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Health system sues thousands of patients, seizes pay and puts liens on homes
- rayiner 7y agoThere are good arguments against our existing healthcare system, but this is not one of them. Collections is an issue whether or not you have universal healthcare, it just happens one step removed. What exactly do you think happens when you don’t pay your taxes? The government takes pity on you and lets you off the hook? In my county, the government auctions off a lien on your house when you fall behind on your property taxes.
- grecy 7y agoIncome tax is a different story though - and remember a massive percentage of people don't any any property and therefore have never paid a cent of property tax (me!) If you have a very low paying job (or no job) and therefore pay extremely low income taxes, you still get fantastic healthcare!
- bkohlmann 7y agoIf you’ve ever paid rent, you’ve implicitly paid property taxes. The sustainable, market rate for rent factors in all costs of the owner.
- jackvalentine 7y agoMy understanding is that setting rent is more related to what people are able to pay than the underlying cost structure of owning a building.
- munk-a 7y agoThere is a different though - when you are in poor health does your government decide you suddenly owe them 230k for surgery while you're unable to collect your income?
- SketchySeaBeast 7y agoNo, this is an excellent case of universal healthcare. In countries with it, this situation - an emergency illness leading to a pile of debt, doesn't happen. There's a huge difference between "you didn't pay your taxes" and "you got stick and are now stuck with a bill you can never hope to pay off".
- F147H34D 7y agoIt's pretty sad to think someone could be in a situation where they are sick and simply won't go to the doctor to get help -- because they can't afford it. The last thing someone should have to worry about when trying to recover from cancer or some other illness/injury is how is this bill going to get paid. I'm in law enforcement, imagine how many less calls there would be if the person calling the police had to pay for the service (directly, full cost). Healthcare should be in the same bucket as other public services, regardless of the income generated by that person.
- noobermin 7y agoPeople who make arguments for American systems benefit from American ignorance of the fact that ills that occur in America don't happen anywhere else.
- js2 7y agoExcept you don't unexpectedly get hit with a tax bill. The tax system is also the place best suited for progressive income withholding. From the article: > Patients also have trouble because like many U.S. hospitals, UVA bills people lacking coverage at rates far higher than what insurance companies pay on behalf of their members. Such bills often have little connection to the cost of care, experts say. Insurers obtain huge discounts off hospital sticker prices — 70 percent on average in UVA’s case, according to documents it files with Medicare. This is just insane. Price discrimination by health care providers should be illegal.
- rayiner 7y agoPeople get hit with unexpected tax bills all the time. Any scheme of property taxes will generate taxes on illiquid assets. So will municipal user fees (sewer, water). So will I come taxes for people likes tipped employees.
- js2 7y agoNo one ever went bankrupt from income tax. Property taxes don't suddenly jump an order of magnitude. An unexpected user fee is almost always a rare event like a broken water pipe or a bad meter and can often be negotiated with the utility.
- rayiner 7y agoPeople don’t declare bankruptcy for tax debt largely because federal taxes aren’t dischargeable in bankruptcy. But tons of people lose, for example, their homes due to tax related financial problems.
- likpok 7y agoPeople have absolutely gone bankrupt from income tax. Let's say you receive a large amount of income in the form of an asset which is suddenly devalued before you sell it. You owe income tax on the original value you received. But the stock is now worthless, so you have nothing you can sell to pay your income tax. This used to happen with ISOs during the dot-com bust. It can still happen with other volatile instruments, like cryptocurrency.
- anigbrowl 7y agoWhat a specious argument. In countries with universal healthcare if you have to go to hospital you either don't get a bill at all or just get a nominal one, and your income tax exposure doesn't change.
- rsynnott 7y agoI mean, I’m not sure how you do it over there, but here in dystopian euro-socialist Ireland (in real life, we’ve had mostly center-right coalitions for the last century, but we do have a health-care system and so on), no, the government very much won’t take your house for inability to pay property tax. There would be a revolution. Property tax is also much lower here than nearly anywhere in the US, of course; typically 0.18% of the 2013 value for homes (so about 0.1% of current value in practice). Typically, if you can’t pay, they’ll collect when you sell or die. Income tax is much higher than anywhere in the US for mid to high income people, of course, but it’s harder to be hit with unexpected income tax. The Irish healthcare system is far from perfect, by the way. Public hospital care is free for everyone(except for a capped per-night charge at 750 euro per year unless you’re low income) and primary care is free for low income people, the elderly, and young children, but there’s still a gap where lowish-income people can struggle with it, and public waiting lists for elective procedures can be long. But no-one’s going bankrupt over it, so there’s that.
