27 ms·

Congress is set to ban most surprise medical bills

463 points by jseliger 6y ago

pxeboot 6y ago
Really happy to see this practice banned. Sadly it will not take effect for another year. Unfortunately, this is only one of many significant issues with US healthcare.
- spaetzleesser 6y ago
  I wouldn’t be surprised if hospitals already have other ways ready to screw people over once this goes into effect. As far as billing goes in my view they are basically criminal organizations that use fraud, intimidation and other things to squeeze people for money.
lordnacho 6y ago
> Surprise bills happen when an out-of-network provider is unexpectedly involved in a patient’s care. Patients go to a hospital that accepts their insurance, for example, but get treated there by an emergency room physician who doesn’t. Such doctors often bill those patients for large fees, far higher than what health plans typically pay. How do courts uphold this? You go to a restaurant, they say you can buy the tasting menu for $100, but they have a temp chef working that day which will cost you $50 extra, which you find out as you're paying. I mean you might even be unconscious when this is happening? EDIT Actually someone brought up an important point. If you go to a restaurant, you are kinda expected to know that there's taxes and tipping to pay. Do the US courts think the same of healthcare? "You were in a hospital, you should have known that the bill is always higher than the sticker price?" It would surprise me as a European.
- curiousgal 6y ago
  It's just appalling to see a nation as smart, rich and well accomplished as the U.S. being straight up retarded when it comes to healthcare.
  - deleted 6y ago
    [deleted]
  - dpeck 6y ago
    That is inappropriate word choice here or anywhere. Remove your slur.
    - t0mbstone 6y ago
      re·tard verb past tense: retarded; past participle: retarded /riˈtärd/ delay or hold back in terms of progress, development, or accomplishment. "our progress was retarded by unforeseen difficulties" It seems to me that the word's usage is an accurate description of America's lack of progress in this area...
      - luhn 6y ago
        At least here in the US, it's generally no longer considered appropriate. https://www.specialolympics.org/stories/impact/why-the-r-word-is-the-r-slur https://www.specialolympics.org/stories/impact/why-the-r-wor...
        samch 6y ago
        Thank you. My wife worked for the Special Olympics for several years, and we were privileged to meet so many wonderful athletes in the program. I doubt a single one would think this usage of the r-word was appropriate.
      - colejohnson66 6y ago
        The word itself isn’t wrong per se, but it has a negative connotation that’s associated with “slow” people (from the medical terminology “mental retardation”). It’s a playground insult to call someone “retarded” because they’re “stupid”. It could just be an American thing, but using it like that is very common. I think a good comparison is “fag”. Sure, it means a cigarette, but it is (was?) a common insult towards gay people. Should we not use the word? I don’t know. I’m just explaining why dpeck wrote their comment.
- nottorp 6y ago
  From what I know about the US even your restaurant example has hidden service fees and mandatory tips and taxes that aren't on the menu?
  - shreyansj 6y ago
    But generally the tips and taxes is something you know about if you are a US resident. And you might not be unconscious at the time of payment :) And restaurant staff getting paid a decent wage without relying on tips is also something that should get fixed sooner than later.
  - dx87 6y ago
    Every restaurant I've been to with mandatory tips or fees has it written on the bottom of each page. The only shady thing I've seen them do is add the mandatory tip, then give you the bill with an option for an additional tip, hoping people will forget that the tip was already included in the bill.
  - leetcrew 6y ago
    not really the same. tipping is a custom, but it's not legally required unless the restaurant clearly states that it will be added to the bill. sales tax is not really a hidden fee. americans usually know the general sales tax for their state. it gets a bit more complicated with specific excise taxes (eg, alcohol), but these rates are publicly available. if you're really concerned, you can always just ask your server or their manager what the after-tax cost of an item on the menu is. even if you know exactly what medical procedure will be performed, it is still pretty hard to get an exact quote for the cost. it certainly can't be calculated from freely available numbers.
  - wil421 6y ago
    No hidden service fees. Taxing is not so simple in the US. My county has a lower sales tax rate than other counties around me. When I worked as a waiter the municipality had a special tax on alcohol in addition to the county and states alcohol and regular sales taxes.
    - 6y ago
- amelius 6y ago
  Some people wear a tag with their blood group on it. Perhaps we should be wearing tags with the amount of money we're willing to spend on a hospital visit.
  - lotsofpulp 6y ago
    I have joked before that I should wear an undershirt that says “Healthcare accepted only by in network providers <insurance ID #>. If out of network, stay away and let me die”.
  - hn_throwaway_99 6y ago
    I'm curious, would this even be essentially "accepted" by any hospital in the US? Not just a tag, but if you were going in for a procedure, could you even say "I want to be sure I will not be treated by anyone not covered by my insurance plan"? Because basically all the forms you need to sign upon admittance essentially say "We can charge you whatever we want and you are responsible for paying it."
    - jdmichal 6y ago
      I would probably refer to the ethics dilemmas around "do not resuscitate" tattoos as the closest analog that I've heard about.
    - 93po 6y ago
      They would tell you that you need to talk to billing, and billing would tell you they can't provide pricing at all and they can only tell you after going through your insurance, or they would require a zillion digit billing code that only your doctors can provide, and your doctors are not going to waste their time giving you the list of a thousand codes for whatever operation you're doing, or at least not accurately. In short there is no way. Either you accept treatment and you're billed what you're billed and you hope insurance only fucks you over a little bit, or you're denied any service short of immediate life saving.
    - meowster 6y ago
      Whenever I took my vehicles in for service at a dealership, they would always provide a form for me to sign to pre-authorize any work they deem necessary. I always leave those forms blank. Never had an issue. Whenever I go to a new doctor or medical facility, they always ask for tons of personal information such as my social security number. I always leave most of that blank. Never had a problem. I've never been asked to write a blank check for a medical operation like I have at a dealership, but perhaps we should just make such practices illegal?
- freeone3000 6y ago
  The courts can only act where there is law. It's a legal system, not an inherent fairness system -- current law upholds the status quo, which is why this measure passing is good news.
- harperlee 6y ago
  > you are kinda expected to know that there's taxes and tipping to pay Also not reasonable, so at least in Spain the menu has to include VAT.
- spaetzleesser 6y ago
  "How do courts uphold this? You go to a restaurant, they say you can buy the tasting menu for $100, but they have a temp chef working that day which will cost you $50 extra, which you find out as you're paying. " In the US you go to a hospital and basically sign a contract "you can charge me for whatever you feel like". What surprises me is that they get away with often charging for stuff that never happened. When you confront them they just say "Oops!" ad take it off only to try it again next time. I don't understand how they get away with that.
  - meowster 6y ago
    > I don't understand how they get away with that. 99% of people don't confront them.
- crossroadsguy 6y ago
  > and tipping to pay Tipping is demeaning and derogatory to the person being tipped, especially in the manner it is done. Also, it can be reason for discrimination against the expected tipper. It always astounds me how people (mostly a lot of Americans) defend this practice just calling it "custom" and that it helps the receiver.
  - jdgiese 6y ago
    > Tipping is demeaning and derogatory to the person being tipped, especially in the manner it is done. Why?
standardUser 6y ago
The change does not apply to ambulances (except for air ambulances), ensuring the United States remains one of the few places in the world where a seriously ill person needs to debate if they're willing to risk their health and life to avoid a financially crippling trip to the hospital.
