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Insured, but Still Owing $109K for a Heart Attack
- psycombi 8y agoI a non-immigrant here in SA's medical/emergency system is fully corrupted and broken. Citizen's of USA are not standing up/protesting this issue which can virtually affect everyone. Why are citizens sleeping? Same surgery with more experienced docs and equipment are done in 10-20 times less in my and the rest of the countries in the world. It's time to wake up USA
- cmurf 8y agoFTA St. David’s is out-of-network on his school district health plan So apparently the "max out of pocket" on the cover sheet of your plan is b.s. and only applies in-network. I guess good luck having in-network coverage if you're on a vacation and have an emergency.
- throwawayjava 8y agoThe article goes on to clarify the problem: the school district has a self-funded insurance plan. Actionable advice: check if your employer-provided healthcare is a self-funded insurance plan or a fully insured plan. And then look up the relevant consumer protections in your state for that type of plan. Also, in case you're wondering what the hell all those hospital administrators are dong, the answer is "shaking down your employer and screwing you over": > In a statement, St. David’s HealthCare defended its handling of Calver’s bill and sought to blame the school district and Aetna for offering such a narrow network. >“While we did everything right in this particular situation, the structure of the patient’s insurance plan as a narrow network product placed a large portion of the financial responsibility directly on the patient because our hospital was not in-network,” the hospital said. > WellRithms reviewed Calver’s bill in detail at the request of Kaiser Health News and determined that a reasonable reimbursement would have been $26,985. That’s less than half what Aetna paid.
- cmurf 8y agoI wonder if the local county this school district is in, also provides only a "self-funded" plan to their employees. Are all the government employees getting screwed or just the teachers? It's a quaint ethical puzzle which is worse. So the last line, "less than half what Aetna paid", does that ostensibly mean the hospital is definitely charging an unreasonable price, and by having been paid twice what is reasonable by Aetna that ostensibly this teacher shouldn't have to pay a dime? It's just a contractual reason he owes this money?
- throwawayjava 8y ago> does that ostensibly mean the hospital is definitely charging an unreasonable price Not ostensibly, but actually. The article goes on to identify some concrete charges that independent auditors felt were ridiculous, including charging $19k for stents that the hospital most likely purchased for about $2K. > It's just a contractual reason he owes this money? The hospital just straight up dropped all but $800 of the charges when they got PR heat.
- ubernostrum 8y agoIt's useful to understand what a "self-funded" plan means. People in the US are used to their employers purchasing group health plans from insurance companies. In that model, a premium (often part paid by the employer, part by the employee) is paid to an insurance company in return for coverage. When there's a claim, the insurance company pays, out of its own money, and the insurance company's profit comes from taking in more money in premiums than it pays out in claims. In a self-funded plan, the employer and employees still pay premiums, and all that money goes into a pool which is used to pay the claims. Typically a company is hired to administer the plan, but that company is not an insurer, and that company does not pay claims; the money to pay off claims comes directly out of that pool of premiums. What this means is that the administrator just pays whatever it's told to pay by the company that hired them to run the plan. It's not the administrator's money being spent, and their profit is in the fees they charge to run the plan, not in denying or underpaying claims. My very first real job out of school, years and years ago, was a place that did administration for self-funded plans. About once a month we'd get a call from one of our client companies saying "yeah, we know our plan's rules say not to pay that claim, but we want to pay that claim". And we'd say "OK, it's your plan and your money, you make the rules". The downside is that if the company gets into financial trouble, its contributions to the pool of money that pays claims are often one of the first things to stop happening. I remember pretty clearly one client company that went bankrupt and just stopped paying into its plan, and once the money in the plan's pool ran out there were no more claims paid.
- woobar 8y agoYeah, out-of-network coverage (if provided) is often limited by terms like "the usual, customary, and reasonable amount". When a provider charges unreasonable amount the insurance will not have any contracts that enforce the cost of services. And the patient left holding the bag. ;( My guess is in a situation like this I'd get the reasonable amounts for services provided from my insurer and use them as a basis to refuse any unreasonable charges.
- nerdponx 8y agoThe whole warped part of this is that the consumer has no way to anticipate cost in advance, and often the individual providers (doctors, nurses, etc.) don't either. Shouldn't the burden be on the insurance company to investigate and discourage excessive billing? Or are they too strict as it is, leading providers to play games with billing?
- woobar 8y agoI think in this particular case insurance did investigate actual (or within a reason) costs and paid them. But there is no business relationship between the insurance company and an out-of-network provider. Should they go to the court on behalf of the patient? As a customer I'd like this. But it looks like combining health and legal insurances. Another option is maybe to require that language on the "patient responsibility form" to include the blurb about fair prices. For instance: In the event that my health plan determines a service to be “not payable”, I will be responsible for the complete charge and agree to pay the usual, customary, and reasonable costs of all services provided.
- nerdponx 8y agoIs there an analogy in the car insurance world? Let's say I know nothing about cars and I get in a collision somewhere far away from home. I need a repair th let's say I know nothing about cars and I get in a collision somewhere far away from home. I need some bodywork and a replacement for the flimflam crankslap in the engine. The shop knows that I don't know anything about cars, and they know that I am covered by insurance. What is stopping them from charging me an exorbitant rate for a new crankslap, and then me getting screwed when the insurance won't cover it?
- quickben 8y agoAll this is a bit surreal (Canadian here), but it prompts the question: why won't people sue in a class action to refund money they gave to the insurance in the first place? I realize it's a complex subject, but at the end of the day, the insurance companies advertise and sell: insurance.
- FactolSarin 8y agoHahahahahaha. No. The American legal system is so stacked in favor of insurance companies it's ridiculous.
- refurb 8y agoThis isn’t true at all. Insurance is heavily regulated. If you can’t resolve an issue with your insurance, most states have arbitration committee that will smack down insurance companies pretty quickly.
