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> As a Bank of America emplyee he had somewhat goog insurance that paid some. He was left with $180,000 bill. Forgive my ignorance but how is that possible? T

> As a Bank of America emplyee he had somewhat goog insurance that paid some. He was left with $180,000 bill. Forgive my ignorance but how is that possible? The highest out of pocket maximums for Marketplace plans is $15700 for an entire family.

EvanAnderson 8y ago
He may have been traveling when he had his heart attack: https://www.wsj.com/articles/john-stockmans-medical-bills-topped-1-million-what-happened-11545934412 https://www.wsj.com/articles/john-stockmans-medical-bills-to... He may have been attended-to by out-of-network practitioner: https://www.nbcwashington.com/news/local/Out-of-Network-ER-Surgeon-Leads-to-Surprise-34K-Bill-for-Virginia-Family-493660951.html https://www.nbcwashington.com/news/local/Out-of-Network-ER-S...
- lostlogin 8y ago
  What’s with the ‘out-of-network’ thing that gets pulled out regularly? Is healthcare really that much more expensive to an insurer if it’s done at one site or another? Sure, they’d prefer it was done in-house so that the ticket can be clipped multiple times, but it’s clearly just made up numbers that are produced currently.
  - roganartu 8y ago
    It's not that it's more expensive at one place or another for the most part. When you go in-network you are seeing providers that your insurance has a contract with. This contract includes agreed amounts for procedures. Providers will often grossly overbill (mostly because it's easier to let the billing backend resolve these limits than bill accurately in the first place) and your insurance will respond with the amount covered. The remaining amount of the bill is written off because it was in-network so the provider is not allowed (by the contract with your insurance) to bill the balance not covered to the patient. Out-of-network does not have this protection. Your insurance will possibly cover some of the bill, normally up to some percentage of what they consider a normal amount for the procedure in the area, and then you will be billed for the entire balance. Say your provider bills $100k and your insurance says they think that procedure normally only costs $50k and you have 80% out of network coverage. You would be billed for 20% of the $50k covered as coinsurance, plus the remaining $50k that would've been written off if you were in-network. This is generally how people get surprise bills. For a real world example: last year my insurance got billed ~$3k for a routine blood test for my wife as part of an annual checkup. It was in-network and the insurance paid $27 and the provider wrote off the rest.
    - lostlogin 8y ago
      I understand this, but don’t understand why millions of people are ok with the system. It has a lot more in common with a protection racket than with patient care in my view.
      - komali2 8y ago
        Propaganda and lobbying by the insurance companies ensure that the will of the people doesn't turn against them.
        deleted 8y ago
        [deleted]
        deleted 8y ago
        [deleted]
        sbov 8y ago
        Not true, because people actually hate insurance companies. The best propaganda is by the hospitals because no one ever seems to complain much about them. There's been a lot of revealing reporting over the past decade but people don't seem to care: the price of a procedure in two different hospitals in the same city can vary by 10x because they literally pull prices they charge from their asses. They tend to justify this by saying "no one ever pays that price". But when I got a bill for my wife's surgery that included 15k for 1 hour in a recovery room, another 25k for 1 hour in a surgery room, and 9k for an overnight stay (on top of the 20k from the surgeon, 3k from the anesthesiologist, and 3-5k from random doctors we saw for a few seconds) those words sure as shit were not reassuring. All my past attempts to get an idea of what something might cost me, even when I knew insurance wouldn't cover it, have failed. It takes days worth of time on the phone only to get the wrong answer. One even told me that I only get the cash price if I don't have insurance even if my insurance won't cover it - and I must have insurance because its illegal to not have insurance so I can't get the cash price. What the fuck man? Hospitals can fuck off. I have no idea why they don't get more blame in this mess.
        8y ago
  - patient_zero 8y ago
    It doesn't make sense, but you have to (as a patient) make sure that the provider you're getting healthcare from is covered by the insurance company's (changeable) list. Its indefensible but it's reality. I cannot wait for reform and I hope it hits before I get old and need it often. As an aside, even the billing system is fucked up. When I get a receipt for covered care, it often looks a lot like a bill. This has to be by design. Its bad enough that I just ignore both "receipts" and bills and wait for the collectors to call me. That's how I know which is which.
- istruble 8y ago
