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> 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

• samfisher83 8y ago
  The 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 ago
    Yes, 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 ago
    The 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 ago
    I 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
    • dv_dt 8y ago
      For hospitals which really are non-profit a) the non-profit status doesn't prevent price gouging b) even if acting as a traditional non-proft, they may do so to balance revenue against people with no insurance and no ability to pay. (a burden we load onto hospitals that we should actually be sharing much more explictly and universally across our nation).
    • jhayward 8y ago
      > despite having a religious nonprofit-sounding name They came by the name honestly, but it is indeed a shame the way it has gone since the St. David's Foundation partnered with HCA. The hospital(s) were originally founded and run by St. David's Episcopal and were one of the first and foremost hospitals in Austin, with very high quality care and good service to the community. After operating them for nearly 75 years, and growing to an enormous enterprise, it became clear that a church congregation simply couldn't and shouldn't be operating them any further and they were spun out. Some of the profits are still sent back to the foundation for community health care grants. This particular wealth extraction strategy would never have occurred under church leadership. (disclaimer: I was a member of the church during this period and hold it in very high regard)
    • diab0lic 8y ago
      My ex worked for HCA and she insisted that she could tell you the exact cost of a procedure before undergoing it. Well at some point she needed surgery (at HCA), and about five months later after dealing with 10 < x < 20 bills including one we'd never heard about until collections came knocking she just looked at me and said "Nobody knows what this is going to cost." It really bums me out that a human being working in healthcare here isn't able to even remotely predict the cost of a procedure at the hospital at which they work.
    • bmmayer1 8y ago
      > squeezing money out of insurance companies because they can FTFY. But seriously, how can it possibly be the hospital's fault for doing exactly what the law and market incentives give them every reason to do? There's almost no downward pressure on prices: little competition, no transparent pricing, huge barriers to market entry, and third party payers.
  • jimmydddd 8y ago
    What's strange is that many hospitals seem to legitimately be in financial trouble. You often hear about smaller hospitals not being able to make it financially, and being gobbled up by larger health networks. How can I be paying them $600 for an asprin, and other fake charges, and they still can't make any money?
    • FireBeyond 8y ago
      Well, you'll notice on this bill in the article they've taken to charging "near retail" pricing for aspirin, and generic pricing for common drugs many of us will know the price of (still relatively outrageous, but $1/pill for aspirin, $10/pill for metoprolol). Why? Not out of the kindness of their hearts. They know that their name showing up with a bill for $500 for ASA is bad PR, so better to make those common things realistic, and pad their numbers elsewhere (like charging $19,500 for a $1,500 stent)...
    • bobmarley1 8y ago
      Like in Education the glut of "Administrators" is certainly not helping.
• FactolSarin 8y ago
  Yeah, more like he qualifies for the "got some sympathetic media coverage" discount. That's not something most people can count on.
• BLanen 8y ago
  Can you stop blaming individuals and start blaming the people who set up and keep the current system?
• agumonkey 8y ago
  The power of companies. They write words and numbers on a stamped letter and now it's god spell. I once played dumb to an importer abusing fees, after monthes of bouncing mails to different people babbling the same thing over and over, then dealing with a 'lawyer firm' who behaved the same (basically nobody knew precisely what they were talking about). They suddenly accepted to give me a rebate of NN%. So I received a new bill with 100$ - '80$ promotional deal' = 20$ (normal fee). A very partial grin ensued.
  • pc86 8y ago
    I don't think anyone is treating the company's word as law. Just about everything is open to negotiation just about all of the time. I'm assuming you mean "gospel" and not the 1971 Broadway musical.
    • agumonkey 8y ago
      People have and will pay the minute they receive an official looking letter.
• opencl 8y ago
  There is a whole industry of "medical billing advocates" you can pay to find what is likely thousands if not tens of thousands of dollars of completely made up charges on any given US hospital bill and "negotiate" them away. You don't necessarily need press coverage though it obviously helps. Hell one time I got a $15k bill for something insurance should have covered. Called the hospital, turns out insurance had covered it and I didn't actually owe any money at all. How many people get this kind of stuff and just pay it anyway?