- acomar 8y agoCrucially, that's only true if you have the money and time to fight. For the people hurt worst by the system, they lack some or all of: knowledge that they can fight it, money with which to fight it (or again, knowledge that a lawyer will take it pro bono), and the time with which to fight it and not work one or more jobs. I know people on this forum are relatively well off, but everyone reading this should try to put themselves in the shoes of someone working multiple jobs, trying to take care of a sick family member, and facing predatory companies trying to bilk them for all they're worth. That the government will protect you, in theory, is not the same thing as in practice.
- bobmarley1 8y agoLolwat the entire purpose of Arbitration is to give a massive advantage to corporations.
- refurb 8y agoThis is a govt arbitration headed up by a state committee that regulates insurance in the state. It’s not forced arbitration at all. You can still sue them.
- lainga 8y agoAfter a reporter made inquiries, St. David’s said collection efforts were put on hold, and a hospital representative called Calver, offering to help him apply for a discount based on his income. I refuse to believe that the US medical system is run by humans, and not trolls we pulled from under a nearby bridge.
- HarryHirsch 8y agoNo, it's run by people like George Shultz, who himself pays for an on-call boutique physician, while the plebs can get their medical testing for cheap from Theranos. When the grandson, who was a Theranos intern, becomes concerned because Theranos' numbers are not better than throwing darts on a board the grandfather becomes enraged, arguing that his investment and his reputation are being threatened.
- Talyen42 8y ago.
- aantix 8y agoI’m not sure I agree with what you’ve described as a “simpler life”.
- thrillgore 8y agoWhat about when I need to get a heart valve replaced and my insurance covers 20% of it?
- rabidrat 8y agoEarly death == simpler life. Old age really complicates things.
- acomar 8y agoYou joke, and the OP is possibly joking as well, but this is a reality for a lot of people... Their poverty freezes them out of the credit system, they lack health insurance, etc. Poverty in the US has gotten so bad in some places that it rivals the worst of Africa[0][1]. [0]: https://www.nytimes.com/2018/01/24/opinion/poverty-united-states.html https://www.nytimes.com/2018/01/24/opinion/poverty-united-st... [1]: https://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?NewsID=22533&LangID=E https://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?N...
- whymsicalburito 8y agoI agree, but why no credit cards? Just keep them on autopay and get free points right?
- mikeryan 8y agoThis is what I do. I did reach a point in my life though where I could manage this.
- 8y ago
- scarejunba 8y agoWell, it doesn't have to cost that much to take care of a heart attack. Remove the AMA from the equation and it'll clear up. The real problem is that we restrict the supply of doctors. Without that, competing hospitals can arise that will compete on price.
- maxxxxx 8y agoWhy don't they compete now or why can't you even get a price upfront from them? EDIT: I am responding to a comment that the AMA is the problem. Maybe the AMA is a problem but it has nothing to do with hospitals not competing over prices.
- whb07 8y agoBecause price negotiations aren’t disclosed and are privy between hospitals and insurance provusers. The real crux is that point, the patient is removed from pricing and so the whole market becomes distorted. It’s like going to a store without price tags and complaining that your bill is much higher than you expected.
- maxxxxx 8y ago"t’s like going to a store without price tags and complaining that your bill is much higher than you expected." It's more like only having stores without price tags and then when you overpay people telling you that you should have shopped around for a good price.
- jjeaff 8y agoYou can get a price upfront in my experience. Especially for standard procedures. And definitely for outpatient stuff. But it isn't reasonable to expect upfront pricing in things as complicated as heart surgery. Or where you are going in for unknown problems. There is no way to know what complications may arise or additional procedures, x-rays or scans may be required.
- maxxxxx 8y ago
- jtokoph 8y ago> UPDATE: Monday, shortly after publication and broadcast of this story by Kaiser Health News and NPR, St. David’s said it was now willing to accept $782.29 to resolve the $108,951 balance because Drew Calver qualifies for its “financial assistance discount.” Sounds all fine and dandy until you realize that these charges will just be made up for by people that aren't able to get NPR to publish a story about them.
- samfisher83 8y agoThe hospital already got 50k from the insurance company. The article also the treatment should have cost ~25k.
- jhayward 8y ago> Sounds all fine and dandy until you realize that these charges will just be made up for by people that aren't able to get NPR to publish a story about them. No, St. David's has already fully recouped their costs and then some. They were simply trying to extract as much money as the stone could bleed.
- toomuchtodo 8y agoYes, but OPs point is they will still do this to people who can't get media attention. It continues to be a systemic issue that must be fixed. Disclaimer: Universal healthcare advocate
- manigandham 8y agoThe point is that the bill won't just go away for other people, regardless of how much profit is made and whether costs are already covered by the hospital.
- lacker 8y agoI was going to respond saying that most hospitals are nonprofits and aren't actually making a great profit margin off this sort of overcharging. But then I looked it up and St. David's, despite having a religious nonprofit-sounding name, is actually owned by HCA Healthcare, which is a for-profit that has almost 4x'd its stock price over the past five years while acquiring more hospitals to grow. So, yeah, this one is about corporations squeezing money out of people because they can. sources: https://www.beckershospitalreview.com/hospital-transactions-and-valuation/hca-owned-st-david-s-healthcare-acquires-9-texas-clinics.html https://www.beckershospitalreview.com/hospital-transactions-... https://www.google.com/search?q=NYSE:HCA https://www.google.com/search?q=NYSE:HCA
- huangbong 8y agoCrazy that you need to make national news to pay a medical bill fairly in this country.
- elorant 8y ago40k for four plastic tubes. Why on earth are medical supplies so fucking expensive?
- CommieBobDole 8y agoBecause the markup is arbitrary. An NPR article notes that the average price paid for the stents by hospitals is $1,153. https://www.npr.org/sections/health-shots/2018/08/27/640891882/life-threatening-heart-attack-leaves-teacher-with-108-951-bill https://www.npr.org/sections/health-shots/2018/08/27/6408918...
