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I went to the ER with chest pains seeming like a heart attack. They did an EKG, determined it wasn't a heart attack, then a blood test, which determined it was

I went to the ER with chest pains seeming like a heart attack. They did an EKG, determined it wasn't a heart attack, then a blood test, which determined it was low potassium, and did a chest x-ray just in case. I received a saline IV and potassium pills as treatment, and went home after a couple of hours. The bill was about $18,000 for this. The insurance negotiated rate was about $1,500, of which I had to pay about $600, then over the next weeks, I received about 20 bills, each of which was for a large amount, bit the resultant patient "responsibility" was about $20 - all from shell organizations like "CA ER Physicians", or "Hospital Diagnosticians", etc. It's such a mess! Another example was the birth of my child. We prepared for this by setting up an FSA, and having really good PPO coverage that year, supposedly, with a 10% copay. After all the billing shenanigans, my copay was about 30% and well above the out of pocket maximum. How does that happen? You can go to an in-network hospital, and be treated by a mix of providers, all of whom bill separately. Some will be in-network, others will be out of network, so you are in effect deducting against two out of pocket limits. Medical billing is fraudulent. Medical insurance is fraudulent. These people are all acting in violation of tons of existing laws - I don't understand why this isn't prosecuted.

hurrdurr2 7y ago
The lobby for insurance companies, pharmaceutical companies, and hospital chains spend ungodly amounts of money to influence our political process. Once all the politicians are bought and paid for everything becomes kosher.
- lopmotr 7y ago
  For some reason, Americans keep complaining about the same problems with their government over and over again - particularly lobbying, and yet every election they nearly universally reject all their concerns in favor of tribalism and vote for the same two parties that are responsible for everything they don't want, or nobody at all, which has the same effect. Wouldn't it be fun if whenever somebody criticizes their government, they also state who they voted for to force them to open their eyes to the fact that it's their own fault. People rationalize it by saying that voting for a 3rd party is "wasting" their vote, but in that sense, voting for anybody is wasting their vote because it never comes down to one individual's vote deciding things. Really they just have two driving forces - allegiance to whatever tribe they randomly found themselves feeling like a part of (and mysteriously agree with all the inconsistent aims of), and wanting to be on the winning team. Healthcare be damned.
  - harshreality 7y ago
    https://en.wikipedia.org/wiki/Duverger%27s_law https://en.wikipedia.org/wiki/Duverger%27s_law Without a switch to range voting, approval voting, or one of the condorcet variants, the party system will remain broken into two corrupt halves.
    - ClayShentrup 7y ago
      Condorcet won't work. http://scorevoting.net/NESD http://scorevoting.net/NESD
  - u801e 7y ago
    > People rationalize it by saying that voting for a 3rd party is "wasting" their vote In reality, voting for someone who didn't win the election is a "wasted" vote. But people will say that a particular candidate has no chance of winning the election, so voting for them is "wasting" your vote. Unfortunately, because most people follow this line of reasoning, it becomes a self fulfilling prophecy.
  - Ididntdothis 7y ago
    “People rationalize it by saying that voting for a 3rd party is "wasting" their vote,” I guess I am stubborn but I will never vote for one of the two big parties. However it would be great if smaller parties got some kind of representation in Congress. It seems ridiculous that in the 90s Ross Perot got 20% of the vote but that resulted in zero representation.
    - code_sloth 7y ago
      There's an ideal world we want (that might never happen) and there's the real world. We live in the latter. Voting for the 3rd party is effectively voting one of the big 2. Also, I find it curious that while our community has generally settled on "incremental improvement" approach, we expect different from our governments and want the "big bang" changes. Then we are surprised when things get worse.
      - 7y ago
omegaworks 7y ago
>I don't understand why this isn't prosecuted. Simply examine the way the issue was presented by frontrunners in the supposedly liberal party of the United States on the debate stage yesterday. Two candidates call for true universal coverage, a few call for a public option but brand it as universal coverage to confuse viewers, and several (with moderator and broadcast sponsor support) outright mislead by stating that universal coverage that eliminates private insurance will threaten access to health care. We have a long way to go.
- misosayer 7y ago
  Elizabeth Warren’s plans are very vague, and only a few weeks old at this point. We still know very little about what she actually proposes. Bernie Sanders’ plans are about 5 years old at this point, and have been modified, but are rather solid.
- dcposch 7y ago
  Three candidates actually. (Bernie, Warren, and Yang.) ... Loss aversion is a powerful emotion with destructive effects on our politics. Once enough people have something to lose from a change, change becomes extremely hard, even if the overall net effect would be positive. Not only does this preserve bad policies, it turns some into a one-way ratchet--where it's easy to make things worse and very hard to make them better. Examples - Medical middlemen (insurance, insurance brokers, billing companies...) are pure waste. But they employ so many people and generate so much revenue that they are very hard to attack. The US has slowly climbed to ~2x the per-person medical spending of our peers... so now, any effort to reduce that to 1.9x will be met with fierce resistance. - Prison guard unions are powerful nationally and in many states, including California. They fight any and all attempts to reduce incarceration. That was true in 1980 with ~100 prisoners per 100k population... and it's true now with ~650, by far the highest in the world. - Realtors and car dealers essentially tax the two biggest purchases most people in America make, house and car. They have powerful lobbies in all 50 states. There is no particular amount that will placate these rent-seekers. They just never want their income stream reduced.
  - AstralStorm 7y ago
avocado4 7y ago
Medical cartel needs to be investigated by FTC. HHS and Medical Boards are infiltrated with physicians with conflict of interest, so their supervision is not enough.
repiret 7y ago
