8 ms·

The face values on medical bills in the US are like a bizarre joke - to a first approximation, no one ever pays them. Everyone with insurance gets insurer-negot

The face values on medical bills in the US are like a bizarre joke - to a first approximation, no one ever pays them. Everyone with insurance gets insurer-negotiated "discounts" to around ~10% of the listed cost. It's tougher for people without insurance - my understanding is that you can negotiate with the entity that sent you the bill to get significant reductions, but I don't have first-hand experience doing this. Even so, it sounds exhausting, since a single doctors visit will often result in bills from 2-3 separate entities (doctor, lab, radiologist, etc.), so you'd have to negotiate with each of them individually.

Havoc 7y ago
>Everyone with insurance gets insurer-negotiated "discounts" to around ~10% of the listed cost. That whole setup is downright cruel & evil. Pretty much guarantees the most vulnerable get fk'd.
- t0mas88 7y ago
  Welcome to America, where the dream is that everyone can make it but reality is that large groups of people really can't.
- afterburner 7y ago
  But won't you be so proud when you sign up for a health plan! You can exclaim to everyone "well I did my due diligence and I signed up for a great plan! why didn't you??" Meanwhile people in non-US countries are thinking "I don't have to think about any of this shit, at all."
  - mgkimsal 7y ago
    You'll 'sign up' for the only one your employer offers, because so few people ever consider getting direct coverage, partially because... if you have an employer that offers insurance, you can't effectively buy direct (you can't deduct the expense if you're 'eligible' via an employer, whether you take it or not). insane...
  - jjoonathan 7y ago
    ... and half the time people bragging about the spectacular insurance they found have just fallen for one of those "fake insurance" scams that are now legal again. Sure, you get $1,000,000 per year of coverage -- with a per-incident cap of $1000 buried in the fine print. And even though fake insurance is cheaper than real insurance in this country, it's not cheaper than real insurance in most single-payer countries, which is just nuts.
  - Havoc 7y ago
    >Meanwhile people in non-US countries are thinking "I don't have to think about any of this shit, at all." Yup. And if you opt to buy one they're far more impressive. e.g. the one I'm on has global coverage (except US lol) for like 1.5k a year. The whole thing is just comical (Yes we'll totally cover you in Iraq...but USA you're on your own there)
- _bxg1 7y ago
  The entire system just assumes you have insurance. Everything outside of that is a totally unpredictable financial wasteland that cannot be compared to a real marketplace in any sense. Except obviously, in reality, many people don't have insurance. This is why the whole of it is so perverse and broken.
cj 7y ago
Lab test are particularly baffling to me. Except strangely, if buying lab tests without insurance (and without a doctor) using a company like https://www.directlabs.com https://www.directlabs.com you can get a panel of 100 tests for $150-300 (cholesterol panel, vitamins, thyroid, testosterone, etc - the whole works). Yet when my doctor refers me to a lab for 1 or 2 specific tests, each individual test is billed at $150+ with a $60 copay paid to the lab. With lab tests in particular, it’s sometimes cheaper to buy them without going through a doctor / without insurance.
themark 7y ago
Yes! I had a bill recently and thought the way that the list price of the services were represented was a cruel joke. It only adds to the confusion. I feel like the insurance companies get blamed all the time but it seems like the problem is really the pricing that is set by providers. Can’t we pass legislation governing these list prices?
Cyph0n 7y ago
It depends on your deductible, though. If you’re on a HDHP, you could end up paying quite a bit more than 10% of the cost. But the expectation is that you “negotiate”, which is one the dumbest things I’ve ever heard of. Why can’t my insurance company do that? I already have a ton of stuff to handle, and now I have to worry about negotiating my health bills? It’s a joke.
- alexhutcheson 7y ago
  Even on an HDHP, the discount you get by going through insurance is significant. For a recent bill, my insurance website shows: Total amount billed: $771 Plan discount: $699 Plan paid: $0 You may owe: $73 Because I haven't hit my deductible yet, the plan didn't pay for anything, but I got their negotiated pricing, so I'm only paying ~9.5% of the "billed rate". > But the expectation is that you “negotiate”, which is one the dumbest things I’ve ever heard of. Why can’t my insurance company do that? If you have insurance, you're not expected to negotiate - the insurance company does that for you. That's the "plan discount" quoted above. You have to negotiate if you don't have insurance. Not defending the system - I think billing is incomprehensible and hard to stay on top of. Just pointing out that you get significant benefits from being insured even if you never hit your deductible.
  - Cyph0n 7y ago
    In my case, an appointment with my GP was billed at $200. My insurance negotiated a discount of... $10. Based on this, my expectation is that this will only get worse with more expensive bills. I suppose it varies by plan and provider? Regardless, dealing with medical bills is indeed a nightmare in the US. I am not looking forward to doing this all with children in the mix.
mgkimsal 7y ago
my experience is similar, but never 10%. more like final bills end up being ~60% of original. We had a $3400 ER bill for a cut hand in November. Our 'final total' after 'negotiated pricing' was closer to $2400 - approx 30% reduction, not 90%. (fantastic savings for $10k/year premiums!)
- rad_gruchalski 7y ago
  Jesus. How much? My mother’s THR would cost roughly €5.5k, if she WASN’T insured.
  - mgkimsal 7y ago
    wife sliced her hand pretty bad. took 9 stitches to mend up, and, she's lost the feeling in one finger. end of the day we were >$2k out of pocket - it might have been $2200, not $2400 - we got a few different bills, and paid some 'up front' in the emergency waiting area (after triage). Sitting in a room waiting for medical attention, and someone comes in with a rolling POS asking for payment. insane.
jjoonathan 7y ago
Is begging (negotiation without leverage) a remotely reliable move for those without insurance or is it just an excuse dangled by apologists when in fact the reality is that it usually results in a very small discount unless you get the story to go viral?
- extradego 7y ago
  I don’t exactly know what you’re talking about, but you can always get healthcare if you don’t mind going bankrupt for it.
- anewhope 7y ago
  Yes, generally your leverage is that you can just not pay.
  - jjoonathan 7y ago
    That only applies once their demands are going to actually bankrupt you, and even then only if you're offering them more than a court would take. "No leverage" is the usual case. "You COULD get a huge discount!!!" is, to first approximation, pure bullshit.
grecy 7y ago
> Everyone with insurance gets insurer-negotiated "discounts" to around ~10% of the listed cost. Except when they get screwed. Friends are middle-class teachers in a good neighbourhood outside LA. Have been so for 18 years, have good health insurance. She has a baby (should be a joyous time), emergency C section required. The following morning the insurance company says $60k/day is too expensive, and they need to move hospitals this very moment or they won't pay a dime. No transport provided. A day after a C section he had to drive his wife and <1 day old baby in his own car to another hospital. That's downright barbaric.
- vidarh 7y ago
  On one hand that's awful. On the other hand I can understand the insurance company balking at that price. I'm in the UK. My ex considered private C section, and checked prices in the UK. We could have had it done by one of the top specialists in the country for ~12k GBP including the subsequent hospital stay. In the end we chose not to, and our total costs were ~40 pounds/night for her to get a private room (NHS is allowed to charge for some extras) instead of sharing.
  - grecy 7y ago
    Ugh. Having a baby should be a joyous time in life, and it shouldn't have anything to do with money.
    - vidarh 7y ago
      I agree. I briefly looked into moving to the US due to work, and dealing with US level healthcare was one of those things that just made it a lot less attractive.

