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It happens all the time here; it's ridiculous. At my company's last benefits meeting (where they go over the yearly changes to our insurance coverage) a cowork
by jlarocco 7y ago
It happens all the time here; it's ridiculous.
At my company's last benefits meeting (where they go over the yearly changes to our insurance coverage) a coworker described a situation where they had a surgery at an in network (accepted by our insurance) hospital, with in network surgeons and nurses, but was assigned an out of network anesthesiologist without his knowledge, and later got a giant bill for it (well over $1000, IIRC).
Even when a person tries to follow all the rules, they find a way to screw you.
- drewg123 7y agoI'd like to see a legal limit to this out-of-network billing. If you limit them to the medicare reimbursement rate, I think this would stop happening.
- maxerickson 7y agoBanning networks would be less drastic than setting out of network prices to Medicare.
- craftinator 7y agoMaybe before a surgery, gather all of the hospital staff who are going to attend, and record a video while saying "I do not consent to working with anyone from out of network. If you are an out of network physician, I do not consent to be your patient." That ought to be interesting in court if they bill you. Really, the onus of responsibility is between your insurance company and the hospital (i.e. paying and billing party). If they fail, it needs to be something resolved between them. Because that's their fucking job.
- Ididntdothis 7y agoYou clearly haven't dealt with these guys. The hospital can charge whatever it feels like and the insurance pays whatever it feels like. And the patient sits in the middle and has to figure it out.
- craftinator 7y agoI have dealt with them, once, and I got the pokey end of the stick. I honestly don't know what would work, but I think operating on someone who has specified that they don't consent is kinda the definition of criminal; I think Mayhem would be the official charge.
- Ididntdothis 7y agoYou would think that repeatedly charging people for procedures that never have been performed would also be viewed as criminal but they get away with it all the time.
- anigbrowl 7y agoLook up a legal concept called quantum meruit - you can be on the hook for things you didn't consent, on the grounds that your needs were not foreseeable and a reasonable person would have consented if they were conscious at the time. I am of course over-simplifying but HN isn't the place for a long discourse on medical litigation strategies.
- craftinator 7y agoI am familiar with the concept (still think it's insane though; I value my freedom of choice more than my well being). I came up with this idea because it records me expressly refusing consent to the doctors if they are not in network. If they still operate, and are not in network, I'll see them in court with video evidence of malpractice and mayhem. I'm sure in the US legal system this has a low probability of success, but hey, maybe I can crucify them on the news for it.
- dboreham 7y agoIn my family we had a situation like this (slightly different issue: whether or not a certain procedure was covered). The hospital had the insurance company RECORDED ON A PHONE CALL stating the procedure was covered. They still refused to pay. Also interesting that the hospital apparently routinely records their calls to insurance companies.. And no, the onus isn't on the hospital. They want their pound of flesh even though they assumed you the procedure was covered on the basis of their staff calling your insurance company.
- Ididntdothis 7y ago"Even when a person tries to follow all the rules, they find a way to screw you." The whole hospital seems designed to set a bunch of elaborate traps and all of these traps will cost you a lot of money. Whatever I hear there is almost no way to protect yourself besides being lucky.
- kd5bjo 7y agoA lot of the practical billing annoyances would go away if the individual practitioners had to get paid by the hospital instead of directly by the patient’s insurance, like subcontractors in any other industry. As a patient, you should be dealing financially with no more than 2 parties: your insurance provider and the hospital.
- wool_gather 7y agoVery much agree. This is something you learn after a hospital visit or two, and it makes no sense. Doubly so since, as a patient undergoing examination/treatment, you have zero chance of sussing out who is who, what organization they work for, how their billing works, etc. All you know is someone came into the room to run a test or otherwise interact with you. It's not like you can interrogate them and then refuse their services -- among other things, they don't even know how their financial org is going to bill you.