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Doctors Are Fed Up with Being Turned into Debt Collectors
- jedberg 8y agoDoctors being debt collectors is annoying for both the doctor and the patient, and they're also bad at it. Just the other day I got a bill for a procedure in July of 2017, despite 1) not having seen that doctor since 2016 and 2) never having had that procedure. Now I have to fight with them to prove a negative, until it goes to collections and I can make them prove the debt, and then wait for my credit to get fixed after they figure it the debt isn't valid. Yay.
- ndiscussion 8y agoYou have my sympathies. My insurance keeps sending me a bill for $5 for "unpaid services". Every time, I tell them everything is accounted for, and they remove the charge. Only to get another one a week later.
- toomuchtodo 8y agoI suggest when you reply regarding the erroneous charge, you send it certified mail return receipt ($7 at your local USPS), and build a paper trail. It ensures any discrepancies will be resolved in short order if you need to pursue legal remedies. Conversely, when you make payments that you might encounter turbulence on, write a check (I know, gasp) or a USPS money order. Once it clears, save the front and back of the check images as proof of payment (for the money order, save a copy of the receipt and the entire check and receipt assembly prior to mailing or delivery). I've found this to be much more effective than a debit or credit card line item on a statement. There are few weapons more powerful than a properly assembled paper trail, and the mere act of showing you're building one is usually enough to get action taken.
- vidanay 8y agoThere's the rub. It's 40% more expensive to get the certified letter (which doesn't guarantee the issue will go away) than it is to just pay the ghost bill, get a receipt and it's guaranteed to be done.
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- chrisjc 8y agoAgreed. Just got contacted by collections about unpaid services. Contacted the doctor's office about this and they said our insurance denied the claim and they couldn't get in touch with us to resolve the matter. Turns out they were submitting to our old health insurance company, and using our old home address. We were also at this office about 3-4 times before and 3-4 times after the procedure that went to collections. Tangentially, we've started to notice that doctor offices will often claim that procedures aren't covered and we have to pay out of pocket. However, we keep track of these out of pocket expenses since we're close to hitting out of pocket maxes. Turns out most of the time, the doctor's offices will still submit the claim to our health insurance company even though we paid, effectively double dipping. Also, the amount of time spent following up with doctors, payments, procedures, claims, etc is mind boggling. At least 4-8 hrs a week. Getting an answer about what is and isn't covered also seems to be some kind of black art.
- FireBeyond 8y ago> Tangentially, we've started to notice that doctor offices will often claim that procedures aren't covered and we have to pay out of pocket. However, we keep track of these out of pocket expenses since we're close to hitting out of pocket maxes. Turns out most of the time, the doctor's offices will still submit the claim to our health insurance company even though we paid, effectively double dipping. Let's not beat about the bush, this is _insurance fraud_, not "double dipping". The provider has to assert to the insurer that they have not been paid for that service rendered when they bill insurance.
- HarryHirsch 8y agoLet me guess, the Attorney General is not interested in prosecuting, because if he were physicians would be more honest. The advice would be to let the dubious bills go to collection, they'll never end up in court because that would make a paper trail.
- FireBeyond 8y agoThe AG doesn't need to be involved. Insurers, for all their faults, _love_ to hear about provider fraud and can make that an entirely uncomfortable situation for the provider.
- old-gregg 8y agoPoor "providers"... They charged us $250 for a can of apple juice and two Advil pills (AKA "recovery kit") after a broken wrist surgery, which itself was $45K without a hospital stay. No wonder they now have a "problem" having to chase non-paying people. It's like charging $10K for a handshake and then sponsoring an article on Bloomberg about being unable to collect it.
- jstewartmobile 8y ago------------------------
- blang 8y agoYou will notice with most (probably all) things medically billable the amount the insurance company pays is lower that the billing amount, that is the insurance company's negotiated rate, setting that price is one of the central things insurance companies do.
- jstewartmobile 8y ago-------------------------------
- travem 8y agoActually many readers of HN outside of the US will not be that familiar with the peculiarities of the US system.
- DoreenMichele 8y agoI'm American. I even worked in insurance for a few years. I've been a military dependent my entire life first under my father, then under my husband. I've essentially never dealt with American medical insurance. The military system is basically a different medical system. There are probably other Americans who don't really know how it works either.
- yardie 8y agoThen what are these additional bills I get from Doctors service companies. I recently paid $250 for an ER visit. That was an expected deductible as outlined in my healthcare plan. What I didn’t expect was a separate bill from the ER doctor for an additional $200 for a 5 minute visit.
