10 ms·

Seattle coronavirus survivor gets a $1.1M, 181-page hospital bill

57 points by deegles 6y ago

ebg13 6y ago
I can predict how this thread is going to go. A: "Just an explanation of charges, not a bill. He won't have to pay any of it." B: "Yeah. This time. By special exception. Any other time for any other reason and he'd have been on the hook." A: "For $6000. Big deal. He almost died and they saved his life. That's chump change." B: "Anyone uninsured wouldn't be so lucky." A: "Maybe they should have been insured." B: "What if they can't afford insurance?" A: "How is that _my_ problem?" B: [daggers] A: [daggers] Did I miss a step?
jmchuster 6y ago
A lot of the inflation in medical prices comes from how the incentives in the US medical system are lined up (e.g. "Usually hospitals get paid only a portion of the amount they bill, as most have negotiated discounts with insurance companies."). So, UHC doesn't just mean that the cost is paid for, but that the price itself wouldn't be so astronomical. I'd really love to see a comparison between 1) the $1MM bill 2) the "actual" negotiated money that changes hands 3) what it would cost in other countries with different healthcare systems.
- noobaccount 6y ago
  What’s the link between “everyone has a way to pay” and “hospitals won’t overbill”?
  - hedora 6y ago
    If the hospitals get paid what they bill, then they won’t have to add nonsense charges to make up the difference.
- indiannotation 6y ago
  I reside in India and I have also lived in the US, so I can comment on 3. India is going through an interesting phase of aping the "insurance system" of the US over the last 10 years or so (maybe longer, but that's not the main point), but a lot of people are too poor to afford health insurance. Only people who go to the more expensive hospitals use insurance, as a rule of thumb. And guess what? The costs for many procedures have increased 4-5x over this period at those hospitals which do ask for insurance, which still beats inflation handily. On the other hand, the vast majority of people don't have insurance, which means people get to pay actual medical costs for the trivial stuff like cold and fever, and common ailments. These costs generally track inflation. On seeing this, and realizing that except for some really complicated stuff, India's healthcare system is generally quite OK, I have come to the conclusion that the insurance industry in the US is just a complete scam. Insurance is supposed to be something you use in case of a catastrophe, and I don't know how it ended up as such a mandatory thing in the US.
  - theonemind 6y ago
    I think that inelastic demand and relative difficulty of ability to price compare lead to it pretty naturally Once you have an insurance layer in the system. I mean, if you get shot, and the ambulance rushes you off to a hospital, you (literally) can’t haggle and shop around. As for it staying like it is, laws in the US radically favor entrenched monied interests because of lobbying, and we have a huge amount of political propaganda convincing uneducated voters to vote against their own interest to the extent that votes even could do anything.
  - disabled 6y ago
    > The insurance industry in the US is just a complete scam Correct. I came to that conclusion as a chronically ill university student back in the early 2010s. I also had never experienced other health systems before, at that point, but I had graduate student TAs ask me what I thought of the US healthcare system, and I said "it's a scam and a rip-off". The dude who asked me had an appendicitis surgery on student insurance, and he agreed as he paid a lot of money for the procedure.
- disabled 6y ago
  > I'd really love to see a comparison between 1) the $1MM bill 2) the "actual" negotiated money that changes hands 3) what it would cost in other countries with different healthcare systems. For example: Blood products in general (medication developed by publicly traded companies and formally approved by governmental bodies), which are regularly required for some rare diseases, generally cost around twice as much in the US compared to the rest of the developed world that has universal healthcare (excluding Switzerland). I have 2 rare immune-mediated neurological diseases affecting my peripheral nervous system, and I require a self-administered blood product to quite literally, stay alive. It is called subcutaneous immunoglobulin. It is the only treatment that has ever worked: I have tried about 10 different medications, plus combinations of them, to no avail. Anyways, the cost of this blood product (immunoglobulin--both intravenous and subcutaneous forms) in developed countries that have universal healthcare (excluding Switzerland and the US) is 40 Euro per gram. Right now, the exchange rate, Euro to US Dollar is 1 Euro per 1.13 US Dollar. So, currently, this blood product costs about USD $45.01 per gram. My US-based private medical insurance, pays for this medication at a contracted rate of USD $100 per gram. The provider (the billing party) is a very well known Pharmacy Benefits Management company, and bills for the medication at a rate of USD $500 per gram. I take very close to 250 grams per month of subcutaneous immunoglobulin. Let's do the math: What my insurance pays to the provider every month, for the blood product, via claims filed over the past 2 years = ($100/gram)(250 grams/month) = USD $25,000/month What the provider bills, and what I could theoretically owe, if something goes wrong = ($500/gram)(250 grams/bill) = USD $125,000 per bill So, if for some reason a mistake is made, with respect to honoring a prior authorization, I can literally end up with a bill over USD $100,000 for a "one month's supply" of medication, with no resolve. What a government in Europe (excluding Switzerland) pays per month for the medication (and I never have to worry about owing) = ($45.01/gram)*(250 grams/month) = USD $11,252.50/month