They’re not shell organizations, hospitals just outsource tons of stuff, frequently including physicians. (In fact, in California, hospitals may not legally employ physicians to practice medicine)
- mkhalil 7y ago
  Yeah, but when you pay for services you don't expect to have to write checks for every subcontractor your service provider users. They do that. You pay them. Everywhere but our messed up Medical System is like that. Imagine if every time you went grocery shopping you had to pay for the people stocking the shelves, putting the carts back if you used one, the cashier, and each wholesale distributor. It's crazy and senseless. Just the way they like it so they can get away with so much more.
  - dragonwriter 7y ago
    > Yeah, but when you pay for services you don't expect to have to write checks for every subcontractor your service provider users. Well, yeah, that's true by the definition of “subcontractor”, which doctors in hospitals often are not. OTOH, healthcare isn't the only place where you might pay a fee to a facility for use of the facility and a fee to a service providers associated with the facility for services they provide in the facility. It's perhaps an inconvenient arrangement, but by no means unique.
    - MegaButts 7y ago
      > OTOH, healthcare isn't the only place where you might pay a fee to a facility for use of the facility and a fee to a service providers associated with the facility for services they provide in the facility. Where else does this occur?
      - brians 7y ago
        Weddings: you pay the caterer directly, even if the facility dictates which caterer you use
inferiorhuman 7y ago
I ended up in the ER a few months ago. The paramedics wanted around $2,500, the hospital (Dignity Health) wanted maybe $3,500, and the doctor had another few hundred in fees. Sadly that all felt pretty cheap. Dignity Health deserves a special mention though. They obfuscate their billing as much as possible. The initial bill indicated they'd give me a cash discount and wanted something like $2500. Then they sent me another bill for $1800 if I paid promptly, with lots of weasel words to make it seem like I really owed more than $1800. So, of course I paid but I had no real idea if $1800 would be sufficient (in fact their online payment portal hinted it wouldn't be). The best part was getting a survey about the quality of their billing statements right after.
- camel_gopher 7y ago
  Did you feel dignified?
pg_is_a_butt 7y ago
This is what the 2nd amendment is for. Exercise your rights. Fix your country.
jorblumesea 7y ago
> These people are all acting in violation of tons of existing laws - I don't understand why this isn't prosecuted. $$$$$$. The Medical system is being used to transfer wealth from the working and middle classes to the capital class under the guise of "free market". That money is being used to shape legislation, buy politicians, influence elections and kill threats to the system, allowing for even greater wealth transfer. The rigged markets of socialist Europe are far more transparent, fairer and free, whereas our "free market" is opaque, completely unfair, totally impossible to understand and offers very little in terms of real free market choice. Yet we are brainwashed to think that our system is superior, due to the propaganda the industry pumps out.
- dantheman 7y ago
  People can think our system is awful and still not want the European one.
  - Ididntdothis 7y ago
    There is no single European one. There is a whole range of systems that are very different.
    - Gibbon1 7y ago
      A lot of systems will work when the people involved are acting in good faith. And that is what's missing from the US system. US corporations and government have been captured by looters.
      - Ididntdothis 7y ago
        That’s probably the real problem.
  - specialist 7y ago
    What system do you want?
goostavos 7y ago
>then over the next weeks, I received about 20 bills I'm going through this now! It is completely baffling! I went to the ER, and then I received a steady stream of bills over a period of months. They were so numerous and so devoid of useful context that I began to worry that they were illegitimate. The billing process is absolutely insane.
- ryantgtg 7y ago
  For full years after we had a baby we’d get 1-2 $20 bills a month. And they could always be traced back to a specific appointment or procedure, so we didn’t argue. But yeah, it’s loco.
mikepurvis 7y ago
And yet, Canadians and others come into these discussions talking about how sane and reasonable our system is, and invariably someone immediately jumps in with "yeah but at least we have CHOICE here instead of having to appear before DEATH TRIBUNALS and then going on INFINITY WAIT LISTS." Oh, America, you will never change.
nojvek 7y ago
America kills more people willingly than most other western countries. I work for a startup with a decent health insurance plan. But even then out of pocket is nuts. For many procedures, we’ve just been avoiding going to the doctors. Doctors have been a hit and miss too. Most really don’t know what they’re talking about. I’m kinda hopeful that someone will really commoditize common procedures and checks and will make them dirt cheap. May be amazon. Can’t say. But shit like LapCorp and a whole swath of vulture physicians and insurance companies need to die. US healthcare is really fucked up.
bryan11 7y ago
Stories like this are scary. My employer based health insurance has an $18,000 deductible before it starts to cover 70% of approved, in-network bills. One visit to ER could easily cost me $20,000. A simple doctor visit can range from $150 to $1000. The effect is that any doctor visit is viewed as a last resort option.
- lotsofpulp 7y ago
  Your employer is screwing the employees via a terrible grandfathered plan. Any new insurance plan after ACA would have a maximum deductible equal to out of pocket maximum, which for 2019 was $15.8k for non HSA and $13.5k with HSA. https://www.uhc.com/employer/news/consultant/irs-sets-new-2019-limits-for-group-plans-and-hdhp-hsa-plans-.html https://www.uhc.com/employer/news/consultant/irs-sets-new-20... https://www.cigna.com/assets/docs/about-cigna/informed-on-reform/cost-sharing-limits-fact-sheet.pdf https://www.cigna.com/assets/docs/about-cigna/informed-on-re... But I’ve never heard of a deductible actually being set equal to out of pocket maximum or even anything close to it. Even the bronze family plans on healthcare.gov had deductibles of a few thousand.
jen_h 7y ago
I once went to the ER and the FIRST bill I received was from a law firm/collection agency. They actually employed a law firm to do first-line billing (which they of course double-billed, sending the bill to the insurance company and the threat to me at the same time!).
ecf 7y ago
Because if they were truly investigated, our dire need for universal health care would become kite apparent and the party in power just can't have that can they?