- ReverseCold 8y agoFirst reaction: Hmm that's not so bad. Second reaction: It doesn't seem as bad because it's put in context of "40k" - in reality that's still pretty bad.
- crististm 8y agoSnowflakes downvoting f-bombs. Pathetic.
- sctb 8y agoI'm sorry but could you please not post like this here? It's against the guidelines. > Please don't comment about the voting on comments. It never does any good, and it makes boring reading. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
- crististm 8y agoYou are right. Let me rephrase that. Snowflakes get offense at f-bombs. Pathetic.
- donretag 8y ago"Calver asked whether his health insurance would cover all of this... The hospital told him not to worry and that they would accept his insurance." From my experience, it is completely legal for any medical practitioner to say they accept an insurance even though they really do not.
- maxxxxx 8y agoThat's just nuts. As patient you go in blind and can just hope for the best.
- lacker 8y agoFrom my experience, no human at the hospital has any idea whether they will accept your insurance or not. The doctors certainly don't. They just report things into the bill-processing system which occasionally delivers patients a crazy $100,000 bill.
- dboreham 8y agoThey have no idea if the insurance company will pay. I know this from personal experience where the hospital explicitly called insurance co to ask if a procedure would be covered, received confirmation that it would be, AND the hospital recorded the call. But coverage was subsequently denied.
- benbreen 8y agoYep, this happened to my wife - she needed a fairly intensive and costly surgery and was told she was in-network and covered. It turned out the person on the phone was wrong and she ended up having to cash out her entire 401k to pay the 20k+ bill. We learned a lesson about the US healthcare system with that one...
- exolymph 8y agoMere acceptance of insurance doesn't mean there won't be an exorbitant copay, anyway.
- dboreham 8y ago"accept an insurance" doesn't mean what you think it means. It just means they will exchange paperwork with said insurance company. Whether or not your policy/company covers treatment is a completely different issue.
- kimsk112 8y ago> Industry analysts and consumer advocates say St. David’s has a reputation for exorbitant billing and for trying to collect big payouts as an out-of-network provider. Sounds just like St. David’s Medical Center in Austin, TX is run by crooks. I like the take-home message that "Faced with a surprise bill or a balance-billing situation, don’t rush to pay any medical bills you receive."
- lacker 8y agoMore specifically, it is run by HCA Healthcare, a for-profit company listed on the NYSE.
- armanini_io 8y agoOnly in US.
- cabaalis 8y agoThere are different horror stories from different systems. Bottom line is that access to health care professionals and equipment is a scarce resource, and any resource management process whether through governmental regulation, or individual funding, insurance program, etc will be faced with managing access to that resource one way or another.
- TomVDB 8y agoAnd in some systems, horror stories are way more common than others. The simple fact is that I don't know anybody from my European family or friends who would willingly switch their system to the US one. And as a very well insured employee in the US, if, hypothetically, I had the option to use my European health care in the US, I'd switch immediately a well.
- h4b4n3r0 8y ago>> I'd switch immediately a well I doubt it. Someone needs to pay for it, so this switch would have to imply a 20% tax increase. Unless you’re paid peanuts, it’s not worth the tradeoff.
- freeone3000 8y agoHuh? Tax rates are not 20% higher in Canada than in the US, and we somehow muddle through.
- h4b4n3r0 8y agoThat’s why I deliberately did not say income tax rates. They ream you in other ways. Canada’s taxes as percentage of GDP are 31.7%. US is 26%. And on top of that I was referring to Western Europe, where they are close to or above 50% GDP.
- megous 8y ago'We saved your life so that you can spend the rest of it in indentured servitude.'
- geggam 8y agoReads like a breaking Bad prequel in the making
- donclark 8y agoI curious to know the details of his health. He just did an IRONMAN 5 months before. Why was he unaware of the status of his clogged “widow-maker” artery? Why was his artery clogged? high cholesterol? What does his diet consist of? Use of ultrasound imaging to measure the thickness of the inner walls of the carotid arteries that supply blood to the brain. Increasing carotid artery intima-media thickness, or CIMT, indicates a build-up of fatty deposits, known as plaque, in crucial arteries to the heart and brain. Plaque build-up in the arteries, which is usually affects adults, can restrict the flow of blood, causing heart attacks or stroke.
- stan_rogers 8y agoThere's not always a lot in the way of warning signs, and people tend not to get casual arteriograms just for kicks. The apparently-healthy suddenly dropping dead isn't exactly a rare phenomenon, and "being in shape" can be misleading. Jim Fixx[1] was kind of the poster child for this sort of thing; his death pretty much kicked off the over-40 checkup routine. [1]https://en.wikipedia.org/wiki/Jim_Fixx https://en.wikipedia.org/wiki/Jim_Fixx
- AstralStorm 8y agoUnfortunately you can't really get a heart arteriogram done as a checkup and anything else is actually guesswork. Both MRA and CTA are really expensive. Bloodwork can point to problems but there is still a plenty of differential diagnosis involved... You need a bunch of history (main factors are currently age and family history) to reasonably evaluate risk using e.g. European joint guidelines. You can perhaps guess better based on local doppler USG of some big extremity artery or of carotid. Doppler of heart is not precise enough to show anything useful.
- maxxxxx 8y ago"I curious to know the details of his health. He just did an IRONMAN 5 months before. Why was he unaware of the status of his clogged “widow-maker” artery? Why was his artery clogged? high cholesterol? What does his diet consist of?" That just happens. There are people who are in great health and drop dead one day. Whatever you do lifestyle-wise just improves your chances of being healthy but there are no guarantees. You can smoke a pack of cigarettes daily and live up to 100 and others will get lung cancer without ever touching a cigarette.