- itronitron 8y agoERs are weird in that people (doctors/nurses) can just pop in and sound like they have something meaningful to say, then disappear 30 seconds later. During a recent trip to the ER with my son, for abdominal pain, one of the pop in doctors told me that he reviewed the CAT scan and 'her ovaries look good' ... I'm now inclined to write down identifying information with timestamps and summary of interaction for anyone that comes past the curtain.
- AnimalMuppet 8y agoI get those, too. I've been somewhat successful at fighting them, though.
- FireBeyond 8y agoMany hospitals like to have their physicians as contractors or consultants. For bonus points, not all hospitals require their physicians to be in the same network as the facility, so you can get an "out of network" bill for the ER doc at an in network hospital. Or, to get even more ridiculous, I went to a large chain urgent care. They had labs in house. I got a blood draw there as part of a physical from the PA-C. And an out of network bill. Lab ABC, owned by healthcare provider ABC, inside an ABC urgent care, was somehow out of network, in contrast to the facility and the provider. Cue a $600 bill...
- pfisch 8y agoProcedures can't cost more than the average cost of the same procedure across similar oecd countries. We pop the corruption bubble and all fights about insurance costs would just disappear because in reality the reason they are so high is because all of this is just a shakedown from the medical/pharma industry. I'm so sick of this all being framed as a battle over single/multi provider obamacare insurance bullshit when it is really just misdirection and we are being wildly overcharged for services. It's like we can only debate whether we pay 1000% markup using a credit card, paypal or cash, and not talk about the 1000% markup.
- aidenn0 8y agoBut where is the money going? I don't know many poor doctors, but most of the ones I do know are not exactly rolling in cash.
- itronitron 8y agoThe money is probably going into custom homes, the practice, malpractice insurance, children's education, restaurants, and vacations.
- darawk 8y agoWhat? No. Doctors make good money, but not enough to explain anywhere near the costs seen in the healthcare system. Doctors make between 200k and 1mm/year depending on how specialized they are. That isn't even close to sufficient to explain the cost inflation in healthcare.
- itronitron 8y agoTrue, I am just pointing out where their income is likely going. Is there any good source of hard data on the billing amounts and quantity by doctor, practice, or hospital?
- pishpash 8y agoIt's the administrative apparatus of hospitals. Not only doctors, but staff, admins, real estate, etc. Notice how swanky some "clinics" are? Also doctors' pay does grow at super-inflationary rates according to data. That's at least part of the story.
- devonbleak 8y agoAnecdotally I just find it ridiculous that they can't charge me whatever I'm going to owe at the time of the visit. I'm fine paying it then and there, but when you send me a dead tree 3 months later and want me to either send a check or write down my credit card number and send that back forget it - I'll pay you when I see you again. Seems like a much better solution would be for the insurance to just pay it and then charge me the rest. At least that way I only have one entity to deal with and they probably support online payments. And they're in a much better position to exert leverage to get me to pay - if I'm too far behind on paying them they can suspend my insurance whereas a care provider that I'm unlikely to see for months or years really has no recourse other than sending me more dead trees begging for payment.
- hinkley 8y agoOr just be consistent about the bills. If I get a bill for $850 and then another one for $1150 do I owe $1150? $2000? Have you run this by my insurance yet? So I just wait 60 days and go with whatever the last bill is they sent me. I could do 30 days but I'm already pissed that they can't get their shit together (and at the state of health care) so they can stew for all I care.
- darawk 8y agoThis is exactly how insurance and medicine ought to work. The only way we're going to fix the costs in our healthcare system is through high-deductible plans and transparent pricing. > Now, instead of getting paid by insurance companies on a predictable schedule, health-care providers have to engage in an awkward dance. One moment they’re removing a pre-cancerous skin mole. The next, they’re haranguing patients to pay what’s become a growing portion of the total medical bill. In a situation like that, why aren't they just taking the money upfront? It's not like a skin mole is ultra urgent.
- fzeroracer 8y agoConsidering high deductible plans are a scam and part of the reason why we're in this situation in the first place, I disagree.
- lotsofpulp 8y agoHigh deductible plans are the closest thing to health insurance by definition. Your home insurance doesn't cover routine and expected problems such as roofing replacement or seal coating the driveway. It's for unexpected AND unaffordable damages.
