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So glad to see Simone back on her feet. The shy robot nation needs its queen! As for that bill -- I'm curious: is there any resource I can look up to see how m

So glad to see Simone back on her feet. The shy robot nation needs its queen! As for that bill -- I'm curious: is there any resource I can look up to see how much of that the average Medicare/Medicaid/private insurance plan pays? I ask because I just had two teeth repaired after a bike accident and it'll cost me ~$100 after insurance covers the other ~$500. By that ratio, she'd be looking at ~$38,000 bill.

danesparza 8y ago
It really depends. I have an PPO / HSA plan where I have discounts up to a certain set "total annual amount" (currently around $5k) -- then insurance kicks in and I start paying a lot less. That $5k (for me) resets every year.
- justaman 8y ago
  I recently had a heart thing that put me in the hospital and included a med-flight to the hospital. Total bill was close to $40,000 if i'm not mistaken. I had to cover the $4,000 deductible but after that everything was covered. Additionally, my employer is part of something I don't understand(insurance is too damn confusing), I think its an HSA which covered an additional $2,000 towards my deductible. End of the day I only had to pay $2,000 out of pocket. Not bad.
  - bloopernova 8y ago
    I hope you are doing OK now, and I'm glad your insurance/billing situation was resolved relatively easily. I really, really wish insurance was less confusing though! So many copays, coinsurances, deductibles, out of pocket maximum, lifetime maximum, different tiers of drug prices, etc etc. That stuff should be made simple by law.
    - Rjevski 8y ago
      This can’t be made simple by law when the lawmakers profit off the current situation.
mrrsm 8y ago
With most insurance I feel like you will hit your max out of pocket before you would hit that amount. Depending on your insurance plan you could be talking $3,000-$10,000 max you would have to spend.
- VBprogrammer 8y ago
  I mean this in the nicest possible way; the casual way Americans talk about these things makes me wonder if they aren't suffering some form of Stockholm syndrome. The percentage of the population who don't have anything like that kind of money in savings is huge. And that is after you already pay huge amounts for insurance.
  - mikestew 8y ago
    Ever been around someone with, say, cancer and experienced the casual way they might talk about procedures that would horrify you (or at least make you a bit squeamish)? No one sympathizes with their cancer, but one would do well to make peace with reality. I have no sympathy whatsoever for my hostage-takers, but I'm unlikely to fight my way out of this one, so might as well go back to talking about out-of-pocket maximums until I can make a shiv out of this toothpick.
  - fossuser 8y ago
    For me it’s more that I’ve accepted it’s hopeless. Like gun control the issue has reached a stable equilibrium of political stupidity and I don’t see how it could change in the current climate.
  - JacobDotVI 8y ago
    It's worse than that: "63% Of Americans Don't Have Enough Savings To Cover A $500 Emergency" https://www.forbes.com/sites/maggiemcgrath/2016/01/06/63-of-americans-dont-have-enough-savings-to-cover-a-500-emergency/#63123a144e0d https://www.forbes.com/sites/maggiemcgrath/2016/01/06/63-of-...
    - SketchySeaBeast 8y ago
malaporte 8y ago
Maybe the deductible part is a fixed amount and not a % of the total bill? (I have no knowledge of health care in the US - both countries I lived in have free health care)
- RandallBrown 8y ago
  The deductible is (in my experience) a fixed amount. I have to pay about $5000 out of pocket before everything becomes "free".
  - tehwebguy 8y ago
    Many plans now have a co-insurance percent, so something like 20-80% is billable back to the patient after the deductible up to the out of pocket maximum (or Really Real Deductable as I call it)
cepp 8y ago
Unless you have access to a private repository of billing and insurance data, no. There is no publicly available source for price cross lookups. This is largely due to the fact that billing, coverage and pricing varies not only from hospital to hospital but even within the same provider on the same service (a given CPT). So now, there is no way to know the likeness of billing/coverage and it's also highly likely that if she disputes the claim, or there is a renegotiation then she will end up paying significantly less.
Kiro 8y ago
Did she do it in the US? I was under the impression she did it in Sweden, which would cost her $0. EDIT: Ok, she lives in San Fransisco now. Didn't know.
cptskippy 8y ago
Because of the way insurance tends to work in America, care providers tend to throw shit at the wall to see what sticks. In other words the first bill is always an outrageous amount of charges that may or may not be valid. Additionally there's something called a negotiated rate that an insurer has with the care provider, usually the care provider's bill does not show this rate but rater some fiction that not even those without insurance pay. If you look at the claims your insurer pays out to the care provider you will see significantly lower amounts than what's billed. If anyone knows why care providers high ball the rates on bills when insurers have negotiated rates, I'd love to hear it. Is it something in the insurer's contract that gives insured the illusion that insurance is saving them a lot? In any case I've received first medical bills in the many thousands of dollars only to have them go through four or five revisions before settling down to hundred dollars. This is because the first bill you receive reflects all of the claims to insurance (e.g. if your insurance covers 80% you're on the hook for 20%) but as the insurer and the care provider negotiate and revise the billing the price falls. In my opinion it's a horrible experience for the insured and the added stress of the huge bills certainly doesn't help with recovery.