  Number two for sure. You are almost guaranteed to be seen by an out-of-network provider. It does not matter if you go to an in-network hospital/ER, the providers go out of their way to work a couple hundred miles from home just to bring in the big OON prices. Out of three visits to in-network ERs (in two different states) in the last seven years, how many do you think resulted in crazy charges from OON providers? If you said anything other than all of them you must not be from the states. It is basically impossible not to get fleeced by "health care" in the US.
  - kasey_junk 8y ago
    I’ve been to the ER twice in the last 2 years. Once at the hospital blocks from my house & once while traveling for work 800 miles away. In neither case did I get charged out of network charges. In fact in the 25 years I’ve paid for mine or my families health care I’ve never seen what you describe over lots of ER visits. There are lots of things wrong with the US health system, providers systematically trying to get out of network fees isn’t one of them.
    - dd36 8y ago
      Your experience is the only experience. Good point.
      - vonmoltke 8y ago
        Not what kasey_junk said at all. It was responding to someone who said: > It is basically impossible not to get fleeced by "health care" in the US. The experience is evidence against this very strong statement. You have uncharitably decided it was making an equally strong statement in the opposite direction.
deleted 8y ago
[deleted]
JAlexoid 8y ago
There are interesting cases, where doctors prescribe stuff they get no valuable information from. I had this in US. Shoulder pain, that was diagnosed via an XRay... But the doctor decided he wanted an MRI. That's no unusual, but unnecessary in my case. Got charged extra $500 for the pleasure. Thankfully I was on an HDHP, so the HSA savings got hit.
- lostlogin 8y ago
  That’s not an unreasonable charge for an MRI and I’d argue that you got off quite lightly. You can’t diagnose many of the potential problems shoulders have from an x-ray but a good clinical examination will catch many of them, with an MRI for confirmation. Labral tears would be an example of this.
  - JAlexoid 8y ago
    No it's not an unreasonable charge. The amount I had to go through and the necessity of it was the question. I got charged with two things - XRay and MRI. One was enough, apparently... And I wasn't in any critical condition to an XRay immediately.
    - yholio 8y ago
      It's 2-3x more than you would pay in a regular civilized country... it speaks volumes about the US system that you think it's not an unreasonable fee.
      - lostlogin 8y ago
        I’m not sure you are correct in that - MRI scanners are expensive to run as they are rarely as low priced as you are suggesting. See link below which is a little old but gives a spread of prices. Note that the prices cited i this thread is less than half the US average. Another factor that is relatively rarely discussed is the quality. You can do a fast scan or a good scan. That’s inherent in how MRI works. A good gynaecological, cardiac or liver scan takes about 45mins, and there isn’t much you can do to improve on that as you are limited by metabolic activity (eg liver or heart contast wash-in and wash-out). If corners are cut here diagnosic quality will be reduced. I regularly see scans that are of such poor quality that they are initially mistaken for the survey scans/scouts that we use to localise the patient in the bore. They are generally from places that you would intuitively avoid for healthcare, but not always. https://www.statista.com/statistics/312020/price-of-mri-diagnostics-by-country/ https://www.statista.com/statistics/312020/price-of-mri-diag...
gumby 8y ago
In a hospital you'll likely be seen by a variety of providers some, or even many of whom are not in your network. You insurer will pay some amount out and then the provider will bill you for the rest...which can be huge. This bill is unrelated to your insurance and is unrelated to any out of pocket maximum. That maximum only relates to copays etc as part of your insurance.
- narrator 8y ago
  When I had a kidney stone, I made sure to get to Kaiser. Not the closest hospital, but at least everyone's going to be in network. That's the biggest benefit of Kaiser IMHO, no wacky out of network stuff at their hospitals.
  - VBprogrammer 8y ago
    In the UK which hospital you would go to is nearly 100% based on ease of getting there and the facilities they have on hand. The idea of driving past a hospital to get to another which is more friendly to my insurance plan completely blows my mind.
    - dogma1138 8y ago
      Only if you use the NHS, private insurance would require you to pay extra if you don’t live there especially for inner London Hospitals.
      - VBprogrammer 8y ago
        Have you lived in the UK? I personally haven't encountered anyone who has had that issue. Most people primarily use the NHS and private health insurance is provided only occasionally as an employee benefit (often by American companies). That's nice for perhaps getting faster treatment for minor issues and maybe getting a nicer room but generally not required. I'm sure that the 1% have other arrangements but that's another thing altogether.