- fzeroracer 8y agoI would say anything that discourages people from getting basic preventative care is a bad thing even if in your strange world HDHP is somehow closer to 'real' health insurance. HDHPs as I mentioned encourage people to bet against their own health, that they will never get in an accident, or their body won't decide to crap out on them and so forth. Additionally they defeat the entire purpose of insurance which is that the people at risk are subsidized by the healthier people; if you separate the two pools then the healthy pay marginally less while the unhealthy pay a lot more. For example, would you consider HDHPs that don't cover vaccines to be a good or a bad thing? It's a routine checkup, yet we've established that in general it's of greater benefit to society if we do get those routine checkups done.
- mjevans 8y agoHealthcare, in America, is broken. We need single payer healthcare for all emergency and 'standard' care (government gets a bid on rates from practitioners in the area, and if it doesn't like the rate, supports patients via the military systems). That includes vision and dental; being able to see and being able to consume food properly tend to be requirements for workforce productivity. Cosmetic and luxury care (like cutting triage lines in non-emergencies) can be premium services.
- chrisseaton 8y ago> supports patients via the military systems Why should the military be involved?
- SolarNet 8y agoAuthor probably meant military health care systems.
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- maxerickson 8y agoI think they are probably partly talking about VA hospitals, which aren't part of the Department of Defense (the VA is a cabinet level department all its own). There aren't enough military hospitals to meaningfully support civilians. There's not enough VA hospitals to do it either, but whatever.
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- mjevans 8y agoProvider of last resort / "I can do it better"; the argument is generally that private healthcare can do things better/faster/cheaper. So then why not let the infrastructure that serves the active military provide care? Or training for doctors beyond what civilian residency programs provide?
- toomim 8y agoPart of the problem is that hospitals don't disclose prices before performing services. So patients must agree to a procedure -- yet only afterward find out how much it costs. That price can be shocking, and the patient never agreed to pay it. No wonder it becomes hard to collect from them. In the rest of the economy, we agree on a price beforehand. That makes customers more likely to pay. The medical system, however, has given up on disclosing prices to patients, because everything is paid by insurance. And now we have Doctors who say: > “It's harder to collect from the patient than it is from the insurance,” said Amy Derick, a doctor who heads a dermatology practice outside Chicago. If you want people to pay, then make an agreement with them before you perform the service!
- pishpash 8y agoExactly. Fed up with being turned into debt collectors? Then don't be shady loan sharks using debt collection as a price negotiation tool.
- aczerepinski 8y agoFinding out the price is only half the battle - finding out every doctor who might be involved in a procedure so you can make sure they're in network is the other half. Getting healthcare - even with insurance - can be terrifying.
- badwolf 8y agoGah. This is such a shitty thing. "Sorry, the anesthesiologist was out of network, though everyone else in the hospital is in network"
- sumoboy 8y agoIf you're in an in-network hospital it's not your job to interview every doctor that sees you and determine if they're in or out of network. Take it up with the hospital billing when you get the bill is what I was told by hospital admin people and tell them it's not my problem.
- rwbt 8y agoIn any industry that involves insurance companies predominantly paying bills, will eventually lead to out of control costs (health, auto collision repair etc) Higher the costs, more incentive (or mandatory) for users to buy insurance and also more profits to insurance companies.
- stephen_g 8y agoIt's true - a higher proportion of cost borne by insurance companies and the private sector is very strongly correlated with higher healthcare spending - this is from OECD data: https://images.theconversation.com/files/44253/original/3y3hh26p-1395196169.jpg https://images.theconversation.com/files/44253/original/3y3h... Full article - https://theconversation.com/private-insurance-reliance-means-countries-pay-more-for-health-care-24486 https://theconversation.com/private-insurance-reliance-means...
- jld 8y agoI am always amazed at how little of the total bill insurance pays for normal visits. By the time you include copays, coinsurance, and the insurer's negotiated rates, nearly half of what the doctor gets paid is paid by me.
- FireBeyond 8y agoPretty much. They'll argue that the negotiation is part of the "value" they add, but beyond that in many cases they're merely rent seeking.
- Vekz 8y agoSame concerns here. Always left feeling "why do I have to pay this I thought I was insured?". Seems everything has some papercut payment that is un covered
- sergiotapia 8y agoCry me a river. Stop charging obscene amount of money for services.
- nickthemagicman 8y agoI don't know why you're being downvoted. Everyone tries to lay the problems with healthcare everywhere else BUT the actual cost of the service. My aunt went to the ER for a snakebite. They gave her the anti-venin and let her stay for 12 hours. It cost 46,000 dollars. It was a rattle snake. They do this thing all the time in India for COBRA bites and it's not even close to being that expensive.