- Ididntdothis 7y agoStuff like this simply shouldn’t happen in a developed country. It’s insane that this can’t get solved.
- vkou 7y agoWe have solved it - I can't think of an alternative system that would be any more optimized, towards the benefit of medical schools[1], doctors[2], hospitals[3], pharma firms[4], and insurance companies[5]. Oh, you meant solving it for actual people? That was never the goal of the self-serving architects of this rotten mess. I don't expect the farmer to grow me food out of the goodness of his heart, but to quote Adam Smith, this is a conspiracy to the detriment of the public. [1] Who charge absolutely ludicrous, jaw-dropping, nowhere-else-in-the-world-comes-close tuition. [2] Who, after paying off the debts on their ludicrous tuition, are absolutely rolling in money. [3] Who don't let their patients comparison-shop (Just try getting a straight answer on how much a routine procedure is going to cost), and in effect, can charge whatever prices they want. [4] Who are happy to make billions of dollars off inefficiencies created by them, in the generic space. [5] Who have created a captive market where not getting your healthcare through them is financially ruinous.
- mschuster91 7y agoLook to Europe, we solved this decades ago.
- samfisher83 7y agoOr Canada or pretty much every developed country in the world.
- Frost1x 7y agoThere's been an ongoing shift of power and rights to the very wealthy over everyone else's interests. It's not new but it's becoming more and more obvious to the average citizen. Here in the US, our culture still praises this behavior because it props up the carrot that is the American dream. It's a cultural problem where everyone has been convinced they're the next billionaire to reap the rewards of the broken political and economic system... they're just temporarily and shamefully poor for now. So the problem runs far deeper than healthcare, it's everywhere. Healthcare is just an obvious target because it directly effects people when they're most vulnerable and it actually angers them enough to complain a little. We need a cultural shift that is reflected in our politics (if it's not too late already).
- oceanghost 7y agoThis violates our long-held arrangement-- that they can keep charging these ridiculous prices because we have no intention of paying them.
- SketchySeaBeast 7y agoTurns out the entity with the money and lawyers can change the agreement at any time - who knew?
- donclark 7y agoHow is our health system legally mandatory? Why do we HAVE to pay into medicaid etc. if the system is not run efficiently? Why is there not an alternative?
- munk-a 7y agoBecause the market has been fully captured by current players and new entrants either play along or are forced out of business - but generally don't even try to join because of the prohibitive barriers to entry. Medicaid is one of the less broken parts of the system actually.
- ASalazarMX 7y agoThe moral of the history is: Not everything should be run by businessmen.
- Shivetya 7y agoMedicade will take your property too so they can recoup costs if you die, so let me be blunt. the whole US health care system is a mess because government, state and federal, made it one. then they continue to pile on to make it worse all the while fattening their campaign chests at the expense of everyone else. the only way to fix US health care is to forever remove it from influence by politicians. Yeah it would take a law to do it but the system setup should basically tell the government, pay us and shut up.
- munk-a 7y ago> the only way to fix US health care is to forever remove it from influence by politicians. Politicians aren't controlling the health care system at this point - they've been entirely declawed. There is a strong enough cartel that it would survive anything the free market could throw at it, only active government action would actually resolve this issue... just... not entirely corrupt government action.
- wolco 7y agoRemoving the barriers to entry could be one path to fix the issue.
- ars 7y agoThat's the wrong moral, this hospital is state run.
- easyat 7y agoStates are employing the same business grads getting churned out of MBA schools as the private sector is. They all operate under the same ethos that MBA schools push. It's all pushing units to them, regardless of the "product"
- artixtn 7y agoReading this article just down right sickens me... Corruption is everywhere, people who do the right thing get screwed over in the end. Why can't we just adopt the European model or Canadian model. This is the very reason why I just want to leave the US.
- pkaye 7y ago> The hospital ranked No. 1 in Virginia by U.S. News & World Report is taxpayer supported and state-funded, not a company with profit motives and shareholder demands. Its taxpayer funded however.