- paulcole 8y agoWent to the ER on the advice of my doctor. Went to my insurance's website to find an ER that accepted my insurance. Got there and asked at admittance, "Do you take my insurance?" Was assured they did. Got a big bill a few months later and it turned out the doctor working in the covered ER was not covered by my insurance.
- deleted 8y ago[deleted]
- petelevinea 8y agoExact same thing happened to me. I went last April and just now got it all "fixed". I ended up negotiating with the hospital, the contracting company for the hospital's ER department, and my insurance on the phone at the same time to reduce the cost to what the contracting company's ER doctor on staff would normally bill the insurance company and paid that out of pocket. I guess you have to ask if the doctor who may or may not see you depending on what you're in for also takes your insurance? I don't even know.
- maxxxxx 8y agoHow is a regular person who has other things to do than to read and understated all the details and traps of his health insurance supposed to navigate this insane system? From what I read going to a hospital is pretty much a gamble that has a certain probability to bankrupt you and there is pretty much nothing you can do about it. There should be bipartisan agreement that these practices are just not acceptable and that there must be a way for a patient to get binding information upfront.
- 0x7f800000 8y agoYes, I demand full and final information about what the heart attack I am currently suffering is going to cost me to be treated at this hospital. If I think you are trying to extort me, I am just going to go to another hospital.
- krupan 8y agoI'm actually not sure if you are being serious. If the information on costs for emergency services were clear and available up front people could shop around ahead of time and basically write up a living will saying, if I have a heart attack, take me here. Insurance companies are the reason the costs are not clear and up front.
- mfringel 8y ago"Sorry, sir. Your spouse's living will restricted emergency care provider vendors such that she was unable to receive care in time. With our CareWatch(tm) package, we can give you geo-fence alerts with response times that would be outside your living will provider preference range. Press one to be connected with a sales associate."
- burkaman 8y agoAre you serious? You think every American should be required to write a living will for them and their children listing every conceivable illness and injury by individually researching all the medical options in their area? And what, update it weekly as they follow the markets? Should they keep up with the latest medical research so they know what the newest drugs and treatments will cost? What about vacation, do you need to do a week of research to prepare for a weekend trip to NYC?
- alkonaut 8y agoThere are midterms coming up. Vote for change and don’t vote for anyone who took one cent from the insurers.
- swebs 8y agoAnd here's a handy list of all representatives and how much they took from healthcare lobbyists. https://www.opensecrets.org/industries/summary.php?ind=H&cycle=2018&recipdetail=S&sortorder=A&mem=Y https://www.opensecrets.org/industries/summary.php?ind=H&cyc...
- Wohlf 8y agoAt least there's one thing with overwhelming, bipartisan support in Congress.
- DesiLurker 8y agowhats amazing to me is how little money it takes to sway a politicians vote. yes there are big numbers in the list but most of them are 10s of thousands. its just amazing that they are willing to put their conscience aside and condemn people to bankruptcy or worse for that little. for the worshipers of free market they sure are selling themselves off cheap.
- swebs 8y agoI'm amazed by just how high the donations can go. What the hell did senator Sherrod Brown do to get $1.4M from the healthcare industry? A quick Google search doesn't reveal anything out of the ordinary, except for maybe the most ironic tweet of all time: https://twitter.com/sensherrodbrown/status/890823217530650624 https://twitter.com/sensherrodbrown/status/89082321753065062...
- whamlastxmas 8y agoThe problem isn't that they're bought with $10k. They're approached and told "Take this money or we'll give your competitor $5 million to campaign and take your place". And they know they follow through with the threats, so they take the $10k.
- aaroninsf 8y agoHere is a reminder that in the US, we pay much more and receive far worse outcomes than any other first world nation, by any metric you care about: life expectancy; infant mortality; incidence of chronic disease; obesity; incidence of addiction; etc. Then consider we are the only first-world nation in which medical bankruptcy is not just a thing, but a profound source of anxiety and genuine risk. What do we get in exchange for worse care, worse lives, and risk of financial ruin...? A "free market" like the one functioning in OP's case. Oh, and in the time since the ACA passed? Record private industry profits. It's not just Trumpism sh-tcanning this country.
- PeekPoke 8y agoThis is why it's good to be English - our national health service fixes you up and sends you on your way without providing you with a bill.
- wang_li 8y agoUnless the NHS has no approved treatment, in which case you die instead of being able to go abroad for care.
- DanBC 8y agoIf the NHS has no approved treatment you can go abroad or you can pay privately in the UK. What conditions are you thinking of that don't have "approved" treatments?
- wang_li 8y agoWithin the NHS specifically, there was the recent case of Alfie Evans[0], where the medical practitioners said there was no hope for him and the family wanted to take him abroad for care. The NHS and the UK legal system decided that his best interests were to die in the UK. His family was not allowed to take him for additional care. 0. https://en.wikipedia.org/wiki/Alfie_Evans_case https://en.wikipedia.org/wiki/Alfie_Evans_case
- rdtsc 8y ago> St. David’s HealthCare defended its handling of Calver’s bill and sought to blame the school district and Aetna for offering such a narrow network. So while dying of a heart attack he should have been negotiating with the ambulance driver, the paramedics, the nurses, each intern and doctor to make sure they are "in-network". > St. David’s said it was now willing to accept $782.29 to resolve the $108,951 balance because Drew Calver qualifies for its “financial assistance discount.” I You can pay $100k or just $700, whatever is cool with us. I guess, go to the media and try to shame everyone involved is your best hope? I can see if they did this to people buying luxury suites or yachts. Doing this to people who are dying of a heart attack is particularly disgusting. And it's not like anyone involved is going to be punished for this practice or learn a lesson. They'll turn around and do the same thing to the next patient.
