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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 alway

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.
  - maljx 8y ago
    I can do the same in Germany with public insurance.
    - evfanknitram 8y ago
      Probably similar in sweden. I'm sure I could get a second or third opinion without a problem (for anything potentially serious). Maybe someone would start question what I'm doing if I ask for >3 doctors but I'm not sure that's a bad thing.
  - pornel 8y ago
    You know that's possible everywhere? It's not like socialized healthcare imprisons doctors and forbids capitalism. You can still go to 10 doctors, and pay for 9 of these visits. US companies operating in the UK even tend to provide private healthcare insurance. Such "perk" makes UK employees chuckle, but hey, if you want private healthcare, the same US/multinational corporations operate in the UK too.
  - decebalus1 8y ago
    Nice anecdote. I also have a few (also in the USA, with allegedly premium 1percenter insurance): > I can go straight to a specialist. Me too. But if I schedule an appointment with any specialist it's going to be at least a month. And after that appointment, the followup will be in another two months. The appointment costs at least $400 and gets me about 10 minutes of face-time with the doctor but about one hour with the administrative/support staff. > When I need non urgent surgery it's scheduled with a few weeks instead of months. That is true, because that's the bread-and-butter of the McMedicine world. If however you need to do something which is not an emergency and slightly off the beaten path in terms of symptoms or which crosses medical specializations, good luck coordinating medical care. You will be scheduled in a couple of months to minimize liability, so that perhaps it goes away or you go away.
  - cptskippy 8y ago
    > my insurance Not all insurances are equal, you or your employer are paying for that privileged and can obviously afford it. You should price out insurance options for a minimum wage job and compare it to your own to see just how lucky you are. > I can go straight to a specialist. Cadillac insurance, PPO? Most people have HMOs which don't allow that. In socialized medicine doctors usually aren't profit driven and their job/salary are dependent on the level of care they provide and not the number of patients they churn through.
- gdulli 8y ago
  > I really wish people would talk about these sorts of soft costs more often. It can get even worse and more subtle than that. I don't even get care in some situations that feel optional because I don't know what the true cost will be. I have money and insurance, but I'm instinctively uncomfortable about electing for services that I won't know the true cost of until weeks later after the care provider and insurance company have done their dance. There's the deductible which I understand but that's not a blanket thing where everything is free after that. There's always fine print and a cloud of uncertainty about where the limits are for each category. I'm starting to break this instinct, Blue Cross seems transparent enough when I call them and have a specific question. But that's because I'm getting older and taking health more seriously. I went through a long period when I was younger just ignoring symptoms when I could. Nothing bad happened to me but I've seen friends get diagnosed with cancer that might have been more treatable if found sooner. How many insured people don't get care that they should because they're confused or cynical about the system being set up to extract money from them?
- smacktoward 8y ago
  It's not even necessarily just a soft cost. People hear about a friend getting a huge medical bill, they don't go to the doctor as often as they should because they're afraid they'll get stuck with a huge bill, some condition that could have been treated inexpensively if caught early gets missed, the person eventually goes to the hospital when the condition gets too bad to ignore anymore, and huge, expensive efforts have to be made to treat the condition in its advanced stage. And at the end of all this... our person gets handed a huge medical bill. Healthcare in the US is screwed up beyond belief.
danbee 8y ago
Adam Ruins Everything did an episode on this: https://www.youtube.com/watch?v=CeDOQpfaUc8 https://www.youtube.com/watch?v=CeDOQpfaUc8
- tonysdg 8y ago
  Such an awesome show -- thanks!!

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.
- maljx 8y ago
  I can do the same in Germany with public insurance.
  - evfanknitram 8y ago
    Probably similar in sweden. I'm sure I could get a second or third opinion without a problem (for anything potentially serious). Maybe someone would start question what I'm doing if I ask for >3 doctors but I'm not sure that's a bad thing.
- pornel 8y ago
  You know that's possible everywhere? It's not like socialized healthcare imprisons doctors and forbids capitalism. You can still go to 10 doctors, and pay for 9 of these visits. US companies operating in the UK even tend to provide private healthcare insurance. Such "perk" makes UK employees chuckle, but hey, if you want private healthcare, the same US/multinational corporations operate in the UK too.
- decebalus1 8y ago
  Nice anecdote. I also have a few (also in the USA, with allegedly premium 1percenter insurance): > I can go straight to a specialist. Me too. But if I schedule an appointment with any specialist it's going to be at least a month. And after that appointment, the followup will be in another two months. The appointment costs at least $400 and gets me about 10 minutes of face-time with the doctor but about one hour with the administrative/support staff. > When I need non urgent surgery it's scheduled with a few weeks instead of months. That is true, because that's the bread-and-butter of the McMedicine world. If however you need to do something which is not an emergency and slightly off the beaten path in terms of symptoms or which crosses medical specializations, good luck coordinating medical care. You will be scheduled in a couple of months to minimize liability, so that perhaps it goes away or you go away.
- cptskippy 8y ago
  > my insurance Not all insurances are equal, you or your employer are paying for that privileged and can obviously afford it. You should price out insurance options for a minimum wage job and compare it to your own to see just how lucky you are. > I can go straight to a specialist. Cadillac insurance, PPO? Most people have HMOs which don't allow that. In socialized medicine doctors usually aren't profit driven and their job/salary are dependent on the level of care they provide and not the number of patients they churn through.
gdulli 8y ago
> I really wish people would talk about these sorts of soft costs more often. It can get even worse and more subtle than that. I don't even get care in some situations that feel optional because I don't know what the true cost will be. I have money and insurance, but I'm instinctively uncomfortable about electing for services that I won't know the true cost of until weeks later after the care provider and insurance company have done their dance. There's the deductible which I understand but that's not a blanket thing where everything is free after that. There's always fine print and a cloud of uncertainty about where the limits are for each category. I'm starting to break this instinct, Blue Cross seems transparent enough when I call them and have a specific question. But that's because I'm getting older and taking health more seriously. I went through a long period when I was younger just ignoring symptoms when I could. Nothing bad happened to me but I've seen friends get diagnosed with cancer that might have been more treatable if found sooner. How many insured people don't get care that they should because they're confused or cynical about the system being set up to extract money from them?
smacktoward 8y ago
It's not even necessarily just a soft cost. People hear about a friend getting a huge medical bill, they don't go to the doctor as often as they should because they're afraid they'll get stuck with a huge bill, some condition that could have been treated inexpensively if caught early gets missed, the person eventually goes to the hospital when the condition gets too bad to ignore anymore, and huge, expensive efforts have to be made to treat the condition in its advanced stage. And at the end of all this... our person gets handed a huge medical bill. Healthcare in the US is screwed up beyond belief.

danbee 8y ago

Adam Ruins Everything did an episode on this: https://www.youtube.com/watch?v=CeDOQpfaUc8 https://www.youtube.com/watch?v=CeDOQpfaUc8

tonysdg 8y ago
Such an awesome show -- thanks!!