5 ms·

I recently watched a family member go through this. A few things that were sobering to see: - Three weeks in she was buried in paperwork. One chemo treatment w

by kbos87 8y ago

I recently watched a family member go through this. A few things that were sobering to see: - Three weeks in she was buried in paperwork. One chemo treatment would turn into 4-5 invoices from different subcontractors at a single hospital, some covered by her insurance, others not covered. Her insurer denied claims arbitrarily and made her go through a bunch of invasive and unnecessary procedures to prove her illness. - Her insurer started calling her incessantly, insisting that she join some sort of program where they would “help” her make decisions about her care. It undermined the confidence she had in her doctors and the decisions she was trying to make, which is a terrible feeling for anyone to go through when they are sick with cancer and trying to survive. - There were a series of insurance “land mines” on the horizon - forget to renew this thing on this random date 2 months from now? You’ve lost your insurance. The whole healthcare and insurance system is a dark pattern, even for working adults who are fully covered.

Bjorkbat 8y ago
I'm curious to find out what it would take for someone to create a service that counters some of these dark patterns. The abundance of companies using dark patterns in their subscriptions to prevent subscription cancellations has led to other companies offering services that allow you to manage your various subscriptions with ease and cancel subscriptions with even greater ease. I'm wondering what it would take to apply the same mindset to managing healthcare-related paperwork.
- platz 8y ago
  It's called medical tourism
  - andrewprock 8y ago
    I somehow read that as "medical terrorism".
    - mythrwy 8y ago
      No that's the topic of the article.
      - joelx 8y ago
        I found this article extraordinarily helpful in understanding the high cost of US care - https://mises.org/library/how-government-helped-create-coming-doctor-shortage https://mises.org/library/how-government-helped-create-comin...
  - joelx 8y ago
    Insurance companies are often used as the punching bag for healthcare costs. In reality, insurance companies are just a payment method for the true cost - enormously expensive doctors. Insurance companies are portrayed as having crazy profits, but in reality the insurance company Cigna has a profit margin of 6%. The American Medical Association realized a century ago that medical care demand is inelastic... Basically if you need medical care, you will pay any price to get it. Doctors took advantage of the situation by passing laws and regulations limiting the number of new doctors allowed each year, who can practice medicine, and the types of businesses that can compete. This greatly limited the supply of doctors. There are not enough doctors to fully meet demand. The basic laws of economics say that when you have strong and inelastic demand, and a limited supply then prices will go through the roof. I propose we remove these artificial limits that are grossly enriching doctors. If you allow anyone to practice medicine, just like we allow anyone to prepare and serve food or distribute goods then you will end up with a lot more competition. This will result in far better patient outcomes at a far lower price. The AMA will argue that without limits on who can practice medicine huge numbers of people will die. This is false. Our lives rely on many businesses that if they screw up would kill us. Everything from farming to distribution to food prep to construction needs to perform and deliver for us to survive. The AMA is self serving and greedy. There is no reason an individual surgeon should make hundreds of thousands of dollars. There is no reason certain business types should be legally prevented from competing. Imagine if you had the efficiencies of a business like Amazon or Google in healthcare. Imagine if you could see statistics on the performance of every doctor and hospital in the country, then decide where you wanted to get treated. Allow competition in healthcare by removing limits on the number of doctors each year and by allowing new business types that can take advantage of scale and specialization. This will drive down healthcare costs a hundredfold and allow everyone in America access to top healthcare at reasonable prices
    - selimthegrim 8y ago
      What’s top healthcare defined as - my doctor was nice to me? My doctor made me feel better? My doctor was better?
- tracker1 8y ago
  Making insurance carriers legally required to act as a fiduciary to the person holding insurance benefits would be a good start. States requiring medical services to bundle billing through a state agency (one place to pay) would be another. Although this would in practice mean a bigger government, I think a majority of people would agree to it. Likewise apportionment of payments would go to approved and priority based on service date. Of course the next step would be to limit exposure to credit to a "single" entry for all medical related bills, and limit the total payroll deductions allowed for medical bills to a total of 10% of one's gross income (deduction pre-tax). This would take a lot of work inside individual states and at the federal level.
yborg 8y ago