perl4ever 6y ago
"because Flor has insurance including Medicare, he won’t have to pay the vast majority of it" Did they really use stuff that truly cost $1.1M on him, and did they need to? If they're charging some absurd amount for a room, maybe it's just a way of rationing at some level, not what is being consumed. I wish people would look at more what was spent in resources than what the dollar amount of the treatment was - if the patient didn't pay, then what matters to society is what was spent by society, not what number was written down as part of weird accounting. The article acknowledged "hospitals get paid only a portion of the amount they bill". It's not helpful or necessary to write anguished stuff based on your conviction that the accounting style is wrong. What matters is the effect on real people. On the other hand, if the reason that drug costs for instance were so high was because unnecessary drugs were used, or because they were wasted, or because the manufacturing of them was inefficient, that's a real problem and I wish that an article like this would focus on it, delve into it. Just...don't write stuff about how America is terrible because big numbers are scary. I can't tell if the article is meant to be pro or con universal coverage, or if the point is, America is terrible and always will be and universal coverage won't fix it. If the point is the latter, I think it's a cheap effort in support. If people take it seriously, it's very demotivational and makes me want to find a scapegoat for catharsis. Which for me, the default is adtech incentives these days.
- Terretta 6y ago
  At 400K hospitalizations per 30 days, and $1M per patient, that’s nominally $400B transfer of wealth per month from citizens (via patients, patients’ insurance, or taxpayers) to healthcare industry, with significant percentages extracted as income and profits at each step. Imagine if there were some way to cut out duplicative overhead and administrative costs from all these counter-parties and cut-outs...
  - perl4ever 6y ago
    I think impugning or debating the legitimacy of the entire healthcare industry based on ignorance of the details is not productive. It disgusts me. Nearly everybody has a job in modern society that a random person on the street wouldn't understand, and yet too many people spend their time on the internet declaring most other people have "bullshit jobs". That is toxic bullshit. First the narrative was private insurance companies are useless, now it's the whole healthcare industry. You can't say that in fact $400B is being transferred, just because a number that big can be or is written down, and if it is, that it's inappropriate, without reference points and context. Anything that affects large numbers of people involves big numbers, so negative reactions to billions or trillions in and of themselves are useless or harmful.
mikeknoop 6y ago
Something I don’t understand. Insurance companies seem to have an incentive (more profit) and collective bargaining power to reduce what they pay. Why don’t we see a downward pressure on healthcare prices, then? The typical narrative I hear around large healthcare bills is “racked up large charges because insurance will pay it” which is the opposite of what I would expect given the incentives I understand. Do insurance providers have a non-obvious incentive to keep costs high?
- setr 6y ago
  There's a strange relationship where the bill provided to you is not actually expected to be paid as-such when given to the insurance company -- they will generally challenge the bill, and through a court, it will be negotiated to something more sane -- and this bill will finally be paid out. So a doctor can charge you 10k, but the insurance company itself will only end up paying 2k to cover it (and you pay your deductible). So the charged price is entirely divorced from reality. You get fucked when you don't have insurance, because you can't participate in this process
  - yks 6y ago
    Could you go to court as a private person to negotiate the bill down?
    - nradov 6y ago
      As a private person you don't need to go to court to negotiate. Just call the hospital, threaten not to pay, and offer a lower amount. Ask to speak to a manager. Every hospital has different policies on collections, and exceptions are always possible.
      - Borish_Johnson 6y ago
        In America, We are all Karen.
  - tssva 6y ago
hedora 6y ago
They charged him $82,000 to use a ventilator. I wonder if that includes supplies and labor, because you can buy multiple ventilators for that price, and they’re reusable. Also, $400,000 to seal a hospital room seems excessive. I don’t imagine how it could possibly cost that much. Add a few hepa filters to pull negative pressure, and you’re already pretty close (not counting decontaminating the doctors on the way in and out, but still, $400K?)
seesawtron 6y ago
Reminds of this story. Perhaps not relevant here or is it? Henry Ford once balked at paying $10,000 to General Electric for work done troubleshooting a generator, and asked for an itemized bill. The engineer who performed the work, Charles Steinmetz, sent this: "Making chalk mark on generator, $1. Knowing where to make mark, $9,999." Ford paid the bill. [0] https://www.smithsonianmag.com/history/charles-proteus-steinmetz-the-wizard-of-schenectady-51912022/ https://www.smithsonianmag.com/history/charles-proteus-stein...
baconshirt 6y ago
As a Swede, I find it hilarious that you get a $1.1M bill at a place referred as Swedish hospital in the article. In Sweden you would have to pay $130 as this is our one year cap of personal expenses of hospitalization (high cost control, performed by the hospitals, not by the insurance companies).