- joecool1029 8y ago> They do this thing all the time in India for COBRA bites and it's not even close to being that expensive. US Pharma would say because India doesn't care about medical patents and R&D cost. (Not saying I agree at all, but that's the excuse given)
- zaptheimpaler 8y agoHeres an article breaking down the cost of precisely that rattlesnake antivenin [1] Unsurprisingly, its mostly blatant money grabbing. 70% is pure markup that insurers don’t pay but uninsured do. 2% is the R&D cost. Probably for something we invented 100 years ago which makes you wonder just how the R&D continues to cost $100+ per dose decades after its basically perfected anyways. [1] https://www.washingtonpost.com/news/wonk/wp/2015/09/09/the-crazy-reason-it-costs-14000-to-treat-a-snakebite-with-14-medicine https://www.washingtonpost.com/news/wonk/wp/2015/09/09/the-c...
- ucaetano 8y agoPatients are fed up with being turned into money bags
- nickthemagicman 8y agoDoes any one else think that traditional capitalism 'supply and demand' doesn't apply to medicine? Because the demand for your life and health is infinite.
- PinkMilkshake 8y agoEvery time I read this stuff I feel truly privileged. I'm a New Zealand citizen living in Australia. Not only do both countries have universal healthcare, but they have a reciprocal agreement to provide free healthcare to each others citizens. Australia has bulk-billed doctors and there's no shortage of them. I can book an appointment online for tomorrow, wait for 10 minutes in a waiting room and see a GP for free. I can even choose which GP I want to see. And I'll likely get anything they prescribe me for free as well. Medicare refunds so much money I sometimes feel guilty because I know I can afford it. My partner has a chronic health condition that resulted in her large intestine being removed and she requires thousands of dollars worth of medication a month, likely for the rest of her life. We've never paid for surgery or medication beyond admin or prescription fees. I want this for everyone and I pay my taxes gladly. I would pay more for an even better system. You don't have shit if you don't have your health.
- lostlogin 8y agoI’m pleased you and your partner are getting good care. There have been too many stories recently about how rule changes have completely shafted New Zealanders in Australia. Something is changing - the accelerating rate at which people who can be deported from Australia are shunted out is another part of it.
- eriktrautman 8y agoGoing to Australia and NZ earlier this year was when I finally had to admit that there is absolutely no justifiable reason why we have such a shitty system in the US. I paid out of pocket for an MRI because it was cheaper than anything I would have gotten in the US with insurance. The end-to-end experience was great. I returned to find that I couldn't enroll in health insurance until 2019 unless I joined a company as a fulltime employee, resulting in a terrifying 6-month coverage gap where the only option was BOTH paying the lack-of-coverage penalty AND paying for shit "no way they're reimbursing anything" temporary coverage from an agency that didn't even send an insurance card. Our system is undeniably and unjustifiably fucked.
- sangd 8y ago"We can't do it for free" but you can't just set any price. I dislike doctors and hospitals for never disclosing the service fee or being truthful about their treatments done on the patients, especially the ER ones. They often perform unnecessary procedures and mark up the fees so high to jack up the cost and settle with a bit less which is still ridiculously high.
- joecool1029 8y agoHere's a thought: Maybe doctors should do what nearly every other industry can do. Provide a price quote upfront? I will say there was one circumstance where I received upfront billing without health insurance and that was for a colonoscopy. It was around $2k and they gave a 25% discount for payment upfront. So it's certainly possible for healthcare providers to do this. As I mention below, it's not usually the case: I broke my hand a little over a year ago during a gap without health insurance. Knowing the ER would start at $1000 for a 'hello' and that I might not have a competent specialist, I decided to take matters into my own hands (haha). First was a call to a friend in Montreal with a sister that's a surgeon. I assessed that while driving to Canada would be more cost effective than a US emergency room, the border might give me issues and followup visits would be troublesome. So, I walked off the mountain and made a makeshift splint at a Rite Aid with medical tape and a plastic ruler for around $5 ( https://twitter.com/vvtgd/status/879360595526635520 https://twitter.com/vvtgd/status/879360595526635520 ). When I got back home a few days later I went to a hand specialist, told them I'd pay upfront and had them set it. All in with followups it was around $800. Initially the specialist's receptionist idiots couldn't figure out how to bill me in person. If you have staff that doesn't know how to invoice a client that pays in cash, you shouldn't be in business. Full stop. Why should a cash paid-in-full client pay more than any other insurance company is beyond me. Another back on insurance anecdote: I needed an urgent visit not too long ago. PCP wasn't updated on my card, but I did it through health insurance website. Dr still wouldn't accept. Had to pay in person with my CC. Receptionist stole the CC details (it was the only place I used that card for magstripe transaction at in weeks). I needed to get a new card and manually submit the payment details. It's been two months and I still don't have the money back for the visit. (I'm not going to repeat myself but many years back I also had a rabies vaccination story in which I received almost $20k in hospital bills) What the above anecdote suggests is that the industry is broken and relies on fantasyland pricing because providers no longer have to compete due to insurance networks. The new hotness is VC's getting into running clinics because as universities can do, they can charge unlimited pricing and force the market to accept it. You don't have an option to barter with health providers, you can't sue them when they are scumbags (because professional protections, etc), and in most situations you don't have a choice whether you get sick/injured... it's just the risk of living.