- spaetzleesser 6y ago
  I was billed $3000 for a twenty minute ride to the hospital after somebody hit my car. I spent the time chatting with the EMTs. No treatment .
  - jbay808 6y ago
    Send them a $4000 bill for your time!
- HenryKissinger 6y ago
  "‘As I was being eaten, I was thinking about my insurance’: Woman who lost face in bear attack on why she’s voting for Bernie Sanders" https://www.independent.co.uk/news/world/americas/us-election/bear-attack-allena-hansen-face-bernie-sanders-healthcare-insurance-2020-election-super-tuesday-a9370156.html https://www.independent.co.uk/news/world/americas/us-electio...
  - silentsea90 6y ago
    Peak dystopia
  - HarryHirsch 6y ago
    /r/nottheonion
  - mrlala 6y ago
    How any of you snakes on here can downvote this is beyond me. I mean, I know who you are. People who have a great job and don't really have to worry about insurance. Or maybe at a university where insurance is probably covered well. So f everyone else, right? I am self employed so I have to worry about paying all this shit myself; 11k family deductible with 40% co-insurance for $1200. Every time my young kids have had something that was not like a massive emergency, you know what the thought is? Oh god is this worth going to the hospital for and spending 1k? Or when I had my own person health issues, my first thoughts are always how much is this going to fucking cost? So yeah, if you think OPs link is exaggeration.. it sure as hell is not.
jdlyga 6y ago
The current US medical system reminds me a lot of very important legacy code that's become unmaintainable. Maybe the best way of rolling out universal healthcare is to take a refactoring approach. Get more and more people onto medicare, lowering the age limit and raising the maximum income threshold. Eventually, it would only be the wealthy who were still on the private insurance only system. Then employers can gradually replace health coverage with other benefits.
- vidarh 6y ago
  You need to reform regulations as well. Medicare + Medicaid cost US tax payers more per capita as the UK NHS costs UK taxpayers per capita. The UK NHS provides universal coverage. Part of the problem is that Medicare is actively prevented from being cost-effective. E.g. there are restrictions on its ability to negotiate prices in many instances, whereas the NHS will actively use all the leverage it has by coordinating purchases across the board. I'm sure that alone would not solve the issue, but it's unnecessary hard to get support for universal healthcare as long as Medicare is as expensive as it is. Fixing that would make it harder to argue against Medicare expansion. To start with you could expand coverage substantially simply by allowing any savings to go towards expanding coverage. > Eventually, it would only be the wealthy who were still on the private insurance only system. Then employers can gradually replace health coverage with other benefits. It's worth noting that this is pretty much how it is in the UK. We do have private cover, but only about 10% of the population uses it. Notably it's generally "add on" coverage in that almost all policies expect you to rely on the NHS for basics, but lets you pretty much use the policy to queue jump to private hospitals if the NHS is "too slow" or for services above and beyond what the NHS offers. As such that's 10% despite UK policies being generally far cheaper, since they don't need to cover things like ambulances and ER/A&E (whenever anyone complains about the NHS this is a pretty essential point: the NHS is good enough that there isn't a sustainable market sufficient to compete with it; it's not perfect, but as long as private cover is as limited both in takeup and what it provides as it is, that's a pretty good indicator)
- frankbreetz 6y ago
  Not a bad idea, but I would like to point out one of the arguments of getting rid of private insurance is that wealthy would need an incentive to not degrade the system. Like it or not the wealthy have have much more political power then common folk and allowing them to have them own system outside of the general public gives them incentive to cut cost with no effect on themselves.
tthun 6y ago
If the underlying problem (in-network discounted rates for services and out of network excess that the service provider can charge - honestly this practice should be made criminal - imagine Sams club selling a computer to non-members for 10x the cost the members pay) is not addressed, the surprise bill just becomes someone elses prolem (other patients end up paying).
- xyzzyz 6y ago
  > imagine Sams club selling a computer to non-members for 10x the cost the members pay I wouldn’t mind that actually. They can sell for 100x for all I care. I can just not buy it. A better analogy would be if you got a letter 2 months after you shopping visit telling you that the the package of cheese you bought is actually $2000 instead of $5, and no, they do not accept returns.
kayodelycaon 6y ago
> Some private-equity firms have turned this kind of billing into a robust business model, buying emergency room doctor groups and moving the providers out of network so they could bill larger fees. If this doesn’t describe evil, I don’t know what else would.
- tthun 6y ago
  It should be illegal
- leetcrew 6y ago
  I wouldn't reject this out of hand, but I do find that the complexities around healthcare and the obvious political implications lead to a lot of exaggeration and outright falsehoods being propagated. it's my understanding that the affordable care act requires insurers to treat any emergency services (if covered at all) as in-network. can anyone explain either a.) how I am wrong, or b.) how this can be circumvented?
  - breck 6y ago
    > complexities This. Does anyone know if the Founding Fathers discussed the evils of complexity in law back during the conventions in Philadelphia? Is that a more modern day problem, or is it as old as parliament itself? I don't remember reading anything that said the dangers of complexity in law was on their radar. Businesses are guaranteed to take advantage of complexities in law. I don't think this is well enough known. Any and every added complexity will therefore be taken advantage of, and should be considered in passing a law, and every law should have some type of way to "expire" itself, so that it can be removed (and the resulting complexity), when the reasoning for such law is gone. Complexity around healthcare laws is the textbook example.
  - aamar 6y ago
    See here[1] for a pretty good explanation. Importantly, your insurer treating the visit as in-network does not force the provider to treat it as in-network; surprise bills come from the provider, not the insurer. From that post: If the insurer pays less than the out-of-network emergency room bills, the emergency room can send you a balance bill for the difference, over and above the deductible and coinsurance amounts you pay. That “if” condition is usually going to hold, so a lot of surprise bills come out even despite the ACA rule. [1] https://www.verywellhealth.com/get-in-network-rates-out-of-network-1739069 https://www.verywellhealth.com/get-in-network-rates-out-of-n...
jsperson 6y ago
That it takes such effort to pass a bill like this - 80% public approval, banning a clearly predatory practice, has turned me from a pure free market thinking into a believer in single payer healthcare. The free market just doesn't work when there is very little elasticity in consumption. I've been on the receiving end of a $15K air ambulance bill (thankfully covered by insurance) as well as the out of network specialist at an in-network hospital. The latter is particularly galling. What are you supposed to do, interrogate every person that comes in the room?
- mehrdadn 6y ago
  > What are you supposed to do, interrogate every person that comes in the room? I'm curious too. Some people must have tried filing a lawsuit... what do judges think people should be doing?
  - RHSeeger 6y ago
    I had to go into surgery last year and had to sign a "I will pay whatever my insurance doesn't" form. I wrote in a clause saying that any out of network elements (persons, etc) must be personally approved in writing by myself or my proxy before they can do anything they bill for. I don't know if it would have held up in court, but it made me feel a little safer.
  - cmiles74 6y ago
    In my case it was the anesthesiologist who was out of network. Looking at the bill, they looked like just another practice. When I found their phone number and address, however, it turned out that their practice was part of the hospital. I called their number and ended up talking to someone in their office and they agreed to waive the fee. I wonder if this is part of their process: if there's pushback, waive the fee.