Once insurance is involved and has to pay, the system is geared towards shifting as much of this as possible to the patient in the current US system. So now you have the provider and the insurance company working to get the patient to pay. Nobody is on the patient's side; the insurance company is best served by having the patient die as quickly as possible, the provider is best served making the patient pay as much as possible. It's become a dystopian nightmare over the last 25 years.
- joelx 8y ago
  I recently suffered a knee injury that cost into the six figures and required experts to help me with insurance billing. I think we need to remove restrictions regulating how new doctors are trained, and how many new doctors and other medical professionals get lice sed each year. I would even get rid of the requirements to have a license. I don't think it should require $320k in student debt to become a doctor. I think that traps people who may switch careers later into a career they dislike. The only reason the prices are that high is that a limited number of schools control a monopoly on healthcare education. I saw that insurance companies are legally capped to only keep 20% of each dollar spent on healthcare. A competitive insurance company could keep less of course. I also saw that out of each dollar spent on healthcare, 23% goes to prescription drugs, 22% to doctors, 20% to office and clinic visits, 16% to hospitals. https://www.ahip.org/health-care-dollar/ https://www.ahip.org/health-care-dollar/ Prescription drugs should not be as expensive as they are either. This is due to overly strong patent laws preventing competition and stifling innovation. Each new drug is the end result of an avalanche of human work through centuries and the one little idea that advances things slightly should not be long term locked up by a patent. This greatly slows the creative avalanche. I think we would see far more new drugs at a far lower cost if we did away with patents. Science should not be owned by any individual or group. The cost of healthcare is ballooning and is out of reach of many people and bankrupts many more. The number one cause of bankruptcy in America is medical bills. Healthcare costs as a share of GDP have grown from 5% in 1960 to 18% in 2018. This shows that the cost itself is the problem, not just insurance companies. https://www.statista.com/statistics/184968/us-health-expenditure-as-percent-of-gdp-since-1960/#0 https://www.statista.com/statistics/184968/us-health-expendi... How can we solve healthcare's cost while improving outcomes and getting face time with medical professionals for patients? I am proposing we allow many more people to enter the field by removing artificial regulations preventing competition. This is a standard approach suggested by economists... https://www.investopedia.com/university/economics/economics3.asp https://www.investopedia.com/university/economics/economics3... As an entrepreneur, I would like to see doctors innovate with new business models in healthcare... Unfortunately business models are strictly regulated in this industry just as supply of medical professionals is regulated. What are your thoughts on how to solve the problem of the very high cost of healthcare?
teekert 8y ago
For someone living in the Netherlands this sounds truly savage and heart breaking. I really, really wouldn't want to live in the US.
- chris_va 8y ago
  To play devil's advocate, looking at 5-year survival rates by country, you'd be 15-20% more likely to survive in the US after you contract cancer than in the Netherlands. YMMV.
  - _mitch 8y ago
    Do you have a source for that claim?
  - davvolun 8y ago
    Did you factor wealth into that? I would hazard a guess that the bottom 20%-40% in the U.S. would have a considerably lower survival rate than the average for the rest of the country.
    - chimeracoder 8y ago
      > Did you factor wealth into that? I would hazard a guess that the bottom 20%-40% in the U.S. would have a considerably lower survival rate than the average for the rest of the country. The population survival rates for cancer in the US are higher than any other OECD country. That already includes people who don't have insurance or otherwise can't afford treatment.
      - davvolun 8y ago
        Yes, but let's say in the U.S. the numbers are 100% survival for the richest 50% and 0% survival for the other 50%. Clearly the average survival rate is 50%. Now let's say the Netherlands has a flat survival rate of 50%. If I don't consider wealth, it doesn't matter which country I get care in. If I'm at 49.999% of wealth in the U.S., the difference is 0% survival vs 50%. We know healthcare quality and healthcare cost are correlated, e.g. http://www.pnhp.org/news/2016/july/wealthy-get-more-health-care-than-other-americans http://www.pnhp.org/news/2016/july/wealthy-get-more-health-c... , I think we can intuit that ability to bear cost and wealth are correlated. Outliers aside, I don't think you're going to argue to me that a homeless man in Detroit has a chance of getting the same quality of care as Jeff Bezos. Simpson's paradox -- how you split up those percentiles matter, the question is how much.
kxyvr 8y ago