hurrdurr2 7y ago

The lobby for insurance companies, pharmaceutical companies, and hospital chains spend ungodly amounts of money to influence our political process. Once all the politicians are bought and paid for everything becomes kosher.

lopmotr 7y ago
For some reason, Americans keep complaining about the same problems with their government over and over again - particularly lobbying, and yet every election they nearly universally reject all their concerns in favor of tribalism and vote for the same two parties that are responsible for everything they don't want, or nobody at all, which has the same effect. Wouldn't it be fun if whenever somebody criticizes their government, they also state who they voted for to force them to open their eyes to the fact that it's their own fault. People rationalize it by saying that voting for a 3rd party is "wasting" their vote, but in that sense, voting for anybody is wasting their vote because it never comes down to one individual's vote deciding things. Really they just have two driving forces - allegiance to whatever tribe they randomly found themselves feeling like a part of (and mysteriously agree with all the inconsistent aims of), and wanting to be on the winning team. Healthcare be damned.
- harshreality 7y ago
  https://en.wikipedia.org/wiki/Duverger%27s_law https://en.wikipedia.org/wiki/Duverger%27s_law Without a switch to range voting, approval voting, or one of the condorcet variants, the party system will remain broken into two corrupt halves.
  - ClayShentrup 7y ago
    Condorcet won't work. http://scorevoting.net/NESD http://scorevoting.net/NESD
- u801e 7y ago
  > People rationalize it by saying that voting for a 3rd party is "wasting" their vote In reality, voting for someone who didn't win the election is a "wasted" vote. But people will say that a particular candidate has no chance of winning the election, so voting for them is "wasting" your vote. Unfortunately, because most people follow this line of reasoning, it becomes a self fulfilling prophecy.
- Ididntdothis 7y ago
  “People rationalize it by saying that voting for a 3rd party is "wasting" their vote,” I guess I am stubborn but I will never vote for one of the two big parties. However it would be great if smaller parties got some kind of representation in Congress. It seems ridiculous that in the 90s Ross Perot got 20% of the vote but that resulted in zero representation.
  - code_sloth 7y ago
    There's an ideal world we want (that might never happen) and there's the real world. We live in the latter. Voting for the 3rd party is effectively voting one of the big 2. Also, I find it curious that while our community has generally settled on "incremental improvement" approach, we expect different from our governments and want the "big bang" changes. Then we are surprised when things get worse.
    - 7y ago