- bloopernova 8y ago
  > added stress of the huge bills I really wish people would talk about these sorts of soft costs more often. I grew up in the UK, moved to the USA in my mid 20s. While growing up, my parents divorced and my mother had to take care of me and a sibling. All 3 of us had medical conditions that needed regular care/checkups. Not once did my mum ever spend hours on the phone chasing down bills or insurance rejections. We never paid out of pocket for prescriptions, doctor visits, A&E (USA translation: ER) visits, etc. That stress, or lack of, is a huge factor in quality of life for a family. Unfortunately this sort of discussion is heavily politically charged. I really don't want to start an argument thread comparing how taxes pay for socialized care, etc.
  - cobookman 8y ago
    On the flip side people living in socialized healthcare Countries have other stresses. In the usa my insurance lets me go to 10 doctors for differing opinions. I can go straight to a specialist. When I need non urgent surgery it's scheduled with a few weeks instead of months.
sourceless 8y ago
$38k is probably unlikely, she'll have hit her deductible first which will have made several things fully covered and other things probably some% coinsurance, and then later hit the out of pocket limit on the plan and be fully covered from there onwards.
viraptor 8y ago
I remember someone on HN recommending to send a copy of the bill to some health billing transparency project, but I can't find the right link. Google comes up with https://www.fairhealthconsumer.org/ https://www.fairhealthconsumer.org/ although I'm pretty sure it's a different service (they don't use the submitted bills from what I understand)
- HarryHirsch 8y ago
  What's with the strange wording, why do they call patients "healthcare consumers" now?
  - penguat 8y ago
    If the patient is a dependent of someone, or a minor, or dies, does someone else pay? Is the consumer the person paying, or the patient?
- dv_dt 8y ago
  Could it be Vox's project? https://www.vox.com/2018/2/27/16936638/er-bills-emergency-room-hospital-fees-health-care-costs https://www.vox.com/2018/2/27/16936638/er-bills-emergency-ro...
- dredmorbius 8y ago
  I thought NPR has/had one, but can't find a reference.
JshWright 8y ago
Two years ago my wife (25 weeks pregnant with twins) was admitted to the hospital because of some concerning ultrasound findings for one of the twins they wanted to monitor closely. Two months later they were delivered by c-section, both healthy but very small (3 lb 14oz, and 1 lb 13oz). The bigger one spent ~3 weeks in the NICU and the smaller one ~7 weeks. All told it was ~18 weeks of hospitalization (the only major procedure was the c-section, and obviously the NICU care is a little more intensive than average, but neither of the twins needed super high acuity care). Total bill was a bit over a million dollars. We were out of pocket ~$5k (our annual out of pocket max at the time).
- Damogran6 8y ago
  I had twince born about 6 weeks early and it worked out to about $5k per day per kid in the NICU...not including the pyloric stenosis surgery for one or, pretty much, any of the other aspects of the childbirth. Pity they stayed at the most expensive hotel of their life and they really weren't there to see it.
- TomK32 8y ago
  Our daughter arrived a few days late after a long weekend at the hospital when my wife decided 50 hours are enough. A cesarian at 2 in the night sure wasn't everybody's favourite but the big eyes of the little grey bundle staring at us in her first minutes is the thing we'll never forget. Didn't cost us a cent, not the US, obviously.
deleted 8y ago
[deleted]
cobookman 8y ago
Many insurance plans have a yearly max you pay for covered services. For my plan it's way less than 38k. I believe it's something like 10-12k
schreiaj 8y ago
Because you asked about Medicare specifically, that information IS somewhat available. It'll take some digging into it but the raw data is available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FeeScheduleGenInfo/index.html https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Paymen... I will tell you it's HEAVILY dependent on the zip code and procedures. Private insurance is a whole different mess, likely going to hit deductible and be done. Last time my partner had to have surgery and billed insurance she paid $1000 and the insurance picked up the other $10k+ (precancerous mass removal, 45 minute surgery).
CGamesPlay 8y ago
If she is covered on a self-only health insurance plan, she has to pay at most $7,350. Source: https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/2018-oop-caps.aspx https://www.shrm.org/resourcesandtools/hr-topics/benefits/pa...