I'm sorry your family member went through this. That's terrible and no one should have to deal with that kind of treatment. I'll echo much of what you said. When I was 21, I was diagnosed and treated for malignant melanoma (skin cancer) that had metastasized to my lymph nodes. The treatment worked and I've been healthy for many years. That said, it changed the way and manner in which I deal with billing and insurance, so I'll share a couple of things that I learned in case someone else runs into the same issue. - Do not immediately pay any invoice. Wait until the explanation of benefits arrives first and then verify that the two match. Basically, verify that the doctor is billing what the insurance company states is uncovered. Sometimes they're different and that indicates a problem. - Check all statement of benefits for uncovered claims. It's important to understand why a claim is denied. If a doctor is not in network, it's important to drop them right away. If the doctor used an unapproved billing code or sequence of codes, it's important to know this and insure that this doesn't happen again or else it gets expensive. Alternatively, the doctor's office can resubmit the claim using different billing codes. - Just because a doctor shows up under the "find a doc" in the insurance search doesn't mean they're in network. PHCS is notorious for this, which happens to be the network used by the health sharing ministries (which is part of the reason why these organizations are a terrible idea.) Anyway, even if a doctor is listed, it doesn't mean that they're using that tax id for their services. The insurance company and the underwriter maintain a database of tax ids that really determine who is in network or not. The doctor nor the front desk will have this information. The billing department does. As such, the process is to call billing, before the appointment, and get their tax id. Then, call your insurance and verify the tax id directly. Some phone support want to just verify the name. That is not good enough. Verify the actual tax id and insist that this is what is checked. - Even if the tax id is verified, the claim may still be denied. This an innumerable number of reasons why this may happen. I had one denied because they billed a new patient the same day as a procedure. Anyway, the only way to truly know the cost is to get the procedure code and the tax id and then verify with the underwriter that this is covered. I mention the underwriter because the insurance company doesn't have this information, at least the ones I've used. Generally, the insurance company will refuse to give the underwriters contact and the underwriter will refuse to talk to you even if you get it, so the insurance company has to call them and then verify both the tax-id and billing codes. This only works some of the time, but they really can do it if they want. Most of the time, I don't go this far unless there's a dispute. Generally, verifying the tax-id is good enough. - Hospitals do not just hire their own people. Most are filled and staffed with medical groups who use their own billing. Here's where things gets stressful. You basically have to be forceful, while sick, and ask each new physician and lab tech what medical group they work for and what their tax-ids are. The really crappy situations occur when the hospital gets slammed and then they bring in someone to help cover the gap and they use a tax-id that's not in network. This gets astronomically expensive quickly. And, look, the hospital will get tired of you asking. I get it. If I'm there, I'm either sick or dying and don't want to ask either, but these surprise bills can bankrupt you. - Hospitals may randomly apply funds paid to random invoices. If this shell game goes on long enough, bills can be sent to collections even if you've paid them purely because funds paid were applied to new invoices and not old. Generally, hospitals will try 3 or 4 times to collect on an invoice. If you know one has been paid, verify the money has been collected from checking or credit, and then call the hospital to complain. It needs to be fixed sooner rather than later. - As far as paperwork, I save the doctors notes from that day, the insurance explanation of benefits, the bill, and the receipt of payment from my bank, in a single file labeled for that day of service. This has saved my ass multiple times because I can quickly determine whether a bill has been paid and when. - Do not overpay. Ever. Getting money back from a hospital is extremely difficult. Then, they'll randomly apply the credit to new invoices, which screws up the bookkeeping. This is part of why I delay paying invoices till I know they're good. Alright, that was longer than I anticipated. Anyway, the situation is ridiculous and I hope no one here has to go through this mess. Hopefully, what I wrote above will help someone else.
sjg007 8y ago
Depending on the plan there are state insurance regulators you can appeal to who basically have the final say but I agree, the random denials etc... it's like the do it on purpose. There is also an appeal window of like 60 days in most cases so the best thing someone can do to help is help your family member manage and file appeals/paperwork as necessary. You can also find former insurance company employees who act as patient advocates and know who and how to call to get things done. A lot of them work at hospitals but you can find them outside as well. Sometimes your insurance will have a patient advocate. They are actually on your side and will help.
kevintb 8y ago
That’s terrible. I really feel for low-income cancer patients in the US. I’ve dealt with cancer in the family (in Canada) and found it difficult enough, and never had to deal with insurance paperwork.