omegaworks 7y ago

>I don't understand why this isn't prosecuted. Simply examine the way the issue was presented by frontrunners in the supposedly liberal party of the United States on the debate stage yesterday. Two candidates call for true universal coverage, a few call for a public option but brand it as universal coverage to confuse viewers, and several (with moderator and broadcast sponsor support) outright mislead by stating that universal coverage that eliminates private insurance will threaten access to health care. We have a long way to go.

misosayer 7y ago
Elizabeth Warren’s plans are very vague, and only a few weeks old at this point. We still know very little about what she actually proposes. Bernie Sanders’ plans are about 5 years old at this point, and have been modified, but are rather solid.
dcposch 7y ago
Three candidates actually. (Bernie, Warren, and Yang.) ... Loss aversion is a powerful emotion with destructive effects on our politics. Once enough people have something to lose from a change, change becomes extremely hard, even if the overall net effect would be positive. Not only does this preserve bad policies, it turns some into a one-way ratchet--where it's easy to make things worse and very hard to make them better. Examples - Medical middlemen (insurance, insurance brokers, billing companies...) are pure waste. But they employ so many people and generate so much revenue that they are very hard to attack. The US has slowly climbed to ~2x the per-person medical spending of our peers... so now, any effort to reduce that to 1.9x will be met with fierce resistance. - Prison guard unions are powerful nationally and in many states, including California. They fight any and all attempts to reduce incarceration. That was true in 1980 with ~100 prisoners per 100k population... and it's true now with ~650, by far the highest in the world. - Realtors and car dealers essentially tax the two biggest purchases most people in America make, house and car. They have powerful lobbies in all 50 states. There is no particular amount that will placate these rent-seekers. They just never want their income stream reduced.
- AstralStorm 7y ago

avocado4 7y ago

Medical cartel needs to be investigated by FTC. HHS and Medical Boards are infiltrated with physicians with conflict of interest, so their supervision is not enough.

repiret 7y ago

They’re not shell organizations, hospitals just outsource tons of stuff, frequently including physicians. (In fact, in California, hospitals may not legally employ physicians to practice medicine)

mkhalil 7y ago
Yeah, but when you pay for services you don't expect to have to write checks for every subcontractor your service provider users. They do that. You pay them. Everywhere but our messed up Medical System is like that. Imagine if every time you went grocery shopping you had to pay for the people stocking the shelves, putting the carts back if you used one, the cashier, and each wholesale distributor. It's crazy and senseless. Just the way they like it so they can get away with so much more.
- dragonwriter 7y ago
  > Yeah, but when you pay for services you don't expect to have to write checks for every subcontractor your service provider users. Well, yeah, that's true by the definition of “subcontractor”, which doctors in hospitals often are not. OTOH, healthcare isn't the only place where you might pay a fee to a facility for use of the facility and a fee to a service providers associated with the facility for services they provide in the facility. It's perhaps an inconvenient arrangement, but by no means unique.
  - MegaButts 7y ago
    > OTOH, healthcare isn't the only place where you might pay a fee to a facility for use of the facility and a fee to a service providers associated with the facility for services they provide in the facility. Where else does this occur?
    - brians 7y ago
      Weddings: you pay the caterer directly, even if the facility dictates which caterer you use

inferiorhuman 7y ago

I ended up in the ER a few months ago. The paramedics wanted around $2,500, the hospital (Dignity Health) wanted maybe $3,500, and the doctor had another few hundred in fees. Sadly that all felt pretty cheap. Dignity Health deserves a special mention though. They obfuscate their billing as much as possible. The initial bill indicated they'd give me a cash discount and wanted something like $2500. Then they sent me another bill for $1800 if I paid promptly, with lots of weasel words to make it seem like I really owed more than $1800. So, of course I paid but I had no real idea if $1800 would be sufficient (in fact their online payment portal hinted it wouldn't be). The best part was getting a survey about the quality of their billing statements right after.