- darpa_escapee 7y agoTotal health expenditures have skyrocketed[1] along with the amount of hospital administrators[2] over the last few decades. This particular hospital is unlikely to have escaped the trend. [1] https://img.datawrapper.de/z8VeH/full.png https://img.datawrapper.de/z8VeH/full.png [2] https://gomerblog.com/wp-content/uploads/2015/12/Doctors-and-administrators-e1557515296900.jpg https://gomerblog.com/wp-content/uploads/2015/12/Doctors-and...
- pkaye 7y agoI'd be interested in comparing the increase in US health expenditures compare to a couple countries in the EU.
- dv_dt 7y agoEvent if the relative increases were the same, the absolute costs are on a different basis. US health expenditures per capita is double the average EU nation. https://www.healthsystemtracker.org/chart-collection/health-spending-u-s-compare-countries/#item-relative-size-wealth-u-s-spends-disproportionate-amount-health https://www.healthsystemtracker.org/chart-collection/health-...
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- Ancalagon 7y agoI really wish one of the big corps not currently in the healthcare scheme would lobby to change or disrupt the healthcare industry. I recall Amazon, Chase, and Berkshire Hathaway were trying to do this for there employees, but I havent heard the result of that for a while. The current players are too entrenched for any one entity without a lot of capital to disrupt.
- egdod 7y agoSeems unremarkable. Most businesses will do this if you owe them money and don’t pay.
- fdrw 7y ago>...is taxpayer supported and state-funded, not a company with profit motives and shareholder demands. Like other nonprofit hospitals, it pays no federal, state or local taxes on the presumption it offers charity care and other community benefits valued at least as much as those breaks. Gov. Ralph Northam (D), a pediatric neurologist, oversees its board.
- PorterDuff 7y agoAm I missing something here? . Hospital system is a bastard to people who owe them $$$$. . This is an argument for government-run healthcare. . Hospital system is run by the government. I'm certainly not against copying someone else's system (Switzerland? Singapore? it isn't like they're the same) but just assume nothing good will happen. There's too many iron rice bowls, including actual providers, plus you have to fix the plane while it's flying. Best to deal with the world as it is and keep your head down. That memory care center in Thailand is starting to look pretty good.
- Aloha 7y agoThis utterly sickens me - it also gave me a thought - If the uninsured could pay medicare or medicaid pricing for services, they may not need insurance to cover their care. The uninsured should always get the lowest price the hospital is willing to charge anyone for that service, period.
- imulligan 7y agoThe USA is a pure capitalistic country and appears to have little or no sympathy for the poor and disenfranchised.
- newguy1234 7y agoYup, which makes you wonder why poor people go to the USA compared to say the Netherlands or some European country. If you are poor in the USA, you will be exploited.
- marcyb5st 7y agoIt baffles me as well. Especially considering that the "American Dream" (technically defined as Social Mobility [1]) is more achievable in Europe. Especially in Scandinavian countries which are also the "happiest" countries on the planet. [1] https://en.wikipedia.org/wiki/Social_mobility https://en.wikipedia.org/wiki/Social_mobility
- jhare 7y ago"for-profit hospital" industry. It's not your pal. It's there for your money.
- ars 7y agoQuite an ironic statement. This hospital is entirely state run and non-profit.
- worik 7y agoA two word solution: Socialised medicine. The civilised world does it, about time the USA caught up. Socialised medicine is not perfect, but the USA spends the most for the worst results. How American!
- atemerev 7y agoSo, Switzerland is not civilized world?
- Ididntdothis 7y agoTheir system is regulated so you won’t get stuck with $160k bill. Same in Germany.
- atemerev 7y agoWell, I got stuck with a $17k bill once. They usually require that I pay the bill first out of pocket, then they settle the difference. Also a series of unfortunate events can happen if you are an immigrant.
- TkTech 7y agoSwitzerland has universal[1] medical services and compulsory insurance for all residents with strict limits to prevent the private sector from price gouging. All insurers must offer a basic plan with no limitations on age or conditions, and this plan cannot earn a profit. The cost is a fixed percentage of your income, with a government refund if it goes over. It is socialized, tax-funded healthcare in everything but name. They merely pay the tax directly to an insurance entity instead of via the government. That said, Switzerland goes back and forth with Norway for being the 2nd most expensive service, with a significant gap between them and 3rd place.[2] [1] https://en.wikipedia.org/wiki/Universal_health_care https://en.wikipedia.org/wiki/Universal_health_care [2] https://stats.oecd.org/index.aspx?r=458175 https://stats.oecd.org/index.aspx?r=458175 (unable to link directly to page)
- refurb 7y agoYou’re doing a great job convincing the other side! Words like “uncivilized” and a crack about how bad America is is definitely growing support for your position!