57 points by deegles 6y ago

I can predict how this thread is going to go. A: "Just an explanation of charges, not a bill. He won't have to pay any of it." B: "Yeah. This time. By special exception. Any other time for any other reason and he'd have been on the hook." A: "For $6000. Big deal. He almost died and they saved his life. That's chump change." B: "Anyone uninsured wouldn't be so lucky." A: "Maybe they should have been insured." B: "What if they can't afford insurance?" A: "How is that _my_ problem?" B: [daggers] A: [daggers] Did I miss a step?

jmchuster 6y ago

A lot of the inflation in medical prices comes from how the incentives in the US medical system are lined up (e.g. "Usually hospitals get paid only a portion of the amount they bill, as most have negotiated discounts with insurance companies."). So, UHC doesn't just mean that the cost is paid for, but that the price itself wouldn't be so astronomical. I'd really love to see a comparison between 1) the $1MM bill 2) the "actual" negotiated money that changes hands 3) what it would cost in other countries with different healthcare systems.

noobaccount 6y ago
What’s the link between “everyone has a way to pay” and “hospitals won’t overbill”?
- hedora 6y ago
  If the hospitals get paid what they bill, then they won’t have to add nonsense charges to make up the difference.
indiannotation 6y ago
I reside in India and I have also lived in the US, so I can comment on 3. India is going through an interesting phase of aping the "insurance system" of the US over the last 10 years or so (maybe longer, but that's not the main point), but a lot of people are too poor to afford health insurance. Only people who go to the more expensive hospitals use insurance, as a rule of thumb. And guess what? The costs for many procedures have increased 4-5x over this period at those hospitals which do ask for insurance, which still beats inflation handily. On the other hand, the vast majority of people don't have insurance, which means people get to pay actual medical costs for the trivial stuff like cold and fever, and common ailments. These costs generally track inflation. On seeing this, and realizing that except for some really complicated stuff, India's healthcare system is generally quite OK, I have come to the conclusion that the insurance industry in the US is just a complete scam. Insurance is supposed to be something you use in case of a catastrophe, and I don't know how it ended up as such a mandatory thing in the US.
- theonemind 6y ago
  I think that inelastic demand and relative difficulty of ability to price compare lead to it pretty naturally Once you have an insurance layer in the system. I mean, if you get shot, and the ambulance rushes you off to a hospital, you (literally) can’t haggle and shop around. As for it staying like it is, laws in the US radically favor entrenched monied interests because of lobbying, and we have a huge amount of political propaganda convincing uneducated voters to vote against their own interest to the extent that votes even could do anything.
- disabled 6y ago
  > The insurance industry in the US is just a complete scam Correct. I came to that conclusion as a chronically ill university student back in the early 2010s. I also had never experienced other health systems before, at that point, but I had graduate student TAs ask me what I thought of the US healthcare system, and I said "it's a scam and a rip-off". The dude who asked me had an appendicitis surgery on student insurance, and he agreed as he paid a lot of money for the procedure.
disabled 6y ago