Havoc 7y ago

>Everyone with insurance gets insurer-negotiated "discounts" to around ~10% of the listed cost. That whole setup is downright cruel & evil. Pretty much guarantees the most vulnerable get fk'd.

t0mas88 7y ago
Welcome to America, where the dream is that everyone can make it but reality is that large groups of people really can't.
afterburner 7y ago
But won't you be so proud when you sign up for a health plan! You can exclaim to everyone "well I did my due diligence and I signed up for a great plan! why didn't you??" Meanwhile people in non-US countries are thinking "I don't have to think about any of this shit, at all."
- mgkimsal 7y ago
  You'll 'sign up' for the only one your employer offers, because so few people ever consider getting direct coverage, partially because... if you have an employer that offers insurance, you can't effectively buy direct (you can't deduct the expense if you're 'eligible' via an employer, whether you take it or not). insane...
- jjoonathan 7y ago
  ... and half the time people bragging about the spectacular insurance they found have just fallen for one of those "fake insurance" scams that are now legal again. Sure, you get $1,000,000 per year of coverage -- with a per-incident cap of $1000 buried in the fine print. And even though fake insurance is cheaper than real insurance in this country, it's not cheaper than real insurance in most single-payer countries, which is just nuts.
- Havoc 7y ago
  >Meanwhile people in non-US countries are thinking "I don't have to think about any of this shit, at all." Yup. And if you opt to buy one they're far more impressive. e.g. the one I'm on has global coverage (except US lol) for like 1.5k a year. The whole thing is just comical (Yes we'll totally cover you in Iraq...but USA you're on your own there)
_bxg1 7y ago
The entire system just assumes you have insurance. Everything outside of that is a totally unpredictable financial wasteland that cannot be compared to a real marketplace in any sense. Except obviously, in reality, many people don't have insurance. This is why the whole of it is so perverse and broken.

cj 7y ago

Lab test are particularly baffling to me. Except strangely, if buying lab tests without insurance (and without a doctor) using a company like https://www.directlabs.com https://www.directlabs.com you can get a panel of 100 tests for $150-300 (cholesterol panel, vitamins, thyroid, testosterone, etc - the whole works). Yet when my doctor refers me to a lab for 1 or 2 specific tests, each individual test is billed at $150+ with a $60 copay paid to the lab. With lab tests in particular, it’s sometimes cheaper to buy them without going through a doctor / without insurance.

themark 7y ago

Yes! I had a bill recently and thought the way that the list price of the services were represented was a cruel joke. It only adds to the confusion. I feel like the insurance companies get blamed all the time but it seems like the problem is really the pricing that is set by providers. Can’t we pass legislation governing these list prices?