EvanAnderson 8y ago

He may have been traveling when he had his heart attack: https://www.wsj.com/articles/john-stockmans-medical-bills-topped-1-million-what-happened-11545934412 https://www.wsj.com/articles/john-stockmans-medical-bills-to... He may have been attended-to by out-of-network practitioner: https://www.nbcwashington.com/news/local/Out-of-Network-ER-Surgeon-Leads-to-Surprise-34K-Bill-for-Virginia-Family-493660951.html https://www.nbcwashington.com/news/local/Out-of-Network-ER-S...

lostlogin 8y ago
What’s with the ‘out-of-network’ thing that gets pulled out regularly? Is healthcare really that much more expensive to an insurer if it’s done at one site or another? Sure, they’d prefer it was done in-house so that the ticket can be clipped multiple times, but it’s clearly just made up numbers that are produced currently.
- roganartu 8y ago
  It's not that it's more expensive at one place or another for the most part. When you go in-network you are seeing providers that your insurance has a contract with. This contract includes agreed amounts for procedures. Providers will often grossly overbill (mostly because it's easier to let the billing backend resolve these limits than bill accurately in the first place) and your insurance will respond with the amount covered. The remaining amount of the bill is written off because it was in-network so the provider is not allowed (by the contract with your insurance) to bill the balance not covered to the patient. Out-of-network does not have this protection. Your insurance will possibly cover some of the bill, normally up to some percentage of what they consider a normal amount for the procedure in the area, and then you will be billed for the entire balance. Say your provider bills $100k and your insurance says they think that procedure normally only costs $50k and you have 80% out of network coverage. You would be billed for 20% of the $50k covered as coinsurance, plus the remaining $50k that would've been written off if you were in-network. This is generally how people get surprise bills. For a real world example: last year my insurance got billed ~$3k for a routine blood test for my wife as part of an annual checkup. It was in-network and the insurance paid $27 and the provider wrote off the rest.
  - lostlogin 8y ago
    I understand this, but don’t understand why millions of people are ok with the system. It has a lot more in common with a protection racket than with patient care in my view.
    - komali2 8y ago
      Propaganda and lobbying by the insurance companies ensure that the will of the people doesn't turn against them.
      - deleted 8y ago
        [deleted]
      - deleted 8y ago
        [deleted]
      - sbov 8y ago
        Not true, because people actually hate insurance companies. The best propaganda is by the hospitals because no one ever seems to complain much about them. There's been a lot of revealing reporting over the past decade but people don't seem to care: the price of a procedure in two different hospitals in the same city can vary by 10x because they literally pull prices they charge from their asses. They tend to justify this by saying "no one ever pays that price". But when I got a bill for my wife's surgery that included 15k for 1 hour in a recovery room, another 25k for 1 hour in a surgery room, and 9k for an overnight stay (on top of the 20k from the surgeon, 3k from the anesthesiologist, and 3-5k from random doctors we saw for a few seconds) those words sure as shit were not reassuring. All my past attempts to get an idea of what something might cost me, even when I knew insurance wouldn't cover it, have failed. It takes days worth of time on the phone only to get the wrong answer. One even told me that I only get the cash price if I don't have insurance even if my insurance won't cover it - and I must have insurance because its illegal to not have insurance so I can't get the cash price. What the fuck man? Hospitals can fuck off. I have no idea why they don't get more blame in this mess.
        8y ago
- patient_zero 8y ago
  It doesn't make sense, but you have to (as a patient) make sure that the provider you're getting healthcare from is covered by the insurance company's (changeable) list. Its indefensible but it's reality. I cannot wait for reform and I hope it hits before I get old and need it often. As an aside, even the billing system is fucked up. When I get a receipt for covered care, it often looks a lot like a bill. This has to be by design. Its bad enough that I just ignore both "receipts" and bills and wait for the collectors to call me. That's how I know which is which.
istruble 8y ago
Number two for sure. You are almost guaranteed to be seen by an out-of-network provider. It does not matter if you go to an in-network hospital/ER, the providers go out of their way to work a couple hundred miles from home just to bring in the big OON prices. Out of three visits to in-network ERs (in two different states) in the last seven years, how many do you think resulted in crazy charges from OON providers? If you said anything other than all of them you must not be from the states. It is basically impossible not to get fleeced by "health care" in the US.
- kasey_junk 8y ago
  I’ve been to the ER twice in the last 2 years. Once at the hospital blocks from my house & once while traveling for work 800 miles away. In neither case did I get charged out of network charges. In fact in the 25 years I’ve paid for mine or my families health care I’ve never seen what you describe over lots of ER visits. There are lots of things wrong with the US health system, providers systematically trying to get out of network fees isn’t one of them.
  - dd36 8y ago
    Your experience is the only experience. Good point.
    - vonmoltke 8y ago
      Not what kasey_junk said at all. It was responding to someone who said: > It is basically impossible not to get fleeced by "health care" in the US. The experience is evidence against this very strong statement. You have uncharitably decided it was making an equally strong statement in the opposite direction.