    - dr_orpheus 6y ago
      > I wonder if this is part of their process: if there's pushback, waive the fee. This is 100% how a lot of medical offices and/or insurance operates. For some practices that perform complicated procedures bills will get sent with a "catch-all" sort of approach of all possible scenarios that could have happened and you have to go back and tell them what treatment you actually got. Insurance companies will also just initially deny claims in the hopes that people won't spend the time to debate it. My wife had to get back injections for a bulged disk and insurance initially denied the claim on the basis that "it was not inhibiting her daily function". The original request from the doctor included the wording of "this is medically necessary because the pain is inhibiting her daily function" because he knew that was their criteria. Insurance still just rejected it because it is easier for them to do that and only accept the claims people fight for. Luckily in this case the doctors office was on our side and called the insurance company to get it approved. The doctor said that this kind of shit happened all the time.
etskinner 6y ago
https://archive.is/50VQv https://archive.is/50VQv
lwigo 6y ago
This isn't directly related, but some of the credit reporting agencies can have surprise medical bills written off due to covid related hardships. This is to say, if a surprise bill happens to hit collections, and you're affected by covid, it can be removed through the report process. I have no idea what this looks like in the long term, though.
deleted 6y ago
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bearjaws 6y ago
Having gone through cancer treatment here in the USA, I have received over a dozen 'after the fact bills' over the past 5 years, sometimes over 9months after the procedure, mainly involving blood work and CT scans. I missed one bill that came months after chemotherapy for $87 in 2015, it only had a 60 day notice before sending to collections. Mind you I was on disability from my employer that paid well. -80pts on my credit score... It took until last year to get my credit score back to the same level it was prior to starting treatment.
- AdmiralAsshat 6y ago
  If it's any consolation, that time should now be 180 days, and I'm pretty sure the counter should start at the time the collection agency receives it, not from the date of service. IANAL, though, so don't quote me on that.
- JacobSuperslav 6y ago
  how come in Europe credit score isn't really a thing and everything works fine? that's another thing that needs to go
  - jlokier 6y ago
    I don't know if you're counting UK as part of Europe for this purpose, but in the UK credit score is definitely a thing. It affects whether you can get a mortgage, credit card, loan, purchase credit (e.g. for buying a phone), or even a tiny overdraft, and it enormously affects how much interest you will be charged (i.e. very high or very low), and whether the credit limit you can get is zero, tiny or substantial.
  - vasco 6y ago
    There are credit scores in some places in Europe, mostly in the form of lists of people that may have failed to pay something in the past. It's a pain in the ass to correct if you get there by mistake and it's very opaque. Overall credit scores seem like a great idea with a terrible implementation. In general you as a mindful consumer that pays your bills on time wouldn't want to be paying the same prices for loans (spread, interest) as other consumers that have a history of not paying. A well functioning credit score system makes for a more efficient lending market, allowing consumers to save money if they have a good track record. How it actually works in practice is a joke, though.
mcshicks 6y ago
California has such a law already. I went to an ER at the beginning of the year for a minor fracture and had a "contract physician". I was pleasantly surprised when the bill was exactly my er visit copay. I had an equally unpleasant experience several years ago that cost me thousands of dollars. https://dmhc.ca.gov/Portals/0/HealthCareInCalifornia/FactSheets/fsab72.pdf https://dmhc.ca.gov/Portals/0/HealthCareInCalifornia/FactShe...
- kevinofe 6y ago
  The CA law is kind of BS. My partner went to see doc, they ran a few tests, told her it would probably be covered by insurance and then we got a bill for $1700. They said it wasn't "surprise" bill because it wasn't out of network. I told them "it is a surprise to us!" From then on, we always ask the cost of every single test/procedure. (In fairness to the hospital, they did give us a $50/month, interest free payment plan.)
  - mcshicks 6y ago
    Yeah I agree the name is misleading and it doesn't cover all situations. My specific situation both times was ER rooms with out of network doctors, but I agree that there can be many other situations where the law is not that helpful. My personal opinion is those would be better managed by a single payer system like they have in many other countries. I haven't looked at the federal law close enough to know if it covers cases other than out of network doctors.
erlapso 6y ago
> The new changes will take effect in 2022, and will apply to doctors, hospitals and air ambulances, though not ground ambulances. From 2022 and no ambulances. This is a joke..
- silentsea90 6y ago
  Optimists here would claim that this is slightly less of a joke than the status quo.
- lawn 6y ago
  How come it covers air ambulances but not ground ambulances? I know the answer is probably that the ambulance companies lobbied (bribed) the hell out of these laws, but with the ambulance costs this is comical.
2Gkashmiri 6y ago
In India you have these government run hospitals. Entry is essentially free and so is the emergency / opd treatment. For procedures they charge peanuts compared to private sector. The only thing, there is a waiting list and hygeine is not always a priority. There is an AIIMS hospital in Delhi and I had the misfortune of taking a relative there for treating surgical infection. It was brutal. We got in line around 9 am. Had to put the patient on a gurney and wait. Around 3 pm slowly our place reached to the inside emergency ward. Around 7 pm we finally were attended by an intern. Took 6 pricks to insert a catather then a senior resident was called in to help. Around an hour later the medication started to do some work. Around 10 pm more medication was administered. We ended up asking the doctor to let us go because it was 12 am and we needed to consume some food, pee. Never again. This was around 5 years ago and I hope things have improved for the sake of patients.
- silentsea90 6y ago
  Public services in India, especially ones interacting with people en masse are terrible. No recourse but to go to private hospitals.
  - 2Gkashmiri 6y ago
    they are terrible because they are too less. other than that i would rather get treated in a government run hospital because they employ only the most capable of doctors, senior and otherwise. the problem isnt in the doctors. its infrastructure. i think people got my comment wrong way. i am very much in support of these hospitals. just that i want them to be in every major district rather than being restricted to major cities. its not like these places would remain empty
    - selimthegrim 6y ago
      What is happening with Ayushman Bharat in held Kashmir?
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OminousWeapons 6y ago
I was working on a health insurance related startup for awhile so I would say I know more than the average person about the space, and even I get surprised on a regular basis by the absurdity in this field. For example, I was finishing up an advanced degree program between September and January and my University decided to terminate my health insurance in September. Without telling me. In the middle of a pandemic. When I discovered this last week, I attempted to buy health insurance directly from insurers and was informed that I could not get coverage until January 1st of 2021 as I was "outside the eligibility window". They literally won't sell active coverage to me at any price. Apparently you only have two months after losing your insurance to be able to buy new insurance before having to wait until specific times in the year. I can buy home insurance, liability insurance, car insurance, and any other type of insurance whenever I want but god forbid I try to buy health insurance 61 days after an arbitrary point in the year. I effectively cannot go outside until January 1st as if I get covid and have to go to the hospital I'm screwed.
- crazcarl 6y ago
  Just as a heads up in case you or anyone else reading this is in this position. For the uninsured, if your treatment is directly related to Covid-19, you would be covered under the Covid-19 HRSA program described here. https://www.hrsa.gov/CovidUninsuredClaim https://www.hrsa.gov/CovidUninsuredClaim
