5 ms·

To add my own anecdote about US healthcare, I needed a hernia repair surgery in my early 20’s. My dr referred me to a specialist, I asked if he was in network

by cactus2093 6y ago

To add my own anecdote about US healthcare, I needed a hernia repair surgery in my early 20’s. My dr referred me to a specialist, I asked if he was in network for my insurance and everything seemed good. But in what I have since come to realize is a quintessential US healthcare experience, it turns out the facility that this independent surgeon used and the anesthesiologist were not in network. Nobody bothered to tell me about this before the surgery, so I went through with it. Later I see the bill is about $39k, and my insurance has decided they’ll pay $1174. I was freaking out, but I got a call from the billing department and they asked if I could just pay $200, which I did and they called it a day and everything was settled. It makes just as little sense as any of the horror stories I’ve heard, but somehow worked out pretty reasonably for me. I still have no idea how this happened. Did I get incredibly lucky? Or are more of these horror stories you hear where someone “ended up with a $50k medical bill”, just on paper and those amounts rarely actually need to be paid?

dhimes 6y ago
Makes me think they can write it off their taxes as "uncollectable."
- rhino369 6y ago
  Yes, but they also had to add 50k of uncollectable revenue. So its not really doing anything for them for their taxes. It's mostly a game played between insurance provider and medical provider. They ask for 50k--knowing it the insurance is going to low ball them.
  - ncmncm 6y ago
    If they write off $39k, that counts against $39k in other income they actually get that they then don't have to pay taxes on.
jshevek 6y ago
Two anecdotes in support of your last sentence: I once paid cash up front for a procedure, charged at 25% of the insurance rate. This was put in writing as the total cost of the procedure. Afterwards, they billed me as if I owed 75% of the other rate, with threats of legal action accompanying invoices. I did not immediately locate in my files my copy of the initial contract. Like you, I was freaking out. Even after finding my copy, and knowing that I would prevail in court if it came to it, I worried about all the indirect ways the situation could harm me. Eventually they dropped the issue. A friend agreed to a few procedures without knowing the price, and was then charged a bizarre, absurd amount of money (I comparison researched, after the fact). He offered to pay 50%, and they gladly, eagerly accepted. I heard the call, they sounded surprised and happy. Clearly he could have paid much less.
rayiner 6y ago
My dad’s been a chronic diabetic for 25 years, and we’ve never had a large surprise medical bill. Even among people who file for bankruptcy, most have little medical debt: https://www.forbes.com/sites/aparnamathur/2018/04/09/exposing-the-myth-of-widespread-medical-bankruptcies/ https://www.forbes.com/sites/aparnamathur/2018/04/09/exposin... > Department of Justice did a similar survey of bankruptcy filers between 2000 and 2002, which included a much larger sample of 5,203 filers, and found that 90 percent of filers had medical debts less than $5,000, and 54 percent had no medical debt. We’re talking about 10% of 1% of people that file for bankrupt y and have more than $5,000 in medical debt. The other thing people don’t mention is the aggressive cost controls in other countries. In the U.K., the NHS will pay $30k on average for treatment that is expected to increase life by one quality-adjusted year: https://www.kingsfund.org.uk/publications/articles/ministers-not-nhs-england-should-decide-affordability-of-treatments https://www.kingsfund.org.uk/publications/articles/ministers.... For cancer, etc., it’s double that. > NICE has on occasion approved treatments that cost more than £30,000 per QALY. In addition, since 2009, there has been a higher threshold of £50,000 per QALY for end-of-life care, which in practice has applied chiefly, although again not exclusively, to cancer drugs. In the pre-Obamacare days when there were lifetime limits, you’d see stories of people blowing through a $1 million limit, and then dying a couple of years later $500,000 in debt. Tragic yes, but in the U.K. or Germany these people would have been counseled into hospice instead. https://www.politico.eu/article/cancer-europe-america-comparison/ https://www.politico.eu/article/cancer-europe-america-compar... > Speedy access to cutting-edge treatments cuts deep into America’s national purse. One study, summarized in the New York Times, determined that the U.S. averted 265,000 more deaths of colorectal cancer compared to Western Europe between 1982 and 2010. Each year of healthy life gained cost $110,000. The costs for gains in prostate and breast cancers were even more dramatic. The incremental lives we saved in the US for these cancers came at a cost double that of what would have been approved by the U.K. NHS. Finally, the other thing most people don’t mention is that Americans have vastly more money in their pockets due to higher incomes and lower taxes: https://images.app.goo.gl/n8Qs8eBa84yuo3by7 https://images.app.goo.gl/n8Qs8eBa84yuo3by7 There is a small chance that, in the US, you’ll get cancer or have a heart attack, and fall through the cracks of health insurance, Medicaid, and Medicare. But you pay a significant price for reducing that risk.
- 6y ago

dhimes 6y ago

Makes me think they can write it off their taxes as "uncollectable."