- whiddershins 7y agoI mean, I don’t blame them for trying to get paid for treatment they provided. The problem is generally that these patients aren’t covered by private or public insurance at the time of treatment, correct? I mean, someone has to pay for the treatment somehow, right? I’m not sure what is interesting exactly about this article. People being uninsured and unable to afford health insurance is a huge problem. Medical providers attempting to get paid for services they provide seems like what they should do.
- _bxg1 7y agoIt's an example of how incredibly dystopian the system as a whole has become. The individual mechanisms aren't egregiously wrong in isolation; it's the big picture that's clearly broken.
- TinyBig 7y agoThis has been par for the course for UVA for some time. When I was a student at UVA ~2 decades ago, I came down with an especially severe case of food poisoning after having dinner at one of the dining halls. One of my friends found me in a very bad state and took me to the ER. They refused to accept my insurance afterwards and when I attempted to dispute the bill, threatened me with an honor code violation (read: expulsion). They seized my tax refund nearly a decade later after “realizing they undercharged” me.
- mehhh 7y agoI ran into the something similar with Cigna and Kaiser (albiet for a much smaller dollar amount), I called both entities prior to going to urgent care and described the care I needed (xray, splint) and was told that the copay would cover it. Lo and behold, I got stuck with the majority of the $500 bill, wish I had not gone in retrospect.
- Ididntdothis 7y agothat's the evil part. They can charge whatever they feel like and there is pretty much nothing you can do besides maybe having a lawyer on retainer.
- purplezooey 7y agoThat's horrible
- dillonmckay 7y agoHow often do you donate as an alumni?
- bawana 7y agoThe capitalist solution is...... GROUPON This speaks to the opacity of pricing in the healthcare industry. There should be a price list at the door of the hospital for common services.
- nimish 7y agoI would love to know how I could price discriminate when I was in crippling kidney stone pain. Price transparency is only a minor issue.
- purplezooey 7y agoWe could have solved this in the 1970s or 1980s, but didn't, wonder why not. Vote next time.
- AstralStorm 7y agoYes, the main goal of US healthcare system is profit, not health. Totally wrong priorities.
- efitz 7y agoThe way we pay for medical care in the US is screwed up. That said... I’ve always thought it weird that people feel entitled to free (or massively discounted) medical care. Consider the case where some business could sell you a product or service that might add years to your life. How much is that worth? Why is it somehow unfair or immoral if someone buys such a product or service, without considering their ability to pay, and bankrupts themself? Yes the issues are more complex here in the US due to the opacity and arbitrariness of medical billing, but if we set that aside, how much is your health worth to you?
- meesles 7y agoThere's a basic level that every human on earth deserves, especially in a bountiful country like the USA. If you break an arm, get food poisoning, or catch a virus, I think you should be able to get good treatment for free. I don't think we should offer advanced and highly specialized treatments for free. It's just crazy that there's so much wealth here, but you hear plenty of stories of peoples' lives being seriously damaged by an accidental ambulance trip or hospital billing horror-story.
- tastroder 7y ago> Consider the case where some business could sell you a product or service that might add years to your life. How much is that worth? My gym membership is EUR 19.95, what's that got to do with anything? :) > how much is your health worth to you? Whatever percentage of my income currently goes into my health insurance over here in Germany. That's paying towards my health and the health of those unable pay in right now (or ever, I don't care, it's not their fault most of the time and could just as well be me). I plan on getting private health insurance to get better level of care for myself because I can financially afford it, that doesn't imply that those unable to should feel entitled when they seek treatment imho. The opposite of the US system is neither free, nor massively discounted. You're just overpaying on stuff much of the rest of the world managed to put in more effective systems that do not put massive strain on the population. If you don't mind a different perspective here: Framing that as entitlement always seemed odd to me since I don't get why some medical corporation should be held in higher regard than the population of the country that provides them with a market in the first place. > Why is it somehow unfair or immoral if someone buys such a product or service, without considering their ability to pay, and bankrupts themself? Because those people suffer, in the worst case die, in the best case put other costs on society as a whole? We generally moved on from exiling the ill in most firsts world countries, which is what happens if society does not (at least minimally) provide for those that cannot afford to do so themselves.
