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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
by 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 agoI 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 agoPropaganda 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 agoNot 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.
- marcus_holmes 8y agoI think it's something in the American mindset. It's been said before, but Americans think of themselves as "temporarily embarrassed millionaires" when voting (hence why they consistently vote in the interests of the rich - everyone thinks they'll benefit from those tax cuts when they win the lottery/sell their startup/etc). Same situation here; "health care costs are for those sick losers. I'm not going to get sick, so it doesn't matter to me how much it costs, and I don't want to pay more tax to reduce healthcare costs for those losers". I exaggerate, but it does seem like there's something like this going on...
- TheOtherHobbes 8y agoIt is partly a cultural thing - a kind of cult of narcissism. But those attitudes are carefully cultivated by the media. They don't just happen. Congress and the Senate are full of corrupt leeches, and both parties are equally guilty. Votes make no difference. Corporate money buys political careers, and it pays for both sides. There are a few exceptions, cultivated to maintain the appearance of representative democracy, but they're rarely - if ever - allowed anywhere near policy.
- marcus_holmes 8y agoyeah. Can you refuse treatment from an OON provider in a hospital? Because that would be my first question if approached by a doctor who could potentially bill me $100K
- brazzy 8y ago> Can you refuse treatment from an OON provider in a hospital? In most cases you will not know that it's an OON provider. You may be under sedation at the time. The practice is outlawed in many states, as far as I know.
- isostatic 8y agoWhen I go to hospital, on the assumption I'm conscious, the last thing on my mind is deciding which doctor I want
- cm2187 8y agoFor ER agreed. For anything else that is serious / non trivial, you also want to consider the repuation of the department. Some doctors are world specialist of something, or treat dozens of a particular condition every year. Others rarely do or are simply not good. I don't think there is any way for a layman to know. You kind of need to ask relatives in the profession, who can themselves ask around. I have a few doctors as relatives and they systematically check the reputation.
- EvanAnderson 8y agoI don't think millions of people are okay with it. I think the vast majority are unaware, those who are aware have no agency, and very powerful interests seek to maintain the status quo.
- howard941 8y agoWe're not okay with it. And it is a racket. It's not fixed because the racketeers run the place.
- tialaramex 8y agoIt's not that millions of people are "OK" with it, but that in practice democratic elections aren't actually about policy. Suppose Alice's policy is to do X, and Bob's policy is to do Y, we might suppose voters who overwhelmingly want X will go vote for Alice, but nope, the Bob voters will still vote Bob and then be annoyed that Y happened, independent of continuing to support Bob. That doesn't make sense, but it's what happens. This would be a grave defect if the purpose of democracy was to achieve good government, but in fact we haven't the faintest idea how to get good government, democracy is a fix for bloodshed during the inevitable power transitions. So, a bunch of idiots with no clue are still in charge, but now a _different_ bunch of idiots can take over without having to murder a bunch of people to do it.