danesparza 8y ago

It really depends. I have an PPO / HSA plan where I have discounts up to a certain set "total annual amount" (currently around $5k) -- then insurance kicks in and I start paying a lot less. That $5k (for me) resets every year.

justaman 8y ago
I recently had a heart thing that put me in the hospital and included a med-flight to the hospital. Total bill was close to $40,000 if i'm not mistaken. I had to cover the $4,000 deductible but after that everything was covered. Additionally, my employer is part of something I don't understand(insurance is too damn confusing), I think its an HSA which covered an additional $2,000 towards my deductible. End of the day I only had to pay $2,000 out of pocket. Not bad.
- bloopernova 8y ago
  I hope you are doing OK now, and I'm glad your insurance/billing situation was resolved relatively easily. I really, really wish insurance was less confusing though! So many copays, coinsurances, deductibles, out of pocket maximum, lifetime maximum, different tiers of drug prices, etc etc. That stuff should be made simple by law.
  - Rjevski 8y ago
    This can’t be made simple by law when the lawmakers profit off the current situation.

mrrsm 8y ago

With most insurance I feel like you will hit your max out of pocket before you would hit that amount. Depending on your insurance plan you could be talking $3,000-$10,000 max you would have to spend.

VBprogrammer 8y ago
I mean this in the nicest possible way; the casual way Americans talk about these things makes me wonder if they aren't suffering some form of Stockholm syndrome. The percentage of the population who don't have anything like that kind of money in savings is huge. And that is after you already pay huge amounts for insurance.
- mikestew 8y ago
  Ever been around someone with, say, cancer and experienced the casual way they might talk about procedures that would horrify you (or at least make you a bit squeamish)? No one sympathizes with their cancer, but one would do well to make peace with reality. I have no sympathy whatsoever for my hostage-takers, but I'm unlikely to fight my way out of this one, so might as well go back to talking about out-of-pocket maximums until I can make a shiv out of this toothpick.
- fossuser 8y ago
  For me it’s more that I’ve accepted it’s hopeless. Like gun control the issue has reached a stable equilibrium of political stupidity and I don’t see how it could change in the current climate.
- JacobDotVI 8y ago
  It's worse than that: "63% Of Americans Don't Have Enough Savings To Cover A $500 Emergency" https://www.forbes.com/sites/maggiemcgrath/2016/01/06/63-of-americans-dont-have-enough-savings-to-cover-a-500-emergency/#63123a144e0d https://www.forbes.com/sites/maggiemcgrath/2016/01/06/63-of-...
  - SketchySeaBeast 8y ago

malaporte 8y ago

Maybe the deductible part is a fixed amount and not a % of the total bill? (I have no knowledge of health care in the US - both countries I lived in have free health care)

RandallBrown 8y ago
The deductible is (in my experience) a fixed amount. I have to pay about $5000 out of pocket before everything becomes "free".
- tehwebguy 8y ago
  Many plans now have a co-insurance percent, so something like 20-80% is billable back to the patient after the deductible up to the out of pocket maximum (or Really Real Deductable as I call it)

cepp 8y ago

Unless you have access to a private repository of billing and insurance data, no. There is no publicly available source for price cross lookups. This is largely due to the fact that billing, coverage and pricing varies not only from hospital to hospital but even within the same provider on the same service (a given CPT). So now, there is no way to know the likeness of billing/coverage and it's also highly likely that if she disputes the claim, or there is a renegotiation then she will end up paying significantly less.

Kiro 8y ago

Did she do it in the US? I was under the impression she did it in Sweden, which would cost her $0. EDIT: Ok, she lives in San Fransisco now. Didn't know.

cptskippy 8y ago

Because of the way insurance tends to work in America, care providers tend to throw shit at the wall to see what sticks. In other words the first bill is always an outrageous amount of charges that may or may not be valid. Additionally there's something called a negotiated rate that an insurer has with the care provider, usually the care provider's bill does not show this rate but rater some fiction that not even those without insurance pay. If you look at the claims your insurer pays out to the care provider you will see significantly lower amounts than what's billed. If anyone knows why care providers high ball the rates on bills when insurers have negotiated rates, I'd love to hear it. Is it something in the insurer's contract that gives insured the illusion that insurance is saving them a lot? In any case I've received first medical bills in the many thousands of dollars only to have them go through four or five revisions before settling down to hundred dollars. This is because the first bill you receive reflects all of the claims to insurance (e.g. if your insurance covers 80% you're on the hook for 20%) but as the insurer and the care provider negotiate and revise the billing the price falls. In my opinion it's a horrible experience for the insured and the added stress of the huge bills certainly doesn't help with recovery.

