11 ms·
Whenever I see these outbreak stories (sars, mers, etc..) and it affects a US citizen, I always wonder who actually pays for this level of intensive care. Ambu
by nimbius 7y ago
Whenever I see these outbreak stories (sars, mers, etc..) and it affects a US citizen, I always wonder who actually pays for this level of intensive care.
Ambulance trips in the states are routinely $3,000. my trip to the ER after a wreck was $3800. If you dont have insurance, how do you pay for an "isopod" and a quarantine with a medical robot? What reasonable insurance company would ever cover these expenses? (mine hardly covers birth control.)
Healthcare is private here. When i go to the hospital they ask if "i am a member." Do these treatments take place at in-network facilities? is there such a thing as an in-network facility for being quarantined with an incurable new disease? Can I be compelled to pay for health services in this case if i DO NOT want them?
Its at least reassuring to see CNN is dancing around the HIPAA implicationf of misidentifying or identifying the patient...although I wonder if its only because they recently emerged from a slander/libel lawsuit for painting a highschool kid from kentucky as a racist during a rally.
- mdorazio 7y ago> who actually pays for this level of intensive care If you have decent insurance, you pay your maximum out of pocket and insurance pays the rest (at negotiated rates). If you don't have decent insurance, you declare bankruptcy and the hospital ends up paying for all except the few dollars they are able to get out of you. This is pretty much the same situation as when homeless people show up at an ER, which is legally obligated to help them regardless of ability to pay.
- lotsofpulp 7y agoIf the healthcare providers are in network, i.e. the insurance company and the providers have reached a pricing agreement. Otherwise the providers can bill you whatever they want.
- duxup 7y agoI think it is VERY hard to tell what is "decent insurance" anymore. It might say that your hospital stay is covered on paper ... but then at the hospital the robot (or another doctor) might not be billed through the hospital and some outside group that is suddenly out of network.... there's no way to know.
- ryanmercer 7y agoEven when you do have 'good' insurance... When I had severe hypokalemia and was effectively paralyzed several years ago [1] (sorta comical read) they never once asked me about my dietary intake, instead they assumed I had some rare genetic disorder (in the ER the doctor literally told me "we're googling your symptoms") and once I was admitted they paraded 3 doctors through my room and billed me for 5 or 6 'consults'. While I considered my insurance to be 'good' getting dinged for each of those 'consults', 2 times each, despite only ever having seen 4 doctors total (one an ER doc that was probably a year or two into his medical career) face to face once each I ended up paying 10-12 different 'consul' fees, then a portion of the ambulance, then a portion of the room, the two different physical therapists they sent by after declaring me a 'fall risk' since I came in functionally paralyzed, then a portion of all the tests. From the time I set foot in the ER until I left I was there about 37 hours. All they had to do was give me some oral and IV potassium and I was fine. I actually diagnosed it myself, with no medical training whatsoever, in the ER unable to move 45 minutes before they did. My mother was there and after I'd somewhat calmed myself (I could not move, I could barely move my fingers) I told her it was probably a sodium potassium imbalance and I could probably still make it to work for overtime that morning. I ended up paying a little bit under 7k$, 1/4 of my gross income at the time, with my 'good insurance'. Took me 4~ years to pay it all off. [1] https://www.ryanmercer.com/ryansthoughts/2013/2/19/flashback-to-the-hypokalemic-episode.html https://www.ryanmercer.com/ryansthoughts/2013/2/19/flashback...
- briffle 7y agoI had a minor procedure a few months ago. Hospital, surgeon, etc, are all 'in-network' the anesthesiologist, however, is not. And there is only one 'group' for anesthesiologists in our town.
- gt_grc 7y agoI didn't even know that an out-of-network provider was involved in my surgery until after it was over. A couple of weeks after the surgery, my insurance company sent me an unexpected check for $3,000. I called and asked them about it. They said, "It's to pay the surgical assistant. They're out of network, so we can't pay them directly." I had no idea that a surgical assistant was even there. (I hadn't yet received the bill.) The insurance company told me that since I had already been anesthetized and couldn't ask the surgical assistant if they were in-network, I didn't have to pay anything out of pocket for the surgical assistant.
- ebg13 7y ago> you declare bankruptcy and the hospital ends up paying for all except the few dollars they are able to get out of you. Does that mean the entirety of your life savings and any liquidatable assets?
- lovich 7y agoIts complicated, there are usually certain assets you can keep in bankruptcy in the US like your primary residence
- Merrill 7y ago401Ks, IRAs and other retirement plans are usually protected unless the creditor is the Federal government, e.g. the IRS or the Department of Education.
- dsfyu404ed 7y agoCombined with state bankruptcy protections practice this means that most middle class people who don't have tons of money in a bank account, a home that is not their primary residence (or in their primary residence above whatever value their state protects) are decently protected but the upper middle class who often does have those things loses them in bankruptcy.
- ebg13 7y ago> 401Ks, IRAs and other retirement plans What about non-retirement investments? Aren't you only allowed to put so much into a retirement plan per year?