  • exolymph 8y ago
    Relevant blog post: https://meaningness.com/metablog/post-apocalyptic-health-care https://meaningness.com/metablog/post-apocalyptic-health-car... > Hiring someone became imperative for me when coordinating my mother’s care got to be a way-more-than-full-time job. (In retrospect, I wish I had done that months earlier.) > It could also be worthwhile in less critical cases, if no one in the family can take enough time off from work, or in which you’d simply rather pay someone else to clean up after a hospital’s paperwork pollution. > This role has developed only recently, as systems have broken down. There’s not yet a standardized term; “health care advocate” is one among several. > Mine specializes in gerontology and dementia. Others specialize in other disease areas; or in other aspects of the administrative nightmare, such as sorting out bogus hospital bills, which frequently include fraudulent additions. > They are not inexpensive (mine charges $150/hour), so not an option for everyone. > There are good and not-so-good advocates. I spoke with several before hiring one. Some were clearly clueless; the one I hired last month has seemed consistently competent. > Since they recommend particular providers, there is an inherent principal-agent problem. Ask if they get any compensation from services they recommend. Take their recommendations with a grain of salt in any case.
  • huevosabio 8y ago
    Billing "mistakes" seem to be standard practice. I went through surgery at the Stanford Hospital, using Stanford's insurance. Prior to the surgery, they charged me $2000, the out of pocket maximum. Then, a couple of weeks post-surgery. I got another $250 bill. I had to spend the whole day on the phone first with the hospital, then the insurance, and then the hospital. Turns out, that all I had to pay was $250, that the hospital had made a mistake in billing me $2000 at the door. I got my money back a month later. I would normally attribute this to ineptitude. But the frequency and scale with which this happens, reeks of widespread scams.
• apetresc 8y ago
  Later in that correction paragraph, it says: > In a statement, the hospital said this offer was contingent on Calver submitting his application for a discount based on his household finances. Calver disputed that he owes any additional money to St. David’s and said this situation should have been resolved long before now. I might be misreading, but is this saying that Calver isn't going to accept even the $700 charge, just to make a statement? I obviously side with him but this seems like a crazy stand to take on principle alone.
  • rabidrat 8y ago
    He shouldn't have to submit for a "discount" based on his "household finances" anyway! What if he doesn't qualify after all? Does he owe $100k if he makes more than $70k/year? Actually what level of income should be the low threshold for having to pay $100k after insurance for your life-critical health event?
    • apetresc 8y ago
      I'm not saying he's wrong on the principle. I'm saying I wouldn't have the guts to risk $108,300 just for a chance to maybe win a moral victory over $700.
• badcede 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. Sounds a bit like getting support from Google.
• achoped 8y ago
  Not always. My mom had a quadruple bypass about 6 years ago during a gap year where she stopped working but didn't have Medicare yet. Unlucky. I think she was billed for around $180k. She told them "I'm on Social Security for $1000/mo, I'll pay you $50/mo". It was basically that or sending it to collections and never getting a dime from a retiree. So they accepted and told her a "non-profit" paid for the doctor's portion of the bill, which was all but about $40k. She'll probably be around another 10 years max, which means she'll end up paying about $10k of that balance. Medical debt is the least concerning type of debt for most lenders. If you ever fall into this hole, don't sweat it. [Unsolicited advice.] Just let it go to collections. You'll get harassed for a little over a year. Debt older than a year is almost never pursued by collections agencies. After things quiet down start sending letters to the credits agencies saying the collections debt has been settled. The collections agency will usually slip up and not respond at some point and it'll be gone from your credit history.
  • mjcl 8y ago
    > Medical debt is the least concerning type of debt for most lenders. Just another data point, a large property management company I used to work for specifically exempted bankruptcies due to medical debt when calculating applicant credit scores.