bloopernova 8y ago
> added stress of the huge bills I really wish people would talk about these sorts of soft costs more often. I grew up in the UK, moved to the USA in my mid 20s. While growing up, my parents divorced and my mother had to take care of me and a sibling. All 3 of us had medical conditions that needed regular care/checkups. Not once did my mum ever spend hours on the phone chasing down bills or insurance rejections. We never paid out of pocket for prescriptions, doctor visits, A&E (USA translation: ER) visits, etc. That stress, or lack of, is a huge factor in quality of life for a family. Unfortunately this sort of discussion is heavily politically charged. I really don't want to start an argument thread comparing how taxes pay for socialized care, etc.
- cobookman 8y ago
  On the flip side people living in socialized healthcare Countries have other stresses. In the usa my insurance lets me go to 10 doctors for differing opinions. I can go straight to a specialist. When I need non urgent surgery it's scheduled with a few weeks instead of months.

sourceless 8y ago

$38k is probably unlikely, she'll have hit her deductible first which will have made several things fully covered and other things probably some% coinsurance, and then later hit the out of pocket limit on the plan and be fully covered from there onwards.

viraptor 8y ago

I remember someone on HN recommending to send a copy of the bill to some health billing transparency project, but I can't find the right link. Google comes up with https://www.fairhealthconsumer.org/ https://www.fairhealthconsumer.org/ although I'm pretty sure it's a different service (they don't use the submitted bills from what I understand)

HarryHirsch 8y ago
What's with the strange wording, why do they call patients "healthcare consumers" now?
- penguat 8y ago
  If the patient is a dependent of someone, or a minor, or dies, does someone else pay? Is the consumer the person paying, or the patient?
dv_dt 8y ago
Could it be Vox's project? https://www.vox.com/2018/2/27/16936638/er-bills-emergency-room-hospital-fees-health-care-costs https://www.vox.com/2018/2/27/16936638/er-bills-emergency-ro...
dredmorbius 8y ago
I thought NPR has/had one, but can't find a reference.

JshWright 8y ago

Two years ago my wife (25 weeks pregnant with twins) was admitted to the hospital because of some concerning ultrasound findings for one of the twins they wanted to monitor closely. Two months later they were delivered by c-section, both healthy but very small (3 lb 14oz, and 1 lb 13oz). The bigger one spent ~3 weeks in the NICU and the smaller one ~7 weeks. All told it was ~18 weeks of hospitalization (the only major procedure was the c-section, and obviously the NICU care is a little more intensive than average, but neither of the twins needed super high acuity care). Total bill was a bit over a million dollars. We were out of pocket ~$5k (our annual out of pocket max at the time).

Damogran6 8y ago
I had twince born about 6 weeks early and it worked out to about $5k per day per kid in the NICU...not including the pyloric stenosis surgery for one or, pretty much, any of the other aspects of the childbirth. Pity they stayed at the most expensive hotel of their life and they really weren't there to see it.
TomK32 8y ago
Our daughter arrived a few days late after a long weekend at the hospital when my wife decided 50 hours are enough. A cesarian at 2 in the night sure wasn't everybody's favourite but the big eyes of the little grey bundle staring at us in her first minutes is the thing we'll never forget. Didn't cost us a cent, not the US, obviously.

deleted 8y ago

[deleted]

cobookman 8y ago

Many insurance plans have a yearly max you pay for covered services. For my plan it's way less than 38k. I believe it's something like 10-12k

schreiaj 8y ago

Because you asked about Medicare specifically, that information IS somewhat available. It'll take some digging into it but the raw data is available at https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/FeeScheduleGenInfo/index.html https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Paymen... I will tell you it's HEAVILY dependent on the zip code and procedures. Private insurance is a whole different mess, likely going to hit deductible and be done. Last time my partner had to have surgery and billed insurance she paid $1000 and the insurance picked up the other $10k+ (precancerous mass removal, 45 minute surgery).

CGamesPlay 8y ago

If she is covered on a self-only health insurance plan, she has to pay at most $7,350. Source: https://www.shrm.org/resourcesandtools/hr-topics/benefits/pages/2018-oop-caps.aspx https://www.shrm.org/resourcesandtools/hr-topics/benefits/pa...