camel_gopher 7y ago
Did you feel dignified?

pg_is_a_butt 7y ago

This is what the 2nd amendment is for. Exercise your rights. Fix your country.

jorblumesea 7y ago

> These people are all acting in violation of tons of existing laws - I don't understand why this isn't prosecuted. $$$$$$. The Medical system is being used to transfer wealth from the working and middle classes to the capital class under the guise of "free market". That money is being used to shape legislation, buy politicians, influence elections and kill threats to the system, allowing for even greater wealth transfer. The rigged markets of socialist Europe are far more transparent, fairer and free, whereas our "free market" is opaque, completely unfair, totally impossible to understand and offers very little in terms of real free market choice. Yet we are brainwashed to think that our system is superior, due to the propaganda the industry pumps out.

dantheman 7y ago
People can think our system is awful and still not want the European one.
- Ididntdothis 7y ago
  There is no single European one. There is a whole range of systems that are very different.
  - Gibbon1 7y ago
    A lot of systems will work when the people involved are acting in good faith. And that is what's missing from the US system. US corporations and government have been captured by looters.
    - Ididntdothis 7y ago
      That’s probably the real problem.
- specialist 7y ago
  What system do you want?

goostavos 7y ago

>then over the next weeks, I received about 20 bills I'm going through this now! It is completely baffling! I went to the ER, and then I received a steady stream of bills over a period of months. They were so numerous and so devoid of useful context that I began to worry that they were illegitimate. The billing process is absolutely insane.

ryantgtg 7y ago
For full years after we had a baby we’d get 1-2 $20 bills a month. And they could always be traced back to a specific appointment or procedure, so we didn’t argue. But yeah, it’s loco.

mikepurvis 7y ago

And yet, Canadians and others come into these discussions talking about how sane and reasonable our system is, and invariably someone immediately jumps in with "yeah but at least we have CHOICE here instead of having to appear before DEATH TRIBUNALS and then going on INFINITY WAIT LISTS." Oh, America, you will never change.

nojvek 7y ago

America kills more people willingly than most other western countries. I work for a startup with a decent health insurance plan. But even then out of pocket is nuts. For many procedures, we’ve just been avoiding going to the doctors. Doctors have been a hit and miss too. Most really don’t know what they’re talking about. I’m kinda hopeful that someone will really commoditize common procedures and checks and will make them dirt cheap. May be amazon. Can’t say. But shit like LapCorp and a whole swath of vulture physicians and insurance companies need to die. US healthcare is really fucked up.

bryan11 7y ago

Stories like this are scary. My employer based health insurance has an $18,000 deductible before it starts to cover 70% of approved, in-network bills. One visit to ER could easily cost me $20,000. A simple doctor visit can range from $150 to $1000. The effect is that any doctor visit is viewed as a last resort option.

lotsofpulp 7y ago
Your employer is screwing the employees via a terrible grandfathered plan. Any new insurance plan after ACA would have a maximum deductible equal to out of pocket maximum, which for 2019 was $15.8k for non HSA and $13.5k with HSA. https://www.uhc.com/employer/news/consultant/irs-sets-new-2019-limits-for-group-plans-and-hdhp-hsa-plans-.html https://www.uhc.com/employer/news/consultant/irs-sets-new-20... https://www.cigna.com/assets/docs/about-cigna/informed-on-reform/cost-sharing-limits-fact-sheet.pdf https://www.cigna.com/assets/docs/about-cigna/informed-on-re... But I’ve never heard of a deductible actually being set equal to out of pocket maximum or even anything close to it. Even the bronze family plans on healthcare.gov had deductibles of a few thousand.

jen_h 7y ago

I once went to the ER and the FIRST bill I received was from a law firm/collection agency. They actually employed a law firm to do first-line billing (which they of course double-billed, sending the bill to the insurance company and the threat to me at the same time!).

ecf 7y ago

Because if they were truly investigated, our dire need for universal health care would become kite apparent and the party in power just can't have that can they?