    • achoped 8y ago
      I have a friend who sells debtor data for a living. He literally sells Excel spreadsheets of debtor data (name, address, SSN, amount owed, etc) to collections agencies for $5k-$25k a pop. He makes mid-six figures doing it. The quality of the data is what commands the price. He said the least desirable debt are debts older than a year and medical debt. He can't even give that crap away. Also, if you're ever called by a collections agency, you should ask them to provide proof that they actually hold the debt you're obligated to pay. In some cases they've just bought the data, usually from another collections agency who couldn't collect, and they're trying to shake you down. Once you use the magic phrase "provide proof" they give up and stop hassling you, because they have no proof.
    • 8y ago
• FireBeyond 8y ago
  When you realize that the hospital was charging $19,000 for a stent that cost $1,500, you realize that painting Calver as someone who is going to cost us all money is misdirected anger. And, to be clear, they charged $19,000 for the stent, not "stent plus theater time to place it plus surgeon, anesthesiology, OR nurses", of course not. Those are all absolutely billed separately.
  • antisthenes 8y ago
    Hospitals should be legally mandated to accept replacement of materials in lieu of payment. If I can source the same stents for cheaper than the hospital bills me, they should be required to erase them from the bill and accept them as material replacement. It's not as if medical supplies are unavailable to the end consumer. https://www.esutures.com/product/0-in-date/41-boston-scientific/661-stents-coronary/ https://www.esutures.com/product/0-in-date/41-boston-scienti... Here are the stents available for under $1000. When I had a broken finger and was uninsured, I was charged ~$40 for a finger splint that costs $7 at Walgreens (yeah, the very basic one made out of aluminum and blue foam). Also, a word of advice - never ever pay what you were sent from the hospital right away. I personally throw most medical bills in the trash and wait until they call me, then negotiate it down to a fraction of what was billed, offering to pay in cash.
    • mythrowaway1124 8y ago
      Honest question - does this really work? I have tried it once or twice without success. Are there particular 'magic phrases' you need to use, or is it jut a question of persistence? Does it impact your credit?
      • antisthenes 8y ago
        > Are there particular 'magic phrases' you need to use, or is it jut a question of persistence? My situations varied, but when I had no insurance and was living off of savings, I found a generic "hardship" form and explained my situation to them - they waived 80% of the fee without much resistance. This is compared to the laughable discount of 2% they offered me on the spot if I paid in cash (at the moment of the visit) In other situations, I'd imagine it's more a question of persistence, but I'd venture to say you can knock off at least 50% on _any_ hospital bill. I recently bought a house, and my credit was 800+, so I don't think it does in any appreciable way. That wasn't the gist of my post though. I was advocating more to resist the bullshit and to legislate something that allows the customer to replace materials instead of paying a hugely marked up item. Same concept would be applicable, for example, for a car mechanic shop. Just because they billed me $600 for brake pads doesn't mean that they've actually provided me with a 10x markup of value on having bought brake pads myself for $60 - at some point this needs to be treated as "usury" (I don't know if there's a word for exorbitant markup on a regular good). Another thing I would add - don't put your social security number on medical forms. I've never seen it enforced and there's no medical reason for them to have it.
• hellofunk 8y ago
  I think this is pretty common. If you get a hospital bill and the insurance already paid a lot, call up the hospital and complain, and it will often be lowered. This happened to me once, a $15k bill was reduced to $3k. The insurance had already paid $50k or so. Hospitals don't really seem to care about the extra portion the patient is supposed to pay. The try to get it, but don't make much fuss when you challenge it, since they already got what they really wanted, the insurance company's money.
• Marazan 8y ago
  No, it just means they will make a little less profit.
• noonespecial 8y ago
  Sounds like the usual billing practice of "send him a bill for everything he'll ever have and then graciously negotiate it down merely everything he's got now".
• maxerickson 8y ago
  Any unmet costs would likely be made up by other patients, but the charges have nothing to do with the costs, so who knows what impact this has.