2 ms·

I am not happy with this solution, but I must say medical establishment - maybe not physicians themselves, but certainly whoever takes care of pricing and billi

by smsm42 7y ago

I am not happy with this solution, but I must say medical establishment - maybe not physicians themselves, but certainly whoever takes care of pricing and billing - were doing everything for years to invite regulation. Because people can tolerate what's going on only for so long. When every time you go to a doctor, you never get a price on anything and then you get a flurry of bills with cryptic codes and unexplainable charges and are expected just to pay exorbitant sums and shut up - people will only go with it for so long. No other good is sold this way, and no other business is conducted this way. I am generally pretty laissez-faire guy, but even my blood starts boiling when I see how the business is conducted there. I tried a couple of times to figure out some of the medical bills, and I almost went crazy. The impression is literally nobody - or at least nobody mere mortal is able to talk to - knows how it actually works and is willing to tell me - who pays the freaking money for the whole charade! - what's going on. I know one medical area where it isn't this way. Dentistry. When I go to a dentist, whatever is the procedure, I can know upfront what are the costs, what I am paying for, and almost always (excluding rare exceptional cases, which usually also are handled by the dentist) which part is out of pocket and which will be covered by insurance. That is before we even start. But if I go into a non-dental clinic - suddenly billing is a riddle, wrapped in a mystery, inside an enigma, nobody can say anything - you just have to wait for the bills to come, and then you'd know. No wonder it ends up with the state coming in and putting the boot down. And no wonder it will be done in a ham-fisted way state regulation usually works. Because however laissez-faire I am, I cannot but see current situation is completely fubar. I'd prefer medical professionals and insurers and administrators and whoever they are figured it out and proposed me a market-based solution that doesn't make each visit to a doctor a reverse lottery - but that doesn't seem to happen (well, there are a handful of medical establishments with proper predictable pricing, but rare and far between). So, no wonder this is happening instead.

hiram112 7y ago
> When every time you go to a doctor, you never get a price on anything and then you get a flurry of bills with cryptic codes and unexplainable charges and are expected just to pay exorbitant sums and shut up - people will only go with it for so long. Nailed it, buddy. I just went through a bad few months of health issues that required numerous trips to see specialists, in-patient and out-patient care, etc. Even though I do have supposedly decent insurance which costs about $1K month between my employer and me, the bills just started piling up day after day. Cryptic codes on all of all of them and absurd costs which were reduced by the insurance company and then sent to me. I'd consistently see crazy, clown-world prices like a one-night hospital stay charged for $25K, reduced by the insurance company to $1200, and then billed to me for $500. It's like they just made up the prices as they went along. And even after doing my best to figure out which bills were valid and which weren't, I still had almost $10K of bills out of pocket, even though I have a deductible for $3K. Turns out the hospital who guaranteed me to be in-network allowed the use an out-of-network anesthesiologist (who billed me twice - once through the hospital where it took place and once through some anesthesiology company). If any other business or industry played these kind of games they'd be instantly bankrupted as consumers would refuse to play, force their credit card companies to make charge backs, or find alternatives. Any other industry with these type of practices would be instantly sued by the SEC and DOJ for RICO act violations and collusion. And while I know it's not just doctors causing the issue, they play a huge part. No sympathy from me if their whole industry were nationalized and they were forced to take government set salaries no higher than GS-15.
- dehrmann 7y ago
  > $25K, ~~reduced~~ [negotiated] by the insurance company to $1200 $25K is the sticker price that someone uninsured would see. Sure, they'll get parts "forgiven," but this markup makes patients feel ripped-off, and it almost looks like an accounting scam. I'd like to see something that the sticker price can't be more than 10% greater than the lowest negotiated price.
  - ericd 7y ago
    IIRC, the “forgiven” part of that “debt” is considered income by the IRS. Just as a nice cherry on that shit sundae.
    - smsm42 7y ago
      Not sure it applies to a disputed debt. Otherwise I could bankrupt any (non-billionaire) person by just claiming they owe me a billion dollars and then "forgive" them. And then I could get a billion-dollar tax write-off. I am pretty sure IRS is not that insane to fall for such a scheme. Though maybe with hospitals it works, it's a bizarro world there.

by smsm42 7y ago

hiram112 7y ago

> When every time you go to a doctor, you never get a price on anything and then you get a flurry of bills with cryptic codes and unexplainable charges and are expected just to pay exorbitant sums and shut up - people will only go with it for so long. Nailed it, buddy. I just went through a bad few months of health issues that required numerous trips to see specialists, in-patient and out-patient care, etc. Even though I do have supposedly decent insurance which costs about $1K month between my employer and me, the bills just started piling up day after day. Cryptic codes on all of all of them and absurd costs which were reduced by the insurance company and then sent to me. I'd consistently see crazy, clown-world prices like a one-night hospital stay charged for $25K, reduced by the insurance company to $1200, and then billed to me for $500. It's like they just made up the prices as they went along. And even after doing my best to figure out which bills were valid and which weren't, I still had almost $10K of bills out of pocket, even though I have a deductible for $3K. Turns out the hospital who guaranteed me to be in-network allowed the use an out-of-network anesthesiologist (who billed me twice - once through the hospital where it took place and once through some anesthesiology company). If any other business or industry played these kind of games they'd be instantly bankrupted as consumers would refuse to play, force their credit card companies to make charge backs, or find alternatives. Any other industry with these type of practices would be instantly sued by the SEC and DOJ for RICO act violations and collusion. And while I know it's not just doctors causing the issue, they play a huge part. No sympathy from me if their whole industry were nationalized and they were forced to take government set salaries no higher than GS-15.

dehrmann 7y ago
> $25K, ~~reduced~~ [negotiated] by the insurance company to $1200 $25K is the sticker price that someone uninsured would see. Sure, they'll get parts "forgiven," but this markup makes patients feel ripped-off, and it almost looks like an accounting scam. I'd like to see something that the sticker price can't be more than 10% greater than the lowest negotiated price.
- ericd 7y ago
  IIRC, the “forgiven” part of that “debt” is considered income by the IRS. Just as a nice cherry on that shit sundae.
  - smsm42 7y ago
    Not sure it applies to a disputed debt. Otherwise I could bankrupt any (non-billionaire) person by just claiming they owe me a billion dollars and then "forgive" them. And then I could get a billion-dollar tax write-off. I am pretty sure IRS is not that insane to fall for such a scheme. Though maybe with hospitals it works, it's a bizarro world there.