- FireBeyond 8y ago> So while dying of a heart attack he should have been negotiating with the ambulance driver, the paramedics, the nurses, each intern and doctor to make sure they are "in-network". Absolutely! </s> I work in EMS. Thankfully, our Medic One system is funded entirely by property taxes and we simply do not bill (at all) for any treatment or transport. However, a few years ago United got a lot of grief over denying airlift transport claims from things like MVAs, or traumas in remote locations, stating that the "transport had not been pre-approved through the insurer". Apparently in their mind, us paramedics (or maybe the chopper pilot) should have been calling in between stabilizing our patient... "This is John, I'm a paramedic working on one of your patients who was hit by a truck. We would like to fly him to the hospital due to his extensive multisystem trauma but we need your approval. His name? Hang on, let me find his wallet. No, that's Smythe, S-M-Y-T-H-E, sorry, it's a bit loud with the jaws of life in the background... Yes, I can hold for a nurse consult..."
- AstralStorm 8y agoSo, when will the rich and powerful start hiring teams units straight from cyberpunk novels? (their own helicopters included) At these rate differences it starts seeming prudent to medical airlift to the right hospital...
- ypeterholmes 8y agoOur system is an ongoing tragedy.
- deleted 8y ago[deleted]
- mabbo 8y agoIf you owe a 6-figure amount of money because of a health issue, you don't actually have health insurance.
- lotsofpulp 8y agoYou do, it just doesn't cover you at all medical providers in all 50 states.
- jimbokun 8y agoSo you have a lottery ticket, which may or may not pay out when you receive health care services, decided by essentially random factors.
- mabbo 8y agoIf you send me a bill for anything over $100,000, you might as well send me a bill for $10 trillion. It doesn't matter, I can't pay. I'm bankrupt now. Great, you get my house and my retirement savings. The point of insurance is to prevent that from happening. I pay a small amount so that if I get unlucky, I'm not ruined. I don't care if "oh the bill was actually much higher before" because the number never mattered- me being ruined is what mattered. If I still am, then the insurance did not do what I wanted it to do.
- MrFantastic 8y agoOr Health Insurance means some of your bills will be paid, not "full coverage" as most people assume.
- tluyben2 8y agoIt should be though: people do not understand healthcare, the insurance they are getting, what is included and what is not, and, very important, at times of illness you really do not have the time or bandwidth to think about it. To me it always sounds rather inhumane what happens over there. But then again, I only get my info from comments and articles like this.
- treyfitty 8y agoMy father had a heart attack 4 months ago, and he’s been in and out of the ICU for 3 of those months. Everyone likes to think “oh, I’m insured. I’ll be fine.” But let me tell you, you won’t be fine. 3 months of ICU at Robert Wood Johnson was billed for $4Mn. BCBS-NJ only paid out $750k. The headache begins there- from a personal financial standpoint, and Tri-party incentive standpoint. Ignoring the difference of $3.25Mn “owed” to the hospital (technically, this $4Mn is an exaggerated number by RWJ to recoup as much as they can), the insurance company is essentially denying basic/reasonable services. The doctors have been fighting with insurance to get him to an LTACH, but the most they’ll pay for is a nursing home. Insurance is a business. They aren’t looking out for you, or your loved ones. I hate to sound cynical, but boy, these past 4 months have shown me the deepest, ugliest side of commerce that inevitably results from aligning incentives with profits.
- lotsofpulp 8y agoHealth insurance companies' profit margins are restricted by law, whereas Robert Wood Johnson and its executives and doctors profit margins are not restricted. If anyone is on the patient's side from a cost perspective, it's insurance, and the ones benefiting from higher pricing and unnecessary procedures are the providers.
- dragonwriter 8y ago> Health insurance companies' profit margins are restricted by law, whereas Robert Wood Johnson and its executives and doctors profit margins are not restricted. If anyone is on the patient's side from a cost perspective, it's insurance, and the ones benefiting from higher pricing and unnecessary procedures are the providers. Untrue, because health insurers profits are limited by law, sure, but to a specified fraction of the costs they pay; if their payouts are too small, they have to refund the excess profits to the people paying premiums.
- lotsofpulp 8y agoHow does that make it untrue? Health insurance companies are supposed to compete with each other based on their premium prices, and the insurance companies with lower premiums (and hence lower costs) will win more customers.
- jim-jim-jim 8y agoJust cut the gordian knot and nationalize the system already. It's a political no-brainer. There are very few Americans, even conservative ones, who are in love with the intricacies of paying medical bills. The only people beholden to the status quo are those paid to defend it.
- honkycat 8y agoWorking as intended. Here is the thing: This hospital is a vampire. They WANT to send you to collections. They WANT to take your house and everything you own.
- ThrustVectoring 8y agoIt's Texas, they can't actually take your house.
- mnm1 8y agoThe insurance company is basically saying, you should still choose the in-network provider even if you are unconscious or don't have a choice or we'll fuck you financially. I've had this happen to me, appealed, and after many months, actually won. In my case I was unconscious and the ambulance and hospital were out of network. I was lucky the hospital was willing to wait over a year and not send it to collections. It was hell. Why the fuck isn't there a law against this kind of shit? Do we expect people who are unconscious or having a heart attack to say, "oh no, take me to an in-network provider so I don't go bankrupt?" Fucking absurd the healthcare in this country and the lack of proper regulation. How long are we going to allow these insurance companies to get rich while people die and go bankrupt?
- acomar 8y ago> Why the fuck isn't there a law against this kind of shit? There's a pretty clear answer to this question almost every single time it's asked... the people who benefit are wealthy and the people hurt are poor. The latter structurally lack the ability to fight it or lobby their congresspeople to change the law to help them. Until a mass movement steps forward to say "no, we will not tolerate this", nothing can possibly change. We have no recourse but each other and collective action.
- lotsofpulp 8y agoBased on voting demographics, the poorest are the ones who are voting for politicians who hate the government and are opposed to any kind of subsidized healthcare.
