parents/canadian-mom-who-gives-birth-hawaii-gets-near-1-million-1D80302220 https://www.today.com/parents/canadian-mom-who-gives-birth-h... It sounds like it was the Canadian insurance provider who screwed them, though. They said[2] that since she had a bladder infection prior to getting the travel insurance, it was a pre-existing condition and therefore wasn't covered. So basically, if you get your travel insurance and come across the border, don't expect it to cover anything like a heart attack, an abcessed tooth, a prescription refill, etc. [2]https://www.change.org/p/blue-cross-blue-shield-pay-for-jennifer-huculak-kimmel-s-medical-bills https://www.change.org/p/blue-cross-blue-shield-pay-for-jenn...
ravitation 9y ago
I mean... Come on. We shouldn't be comparing the US to "poor countries"... How are those other rich countries doing?
nraynaud 9y ago
"You will be asked to make a pre-service deposit of at least $750.00USD. If prescheduled services are estimated to exceed this amount, an additional deposit may be requested. The pre-service deposit can be made in the following ways: major credit card, wire transfer, check (we accept checks from any US bank in US dollars) or by cash. Please know your total and daily credit card limits." Mayo Clinic in Scottsdale AZ, November 2017. edit: I'm a bit off topic, that was for an appointment, not ER.
Florin_Andrei 9y ago
> At least in US you get the medical treatment first and then they hand you a large bill to pay. In poor countries the hospitals will turn you away until you pay a significant sum in advance (not exaggerating it has happened to me). To complete the picture, in the truly civilized countries when you're sick you just go to the hospital, and they take care of you, no strings attached. The whole world is not made just of the USA and some banana republics.
emodendroket 9y ago
For non-emergency services they require payment upfront if you don't have insurance.
dragonwriter 9y ago
> At least in US you get the medical treatment first and then they hand you a large bill to pay This as a legal mandate applies to emergency stabilization (including assessment as to need for same) only. It may happen with other things, but that varies a lot and is mostly a matter of what the particular provider finds most convenient.
pnutjam 9y ago
I've been turned away at a hospital in the US.

chimeracoder 9y ago

> At least in US you get the medical treatment first and then they hand you a large bill to pay. A large bill which, if you're uninsured, you can almost always negotiate down to 10% or less of the original. Of course, most people don't know this, but those large bills aren't what the hospitals expect uninsured patients to pay. They just legally have to present them the same initial bill that they present private insurers.

chromanoid 9y ago
This is a good way to sort out the ones who can't negotiate. They have no place in a capitalist society anyway. /s
- nothrabannosir 9y ago
  I think you make a good point, downvotes notwithstanding. A "market society" inherently rewards people who are good at "the game." Which is fine for most things: worst case scenario you pay too much for a shit car. But having to play that damn game when you life is on the line is inhumane. There's no time out zone.
  - chromanoid 9y ago
    Yeah, it's wonderful how you can make it in such a system. Just imagine - a self-employed blue-collar worker slips with his car on a wet road. He loses his wife, his unborn child and his leg. He sells his house to pay the bills of the hospital and the mortician. His parents also pay some bills because he still had not enough. And then after a year or so on the street somebody tells him how negotiable these bills were. The American dream...
- BookmarkSaver 9y ago
  I hate negotiating for shit where my own identity is economically irrelevant. I suck at it, so if I go and buy a car I'm basically subsidizing people that are better at haggling.
gknoy 9y ago
> you can almost always negotiate down to 10% or less of the original. How does one do this? Where do you learn it? Is there a book you suggest? The fact that I'm even asking this feel weird (I'm insured).
- chimeracoder 9y ago
  > How does one do this? Where do you learn it? Is there a book you suggest? The fact that I'm even asking this feel weird (I'm insured). You can't do this if you're insured, because then the terms of your insurance apply. You can still get bills reduced, but the reasons are different and it's a bit more involved. If you're uninsured, it's simple. You literally just tell them, "I have no insurance. I can't afford $45,000. It would take me years to pay that, and I'd probably default on the bill beforehand. However, if you reduce the billed amount to $500, I can pay that in full today, in cash.". Substitute appropriate values in as needed, but that's the general idea. It's actually not all that different from what private insurers do, except they do all this up-front in bulk, so their rates are set in long-term contracts.
  - ska 9y ago
    I don't disagree with the general message that these things are negotiable, but I'd love to see a citation showing real research on the effective rate. 10% seems way too low from my limited experience. I've known people to successfully negotiate to 40-50% of original bill, usually with proof of (lack of) assets. Maybe if you really are basically broke, they'll write you off rather than carry it on their books until they sell the debt. On the other hand if your bill is 45,000 and you have even meager assets : say a couple of cars and equity in a house, I'm guessing their going to try hard to see a good chunk of that.
    - uberduber 9y ago
      There are businesses that are medical bill negotiators and charge you a percentage of the bill. In general, they only negotiate hospital bills because they are the only bills large enough. I would say that the typical final negotiated rate they get from the hospital is about 3-20% of the billed amount. It depends on how high the original bill is, and it also depends on whether you need to make payments and how long the series of payments is. Hospitals will certainly claim that you need to send in the proof of assets, usually you have to refuse about 6 or 7 times and they will relent. However, things have changed in the last few years and professional medical bill negotiators have told me certain hospitals are completely unreasonable and refuse to negotiate. They advise these people to file bankruptcy.
emidln 9y ago
Of course then you get taxed on the remaining 90% as income.
- chimeracoder 9y ago
  > Of course then you get taxed on the remaining 90% as income. What? No, that's not how it works.
- AnimalMuppet 9y ago
  No, because it wasn't income. When you find something on sale, you don't pay income tax on the difference between the sale price and full price.
  - emidln 9y ago
    That depends on if they are willing to negotiate with you before considering it a debt. If they send you to receivables with a 100k bill and you negotiate down to 10k cash, they are well within their rights to write off the 90k as debt forgiven. If they do so, you will be taxed on it. Good luck finding a 90% off coupon for a surgery prior to the event.
- vonmoltke 9y ago
  What? You do not get taxed on anything. Discounts are not income.
  - oconnor663 9y ago
    Hmm, forgiving a debt is considered income. I wonder if the situation with hospitals depends on a lot of technical details.
    - chimeracoder 9y ago
      > Hmm, forgiving a debt is considered income. I wonder if the situation with hospitals depends on a lot of technical details. It doesn't. It's not a debt yet. You don't have to pay taxes on the difference.
bitshiffed 9y ago
Have you ever done this? Where did you hear this? Where have you seen it? I have never had health insurance. Where I live many people don't have health insurance. I have never heard of this happening. I've seen peoples, my own included, wages garnished before this will happen. I currently have a $20k bill for an emergency appendectomy I had 4 weeks ago. The hospital will seriously take payments for 30 years before they'll lower any cost. If you want to negotiate, you'll have to wait until the collection agency has their account removed from your credit report 7 years after the first reporting. Any time before that you are in no position to negotiate with anybody. EDIT: Unless your income is less than 1.5x the poverty level. In which case you qualify for aid in paying your bills.
- uberduber 9y ago
  Not the op, but I have done this on behalf of friends. Some with significant assets. Did you admit to having assets or significant income? If so, it might be very difficult to negotiate. Google for medical bill negotiation services or "lower my hospital bill" and you should be able to find some professionals near you. The consultation is always free. Be aware that some hospitals have become completely unreasonable in the last few years and would rather you file bankruptcy and collect nothing than negotiate. The initial consult with the negotiation service is always free and they will tell you if this is the case.