- ArtDev 7y agoA criminal racket. Where is the outrage?!
- aussieguy1234 7y agoWe had this problem in Australia. Hospital treatement was the #1 cause of bankruptcy. Then, 30 years ago, our universal healthcare system was introduced. Problem solved. There is a levy on our taxes each year to pay for it, a bit like a private health insurance premium. But its worth it. It also covers people who can't pay, like the unemployed/disabled.
- Johnny555 7y agoIt also covers people who can't pay We have a similar levy in the USA, except it's mostly paid by people that can pay for healthcare, so an aspirin costs $100 when administered by a hospital. And since insurance companies are smart, they negotiate down those exorbitant rates to something more reasonable, so much of the burden lies on those stuck in the middle -- they don't have enough income to pay for health insurance, but have enough assets to pay for healthcare so they end up paying the exhorbitant rates because most people don't have time to rationally evaluate and price out their healthcare and choose the most cost effective provider, and even if they do have the time, the hospital can't tell you how much it's going to cost until the work is done and they bill you. Even when you are insured and have a procedure done by a doctor that's covered by your healthcare plan, sometimes another provider (like an anesthesiologist) will do part of the procedure and you end up paying $10,000 or more out of pocket for his services. Our system is broken in so many ways.
- dcow 7y agoFWIW in California I don't believe it's possible for medical bills to go to collections or affect your credit. IANAL.
- close04 7y agoThis is the effect of lobbying (call it legalized corruption). Insurance shouldn’t be that expensive that even middle class can’t pay for it and a hospital shouldn’t be allowed to charge arbitrary sums for this. It’s clearly possible since many countries successfully pull this off. But in countries that are “for corporations, by corporations” regular people can’t lobby their way into getting what they want or need. Only the wants and needs of a certain few that pay for their laws are considered.
- Johnny555 7y agoThe $164,000 billed to Waldron for intestinal surgery was more than twice what a commercial insurer would have paid for her care This is one of the worst parts of USA healthcare -- why are uninsured patients charged more than insured patients? (sometimes much more, like 10 times more [1]) [1] https://www.washingtonpost.com/national/health-science/why-some-hospitals-can-get-away-with-price-gouging-patients-study-finds/2015/06/08/b7f5118c-0aeb-11e5-9e39-0db921c47b93_story.html https://www.washingtonpost.com/national/health-science/why-s...
- maccard 7y agoIt's not insane to think that a service provider would give a discounted rate to a firm they have continuously done business with over time, who spend a large amount of money, and consistently pay their bills in any other area of business, so at the face of it, it seems sensible. The orders of magnitude are terrifying however
- jacobush 7y agoIt still feels completely alien to me. It's not like there is a different medical procedure is it?
- patrec 7y agoIf you provided something that cost $100 to produce and there are two easily and legally segregable types of customers, one who will pay the bills in 99.9% of cases and whom you charge $110 and one who pays the bills in 30% of cases, how much would you charge the second type of customer? (Having said that, I don't think the pathological cost divergences in US healthcare are mostly explained by this)
- Johnny555 7y agoBut they are charging that other customer $500 for that $100 procedure. If they charged him $110, it's much more likely that he could pay. And it's not like insurance companies are easy to deal with, optimizing payouts means hospitals hire entire coding departments and they still sometimes see long delays untill payment for complicated procedures. And unlike, say, choosing between buying a $250k Lamborghini vs a $20k Toyota, the patient has to choose the $250k bypass surgery or he'll die. Which is why this can't fairly be judged purely in business terms, customers have little choice in whether or not they purchase healthcare services.