- ubernostrum 8y agoMostly because they believe and have been encouraged to believe that any protections/benefits would go to people who "don't deserve it" (also known as: whichever racial/ethnic demographic those voters have been raised to hate the most). They're very much in favor of discriminatory special-treatment programs that help them and only them, but very much against broad safety nets because they've been told such programs would only benefit the bad other people.
- dcosson 8y agoI feel like whenever I hear crazy stories like this about healthcare it usually involves these weird in or out of network issues. I'm certainly not an expert on healthcare, but is there no way to attack the problem from this angle? If you have a hospital with a certain list price for a particular procedure, why is it legal for them to charge one insurance company 5% of that price and charge another insurance company or someone without insurance full price? It seems like exactly the kind of scenario that price discrimination laws are meant to prevent. Similarly for the insurance plans themselves, why can you sell basically the same plan to employees of a large company for much cheaper than you sell it to employees of a small company? (This one might need to be a new law specific to insurance companies, because clearly there are many other products that give group discounts when selling to large companies, but I think health insurance should be treated differently). I'm sure I'm missing what some of the downsides might be, but it seems like making these kinds of backroom network-based deals illegal in health insurance would go a long way in making prices more understandable/predictable, and that might allow for more fair competition on price to emerge.
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- FireBeyond 8y ago> I feel like whenever I hear crazy stories like this about healthcare it usually involves these weird in or out of network issues. I'm certainly not an expert on healthcare, but is there no way to attack the problem from this angle? Because hospitals, and physicians, have decided that, for the most part, it is better for each of them for physicians to be "independent contractors", so the situation of "your hospital is in network, but your physician was not". Or for me, most recently, going to my doctor for a checkup on my hypertension at an Urgent Care/Family Practice hybrid. Facility? In network? Physician/Assistant? In network? Lab in the same building (to be clear, it wasn't a multi-tenant complex, this was a medical practice) that they sent me for CBC draws? Out of network. Boom, hundreds of dollars in lab bills.
- krupan 8y agoPrices, more and more, are negotiated between very few providers and customers. It's like there are 3 fruit stands and 3 buyers of fruit, and those three buyers of fruit are willing to buy huge quantities of fruit (provide a hospital business with lots of patients) as long as the fruit stand meets their price demands. The fruit stand can take it our leave it. If they leave it, they lose out on 1/3 of their potential sales. They go through this kind of negotiation with each of the three fruit sellers every so often. This is far from an ideal free market.
- digitalneal 8y agoI just don't see what value private health insurance companies bring to the table anymore. They are not helping get the best coverage for their patients and they squeeze the crap out of the care-givers until its hardly worth their time.
- csomar 8y agoLooking at the bill, here is some ridiculous: NaCl (basically salted water) costing around $300/liter. That's outrageous. These guys are protected by your politicians and make use of mercenary tactics. Villains in doctors clothing. I'm for free markets but we are kinda going over the limit here. Maybe have fixed rates for emergency where you can't get the approval of the patient. Maybe give the patient the possibility to pay for these ridiculously priced items after. I mean if I get you 1l of NaCl we'd be cool. And fix the rates for emergency.
- jhayward 8y agoRetail cost for Lactated Ringer's solution, injectable (basic saline fluid for IV) was over $40/liter in qty 12 liters about 3 years ago. I can imagine it has gone up since then. The use of the health care system to extract every single excess dollar from the middle class extends to many, many layers of the supply and service chain. It may be that the saline was "merely" marked up by a factor of 2x.
- csomar 8y agoSeems like the problem is broadly in the medical sector (including pharmacological). There is 0 reasons why it would cost over $1. Maybe $2. $40 is still way ridiculous. I mean in a competitive market.
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- jhayward 8y agoThe problem is there will never be a truly competitive market in most health care products and services. Necessary regulation creates too many barriers to entry and competition, and the ultimate consumer has very little demand flexibility or even choice of provider. What is needed is a monopsony buyer who can negotiate in this arena on a more even footing. In other words, single-payer.
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- ThrustVectoring 8y agoThis is why I plan on moving to Texas: creditor protection. At any point in time I could require medical services and have medical service providers simply decide that I owe them a truly massive amount of money. The only route I have to mitigate that risk is through creditor protection laws. In Texas, wage garnishment is limited to child support, unpaid taxes, and some other limited categories that medical billing doesn't have access to. Creditors can sue you, but they can only seize bank accounts, brokerage accounts, and the like - your primary residence is completely exempt, as are employer-sponsored retirement plans and IRAs. So my emergency medical debt plan is to liquidate all taxable investments and close out bank accounts, send the cash from that to pay down a mortgage, and tell them to pound sand. The only real consequence is having to head to Walmart each month to cash paychecks and mail out money orders to pay bills.
- robin_reala 8y agoYou might be better moving to a country with a nationalised health system and avoiding this mess entirely.
- ThrustVectoring 8y agoIt's significantly easier to move between US states than it is to emigrate.
- megamindbrian2 8y agoAnother easy solution, file for bankruptcy. No sane judge will kick a family out of their house over a medical bill. That would be counter productive to their recovery and cause undue hardship. If you don't see the utility in bankruptcy, just remember our President has used it several times over decades. Edit: it's also known as unsecured-debt, which means the worst thing anyone can try to do to you is ruin your credit score. This isn't worth dying over and America is designed to bear the cost.
- ThrustVectoring 8y agoCreditors can do more than ruin your credit score. It's state dependent, but they can also sue you to seize bank accounts, garnish your wages, etc. Fortunately, it's Texas, so wage garnishment is out, as is seizing your primary residence. So is seizure of retirement accounts. Really the practical amount of debt is what the creditor can force you to pay, which is capped at your liquid assets.
- megamindbrian2 8y agoTrue. Good points, so withdraw and store in mattress. Garnishment is still an issue.