- Merrill 7y agoNon-retirement investments are subject to seizure to pay creditors. Yes, retirement accounts are limited in terms of annual contributions. But bankruptcy protection is one factor to consider in whether to max your contributions and/or to pay ahead on the mortgage on your primary residence.
- 7y ago
- aguyfromnb 7y ago>If you have decent insurance, you pay your maximum out of pocket and insurance pays the rest (at negotiated rates). I think the OP's question was more: who decides this person gets treated by a state-of-the-art robot, while this person gets a prescription and told to go home and rest?
- merpnderp 7y agoYou don't always declare bankruptcy. Medical debt can't be deducted from your wages and is usually negotiable with zero interest payments and for massive reductions in amounts. And after enough time, most hospitals will just write it off. And in exchange you can walk into any hospital in the country and they have to provide you emergency services.
- AWildC182 7y ago> which is legally obligated to help them regardless of ability to pay. Which tangentially makes all the Rand Paul bullshit about doctors being slaves under a universal healthcare system kinda moot. I know intelligent people aren't making that argument but it's a reasonable counterpoint in case you come across one of them
- dahfizz 7y agoYour argument is inconsistent. If we accept the premise that being legally compelled to treat a patient makes a doctor a slave, it is perfectly reasonable for Rand Paul to argue against the expansion of such a law. Similarly, the current existence of such a law does not contradict his moral stance unless he advocates or supports the current system, which he does not.
- AWildC182 7y agoI don't believe it is. Rand Paul's entire platform on the issue is based on a false premise. Nobody is putting guns to doctors heads, there is just a legal impetus for hospitals to treat sick people, rather than sitting around demanding payment while the house burns. He makes the argument entirely because he was searching for something to support his platform, not the other way around. He doesn't appear to even delve into the issue beyond healthcare == slavery but rather focuses on supporting his strange forever contradictory hyper-capitalistic vision. As such he waives any possibility to debate the issue from the position that he doesn't support the current solution because he doesn't support anything.
- jacobwilliamroy 7y agoOr option 3: they don't go to real hospitals, use perscription medicine, or see real doctors.
- Konnstann 7y agoIf it's a serious outbreak I'd imagine the CDC would be footing the bill, considering they want as much information about the disease as possible.
- war1025 7y agoIf you can't pay, the hospital absorbs the cost to a degree. Hospitals are most likely also part of a larger "reinsurance" type pool to keep expenses manageable. My mom worked in healthcare billing her whole career. My understanding is that half the reason medical bills are so high for normal people is they need to cover the costs for the people that need and have received care but were unable to pay. In this particular case, it's a matter of national security, so I'm sure the needed funds would magically appear if needed.
- optimiz3 7y agoOnly if the hospital is state run. In WA the University of Washington hospital routinely runs losses because of this. Private hospitals can give you the bare minimum and kick you out the door.
- koheripbal 7y agoThe "bare minimum" required by law is still "doing whatever is required to save you life". They cannot legally kick you out if you are not stable.
- zie 7y agoexcept they (the doctors at the hospital doing whatever is required to save your life) get to decide what "stable" means. I imagine for many doctors that get into the profession because they care about their fellow humans, the answer is sane, but I imagine there are still plenty of for-profit hospitals/doctors whose idea of "stable" is much lower.
- optimiz3 7y agoStable is subjective. It's also common for non-state hospitals to say "outside our expertise; transfer to state run-hospital". Thing is the state hospitals will actually try to cure you; and they are fairly good at it. Harborview (part of University of Washington) is the only L1 trauma center in the region. For-profit hospitals stick it to the taxpayers by doing this. It's a good argument for some form of universal healthcare, since we're paying one way or another.
- tzs 7y agoI don’t think that CNN is a covered entity under HIPAA.
- sterwill 7y agoI'm not sure what you mean by "implication of [...] identifying the patient". Although I didn't see any personal information in the article, there isn't a law in the US that prevents a news agency like CNN from identifying hospital patients. HIPAA only covers entities like health insurance companies, care providers, and their business associates.
- JulianMorrison 7y agoI think the summary answer to these kinds of questions is "if a pandemic gets loose in the present day USA, you're fucked".
- danso 7y agoHIPAA regulates healthcare entities/providers, e.g. what info they can give out about a patient. Not journalists themselves.
- rdtsc 7y agoInsurance covers things to a point as others mentioned, but you may not know what tests or procedures they'll run. Will all the doctors you see be "in-network". Sometimes ambulance trips are not covered if you don't get admitted, so it's a gamble. It's exactly what we'd want a life critical service to be. (/s). In addition to that, workplaces also give out limited number of sick days, so people don't go to the doctor and go to work instead. They ride in public transportation to get there, maybe stop at the store on the way back if symptoms haven't gotten too bad, handle some produce and so on. Well we see where this is headed. I think once something like this virus comes to a large city in US, it just has a pretty good chance of spreading and in large to our broken healthcare system.
- kmonsen 7y agoSome insurances have a yearly max payment including out of network.
- DBYCZ 7y agoI would imagine the cost of isolating patient zero like this is much lower than letting it spread.