Cyph0n 7y ago

It depends on your deductible, though. If you’re on a HDHP, you could end up paying quite a bit more than 10% of the cost. But the expectation is that you “negotiate”, which is one the dumbest things I’ve ever heard of. Why can’t my insurance company do that? I already have a ton of stuff to handle, and now I have to worry about negotiating my health bills? It’s a joke.

alexhutcheson 7y ago
Even on an HDHP, the discount you get by going through insurance is significant. For a recent bill, my insurance website shows: Total amount billed: $771 Plan discount: $699 Plan paid: $0 You may owe: $73 Because I haven't hit my deductible yet, the plan didn't pay for anything, but I got their negotiated pricing, so I'm only paying ~9.5% of the "billed rate". > But the expectation is that you “negotiate”, which is one the dumbest things I’ve ever heard of. Why can’t my insurance company do that? If you have insurance, you're not expected to negotiate - the insurance company does that for you. That's the "plan discount" quoted above. You have to negotiate if you don't have insurance. Not defending the system - I think billing is incomprehensible and hard to stay on top of. Just pointing out that you get significant benefits from being insured even if you never hit your deductible.
- Cyph0n 7y ago
  In my case, an appointment with my GP was billed at $200. My insurance negotiated a discount of... $10. Based on this, my expectation is that this will only get worse with more expensive bills. I suppose it varies by plan and provider? Regardless, dealing with medical bills is indeed a nightmare in the US. I am not looking forward to doing this all with children in the mix.

mgkimsal 7y ago

my experience is similar, but never 10%. more like final bills end up being ~60% of original. We had a $3400 ER bill for a cut hand in November. Our 'final total' after 'negotiated pricing' was closer to $2400 - approx 30% reduction, not 90%. (fantastic savings for $10k/year premiums!)

rad_gruchalski 7y ago
Jesus. How much? My mother’s THR would cost roughly €5.5k, if she WASN’T insured.
- mgkimsal 7y ago
  wife sliced her hand pretty bad. took 9 stitches to mend up, and, she's lost the feeling in one finger. end of the day we were >$2k out of pocket - it might have been $2200, not $2400 - we got a few different bills, and paid some 'up front' in the emergency waiting area (after triage). Sitting in a room waiting for medical attention, and someone comes in with a rolling POS asking for payment. insane.

jjoonathan 7y ago

Is begging (negotiation without leverage) a remotely reliable move for those without insurance or is it just an excuse dangled by apologists when in fact the reality is that it usually results in a very small discount unless you get the story to go viral?

extradego 7y ago
I don’t exactly know what you’re talking about, but you can always get healthcare if you don’t mind going bankrupt for it.
anewhope 7y ago
Yes, generally your leverage is that you can just not pay.
- jjoonathan 7y ago
  That only applies once their demands are going to actually bankrupt you, and even then only if you're offering them more than a court would take. "No leverage" is the usual case. "You COULD get a huge discount!!!" is, to first approximation, pure bullshit.

grecy 7y ago

> Everyone with insurance gets insurer-negotiated "discounts" to around ~10% of the listed cost. Except when they get screwed. Friends are middle-class teachers in a good neighbourhood outside LA. Have been so for 18 years, have good health insurance. She has a baby (should be a joyous time), emergency C section required. The following morning the insurance company says $60k/day is too expensive, and they need to move hospitals this very moment or they won't pay a dime. No transport provided. A day after a C section he had to drive his wife and <1 day old baby in his own car to another hospital. That's downright barbaric.

vidarh 7y ago
On one hand that's awful. On the other hand I can understand the insurance company balking at that price. I'm in the UK. My ex considered private C section, and checked prices in the UK. We could have had it done by one of the top specialists in the country for ~12k GBP including the subsequent hospital stay. In the end we chose not to, and our total costs were ~40 pounds/night for her to get a private room (NHS is allowed to charge for some extras) instead of sharing.
- grecy 7y ago
  Ugh. Having a baby should be a joyous time in life, and it shouldn't have anything to do with money.
  - vidarh 7y ago
    I agree. I briefly looked into moving to the US due to work, and dealing with US level healthcare was one of those things that just made it a lot less attractive.