- ThrustVectoring 8y agoNot in Texas it isn't. Wage garnishment in Texas generally isn't a thing that creditors can do. Skip out on child support? Don't pay your taxes? Yeah, you can get your wages garnished. But a random creditor who convinces the court that you have a valid debt that you're obligated to pay? They can mess up your credit and seize bank or investment accounts, and that's about it.
- chatmasta 8y agoBankruptcy really is the ultimate medical insurance. In fact, when so many people don't even have $2k in liquid assets, it almost makes more sense to skip paying actual medical insurance, and just declare bankruptcy in the event of massive medical bills. What that doesn't help with, though, is something like being diagnosed with a chronic condition where pills cost $800 a pop.
- cimmanom 8y agoI thought this was one of the things the ACA was supposed to prevent, with out-of-pocket maximums?
- dragonwriter 8y agoACA out-of-pocket maximums don't apply to grandfathered plans; the plan at issue may be a granfathered one.
- luminaobscura 8y agoout of max doesnt apply to balance bills since it is not insurance's responsibility.
- cimmanom 8y agoThen what's the point of an out of pocket max? Shouldn't it make the bill the insurer's responsibility?
- tim333 8y agoThere must be a better way. I'm in the UK where the NHS is kind of flawed but at least they don't bill you like that. I'm kind of a believer in customer satisfaction as a guide to how to run things and it seems highest in hybrid systems like Singapore.
- smittywerben 8y agoWhen you are out of network then you are responsible to submit the claim to insurance. I paid < 1% in the end for a 5-figure bill in similar circumstances. The scary part is you must carry this risk to your insurance who can then deny the out-of-network claim. Am I misunderstanding something here, or is everyone else not understanding?
- krupan 8y agoHere's the deal. Insurance is a simple concept. Take house fires. They are fairly rare, but they do happen. We could all just save up enough money to cover a house fire ourselves, or, since we know that house fires are rare, we can pool our money together as friends and neighbors and when one of us in that pool gets unlucky and has their house burn down, it can be covered by insurance. A lot of us pay a little money for peace of mind that if a rare catastrophic event does hit us, we'll be OK. This same concept applies to some medical issues, but there are a lot of medical issues it does not apply to. Getting a routine infection and needing antibiotics? Everyone is going to need that. It makes no sense to pool our money and pay out for the rare person that needs money for that. How many other medical expenses are like that? Even things that are rare for a group of 20-year olds like heart attacks are actually a lot less rare (more common than house fires, probably) for an older age group. So while it might make sense for a group of 20-year olds to pool money together to pay for the rare heart attack amongst that group, it might not make any sense for an over-50 group of people to do that same. It definitely doesn't make sense for a 20-year old to join that group. Yet this is exactly what we do. We all pool our money together and use it to pay for every medical expense that comes up. Minor infection? Use insurance! Need a couple stitches? Use insurance. Routine screening? Wow, didn't see that coming, good thing I have insurance. This is insane, and this is the root of all our problems.
- DennisP 8y agoOne reason they do it that way is that if you don't pay for screenings and small problems, people tend to skip going to the doctor for them, and you end up paying for more big, expensive problems.
- krupan 8y agoYes, and is that line of reasoning working? Are we as a society saving money doing it that way? It seems what people really need is just a savings account and some incentive to actually save money for future expenses (because knowing that someday you are going to get an illness that 100% of people get apparently isn't enough motivation).
- NTDF9 8y agoHas anyone in the US considered flying overseas to get treatment done? Many hospitals in third world countries are cheaper and more humane. Sure, you lose out on the ability to sue them if things go awry but where is the tradeoff between six figure debt at an old age vs paying $10000 to get the whole thing done?
- nickjj 8y ago> Has anyone in the US considered flying overseas to get treatment done? I think a lot of people do but in a lot of situations you need to deal with things right now. If you get a heart attack, you can't just hit the pause button on life, crack open Google and start searching for "best heart attack treatment center outside of the US", then research things, book the travel arrangements and take a long flight.
- GFischer 8y agoA lot of immigrants do that, but you have to know the local system of where you'll be treated (that's why it's mostly immigrants that do it). For what I'm readying, for a lot of non-life-threatening care, it's way cheaper to fly here (Uruguay), have treatment, stay a month, and then fly back, than stay one DAY in the U.S. - a plus is that treatment will likely be better.
- amichal 8y agoNot intentionally but this happened to me. I have bad adult asthma and spent 6hr in an my in network ER (on the advice of my pcp) a couple of years ago. Got some meds a chest X-ray (turns out I had pneumonia!) and got sent home stablized. my bill for the 6h (with BCBS insurance) was ~$3k. Last year I was in Japan for 2 weeks and again got sick. After avoiding it for a few days I again went to the ER and got the same treatments/test (this time it was only the flu). Bill (no insurance at all) $200. Round trip direct flight to Japan from my house is $1300 and takes less then a day. Makes me think what I might want to do next time...
- mikekij 8y ago*Disclaimer: I'm not attempting to support HCA's billing practices here." HCA has profit margins around 10%, which do not appear to me to be exorbitant. (https://investor.hcahealthcare.com/press-release/hca-reports-first-quarter-2018-results https://investor.hcahealthcare.com/press-release/hca-reports...) While this patient's experience is clearly out of whack, and the $19k for a $1,500 stent thing is nuts, this points to a larger pricing / business model issue within US Healthcare. Typically, a few medical specialties (Surgery, Imaging, Rad Onc) have high profit margins, but are offset by losses in other departments (ER).
- krupan 8y agoThank you for pointing this out. How many medicaid patients paying below cost does it take to drag down profits from the occasional 1000% markup that the hospital gets away with?
- mikekij 8y agoCan't tell if you're being sarcastic or not, but yes, there are patients that pay (or are charged) a 1,000% markup, that in turn offsets patients not paying anything. I'm not saying the problem is the patients paying nothing; the problem is that the payment model is broken.
- krupan 8y agoI think you just said what I was trying to say. Thanks!