- mcthrowaway123z 7y agoHippocratic oath meet capitalism
- ptah 7y agoUse the right tool for the job. Consider that possibly free-market capitalism is not the right tool to solve health care
- IG_Semmelweiss 7y agomost people here can't seem to view the apple and the trees. The US is the only country in the world where you get healthcare through your employer. This did not happen naturally. It was mandated by government after WW. Second, all treatment here is expensive: - there is a lack of supply (hospitals require approval from nearby hospitals before opening. Imagine... McD's needing approval from Burger King be4 opening across the street!) - there is no legal a-la carte offering. (no such thing as catastrophic insurance can be sold. So you must buy everything... or nothing) - there is a floor on pricing (medicare, medicaid) - there are no legal substitutes (doctors all must be ferraris, you cannot have Toyota nurses or unlicensed doctors doing treatment) - there is a huge barrier to entry (doctor must undergo many years of training and expensive education) I could go on, but every single distortion we have today in healthcare can be directly traced to some kind of government action. So now we have a corrupt system which was carved out by government.. for corporations. Should the current system die ? Absolutely. For single payer ?? The government is what got us to where we are today. What confidence you have in that they will do better on the evidence presented above ??
- gargravarr 7y agoThe out-of-network stuff is the most insane part of the American health system. No question, it's deliberately set up to trip up those who need urgent care. There are plenty of stories of people who go out of their way to find an in-network hospital to have surgery with an in-network surgeon, only to be billed for the anaesthesiologist who is out of network - something they cannot object to because they're being put under. Even if they could ask, what choice do they have - take the surgery while awake? So beautifully set up to screw over the patient. It's often said that health is a highly profitable business in America. And yet it is astonishing how feverishly the average Joe will fight against free healthcare because those who make the profits have convinced them it's bad for them. Look at any country with nationalised healthcare; none of us in the UK have a bad word to say about paying for the NHS through National Insurance if it means we can walk into any GP's surgery or hospital and never need to worry about money or insurance. In the best possible way I hope the system breaks completely and it has to be rebuilt from the ground up. Maybe then some semblance of fairness can creep in.
- save_ferris 7y agoIt’s not really that astonishing that Americans are divided on healthcare when you look at the fact that neither primary political party truly supports universal healthcare. Only the progressive left does, very much against the wishes of the base of the Democratic Party. We can’t act like Americans not wanting universal healthcare is such a head-scratcher when the vast majority of those in power are fighting to prevent it.
- TuringNYC 7y agoPart of the problem is that many people don't realize how bad it can get until they actually experience problems. These problems don't happen often, but even 5% is too much. If most people understood the edge cases and fall-thru there would be far more support for a national solution. In my family's case, it was a difficult pregnancy and delivery, and pretty soon you were getting bills from 20 odd providers with different names, many out of network, who happened to participate in some capacity or another. I regularly heard comments like "I dont want to change things, I have great insurance!" and I think to myself...yeah just hope you don't experience the reality of it.
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- sershe 7y agoOk so dumb question I always wanted to ask, about the arbitrary prices. Let's say I have no insurance and I collapse on the street, get rushed to the hospital and revived, after which they send me a bill for $10k. I didn't agree to any treatment; I didn't sign anything. What prevents me from saying that I won't pay it - not in "you can send it to collections" way, but in a "this is a fraudulent bill" way, like I don't owe anything at all? If the hospital can claim by fiat the price was $10k after the fact, how come I cannot claim by fiat the price was $100, or send the hospital a counter-bill for $9900 for having had the privilege of touching my chest? I mean, a car dealership cannot send me a bill after the fact for an extra $10k for driving off the lot? (Semi-)serious question, actually. What would they do? There's no contract. Even if I did sign something in an emergency, I may be able to claim to not have been capable enough to reason about it, due to shock/mental issues given the emergency.
- DaiPlusPlus 7y agoA bunch of articles I read about receiving unwanted medical care while being unable to consent (e.g. while unconscious, or involuntarily committed when the person was actually sane) advise readers to get a lawyer to have them drop the bill. Oddly, I can’t find any reports by people reporting success or failure doing that. Of course that’s different to your proposed situation - but if you were indigent then Medicaid would be billed.
- speedplane 7y ago> Ok so dumb question I always wanted to ask, about the arbitrary prices. Let's say I have no insurance and I collapse on the street, get rushed to the hospital and revived, after which they send me a bill for $10k. I didn't agree to any treatment; I didn't sign anything. What prevents me from saying that I won't pay it - not in "you can send it to collections" way, but in a "this is a fraudulent bill" way, like I don't owe anything at all? Not a dumb question. If you don't have insurance, you can make such claim, and very likely you'll never have to pay. If you do have insurance, it's very likely that your insurance has pre-existing contracts with the hospital. Even though the hospital can't force you to do anything, it's likely that they can force the insurance to pay.