4 ms·

Exact same thing happened to my friend. He did all his research, and while he was under anesthesia a nurse assisted that was out of network. $5k out of pocket.

by jclay 8y ago

Exact same thing happened to my friend. He did all his research, and while he was under anesthesia a nurse assisted that was out of network. $5k out of pocket. He ended up getting it removed after some run around between insurance and the hospital.

noja 8y ago
Today is "don't believe the comments day" it seems. How is an unconscious person meant to be stop an "out of network" nurse assisting? Is there a tattoo that you can get?
- hahla 8y ago
  I think OP meant he was able to get the extra $5k removed from the bill after the fact.... not the nurse removed from the operating room.
  - noja 8y ago
    Yes I understood that he got the charge removed. I couldn't understand the initial situation (that such a thing could happen).
- deleted 8y ago
  [deleted]
- ceejayoz 8y ago
  > How is an unconscious person meant to be stop an "out of network" nurse assisting? They can't. That's the problem - there's little you can do to stop it from happening, even if you're aware of this sort of billing problem and try to take steps to prevent it. 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... > Surprise bills occur when a patient goes to a hospital in his insurance network but receives treatment from a doctor who does not participate in the network, resulting in a direct bill to the patient. They can also occur in cases like Calver's, where insurers will pay for needed emergency care at the closest hospital — even if it is out of network — but the hospital and the insurer may not agree on a reasonable price. The hospital then demands that patients pay the difference, in a practice called balance billing. https://www.npr.org/sections/health-shots/2015/02/17/386908835/figuring-out-if-a-doctor-is-in-your-network-can-be-perplexing https://www.npr.org/sections/health-shots/2015/02/17/3869088... > The surgeon's office later told her that he belonged to two different medical groups. One was in Morgan's husband's health plan network, the other wasn't.
  - bemurphy 8y ago
    > The surgeon's office later told her that he belonged to two different medical groups. One was in Morgan's husband's health plan network, the other wasn't. I got this one, it was mindblowing. For ER work, they'd bill through one practice, for scheduled appointments, another. I got balance billed for $11k. My father, who worked in employee benefits for over 30 years, couldn't even figure out what was up at first. Then they filed to send me to collections because I kept refusing to pay (note, I'm in California and this billing is illegal for life-threatening emergency visits matching the situation I was in). Finally, the insurance company stepped in and covered me, but we were only able to achieve this because my family knew people personally at the insurer. All kinds of messed up.
andrei_says_ 8y ago
What blows my mind is how a nurse costs $5k for the duration of a surgery. Surely the nurse did not make $5k. Where does this money go?
- wmil 8y ago
  Hospitals are required to treat the uninsured, but the government doesn't actually compensate them for that. So they jack up everyone else's bills in the hopes that enough people will pay that they'll make a profit. Insurance companies will usually push back, so (sometimes partially) uninsured people with decent credit hit with huge charges.
  - josho 8y ago
    > So they jack up everyone else’s bills No. That’s the justification given so that people get angry at the wrong thing. Hospitals charge this because they CAN. They are doing what businesses do and that is maximizing their profit. Don’t get angry at the uninsured get angry at the politicians for enabling a broken system.
    - vonmoltke 8y ago
      > Hospitals charge this because they CAN. They are doing what businesses do and that is maximizing their profit. Including all the non-profit hospitals? What's their motivation?
      - ceejayoz 8y ago
        Fancy new buildings, giant endowments, amenities for staff, raising administrator salaries "to retain premium talent", etc. "Non-profit" doesn't mean "can't make a profit".
        chimeracoder 8y ago
        > Fancy new buildings Rarely paid for with reimbursement revenues. > giant endowments Definitely not paid for with reimbursement revenues. > amenities for staff Try cutting these, and see how quickly 1199 SEIU comes down on you. > raising administrator salaries "to retain premium talent", etc. Even if you assumed that there were no relationship between the wages paid and the quality of work performed (there is), these are nowhere near big enough to account for the difference. They're also not that far out of line with other countries, either: 25% in the US, compared to 20% in the Netherlands, for example. But more so than that: they're SG&A expenses, which are further down the balance sheet than the reimbursement revenues. And yet, hospitals actually lose money on the top line for Medicare patients (who represent about 40% of the market). That's the real reason reimbursement rates are raised for private insurers - the private insurers are required (by law) to pay more, and they need to subsidize the sub-COGS reimbursements from the public insurers (Medicare, and to a lesser extent Medicaid). So no, none of the things you listed actually explain the reason hospitals charge private insurers the rates they do.