- 8y ago
- almostdeadguy 8y agoIt's baffling to me that so many smart people on this website don't understand how complex health insurance is or seem to think that people don't pay their bills because they don't like the prices
- sumoboy 8y agoRich or poor, money is money and if you feel like your getting screwed there is very little reason to feel obligated to pay when due or ever.
- almostdeadguy 8y agoPeople don't file for bankruptcy to stick it to their hospital, and their hospital isn't putting 7 administrators and clerical workers per 10 physicians on payroll to negotiate repayment and answer questions w/ people who could easily pay their full bill. Let me clarify that I'm not siding w/ the hospitals: you are getting screwed, there's no question about that. My problem w/ the discourse here is people who treat this like some econ 101 practice problem, when there's no evidence that "price transparency" does anything to address healthcare costs [1]. [1]: https://www.nytimes.com/2016/12/19/upshot/price-transparency-is-nice-just-dont-expect-it-to-cut-health-costs.html https://www.nytimes.com/2016/12/19/upshot/price-transparency...
- sumoboy 8y agoI don't know how often people are filing bankruptcy over hospital bills but I don't it would matter even if there was price transparency. I haven't seen any hospitals going bankrupt lately. The cost of healthcare for those not under a group insurance plan or subsidized ACA plans is crazy expensive for a family regardless. To the point of what's more important your house payment or health ins payment? People are just barely scraping by so the intent to pay in the bill in full is just a dream, even if it's just a $100. They would rather face the consequences of bill collectors nagging them which they just ignore.
- 8y ago
- kapauldo 8y agoPoor millionaires.
- deleted 8y ago[deleted]
- sjg007 8y agoThe real issue here is that HSAs are criminal.. Do not work for a company if the only health insurance plan available is an HSA... unless you are young of course.
- pishpash 8y ago> “There’s a burden on both sides,” said Callas. “But health-care providers get caught in the middle.” Caught in the middle my arse. This is bigly shirking the responsibility and falsely playing the victim. Healthcare providers are extremely well versed in the billing rules and are playing dumb when they pretend not to know. There are literally manuals and seminars on how to bill (i.e. "code") one service as several, or code to a more profitable option when several options are possible, while hiding behind a veneer of respectable neutrality. Multiple large providers have been sued for essentially insurance fraud and go back to doing exactly the same. It's a big business driven by quarterly numbers and providers don't hire expensive staff to lose at gaming the system. Do you as a patient have a full-time staff to go through billing arcana for you all day? It's impossible to even find a patient advocate. Then on top of that larger providers like hospitals aggressively sell bills to collections agencies on any dispute, abusing the power over the patient's credit as their first resort at price gouging. Thank god for the CFPB and the 2015 credit reporting rule change [1]. The day of reckoning is coming and doctors need a long look in the mirror for why they are in this line of work. [1] https://ag.ny.gov/press-release/ag-schneiderman-announces-groundbreaking-consumer-protection-settlement-three-national https://ag.ny.gov/press-release/ag-schneiderman-announces-gr...
- kleenme 8y agoAm I the only one who finds it strange to hear a doctor refer to a hospital/practice as a "small business"?
- deleted 8y ago[deleted]
- bdodge4 8y agoAuthor of the article here: if anyone wants to talk more about their surprise bills, shoot me an email at bdodge4@bloomberg.net
- spectrum1234 8y agoHere's an idea. Make it legal to get lower quality service and pay less. Like every other good and service.
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