- faragon 8y agoHow it can be that inefficient? It looks like a monopoly or corruption. In Europe medical costs are way lower (not what the user pays, but the actual cost).
- keithnz 8y agoFrom outside of the US, it baffles me ( and I'm sure others ) why the US doesn't embrace governement based healthcare. We pay the same kinds of tax rates etc and don't have to pay for health insurance on top of that(though you can get extra health insurance for pretty cheap if you want). It's kind of like governement education which the US does pay for up to a certain point. Not only is it worth educating your population, it's worth looking after their health as well. The amount of misery and unpayable debt it seems to cause people who live in the US seems really unecessary. Not to mention nearly everyone in good heealth has a certain level of anxiety about whether their insurance is good enough and will cover them. Mind you guns also seem unecessary yet the general response to that seems to be, It's ok, we will live with our fear and everyone should be carrying guns and make it so everyone needs to be prepared to kill other people in gun fights. If you get wounded of course, then prepare for living the rest of your life in medical debt.. :I
- dragonwriter 8y ago> From outside of the US, it baffles me ( and I'm sure others ) why the US doesn't embrace governement based healthcare. The US has had majority public support for fully-public healthcare for at least ~30 years. What it has lacked—even among politicians championing “healthcare reform” like Bill Clinton and Barack Obama—is politicians willing to challenge the insurance industry even with the backing of majority public support.
- jimbokun 8y agoThere is a rising groundswell of support for government based healthcare recently: https://www.cnbc.com/2018/08/28/most-americans-now-support-medicare-for-all-and-free-college-tuition.html https://www.cnbc.com/2018/08/28/most-americans-now-support-m...
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- kbos87 8y agoI have a relative sick with cancer right now and I’m seeing this first hand. Hearing stories like this you hope it’s a one off, but it’s absolutely the norm of how insurance companies operate. My aunt is still employed, fully insured, and every day is a fight between her and her insurance company. They randomly deny claims for chemo treatments, and put her through invasive procedures to verify the disease after doctors formally diagnosed her. The list of landmines they strategically place that could cause her to lose her insurance seems to only grow. This payment isn’t made on this date? Insurance gets cancelled. This form isnt filed on this day three months from now? Insurance gets cancelled. Forget the fact that she is too sick to work; her insurer is already busy trying to figure out how to not pay. Unless you are wealthy enough to pay for everything yourself, everyone in the US should expect to be left behind by the health insurance they’ve paid their entire life for as soon as the insurer can figure out how to do it.
- ako 8y agoThe US is proof that a free-market system for healthcare does not work. This is also illustrated by all the stories here. For free-market to work, a consumer needs to be able clearly understand what he is buying and how much it will cost before he consumes whatever he buys. This allows him to shop around, and find the best seller and price. The current system just drives prices up instead of down, as the seller, who is in it for the profit, can set his prices after the goods have been bought. Ofcourse prices will go up, there's no competition anymore, as the buyer has already consumed the goods. Trying to make this transparent before an operation would not work. It would just turn healthcare into another IT project, where seller will offer you the lowest prices, and then come up with extra-work that also needs to be done. Image being operated on, and the surgeon informs you they've discovered some required extra work, asking you if you will agree with the additional cost... It's clear to me that healthcare and free-market are an incompatible combination, it needs to be heavily regulated, and probably single-payer.
- maxerickson 8y agoThe way out of this for the US is to have lots more doctors. So tax hospital revenues (yes, revenues) to fund residencies and have an objective standard for accrediting medical schools, where meeting the objective standard automatically qualifies the seats. Of course patients will then be paying for the residencies, but that's fine, it even makes sense. Having more nurse practitioners and physicians assistants would also help, but doctors lobby against them starting independent practices.
- sigvirt 8y agoPropublica [1][2] has done some investigation into the amount of waste, beginning with a 2012 report by the Institute of Medicine of the National Academies. The unnecessary costs amount to roughly 5% of US GDP. For comparison: the defense budget is about 4.5% of GDP, and Social Security Disability Insurance outlays are about 5% of GDP. NASA's budget is about 0.1% of GDP. A number of other commenters have castigated politicians on suspicion of being in the pocket of insurance companies or health care companies. Sure such things may happen occasionally. More certainly, politicians and bureaucrates are regularly attentive to the budget and financing of the government. If medical care was cost efficient, it would 1) reduce GDP and the appearance of economic growth, and 2) wreck the back office math concerning whether the federal government can afford the deficit and the interest on the national debt. Elimination of mass incarceration and criminalization would cause a similar dilema. US economic growth has been 2-3 percent in recent years. If that were negated by substantial reduction of waste-masquerading-as-productivity, then the federal budget could not be financed without massive cuts or dramatic manipulation of interest and inflation rates. There are others who potentially benefit from denial of treatment or claims beside the insurance company. Beside the doctors, medical institutions, and insurance companies are another set of actors: the benefits management and payment processing companies, who often profit per transaction. Some of the calculus in this camp can be seen in [3]. This part of the system (and others) can benefit when a patient is denied or discouraged from or uninformed of curative treatment and manipulated into some ongoing palliatve therapy - despite the possibility of greater overall long-term cost. The cash-flow gets distributed differently than curative treatment, and there are more smaller on-going transactions enabling a higher percentage of skim. [1] Sep 2012 - https://www.propublica.org/article/a-costly-equation-medical-dollars-wasted-are-greater-than-the-u.s.-defense https://www.propublica.org/article/a-costly-equation-medical... [2] Nov. 2017 - https://www.propublica.org/article/a-hospital-charged-to-pierce-ears-why-health-care-costs-so-much https://www.propublica.org/article/a-hospital-charged-to-pie...? [3] Nov. 2017 - https://www.bnymellon.com/us/en/what-we-do/business-insights/the-saga-of-medical-claims-payment-processing.jsp https://www.bnymellon.com/us/en/what-we-do/business-insights...