13of40 9y ago

> poor countries It happened to a friend of mine who was hiking in Canada a year or two ago. Her son cut a big gash in his foot and they couldn't get online, so I had to call around to find an emergency room they could go to. The local emergency room basically said in lieu of proof of (internationally-accepted) insurance they would need $800 up front if he wanted to be seen. I think they wrapped a towel around it and drove back to the US.

Kluny 9y ago
As a Canadian, I find that difficult to believe. Even more difficult to believe that your friend didn't get travel health insurance and carry proof of it while hiking. That's pretty reckless.
- testvox 9y ago
  Do you really find it harder to believe a tourist wouldn't have travel health insurance? I've never heard of anyone buying that for a day trip to Canada. And just generally it's rare in my experience for people to buy insurance unless it's required in some way. Maybe that is an American phenomenon though.
  - Kluny 9y ago
    By contrast, I know few Canadians who would set foot in the USA for one day without travel health insurance. We've all heard the story about the Canadian couple who went to Hawaii on their honeymoon and delivered a baby (prematurely) there, and it cost them 1 million in hospital fees because their coverage wasn't sufficient. And they did have insurance, it just didn't cover baby deliveries.
    - 13of40 9y ago
      https://www.today.com/parents/canadian-mom-who-gives-birth-hawaii-gets-near-1-million-1D80302220 https://www.today.com/parents/canadian-mom-who-gives-birth-h... It sounds like it was the Canadian insurance provider who screwed them, though. They said[2] that since she had a bladder infection prior to getting the travel insurance, it was a pre-existing condition and therefore wasn't covered. So basically, if you get your travel insurance and come across the border, don't expect it to cover anything like a heart attack, an abcessed tooth, a prescription refill, etc. [2]https://www.change.org/p/blue-cross-blue-shield-pay-for-jennifer-huculak-kimmel-s-medical-bills https://www.change.org/p/blue-cross-blue-shield-pay-for-jenn...

ravitation 9y ago

I mean... Come on. We shouldn't be comparing the US to "poor countries"... How are those other rich countries doing?

nraynaud 9y ago

"You will be asked to make a pre-service deposit of at least $750.00USD. If prescheduled services are estimated to exceed this amount, an additional deposit may be requested. The pre-service deposit can be made in the following ways: major credit card, wire transfer, check (we accept checks from any US bank in US dollars) or by cash. Please know your total and daily credit card limits." Mayo Clinic in Scottsdale AZ, November 2017. edit: I'm a bit off topic, that was for an appointment, not ER.

Florin_Andrei 9y ago

> At least in US you get the medical treatment first and then they hand you a large bill to pay. In poor countries the hospitals will turn you away until you pay a significant sum in advance (not exaggerating it has happened to me). To complete the picture, in the truly civilized countries when you're sick you just go to the hospital, and they take care of you, no strings attached. The whole world is not made just of the USA and some banana republics.

emodendroket 9y ago

For non-emergency services they require payment upfront if you don't have insurance.

dragonwriter 9y ago

> At least in US you get the medical treatment first and then they hand you a large bill to pay This as a legal mandate applies to emergency stabilization (including assessment as to need for same) only. It may happen with other things, but that varies a lot and is mostly a matter of what the particular provider finds most convenient.

pnutjam 9y ago

I've been turned away at a hospital in the US.