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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 ht

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.

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.