by kbos87 8y ago

Bjorkbat 8y ago

I'm curious to find out what it would take for someone to create a service that counters some of these dark patterns. The abundance of companies using dark patterns in their subscriptions to prevent subscription cancellations has led to other companies offering services that allow you to manage your various subscriptions with ease and cancel subscriptions with even greater ease. I'm wondering what it would take to apply the same mindset to managing healthcare-related paperwork.

platz 8y ago
It's called medical tourism
- andrewprock 8y ago
  I somehow read that as "medical terrorism".
  - mythrwy 8y ago
    No that's the topic of the article.
    - joelx 8y ago
      I found this article extraordinarily helpful in understanding the high cost of US care - https://mises.org/library/how-government-helped-create-coming-doctor-shortage https://mises.org/library/how-government-helped-create-comin...
- joelx 8y ago
  Insurance companies are often used as the punching bag for healthcare costs. In reality, insurance companies are just a payment method for the true cost - enormously expensive doctors. Insurance companies are portrayed as having crazy profits, but in reality the insurance company Cigna has a profit margin of 6%. The American Medical Association realized a century ago that medical care demand is inelastic... Basically if you need medical care, you will pay any price to get it. Doctors took advantage of the situation by passing laws and regulations limiting the number of new doctors allowed each year, who can practice medicine, and the types of businesses that can compete. This greatly limited the supply of doctors. There are not enough doctors to fully meet demand. The basic laws of economics say that when you have strong and inelastic demand, and a limited supply then prices will go through the roof. I propose we remove these artificial limits that are grossly enriching doctors. If you allow anyone to practice medicine, just like we allow anyone to prepare and serve food or distribute goods then you will end up with a lot more competition. This will result in far better patient outcomes at a far lower price. The AMA will argue that without limits on who can practice medicine huge numbers of people will die. This is false. Our lives rely on many businesses that if they screw up would kill us. Everything from farming to distribution to food prep to construction needs to perform and deliver for us to survive. The AMA is self serving and greedy. There is no reason an individual surgeon should make hundreds of thousands of dollars. There is no reason certain business types should be legally prevented from competing. Imagine if you had the efficiencies of a business like Amazon or Google in healthcare. Imagine if you could see statistics on the performance of every doctor and hospital in the country, then decide where you wanted to get treated. Allow competition in healthcare by removing limits on the number of doctors each year and by allowing new business types that can take advantage of scale and specialization. This will drive down healthcare costs a hundredfold and allow everyone in America access to top healthcare at reasonable prices
  - selimthegrim 8y ago
    What’s top healthcare defined as - my doctor was nice to me? My doctor made me feel better? My doctor was better?
tracker1 8y ago
Making insurance carriers legally required to act as a fiduciary to the person holding insurance benefits would be a good start. States requiring medical services to bundle billing through a state agency (one place to pay) would be another. Although this would in practice mean a bigger government, I think a majority of people would agree to it. Likewise apportionment of payments would go to approved and priority based on service date. Of course the next step would be to limit exposure to credit to a "single" entry for all medical related bills, and limit the total payroll deductions allowed for medical bills to a total of 10% of one's gross income (deduction pre-tax). This would take a lot of work inside individual states and at the federal level.

yborg 8y ago

Once insurance is involved and has to pay, the system is geared towards shifting as much of this as possible to the patient in the current US system. So now you have the provider and the insurance company working to get the patient to pay. Nobody is on the patient's side; the insurance company is best served by having the patient die as quickly as possible, the provider is best served making the patient pay as much as possible. It's become a dystopian nightmare over the last 25 years.