  - OminousWeapons 6y ago
    This is a huge relief; thank you for bringing this to my attention!
- zaroth 6y ago
  The intent here is to prevent people from gaming the system by buying insurance only right after a serious diagnosis. There are several qualifying events to be able to enroll outside the eligibility window if you’ve had a job change for example.
  - mrlala 6y ago
HeyImAlex 6y ago
I had to provide a urine sample to get my ADHD medication. It was sold to me under the auspices of drug testing, even though ADHD meds are out of your system in 48h. A month later I received an explanation of benefits from my insurance company that said they received a 14k bill and had paid 4k of it, so I was on the hook for the other 10k. Furious I went to my psych. They casually said “we’ve taken care of it, you shouldn’t receive an actual bill”. Uh, that’s not the point? The point is why was it necessary to send my urine for 14k in testing in the first place? You cannot convince me they weren’t getting kickbacks from this program. Finding a new psych is difficult, so the next time they asked me to pee in a cup I asked if they’d charge my insurance the same way again. I haven’t been asked for a urine sample since, which is odd considering they have signs clearly posted saying drug tests are mandatory. I guess not _that_ mandatory, huh? It’s wild that individuals are forced to navigate this system, much less fight it when they’re being fucked. The idea that there are people who’s sole purpose is designing beurocratic gears to grind money out of sick people makes me sick. And they employ an army of low wage call center folks to do their bidding, work that I can’t imagine is super rewarding. How much better would the world be if we tore down these machines and paid all of those people to do literally anything else?
- mattkrause 6y ago
  At $14k/test, they could nearly afford to buy a used but functional GSMS system system just for you(!).
- iaw 6y ago
  > You cannot convince me they weren’t getting kickbacks from this program. Given all the problems this caused for the opioid epidemic I'm disappointed (but not surprised) such behaviors are still be legal.
- SkyPuncher 6y ago
  > I had to provide a urine sample to get my ADHD medication. It was sold to me under the auspices of drug testing, even though ADHD meds are out of your system in 48h. FYI, they weren't checking for your ADHD medication. They were likely checking for marijuana. * Marijuana can introduce side effects that basically make it look like you have ADHD * Most ADHD medications are stimulants, they have counter indications when taken with marijuana * Stimulant prescriptions are under scrutiny right now, so places have been doing more diligence > A month later I received an explanation of benefits from my insurance company that said they received a 14k bill and had paid 4k of it, so I was on the hook for the other 10k. Furious I went to my psych. They casually said “we’ve taken care of it, you shouldn’t receive an actual bill”. Uh, that’s not the point? The point is why was it necessary to send my urine for 14k in testing in the first place? The underlying problem is how a bunch of stuff gets billed. Basically your pysch and insurance company have a pre-negotiated rate for re-imbursement on this - it has little to no bearing on what you actually pay as a patient. It's pretty much all BS because there's a secondary system for resolving those bills.
alexfromapex 6y ago
How about “surprise insurance won’t cover this” situations?
chapium 6y ago
When we had our first child, we carefully selected a pediatrician that was covered by our insurance. It turns out that doctor was only billable to our insurance for delivery, any follow up visits were not covered by the insurer because that same doctor was not considered part of that hospital org. The org she did routine pediatric work was somehow different, yet in the same building. We discovered this as we were leaving the hospital and scheduling a follow up visit. It was very urgent since we had a moderate complication and need a doctor immediately. However our insurer (employer provided) was blacklisted by the doctors group that all doctors in our neighborhood were a part of. Ultimately, on short notice we found a new pediatrician an hour away which began ordering lab work. This is not something you want to go through with a newborn and a new mother. It was also bullshit, because we were hit with a surprise caveat to our researched doctor so late in the process even though we had been trying to do our due diligence to get things squared away months in advance. This was all because our insurer decided that our doctor was billed by different rules depending on what part of the job she was doing for the same patient. I've been an ardent supporter of single payer ever since.
- ativzzz 6y ago
  You make it sound like it's the doctor group that chose not to work with that insurance company. The fault probably goes both ways.
  - chapium 6y ago
    They blacklisted our plan for specific visits. That shouldn't be possible.
zaroth 6y ago
This essentially takes the patient out of the loop if one of the providers is not in-network / being directly reimbursed by insurance. Now the provider and insurance company have to work together to resolve the bill. Most importantly it would be charged against the patient’s in-network deductible. It’s really too bad that this bill was watered down in one particular way. The Senate version of the bill would have set the price as the median in-network price for the procedure/service in that market (which ~5x the price that Medicare would pay). Out of network prices are usually another ~5x higher than in-network prices. House Democrats instead pushed for the rate to be set in arbitration, which is the version that will be enacted. https://www.forbes.com/sites/theapothecary/2020/02/19/house-democrats-capitulation-on-surprise-billing-proves-theyll-never-pass-medicare-for-all/?sh=4e735b9b2538 https://www.forbes.com/sites/theapothecary/2020/02/19/house-...
- thesimon 6y ago
  I guess a version that would make them pay what Medicare would pay wouldn't fly?
  - zaroth 6y ago
    No, that’s significantly less than the in-network rate.
Triv888 6y ago
I don't pay surprise bills ... (and I don't think it affects my credit because I had a couple in the last year and my FICO score is still at about 800) ... I'm not going to pay a random bill that comes 3 months after a doctor's visit that they never told me about and I already paid $400 for the emergency 30-min visit (not sure what the insurance paid)
silentsea90 6y ago
As an aside, do we expect the rise of medical tourism options to put downward pressure on pricing for medical procedures in the US?
adamredwoods 6y ago
I feel most comments here fail to separate hospitals and insurance. And that could be separated even more (pharmaceuticals, for example as a separate category).
flowerlad 6y ago
Another thing that is needed urgently is uniform pricing. Today healthcare providers charge different amounts to different insurers, and if you don't have insurance you pay list price. The list price is a arbitrary large number (often 3x the price insurers pay) that has no relation to reality. So if you don't have insurance, you are hit with a double whammy: You have to pay the bill yourself, and if that isn't bad enough, they charge you 300% of the "real" price, meaning what insurance companies pay for the same procedure.
deleted 6y ago
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javier10e6 6y ago
Humana Healthcare CEO Bruce Broussard base salary in 2016 was $1.24 million. No surprise there.
- my_usernam3 6y ago
  I'm actually ok with that salary as they have over 50B in revenue. However, I'm sure he and all the other execs receive exorbitant bonuses and stocks plans that make that salary look like peanuts.
Moodles 6y ago
As an immigrant coming to America, honestly the most shocking and surprising thing (apart from the state of homeless in San Francisco being tolerated as normal) is the medical care expenses. How on Earth is it that I can walk into a doctor's office or hospital to get medical treatment and have no idea how much it's going to cost? $10? $100? $1000? Who knows. I had an ear infection once, went to the doctor who looked at it for a minute and said "give it a few days". I assumed this would cost maybe $20 or something? Nope. $400. There's just no way of even knowing. In no other industry would you buy something without knowing the price ahead of time. With medical care it's even more screwed up because, well, it's your health? You're generally more desperate for services now, so it's not like shopping around for clothes or something.
- deleted 6y ago
  [deleted]
- henrikschroder 6y ago