> I'd really love to see a comparison between 1) the $1MM bill 2) the "actual" negotiated money that changes hands 3) what it would cost in other countries with different healthcare systems. For example: Blood products in general (medication developed by publicly traded companies and formally approved by governmental bodies), which are regularly required for some rare diseases, generally cost around twice as much in the US compared to the rest of the developed world that has universal healthcare (excluding Switzerland). I have 2 rare immune-mediated neurological diseases affecting my peripheral nervous system, and I require a self-administered blood product to quite literally, stay alive. It is called subcutaneous immunoglobulin. It is the only treatment that has ever worked: I have tried about 10 different medications, plus combinations of them, to no avail. Anyways, the cost of this blood product (immunoglobulin--both intravenous and subcutaneous forms) in developed countries that have universal healthcare (excluding Switzerland and the US) is 40 Euro per gram. Right now, the exchange rate, Euro to US Dollar is 1 Euro per 1.13 US Dollar. So, currently, this blood product costs about USD $45.01 per gram. My US-based private medical insurance, pays for this medication at a contracted rate of USD $100 per gram. The provider (the billing party) is a very well known Pharmacy Benefits Management company, and bills for the medication at a rate of USD $500 per gram. I take very close to 250 grams per month of subcutaneous immunoglobulin. Let's do the math: What my insurance pays to the provider every month, for the blood product, via claims filed over the past 2 years = ($100/gram)(250 grams/month) = USD $25,000/month What the provider bills, and what I could theoretically owe, if something goes wrong = ($500/gram)(250 grams/bill) = USD $125,000 per bill So, if for some reason a mistake is made, with respect to honoring a prior authorization, I can literally end up with a bill over USD $100,000 for a "one month's supply" of medication, with no resolve. What a government in Europe (excluding Switzerland) pays per month for the medication (and I never have to worry about owing) = ($45.01/gram)*(250 grams/month) = USD $11,252.50/month

perl4ever 6y ago

"because Flor has insurance including Medicare, he won’t have to pay the vast majority of it" Did they really use stuff that truly cost $1.1M on him, and did they need to? If they're charging some absurd amount for a room, maybe it's just a way of rationing at some level, not what is being consumed. I wish people would look at more what was spent in resources than what the dollar amount of the treatment was - if the patient didn't pay, then what matters to society is what was spent by society, not what number was written down as part of weird accounting. The article acknowledged "hospitals get paid only a portion of the amount they bill". It's not helpful or necessary to write anguished stuff based on your conviction that the accounting style is wrong. What matters is the effect on real people. On the other hand, if the reason that drug costs for instance were so high was because unnecessary drugs were used, or because they were wasted, or because the manufacturing of them was inefficient, that's a real problem and I wish that an article like this would focus on it, delve into it. Just...don't write stuff about how America is terrible because big numbers are scary. I can't tell if the article is meant to be pro or con universal coverage, or if the point is, America is terrible and always will be and universal coverage won't fix it. If the point is the latter, I think it's a cheap effort in support. If people take it seriously, it's very demotivational and makes me want to find a scapegoat for catharsis. Which for me, the default is adtech incentives these days.