deleted 8y ago

[deleted]

JAlexoid 8y ago

There are interesting cases, where doctors prescribe stuff they get no valuable information from. I had this in US. Shoulder pain, that was diagnosed via an XRay... But the doctor decided he wanted an MRI. That's no unusual, but unnecessary in my case. Got charged extra $500 for the pleasure. Thankfully I was on an HDHP, so the HSA savings got hit.

lostlogin 8y ago
That’s not an unreasonable charge for an MRI and I’d argue that you got off quite lightly. You can’t diagnose many of the potential problems shoulders have from an x-ray but a good clinical examination will catch many of them, with an MRI for confirmation. Labral tears would be an example of this.
- JAlexoid 8y ago
  No it's not an unreasonable charge. The amount I had to go through and the necessity of it was the question. I got charged with two things - XRay and MRI. One was enough, apparently... And I wasn't in any critical condition to an XRay immediately.
  - yholio 8y ago
    It's 2-3x more than you would pay in a regular civilized country... it speaks volumes about the US system that you think it's not an unreasonable fee.
    - lostlogin 8y ago
      I’m not sure you are correct in that - MRI scanners are expensive to run as they are rarely as low priced as you are suggesting. See link below which is a little old but gives a spread of prices. Note that the prices cited i this thread is less than half the US average. Another factor that is relatively rarely discussed is the quality. You can do a fast scan or a good scan. That’s inherent in how MRI works. A good gynaecological, cardiac or liver scan takes about 45mins, and there isn’t much you can do to improve on that as you are limited by metabolic activity (eg liver or heart contast wash-in and wash-out). If corners are cut here diagnosic quality will be reduced. I regularly see scans that are of such poor quality that they are initially mistaken for the survey scans/scouts that we use to localise the patient in the bore. They are generally from places that you would intuitively avoid for healthcare, but not always. https://www.statista.com/statistics/312020/price-of-mri-diagnostics-by-country/ https://www.statista.com/statistics/312020/price-of-mri-diag...

gumby 8y ago

In a hospital you'll likely be seen by a variety of providers some, or even many of whom are not in your network. You insurer will pay some amount out and then the provider will bill you for the rest...which can be huge. This bill is unrelated to your insurance and is unrelated to any out of pocket maximum. That maximum only relates to copays etc as part of your insurance.

narrator 8y ago
When I had a kidney stone, I made sure to get to Kaiser. Not the closest hospital, but at least everyone's going to be in network. That's the biggest benefit of Kaiser IMHO, no wacky out of network stuff at their hospitals.
- VBprogrammer 8y ago
  In the UK which hospital you would go to is nearly 100% based on ease of getting there and the facilities they have on hand. The idea of driving past a hospital to get to another which is more friendly to my insurance plan completely blows my mind.
  - dogma1138 8y ago
    Only if you use the NHS, private insurance would require you to pay extra if you don’t live there especially for inner London Hospitals.
    - VBprogrammer 8y ago
      Have you lived in the UK? I personally haven't encountered anyone who has had that issue. Most people primarily use the NHS and private health insurance is provided only occasionally as an employee benefit (often by American companies). That's nice for perhaps getting faster treatment for minor issues and maybe getting a nicer room but generally not required. I'm sure that the 1% have other arrangements but that's another thing altogether.