  It's pretty tragic that there are so many people like you and me, immigrants who have experienced several different healthcare systems, and we can all testify that the US system sucks on every level compared to other systems. And yet, there's a huge amount of Americans who have only ever lived in the US, who are certain the US system is the best in the world, and who believe all the scary stories that are designed to make you think so. You could listen to the people who have actual real-world experience, or you can listen to the lobbyists who are paid to preserve the lucrative US system. How is this even a thing?
  - Moodles 6y ago
    I wouldn't say it sucks on every level. The actual quality of care is usually good.
uberdru 6y ago
Imagine buying a car when the salesman cannot tell you the price, and the lender cannot tell you the interest rate, until after you have driven the car off the lot.
- wmeredith 6y ago
  Now imagine you'll die or be permanently maimed if you don't buy the car in the next 15 minutes.
sebastien_b 6y ago
Not being in the US, I have to wonder - Why aren't the personnel at a hospital not considered part of 'in-network' while performing their duties at that hospital? If being "in-network" is an important thing, it seems like having "out-of-network" personnel is rather deceitful (I would almost say fraudulent).
astrophysician 6y ago
As the recipient of a $25,000 bill for an emergency visit to an out-of-network hospital that I have been fighting for two years (still ongoing), this is such an overdue blessing. FYI -- many individual states ban "balance billing" i.e. hospitals sending you the leftover bill that insurance didn't cover (btw -- hospitals can charge a special "out-of-network" rate, in my case 10x the average cost around the area for the services I received). Problem is, if you are on a "self-insured" plan (your card should say this, these are plans you'll get at university or when working for a large company), the state law can't do anything, and there has been no federal law banning this practice. It's absolutely inhumane.
mLuby 6y ago
[US]: "Stop the surprise prices!" [Hospitals]: "Okay, here's our menu of services: Saline $300, Specialist Consultation (20min) $1K, Ambulance Ride $15K." [Health Insurers]: "If you join our club and pay dues, you get exclusive menu prices: saline $15, consultation $50, ambulance $200." The problem is different people being charged dramatically different prices to continue living, because of which health insurance (if any) they have, and not being able to change that fact (except once a year). The solution is that hospitals—and IMO businesses in general—must not charge different prices to different groups of customers (which single payer accomplishes, as I understand it).
y-c-o-m-b 6y ago
My state (Oregon) has protection against this. Unfortunately my emergency spinal operation was 2 months prior to the bill going into effect, so I got hit by this. The part that pissed me off was I KNEW about the practice and specifically made a fuss about making sure everyone in that OR was IN NETWORK. I went to an in network facility, my surgeon was in network, and so was the anesthesiologist and every person that entered my hospital room I asked if the OR staff was in network (the answer was always yes). 1 month later I get a bill for a neuro-monitoring team and an assistant-surgeon that were both out of network. The assistant surgeon charged me about $500. The neuro-monitoring team sent a ~$20,000 bill with the promise that they'd lower it to a reasonable value when I called to pay. Furthermore Blue Cross sent me a letter saying it wasn't pre-approved (even though the procedure was) and they would not cover a cent of it. Imagine the feeling of doom wondering just how low could these shysters possibly go from 20k. Thankfully that turned out to be true, the final bill was $800. Which still made me furious because I made such a huge deal out of not getting into this situation. So that was $1300 total out of pocket that I was not expecting to pay. Luckily I'm a software developer with a huge savings, but I made several angry calls anyway and even sent an appeal twice to blue cross (which they denied both times). I'm so glad this crap is finally coming to an end, but the right-leaning supreme court makes me afraid some of these laws will get reversed.
- busyant 6y ago
  I had a similar experience. * I paid $20K out of pocket for a surgery that my insurer wouldn't cover. * This was supposed to pay for everything (surgery, anesthesia, hospital stay, etc.). * About 2 weeks post surgery, I got ANOTHER $20K bill from the hospital AND ANOTHER $1800 bill from the anesthesia group. * At the same time, I developed a complication from the surgery that put me in EXCRUCIATING pain. * Wife said I should go to the ER for the complication. * I said, "NO WAY. We're gonna get hit with ANOTHER $20K bill because I developed a complication from a procedure that my insurer doesn't cover. I will ride this out." * After 2 weeks of horrific pain, I broke down and went back to the surgical group. * They told me that the bills that I received were probably an error. * I calmly explained to the physician's assistant that I had neglected dealing with the complication as a DIRECT result of receiving those bills and I not-so-subtly implied that there might be a lawsuit coming their way. * Within 20 minutes of leaving the surgical group, I got 3 phone calls from different people at the hospital expressing deep apologies and rescinding the bill.
tehwebguy 6y ago
There is no such thing as a surprise medical bills ban. The only thing that will happen, without a complete overhaul of the way medical services are paid for in the US, is that patients will be given one extra form to sign before being allowed any services by any provider: Patient waives any and all rights granted by [anti-surprise laws] and agrees to indemnify Provider for any related costs. You have to understand it's not just about the rules, medical insurance companies will do plenty to stay compliant but they'll still screw you. Sometimes they'll send you a bill for something they already said was covered, then suddenly it's on you to fight a several billion dollar company into just doing what they promised.
JarlUlvi 6y ago
This is being made out as a win for patients, but it actually IS NOT. I'd describe it more as a win for insurance companies and potentially patients, with the losers being the out-of-network doctors, depending on the situation. This does have the possibility of reducing the quality of care around trauma in the US. We have a few competing forces involved in surprise medical bills (really, out-of-network bills). Insurance companies that negotiate to obtain in-network rates with medical providers (Doctors mainly). Insurance companies regularly negotiate based on a multiple, or fraction of medicare and medicaid rates. Doctors, and practices providing care. Most doctors are either hospital employed (RVU compensation), or in a private practice. Doctors want to get paid fairly for their services, and there are some with extortionary rates, normally because they are handling the shit work that is not profitable with an in-network model. Hospitals that are the locus for much of it via ERs. Hospitals don't want to employ doctors because they are overstaffed on administrators already, and, RVU based compensation does not equal financial viability. They prefer to punt to contracted practices that handle parts of the care, leaving the hospitals with the fat facility fees that provide much of their income. My wife's practice has negotiated in-network rates with every major insurance (and they try to be in-network with everyone) for a multiple between 100% and 200% of medicare. The practice is clearly geared towards reconstructive in-network care and the surgeons work 9 - 8 regularly. One of the nearby plastic surgeons' practice is focused on trauma plastic surgery, and they are completely out of network. They charge between 500 and 2000% of medicare and they don't have regular hours since their trauma plastic surgery work is based on car accidents and workplace injuries which regularly come in at night and odd hours. Whereas the compensation for an 8-5 cancer surgery via medicare rates would have most practices in the red if 100% of the practice, performing them at multiples of medicare rates are sufficient. For a trauma practice though, the regular compensation (based on codes and billing) for a nighttime surgery don't actually reward the surgeon well enough to gear their practice around performing that service. I think what would be a better approach would be to cap out-of-network practices at 500% of in-network rates and call it quits. This would disincentivize the practices shooting for 2000%, and also, not reward the insurance companies that would shoot for a 50% to 75% of Medicaid, not Medicare, if they could get away with it.

