5 ms·

You 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

by blang 8y ago

You 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
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- travem 8y ago
  Actually many readers of HN outside of the US will not be that familiar with the peculiarities of the US system.
  - DoreenMichele 8y ago
    I'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.
    - maxxxxx 8y ago
      I am always surprised that the "support the troops" Republicans inflict socialized health care on the military. You should think that they would want to liberate the poor soldiers to enjoy the freedom of the free health care market.
      - DoreenMichele 8y ago
        I'm not very political. I'm assuming that's sarcasm, but I don't really know. There are people who genuinely think the military medical system sucks, though I'm not one of them.
        maxxxxx 8y ago
        I was sarcastic. I just don't get how hypocritical it is to claim how bad socialized healthcare is while maintaining socialized healthcare for one of their favored groups (the military). I am sure the VA has its problems but I rarely hear a vet say they want to abolish the VA and enjoy the freedoms of the US healthcare market.
        DoreenMichele 8y ago
        It's a little more complicated than that. Again, I'm not political. I just know a good bit about the military system. The military needs its own medical assets so it can treat soldiers in times of war. For security purposes, it needs medical facilities and medical personnel under its own control. It isn't sufficient for there to be sufficient civilian facilities. Military dependents get free medical care in part to keep doctors busy with real cases during peace time. Military members and their dependents cannot file malpractice suits. There are people who are very unhappy with this fact. Mistakes do happen. When they happen, you don't have recourse to sue and this is a point of contention for some people. They also have world class facilities. If something goes seriously wrong, you can get referred to one of their regional hospitals. I'm alive in part because we happened to be stationed at a base with a regional hospital when things went badly sideways for me. It served military personnel in eight states. It was a teaching hospital with connections to UC-Davis Medical in Sacramento and, I think, Stanford in San Francisco. I had testing in both cities. I got a cutting edge diagnosis. That was a turning point in my life. For the record, I think we need a single payer system in the US. The current civilian medical system is seriously broken.
        80mph 8y ago
        The VA is seriously broken. Just look at how poorly they treat mental health care [1]. What's the point of having access to world class facilities during combat, if you're just left to fend for yourself when you return home? [1]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5563010/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5563010/
- asr 8y ago
  What you have described -- a provider who does not try to collect the patient responsibility portion of a bill -- is actually insurance fraud (because the provider has told the insurer the total price for the procedure is $42k, when the provider actually only intends to collect $38k). I'm not saying that means it didn't happen--things like this are incredibly common--but a reply suggesting you might not have described the full picture and it's possible there is no fraud is not completely out of line or an insult to your intelligence. (I upvoted your original comment, BTW.)
Novashi 8y ago
The fact that the never-paid price ever reaches the patient in the form of a bill is the problem. This isn't for lack of pricing data. Hospitals know what they've paid for procedures previously. Every patient and procedure is different but it's rarely very different. If a hospital has to bill a patient without insurance, what they charge should be pegged to a historical average for the baseline procedure. Forcing us to negotiate puts undue burden on the patient. It's bad enough I have to occasionally call to keep my prices the same for cable and phone services.
- chrisbennet 8y ago
  I can’t find it now but someone responded to one of these threads that is actually illegal to negotiate your bill except for hardship cases.

by blang 8y ago

jstewartmobile 8y ago

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travem 8y ago
Actually many readers of HN outside of the US will not be that familiar with the peculiarities of the US system.
- DoreenMichele 8y ago
  I'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.
  - maxxxxx 8y ago
    I am always surprised that the "support the troops" Republicans inflict socialized health care on the military. You should think that they would want to liberate the poor soldiers to enjoy the freedom of the free health care market.
    - DoreenMichele 8y ago
      I'm not very political. I'm assuming that's sarcasm, but I don't really know. There are people who genuinely think the military medical system sucks, though I'm not one of them.
      - maxxxxx 8y ago
        I was sarcastic. I just don't get how hypocritical it is to claim how bad socialized healthcare is while maintaining socialized healthcare for one of their favored groups (the military). I am sure the VA has its problems but I rarely hear a vet say they want to abolish the VA and enjoy the freedoms of the US healthcare market.
        DoreenMichele 8y ago
        It's a little more complicated than that. Again, I'm not political. I just know a good bit about the military system. The military needs its own medical assets so it can treat soldiers in times of war. For security purposes, it needs medical facilities and medical personnel under its own control. It isn't sufficient for there to be sufficient civilian facilities. Military dependents get free medical care in part to keep doctors busy with real cases during peace time. Military members and their dependents cannot file malpractice suits. There are people who are very unhappy with this fact. Mistakes do happen. When they happen, you don't have recourse to sue and this is a point of contention for some people. They also have world class facilities. If something goes seriously wrong, you can get referred to one of their regional hospitals. I'm alive in part because we happened to be stationed at a base with a regional hospital when things went badly sideways for me. It served military personnel in eight states. It was a teaching hospital with connections to UC-Davis Medical in Sacramento and, I think, Stanford in San Francisco. I had testing in both cities. I got a cutting edge diagnosis. That was a turning point in my life. For the record, I think we need a single payer system in the US. The current civilian medical system is seriously broken.
        80mph 8y ago
        The VA is seriously broken. Just look at how poorly they treat mental health care [1]. What's the point of having access to world class facilities during combat, if you're just left to fend for yourself when you return home? [1]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5563010/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5563010/
asr 8y ago
What you have described -- a provider who does not try to collect the patient responsibility portion of a bill -- is actually insurance fraud (because the provider has told the insurer the total price for the procedure is $42k, when the provider actually only intends to collect $38k). I'm not saying that means it didn't happen--things like this are incredibly common--but a reply suggesting you might not have described the full picture and it's possible there is no fraud is not completely out of line or an insult to your intelligence. (I upvoted your original comment, BTW.)

Novashi 8y ago

The fact that the never-paid price ever reaches the patient in the form of a bill is the problem. This isn't for lack of pricing data. Hospitals know what they've paid for procedures previously. Every patient and procedure is different but it's rarely very different. If a hospital has to bill a patient without insurance, what they charge should be pegged to a historical average for the baseline procedure. Forcing us to negotiate puts undue burden on the patient. It's bad enough I have to occasionally call to keep my prices the same for cable and phone services.

chrisbennet 8y ago
I can’t find it now but someone responded to one of these threads that is actually illegal to negotiate your bill except for hardship cases.