joelx 8y ago
I recently suffered a knee injury that cost into the six figures and required experts to help me with insurance billing. I think we need to remove restrictions regulating how new doctors are trained, and how many new doctors and other medical professionals get lice sed each year. I would even get rid of the requirements to have a license. I don't think it should require $320k in student debt to become a doctor. I think that traps people who may switch careers later into a career they dislike. The only reason the prices are that high is that a limited number of schools control a monopoly on healthcare education. I saw that insurance companies are legally capped to only keep 20% of each dollar spent on healthcare. A competitive insurance company could keep less of course. I also saw that out of each dollar spent on healthcare, 23% goes to prescription drugs, 22% to doctors, 20% to office and clinic visits, 16% to hospitals. https://www.ahip.org/health-care-dollar/ https://www.ahip.org/health-care-dollar/ Prescription drugs should not be as expensive as they are either. This is due to overly strong patent laws preventing competition and stifling innovation. Each new drug is the end result of an avalanche of human work through centuries and the one little idea that advances things slightly should not be long term locked up by a patent. This greatly slows the creative avalanche. I think we would see far more new drugs at a far lower cost if we did away with patents. Science should not be owned by any individual or group. The cost of healthcare is ballooning and is out of reach of many people and bankrupts many more. The number one cause of bankruptcy in America is medical bills. Healthcare costs as a share of GDP have grown from 5% in 1960 to 18% in 2018. This shows that the cost itself is the problem, not just insurance companies. https://www.statista.com/statistics/184968/us-health-expenditure-as-percent-of-gdp-since-1960/#0 https://www.statista.com/statistics/184968/us-health-expendi... How can we solve healthcare's cost while improving outcomes and getting face time with medical professionals for patients? I am proposing we allow many more people to enter the field by removing artificial regulations preventing competition. This is a standard approach suggested by economists... https://www.investopedia.com/university/economics/economics3.asp https://www.investopedia.com/university/economics/economics3... As an entrepreneur, I would like to see doctors innovate with new business models in healthcare... Unfortunately business models are strictly regulated in this industry just as supply of medical professionals is regulated. What are your thoughts on how to solve the problem of the very high cost of healthcare?

teekert 8y ago

For someone living in the Netherlands this sounds truly savage and heart breaking. I really, really wouldn't want to live in the US.

chris_va 8y ago
To play devil's advocate, looking at 5-year survival rates by country, you'd be 15-20% more likely to survive in the US after you contract cancer than in the Netherlands. YMMV.
- _mitch 8y ago
  Do you have a source for that claim?
- davvolun 8y ago
  Did you factor wealth into that? I would hazard a guess that the bottom 20%-40% in the U.S. would have a considerably lower survival rate than the average for the rest of the country.
  - chimeracoder 8y ago
    > Did you factor wealth into that? I would hazard a guess that the bottom 20%-40% in the U.S. would have a considerably lower survival rate than the average for the rest of the country. The population survival rates for cancer in the US are higher than any other OECD country. That already includes people who don't have insurance or otherwise can't afford treatment.
    - davvolun 8y ago
      Yes, but let's say in the U.S. the numbers are 100% survival for the richest 50% and 0% survival for the other 50%. Clearly the average survival rate is 50%. Now let's say the Netherlands has a flat survival rate of 50%. If I don't consider wealth, it doesn't matter which country I get care in. If I'm at 49.999% of wealth in the U.S., the difference is 0% survival vs 50%. We know healthcare quality and healthcare cost are correlated, e.g. http://www.pnhp.org/news/2016/july/wealthy-get-more-health-care-than-other-americans http://www.pnhp.org/news/2016/july/wealthy-get-more-health-c... , I think we can intuit that ability to bear cost and wealth are correlated. Outliers aside, I don't think you're going to argue to me that a homeless man in Detroit has a chance of getting the same quality of care as Jeff Bezos. Simpson's paradox -- how you split up those percentiles matter, the question is how much.