463 points by jseliger 6y ago

Really happy to see this practice banned. Sadly it will not take effect for another year. Unfortunately, this is only one of many significant issues with US healthcare.

spaetzleesser 6y ago
I wouldn’t be surprised if hospitals already have other ways ready to screw people over once this goes into effect. As far as billing goes in my view they are basically criminal organizations that use fraud, intimidation and other things to squeeze people for money.

lordnacho 6y ago

> Surprise bills happen when an out-of-network provider is unexpectedly involved in a patient’s care. Patients go to a hospital that accepts their insurance, for example, but get treated there by an emergency room physician who doesn’t. Such doctors often bill those patients for large fees, far higher than what health plans typically pay. How do courts uphold this? You go to a restaurant, they say you can buy the tasting menu for $100, but they have a temp chef working that day which will cost you $50 extra, which you find out as you're paying. I mean you might even be unconscious when this is happening? EDIT Actually someone brought up an important point. If you go to a restaurant, you are kinda expected to know that there's taxes and tipping to pay. Do the US courts think the same of healthcare? "You were in a hospital, you should have known that the bill is always higher than the sticker price?" It would surprise me as a European.

curiousgal 6y ago
It's just appalling to see a nation as smart, rich and well accomplished as the U.S. being straight up retarded when it comes to healthcare.
- deleted 6y ago
  [deleted]
- dpeck 6y ago
  That is inappropriate word choice here or anywhere. Remove your slur.
  - t0mbstone 6y ago
    re·tard verb past tense: retarded; past participle: retarded /riˈtärd/ delay or hold back in terms of progress, development, or accomplishment. "our progress was retarded by unforeseen difficulties" It seems to me that the word's usage is an accurate description of America's lack of progress in this area...
    - luhn 6y ago
      At least here in the US, it's generally no longer considered appropriate. https://www.specialolympics.org/stories/impact/why-the-r-word-is-the-r-slur https://www.specialolympics.org/stories/impact/why-the-r-wor...
      - samch 6y ago
        Thank you. My wife worked for the Special Olympics for several years, and we were privileged to meet so many wonderful athletes in the program. I doubt a single one would think this usage of the r-word was appropriate.
    - colejohnson66 6y ago
      The word itself isn’t wrong per se, but it has a negative connotation that’s associated with “slow” people (from the medical terminology “mental retardation”). It’s a playground insult to call someone “retarded” because they’re “stupid”. It could just be an American thing, but using it like that is very common. I think a good comparison is “fag”. Sure, it means a cigarette, but it is (was?) a common insult towards gay people. Should we not use the word? I don’t know. I’m just explaining why dpeck wrote their comment.
nottorp 6y ago
From what I know about the US even your restaurant example has hidden service fees and mandatory tips and taxes that aren't on the menu?
- shreyansj 6y ago
  But generally the tips and taxes is something you know about if you are a US resident. And you might not be unconscious at the time of payment :) And restaurant staff getting paid a decent wage without relying on tips is also something that should get fixed sooner than later.
- dx87 6y ago
  Every restaurant I've been to with mandatory tips or fees has it written on the bottom of each page. The only shady thing I've seen them do is add the mandatory tip, then give you the bill with an option for an additional tip, hoping people will forget that the tip was already included in the bill.
- leetcrew 6y ago
  not really the same. tipping is a custom, but it's not legally required unless the restaurant clearly states that it will be added to the bill. sales tax is not really a hidden fee. americans usually know the general sales tax for their state. it gets a bit more complicated with specific excise taxes (eg, alcohol), but these rates are publicly available. if you're really concerned, you can always just ask your server or their manager what the after-tax cost of an item on the menu is. even if you know exactly what medical procedure will be performed, it is still pretty hard to get an exact quote for the cost. it certainly can't be calculated from freely available numbers.
- wil421 6y ago
  No hidden service fees. Taxing is not so simple in the US. My county has a lower sales tax rate than other counties around me. When I worked as a waiter the municipality had a special tax on alcohol in addition to the county and states alcohol and regular sales taxes.
  - 6y ago
amelius 6y ago
Some people wear a tag with their blood group on it. Perhaps we should be wearing tags with the amount of money we're willing to spend on a hospital visit.
- lotsofpulp 6y ago
  I have joked before that I should wear an undershirt that says “Healthcare accepted only by in network providers <insurance ID #>. If out of network, stay away and let me die”.
- hn_throwaway_99 6y ago
  I'm curious, would this even be essentially "accepted" by any hospital in the US? Not just a tag, but if you were going in for a procedure, could you even say "I want to be sure I will not be treated by anyone not covered by my insurance plan"? Because basically all the forms you need to sign upon admittance essentially say "We can charge you whatever we want and you are responsible for paying it."
  - jdmichal 6y ago
    I would probably refer to the ethics dilemmas around "do not resuscitate" tattoos as the closest analog that I've heard about.
  - 93po 6y ago
    They would tell you that you need to talk to billing, and billing would tell you they can't provide pricing at all and they can only tell you after going through your insurance, or they would require a zillion digit billing code that only your doctors can provide, and your doctors are not going to waste their time giving you the list of a thousand codes for whatever operation you're doing, or at least not accurately. In short there is no way. Either you accept treatment and you're billed what you're billed and you hope insurance only fucks you over a little bit, or you're denied any service short of immediate life saving.
  - meowster 6y ago
    Whenever I took my vehicles in for service at a dealership, they would always provide a form for me to sign to pre-authorize any work they deem necessary. I always leave those forms blank. Never had an issue. Whenever I go to a new doctor or medical facility, they always ask for tons of personal information such as my social security number. I always leave most of that blank. Never had a problem. I've never been asked to write a blank check for a medical operation like I have at a dealership, but perhaps we should just make such practices illegal?
freeone3000 6y ago
The courts can only act where there is law. It's a legal system, not an inherent fairness system -- current law upholds the status quo, which is why this measure passing is good news.
harperlee 6y ago
> you are kinda expected to know that there's taxes and tipping to pay Also not reasonable, so at least in Spain the menu has to include VAT.
spaetzleesser 6y ago
"How do courts uphold this? You go to a restaurant, they say you can buy the tasting menu for $100, but they have a temp chef working that day which will cost you $50 extra, which you find out as you're paying. " In the US you go to a hospital and basically sign a contract "you can charge me for whatever you feel like". What surprises me is that they get away with often charging for stuff that never happened. When you confront them they just say "Oops!" ad take it off only to try it again next time. I don't understand how they get away with that.
- meowster 6y ago
  > I don't understand how they get away with that. 99% of people don't confront them.
crossroadsguy 6y ago
> and tipping to pay Tipping is demeaning and derogatory to the person being tipped, especially in the manner it is done. Also, it can be reason for discrimination against the expected tipper. It always astounds me how people (mostly a lot of Americans) defend this practice just calling it "custom" and that it helps the receiver.
- jdgiese 6y ago
  > Tipping is demeaning and derogatory to the person being tipped, especially in the manner it is done. Why?