Terretta 6y ago
At 400K hospitalizations per 30 days, and $1M per patient, that’s nominally $400B transfer of wealth per month from citizens (via patients, patients’ insurance, or taxpayers) to healthcare industry, with significant percentages extracted as income and profits at each step. Imagine if there were some way to cut out duplicative overhead and administrative costs from all these counter-parties and cut-outs...
- perl4ever 6y ago
  I think impugning or debating the legitimacy of the entire healthcare industry based on ignorance of the details is not productive. It disgusts me. Nearly everybody has a job in modern society that a random person on the street wouldn't understand, and yet too many people spend their time on the internet declaring most other people have "bullshit jobs". That is toxic bullshit. First the narrative was private insurance companies are useless, now it's the whole healthcare industry. You can't say that in fact $400B is being transferred, just because a number that big can be or is written down, and if it is, that it's inappropriate, without reference points and context. Anything that affects large numbers of people involves big numbers, so negative reactions to billions or trillions in and of themselves are useless or harmful.

mikeknoop 6y ago

Something I don’t understand. Insurance companies seem to have an incentive (more profit) and collective bargaining power to reduce what they pay. Why don’t we see a downward pressure on healthcare prices, then? The typical narrative I hear around large healthcare bills is “racked up large charges because insurance will pay it” which is the opposite of what I would expect given the incentives I understand. Do insurance providers have a non-obvious incentive to keep costs high?

setr 6y ago
There's a strange relationship where the bill provided to you is not actually expected to be paid as-such when given to the insurance company -- they will generally challenge the bill, and through a court, it will be negotiated to something more sane -- and this bill will finally be paid out. So a doctor can charge you 10k, but the insurance company itself will only end up paying 2k to cover it (and you pay your deductible). So the charged price is entirely divorced from reality. You get fucked when you don't have insurance, because you can't participate in this process
- yks 6y ago
  Could you go to court as a private person to negotiate the bill down?
  - nradov 6y ago
    As a private person you don't need to go to court to negotiate. Just call the hospital, threaten not to pay, and offer a lower amount. Ask to speak to a manager. Every hospital has different policies on collections, and exceptions are always possible.
    - Borish_Johnson 6y ago
      In America, We are all Karen.
- tssva 6y ago

hedora 6y ago

They charged him $82,000 to use a ventilator. I wonder if that includes supplies and labor, because you can buy multiple ventilators for that price, and they’re reusable. Also, $400,000 to seal a hospital room seems excessive. I don’t imagine how it could possibly cost that much. Add a few hepa filters to pull negative pressure, and you’re already pretty close (not counting decontaminating the doctors on the way in and out, but still, $400K?)

seesawtron 6y ago

Reminds of this story. Perhaps not relevant here or is it? Henry Ford once balked at paying $10,000 to General Electric for work done troubleshooting a generator, and asked for an itemized bill. The engineer who performed the work, Charles Steinmetz, sent this: "Making chalk mark on generator, $1. Knowing where to make mark, $9,999." Ford paid the bill. [0] https://www.smithsonianmag.com/history/charles-proteus-steinmetz-the-wizard-of-schenectady-51912022/ https://www.smithsonianmag.com/history/charles-proteus-stein...

baconshirt 6y ago

As a Swede, I find it hilarious that you get a $1.1M bill at a place referred as Swedish hospital in the article. In Sweden you would have to pay $130 as this is our one year cap of personal expenses of hospitalization (high cost control, performed by the hospitals, not by the insurance companies).