kxyvr 8y ago

I'm sorry your family member went through this. That's terrible and no one should have to deal with that kind of treatment. I'll echo much of what you said. When I was 21, I was diagnosed and treated for malignant melanoma (skin cancer) that had metastasized to my lymph nodes. The treatment worked and I've been healthy for many years. That said, it changed the way and manner in which I deal with billing and insurance, so I'll share a couple of things that I learned in case someone else runs into the same issue. - Do not immediately pay any invoice. Wait until the explanation of benefits arrives first and then verify that the two match. Basically, verify that the doctor is billing what the insurance company states is uncovered. Sometimes they're different and that indicates a problem. - Check all statement of benefits for uncovered claims. It's important to understand why a claim is denied. If a doctor is not in network, it's important to drop them right away. If the doctor used an unapproved billing code or sequence of codes, it's important to know this and insure that this doesn't happen again or else it gets expensive. Alternatively, the doctor's office can resubmit the claim using different billing codes. - Just because a doctor shows up under the "find a doc" in the insurance search doesn't mean they're in network. PHCS is notorious for this, which happens to be the network used by the health sharing ministries (which is part of the reason why these organizations are a terrible idea.) Anyway, even if a doctor is listed, it doesn't mean that they're using that tax id for their services. The insurance company and the underwriter maintain a database of tax ids that really determine who is in network or not. The doctor nor the front desk will have this information. The billing department does. As such, the process is to call billing, before the appointment, and get their tax id. Then, call your insurance and verify the tax id directly. Some phone support want to just verify the name. That is not good enough. Verify the actual tax id and insist that this is what is checked. - Even if the tax id is verified, the claim may still be denied. This an innumerable number of reasons why this may happen. I had one denied because they billed a new patient the same day as a procedure. Anyway, the only way to truly know the cost is to get the procedure code and the tax id and then verify with the underwriter that this is covered. I mention the underwriter because the insurance company doesn't have this information, at least the ones I've used. Generally, the insurance company will refuse to give the underwriters contact and the underwriter will refuse to talk to you even if you get it, so the insurance company has to call them and then verify both the tax-id and billing codes. This only works some of the time, but they really can do it if they want. Most of the time, I don't go this far unless there's a dispute. Generally, verifying the tax-id is good enough. - Hospitals do not just hire their own people. Most are filled and staffed with medical groups who use their own billing. Here's where things gets stressful. You basically have to be forceful, while sick, and ask each new physician and lab tech what medical group they work for and what their tax-ids are. The really crappy situations occur when the hospital gets slammed and then they bring in someone to help cover the gap and they use a tax-id that's not in network. This gets astronomically expensive quickly. And, look, the hospital will get tired of you asking. I get it. If I'm there, I'm either sick or dying and don't want to ask either, but these surprise bills can bankrupt you. - Hospitals may randomly apply funds paid to random invoices. If this shell game goes on long enough, bills can be sent to collections even if you've paid them purely because funds paid were applied to new invoices and not old. Generally, hospitals will try 3 or 4 times to collect on an invoice. If you know one has been paid, verify the money has been collected from checking or credit, and then call the hospital to complain. It needs to be fixed sooner rather than later. - As far as paperwork, I save the doctors notes from that day, the insurance explanation of benefits, the bill, and the receipt of payment from my bank, in a single file labeled for that day of service. This has saved my ass multiple times because I can quickly determine whether a bill has been paid and when. - Do not overpay. Ever. Getting money back from a hospital is extremely difficult. Then, they'll randomly apply the credit to new invoices, which screws up the bookkeeping. This is part of why I delay paying invoices till I know they're good. Alright, that was longer than I anticipated. Anyway, the situation is ridiculous and I hope no one here has to go through this mess. Hopefully, what I wrote above will help someone else.

sjg007 8y ago

Depending on the plan there are state insurance regulators you can appeal to who basically have the final say but I agree, the random denials etc... it's like the do it on purpose. There is also an appeal window of like 60 days in most cases so the best thing someone can do to help is help your family member manage and file appeals/paperwork as necessary. You can also find former insurance company employees who act as patient advocates and know who and how to call to get things done. A lot of them work at hospitals but you can find them outside as well. Sometimes your insurance will have a patient advocate. They are actually on your side and will help.

kevintb 8y ago

That’s terrible. I really feel for low-income cancer patients in the US. I’ve dealt with cancer in the family (in Canada) and found it difficult enough, and never had to deal with insurance paperwork.