standardUser 6y ago

The change does not apply to ambulances (except for air ambulances), ensuring the United States remains one of the few places in the world where a seriously ill person needs to debate if they're willing to risk their health and life to avoid a financially crippling trip to the hospital.

spaetzleesser 6y ago
I was billed $3000 for a twenty minute ride to the hospital after somebody hit my car. I spent the time chatting with the EMTs. No treatment .
- jbay808 6y ago
  Send them a $4000 bill for your time!
HenryKissinger 6y ago
"‘As I was being eaten, I was thinking about my insurance’: Woman who lost face in bear attack on why she’s voting for Bernie Sanders" https://www.independent.co.uk/news/world/americas/us-election/bear-attack-allena-hansen-face-bernie-sanders-healthcare-insurance-2020-election-super-tuesday-a9370156.html https://www.independent.co.uk/news/world/americas/us-electio...
- silentsea90 6y ago
  Peak dystopia
- HarryHirsch 6y ago
  /r/nottheonion
- mrlala 6y ago
  How any of you snakes on here can downvote this is beyond me. I mean, I know who you are. People who have a great job and don't really have to worry about insurance. Or maybe at a university where insurance is probably covered well. So f everyone else, right? I am self employed so I have to worry about paying all this shit myself; 11k family deductible with 40% co-insurance for $1200. Every time my young kids have had something that was not like a massive emergency, you know what the thought is? Oh god is this worth going to the hospital for and spending 1k? Or when I had my own person health issues, my first thoughts are always how much is this going to fucking cost? So yeah, if you think OPs link is exaggeration.. it sure as hell is not.

jdlyga 6y ago

The current US medical system reminds me a lot of very important legacy code that's become unmaintainable. Maybe the best way of rolling out universal healthcare is to take a refactoring approach. Get more and more people onto medicare, lowering the age limit and raising the maximum income threshold. Eventually, it would only be the wealthy who were still on the private insurance only system. Then employers can gradually replace health coverage with other benefits.

vidarh 6y ago
You need to reform regulations as well. Medicare + Medicaid cost US tax payers more per capita as the UK NHS costs UK taxpayers per capita. The UK NHS provides universal coverage. Part of the problem is that Medicare is actively prevented from being cost-effective. E.g. there are restrictions on its ability to negotiate prices in many instances, whereas the NHS will actively use all the leverage it has by coordinating purchases across the board. I'm sure that alone would not solve the issue, but it's unnecessary hard to get support for universal healthcare as long as Medicare is as expensive as it is. Fixing that would make it harder to argue against Medicare expansion. To start with you could expand coverage substantially simply by allowing any savings to go towards expanding coverage. > Eventually, it would only be the wealthy who were still on the private insurance only system. Then employers can gradually replace health coverage with other benefits. It's worth noting that this is pretty much how it is in the UK. We do have private cover, but only about 10% of the population uses it. Notably it's generally "add on" coverage in that almost all policies expect you to rely on the NHS for basics, but lets you pretty much use the policy to queue jump to private hospitals if the NHS is "too slow" or for services above and beyond what the NHS offers. As such that's 10% despite UK policies being generally far cheaper, since they don't need to cover things like ambulances and ER/A&E (whenever anyone complains about the NHS this is a pretty essential point: the NHS is good enough that there isn't a sustainable market sufficient to compete with it; it's not perfect, but as long as private cover is as limited both in takeup and what it provides as it is, that's a pretty good indicator)
frankbreetz 6y ago
Not a bad idea, but I would like to point out one of the arguments of getting rid of private insurance is that wealthy would need an incentive to not degrade the system. Like it or not the wealthy have have much more political power then common folk and allowing them to have them own system outside of the general public gives them incentive to cut cost with no effect on themselves.

tthun 6y ago

If the underlying problem (in-network discounted rates for services and out of network excess that the service provider can charge - honestly this practice should be made criminal - imagine Sams club selling a computer to non-members for 10x the cost the members pay) is not addressed, the surprise bill just becomes someone elses prolem (other patients end up paying).

xyzzyz 6y ago
> imagine Sams club selling a computer to non-members for 10x the cost the members pay I wouldn’t mind that actually. They can sell for 100x for all I care. I can just not buy it. A better analogy would be if you got a letter 2 months after you shopping visit telling you that the the package of cheese you bought is actually $2000 instead of $5, and no, they do not accept returns.

kayodelycaon 6y ago

> Some private-equity firms have turned this kind of billing into a robust business model, buying emergency room doctor groups and moving the providers out of network so they could bill larger fees. If this doesn’t describe evil, I don’t know what else would.