rhino369 6y ago
Yes, but they also had to add 50k of uncollectable revenue. So its not really doing anything for them for their taxes. It's mostly a game played between insurance provider and medical provider. They ask for 50k--knowing it the insurance is going to low ball them.
- ncmncm 6y ago
  If they write off $39k, that counts against $39k in other income they actually get that they then don't have to pay taxes on.

jshevek 6y ago

Two anecdotes in support of your last sentence: I once paid cash up front for a procedure, charged at 25% of the insurance rate. This was put in writing as the total cost of the procedure. Afterwards, they billed me as if I owed 75% of the other rate, with threats of legal action accompanying invoices. I did not immediately locate in my files my copy of the initial contract. Like you, I was freaking out. Even after finding my copy, and knowing that I would prevail in court if it came to it, I worried about all the indirect ways the situation could harm me. Eventually they dropped the issue. A friend agreed to a few procedures without knowing the price, and was then charged a bizarre, absurd amount of money (I comparison researched, after the fact). He offered to pay 50%, and they gladly, eagerly accepted. I heard the call, they sounded surprised and happy. Clearly he could have paid much less.

rayiner 6y ago

My dad’s been a chronic diabetic for 25 years, and we’ve never had a large surprise medical bill. Even among people who file for bankruptcy, most have little medical debt: https://www.forbes.com/sites/aparnamathur/2018/04/09/exposing-the-myth-of-widespread-medical-bankruptcies/ https://www.forbes.com/sites/aparnamathur/2018/04/09/exposin... > Department of Justice did a similar survey of bankruptcy filers between 2000 and 2002, which included a much larger sample of 5,203 filers, and found that 90 percent of filers had medical debts less than $5,000, and 54 percent had no medical debt. We’re talking about 10% of 1% of people that file for bankrupt y and have more than $5,000 in medical debt. The other thing people don’t mention is the aggressive cost controls in other countries. In the U.K., the NHS will pay $30k on average for treatment that is expected to increase life by one quality-adjusted year: https://www.kingsfund.org.uk/publications/articles/ministers-not-nhs-england-should-decide-affordability-of-treatments https://www.kingsfund.org.uk/publications/articles/ministers.... For cancer, etc., it’s double that. > NICE has on occasion approved treatments that cost more than £30,000 per QALY. In addition, since 2009, there has been a higher threshold of £50,000 per QALY for end-of-life care, which in practice has applied chiefly, although again not exclusively, to cancer drugs. In the pre-Obamacare days when there were lifetime limits, you’d see stories of people blowing through a $1 million limit, and then dying a couple of years later $500,000 in debt. Tragic yes, but in the U.K. or Germany these people would have been counseled into hospice instead. https://www.politico.eu/article/cancer-europe-america-comparison/ https://www.politico.eu/article/cancer-europe-america-compar... > Speedy access to cutting-edge treatments cuts deep into America’s national purse. One study, summarized in the New York Times, determined that the U.S. averted 265,000 more deaths of colorectal cancer compared to Western Europe between 1982 and 2010. Each year of healthy life gained cost $110,000. The costs for gains in prostate and breast cancers were even more dramatic. The incremental lives we saved in the US for these cancers came at a cost double that of what would have been approved by the U.K. NHS. Finally, the other thing most people don’t mention is that Americans have vastly more money in their pockets due to higher incomes and lower taxes: https://images.app.goo.gl/n8Qs8eBa84yuo3by7 https://images.app.goo.gl/n8Qs8eBa84yuo3by7 There is a small chance that, in the US, you’ll get cancer or have a heart attack, and fall through the cracks of health insurance, Medicaid, and Medicare. But you pay a significant price for reducing that risk.

6y ago