by jclay 8y ago

noja 8y ago

Today is "don't believe the comments day" it seems. How is an unconscious person meant to be stop an "out of network" nurse assisting? Is there a tattoo that you can get?

hahla 8y ago
I think OP meant he was able to get the extra $5k removed from the bill after the fact.... not the nurse removed from the operating room.
- noja 8y ago
  Yes I understood that he got the charge removed. I couldn't understand the initial situation (that such a thing could happen).
deleted 8y ago
[deleted]
ceejayoz 8y ago
> How is an unconscious person meant to be stop an "out of network" nurse assisting? They can't. That's the problem - there's little you can do to stop it from happening, even if you're aware of this sort of billing problem and try to take steps to prevent it. 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... > Surprise bills occur when a patient goes to a hospital in his insurance network but receives treatment from a doctor who does not participate in the network, resulting in a direct bill to the patient. They can also occur in cases like Calver's, where insurers will pay for needed emergency care at the closest hospital — even if it is out of network — but the hospital and the insurer may not agree on a reasonable price. The hospital then demands that patients pay the difference, in a practice called balance billing. https://www.npr.org/sections/health-shots/2015/02/17/386908835/figuring-out-if-a-doctor-is-in-your-network-can-be-perplexing https://www.npr.org/sections/health-shots/2015/02/17/3869088... > The surgeon's office later told her that he belonged to two different medical groups. One was in Morgan's husband's health plan network, the other wasn't.
- bemurphy 8y ago
  > The surgeon's office later told her that he belonged to two different medical groups. One was in Morgan's husband's health plan network, the other wasn't. I got this one, it was mindblowing. For ER work, they'd bill through one practice, for scheduled appointments, another. I got balance billed for $11k. My father, who worked in employee benefits for over 30 years, couldn't even figure out what was up at first. Then they filed to send me to collections because I kept refusing to pay (note, I'm in California and this billing is illegal for life-threatening emergency visits matching the situation I was in). Finally, the insurance company stepped in and covered me, but we were only able to achieve this because my family knew people personally at the insurer. All kinds of messed up.

andrei_says_ 8y ago

What blows my mind is how a nurse costs $5k for the duration of a surgery. Surely the nurse did not make $5k. Where does this money go?

wmil 8y ago
Hospitals are required to treat the uninsured, but the government doesn't actually compensate them for that. So they jack up everyone else's bills in the hopes that enough people will pay that they'll make a profit. Insurance companies will usually push back, so (sometimes partially) uninsured people with decent credit hit with huge charges.
- josho 8y ago
  > So they jack up everyone else’s bills No. That’s the justification given so that people get angry at the wrong thing. Hospitals charge this because they CAN. They are doing what businesses do and that is maximizing their profit. Don’t get angry at the uninsured get angry at the politicians for enabling a broken system.
  - vonmoltke 8y ago
    > Hospitals charge this because they CAN. They are doing what businesses do and that is maximizing their profit. Including all the non-profit hospitals? What's their motivation?
    - ceejayoz 8y ago
      Fancy new buildings, giant endowments, amenities for staff, raising administrator salaries "to retain premium talent", etc. "Non-profit" doesn't mean "can't make a profit".
      - chimeracoder 8y ago
        > Fancy new buildings Rarely paid for with reimbursement revenues. > giant endowments Definitely not paid for with reimbursement revenues. > amenities for staff Try cutting these, and see how quickly 1199 SEIU comes down on you. > raising administrator salaries "to retain premium talent", etc. Even if you assumed that there were no relationship between the wages paid and the quality of work performed (there is), these are nowhere near big enough to account for the difference. They're also not that far out of line with other countries, either: 25% in the US, compared to 20% in the Netherlands, for example. But more so than that: they're SG&A expenses, which are further down the balance sheet than the reimbursement revenues. And yet, hospitals actually lose money on the top line for Medicare patients (who represent about 40% of the market). That's the real reason reimbursement rates are raised for private insurers - the private insurers are required (by law) to pay more, and they need to subsidize the sub-COGS reimbursements from the public insurers (Medicare, and to a lesser extent Medicaid). So no, none of the things you listed actually explain the reason hospitals charge private insurers the rates they do.