- themodelplumber 7y agoJust say "We're still incubating here but I can pay you in exposure!" on the way in. That should get the message across :-)
- adrianmonk 7y agoAnd you could mention that you're pretty agile, so if they don't like your terms, you might move fast, break things, and make a disruptive exit that leads to an acquisition they won't like.
- izzydata 7y agoI don't see why the patient would pay for it. If the country / state wants him quarantined and treated by a robot then they are going to have to take that upon themselves. Otherwise the person could just choose to freely infect as many people as they want because they can't pay for specialized treatment.
- oillio 7y agoIt would be nice if the real world was as rational as this. However, this is America. We always find someone to pay.
- tdons 7y agoSociety as a whole benefits from an infected person being quarantined so therefore society should also pay for it. Is that not the case? I'd assume the US has programs/budgets for this sort of contingency funded at the federal level?
- ergothus 7y agoUntil Obamacare, even flu vaccinations were not commonly covered. Your logic is sound but unable to cope with the insanity of the US healthcare system. I recall an article a few years ago about the google founders (?) paying for kids in San Francisco to get vaccinated. The comments were split between Americans praising the act and Canadians that were confused.
- mattkrause 7y agoFlu shots aren't necessarily free in Canada. They were $20 or so in Quebec if you weren't in an at-risk group. https://www.quebec.ca/en/health/advice-and-prevention/vaccination/flu-vaccination-program/cost/ https://www.quebec.ca/en/health/advice-and-prevention/vaccin...
- ChuckNorris89 7y agoEven in most of Europe you pay for the flu shots yourself or you can get it done cheaply at a free clinic with the downside of long waiting times or some companies will even bring in doctors to administer the vaccines to their employees for free on site.
- serpix 7y agojust got a free flu shot last week in Finland when visiting a nurse.
- glbrew 7y agoI believe in extreme cases such as this the hospital considers it an academic/research/prestige/security cost and would essentially charge the patient nothing or standard daily rates. I know when the Ebola scare happened in the US the prestigious hospitals near me were throwing $1,000,000's into constructing state of the art rooms for preparedness and to impress the CDC and get federal approval and academic recognition. Also the hospitals can write these costs off of their taxes in various ways. If outbreaks like this cost them millions in expenses they have tax loopholes and it ends up costing them nothing.
- lozaning 7y agoIm continually amazed at the way people think "write offs" work. If a company spends X dollars on something, they don't pay X dollars less in taxes. They pay X dollars * their marginal tax rate less in taxes. Now they may be able to apply for grants or other types of funding, but there is simply no way to "write things off" and then get them for free.
- glbrew 7y agoI agree, I oversimplified for the sake of brevity. I also don't know the details for hospital accounting, only the generals and that it is very complicated. In reality it would be they spend say $1 million on these cases. They could then say it was a public service and take it off their overall income. CDC or other grants might pay the rest depending on the severity of the outbreak. Whatever isn't covered would still be potatoes for most hospitals and worth more in prestige than the hospital could have bought with the cash. Again, I literally saw hospital executives fight over Ebola patients.
- adrianmonk 7y agoI'm not a lawyer, but it looks like the CDC pays (or at least has rules allowing them to pay) for some stuff that insurance doesn't cover. But you may still have to pay deductibles. This page has a lot of good info: https://www.federalregister.gov/d/2017-00615 https://www.federalregister.gov/d/2017-00615 Particularly the "Payment for Care and Treatment" discussion here, which talks about public comments and even gets into the ethics of what you can make someone pay for compulsory treatment or isolation: https://www.federalregister.gov/documents/2017/01/19/2017-00615/control-of-communicable-diseases#h-70 https://www.federalregister.gov/documents/2017/01/19/2017-00... And the rules in 70.13 and 71.30 here and here: https://www.federalregister.gov/documents/2017/01/19/2017-00615/control-of-communicable-diseases#sectno-reference-%E2%80%8970.13 https://www.federalregister.gov/documents/2017/01/19/2017-00... https://www.federalregister.gov/documents/2017/01/19/2017-00615/control-of-communicable-diseases#sectno-reference-%E2%80%8971.30 https://www.federalregister.gov/documents/2017/01/19/2017-00... Excerpt from the rules in 70.13 (which I think covers domestic stuff): > Director may authorize payment ... Payment shall be secondary ... after all third-party payers have made payment in satisfaction of their obligations ... For quarantinable communicable diseases, payment shall be limited to costs for services and items reasonable and necessary for the care and treatment of the individual or group for the time period beginning when the Director refers the individual or group to the hospital or medical facility and ends when, as determined by the Director, the period of apprehension, quarantine, isolation, or conditional release expires.
- hinkley 7y agoIn theory, preventative treatment for epidemics should be paid for by underwriters (the people who insure insurance companies). In practice, that poor bastard is gonna get a huge bill for saving the rest of us from his illness. I hope at least his friends buy him free beers for a while.
- nitwit005 7y agoI'm more curious what happens if you try to refuse treatment. The legal basis for forced quarantine is shaky (The CDC tries to justify it on the Commerce Clause of the constitution), and trying to charge someone for a treatment they refused has some obvious issues.