tthun 6y ago
It should be illegal
leetcrew 6y ago
I wouldn't reject this out of hand, but I do find that the complexities around healthcare and the obvious political implications lead to a lot of exaggeration and outright falsehoods being propagated. it's my understanding that the affordable care act requires insurers to treat any emergency services (if covered at all) as in-network. can anyone explain either a.) how I am wrong, or b.) how this can be circumvented?
- breck 6y ago
  > complexities This. Does anyone know if the Founding Fathers discussed the evils of complexity in law back during the conventions in Philadelphia? Is that a more modern day problem, or is it as old as parliament itself? I don't remember reading anything that said the dangers of complexity in law was on their radar. Businesses are guaranteed to take advantage of complexities in law. I don't think this is well enough known. Any and every added complexity will therefore be taken advantage of, and should be considered in passing a law, and every law should have some type of way to "expire" itself, so that it can be removed (and the resulting complexity), when the reasoning for such law is gone. Complexity around healthcare laws is the textbook example.
- aamar 6y ago
  See here[1] for a pretty good explanation. Importantly, your insurer treating the visit as in-network does not force the provider to treat it as in-network; surprise bills come from the provider, not the insurer. From that post: If the insurer pays less than the out-of-network emergency room bills, the emergency room can send you a balance bill for the difference, over and above the deductible and coinsurance amounts you pay. That “if” condition is usually going to hold, so a lot of surprise bills come out even despite the ACA rule. [1] https://www.verywellhealth.com/get-in-network-rates-out-of-network-1739069 https://www.verywellhealth.com/get-in-network-rates-out-of-n...

jsperson 6y ago

That it takes such effort to pass a bill like this - 80% public approval, banning a clearly predatory practice, has turned me from a pure free market thinking into a believer in single payer healthcare. The free market just doesn't work when there is very little elasticity in consumption. I've been on the receiving end of a $15K air ambulance bill (thankfully covered by insurance) as well as the out of network specialist at an in-network hospital. The latter is particularly galling. What are you supposed to do, interrogate every person that comes in the room?

mehrdadn 6y ago
> What are you supposed to do, interrogate every person that comes in the room? I'm curious too. Some people must have tried filing a lawsuit... what do judges think people should be doing?
- RHSeeger 6y ago
  I had to go into surgery last year and had to sign a "I will pay whatever my insurance doesn't" form. I wrote in a clause saying that any out of network elements (persons, etc) must be personally approved in writing by myself or my proxy before they can do anything they bill for. I don't know if it would have held up in court, but it made me feel a little safer.
- cmiles74 6y ago
  In my case it was the anesthesiologist who was out of network. Looking at the bill, they looked like just another practice. When I found their phone number and address, however, it turned out that their practice was part of the hospital. I called their number and ended up talking to someone in their office and they agreed to waive the fee. I wonder if this is part of their process: if there's pushback, waive the fee.
  - dr_orpheus 6y ago
    > I wonder if this is part of their process: if there's pushback, waive the fee. This is 100% how a lot of medical offices and/or insurance operates. For some practices that perform complicated procedures bills will get sent with a "catch-all" sort of approach of all possible scenarios that could have happened and you have to go back and tell them what treatment you actually got. Insurance companies will also just initially deny claims in the hopes that people won't spend the time to debate it. My wife had to get back injections for a bulged disk and insurance initially denied the claim on the basis that "it was not inhibiting her daily function". The original request from the doctor included the wording of "this is medically necessary because the pain is inhibiting her daily function" because he knew that was their criteria. Insurance still just rejected it because it is easier for them to do that and only accept the claims people fight for. Luckily in this case the doctors office was on our side and called the insurance company to get it approved. The doctor said that this kind of shit happened all the time.

etskinner 6y ago

https://archive.is/50VQv https://archive.is/50VQv

lwigo 6y ago

This isn't directly related, but some of the credit reporting agencies can have surprise medical bills written off due to covid related hardships. This is to say, if a surprise bill happens to hit collections, and you're affected by covid, it can be removed through the report process. I have no idea what this looks like in the long term, though.

deleted 6y ago

[deleted]

bearjaws 6y ago

Having gone through cancer treatment here in the USA, I have received over a dozen 'after the fact bills' over the past 5 years, sometimes over 9months after the procedure, mainly involving blood work and CT scans. I missed one bill that came months after chemotherapy for $87 in 2015, it only had a 60 day notice before sending to collections. Mind you I was on disability from my employer that paid well. -80pts on my credit score... It took until last year to get my credit score back to the same level it was prior to starting treatment.

AdmiralAsshat 6y ago
If it's any consolation, that time should now be 180 days, and I'm pretty sure the counter should start at the time the collection agency receives it, not from the date of service. IANAL, though, so don't quote me on that.
JacobSuperslav 6y ago
how come in Europe credit score isn't really a thing and everything works fine? that's another thing that needs to go
- jlokier 6y ago
  I don't know if you're counting UK as part of Europe for this purpose, but in the UK credit score is definitely a thing. It affects whether you can get a mortgage, credit card, loan, purchase credit (e.g. for buying a phone), or even a tiny overdraft, and it enormously affects how much interest you will be charged (i.e. very high or very low), and whether the credit limit you can get is zero, tiny or substantial.
- vasco 6y ago
  There are credit scores in some places in Europe, mostly in the form of lists of people that may have failed to pay something in the past. It's a pain in the ass to correct if you get there by mistake and it's very opaque. Overall credit scores seem like a great idea with a terrible implementation. In general you as a mindful consumer that pays your bills on time wouldn't want to be paying the same prices for loans (spread, interest) as other consumers that have a history of not paying. A well functioning credit score system makes for a more efficient lending market, allowing consumers to save money if they have a good track record. How it actually works in practice is a joke, though.

mcshicks 6y ago

California has such a law already. I went to an ER at the beginning of the year for a minor fracture and had a "contract physician". I was pleasantly surprised when the bill was exactly my er visit copay. I had an equally unpleasant experience several years ago that cost me thousands of dollars. https://dmhc.ca.gov/Portals/0/HealthCareInCalifornia/FactSheets/fsab72.pdf https://dmhc.ca.gov/Portals/0/HealthCareInCalifornia/FactShe...

kevinofe 6y ago
The CA law is kind of BS. My partner went to see doc, they ran a few tests, told her it would probably be covered by insurance and then we got a bill for $1700. They said it wasn't "surprise" bill because it wasn't out of network. I told them "it is a surprise to us!" From then on, we always ask the cost of every single test/procedure. (In fairness to the hospital, they did give us a $50/month, interest free payment plan.)
- mcshicks 6y ago
  Yeah I agree the name is misleading and it doesn't cover all situations. My specific situation both times was ER rooms with out of network doctors, but I agree that there can be many other situations where the law is not that helpful. My personal opinion is those would be better managed by a single payer system like they have in many other countries. I haven't looked at the federal law close enough to know if it covers cases other than out of network doctors.

erlapso 6y ago

> The new changes will take effect in 2022, and will apply to doctors, hospitals and air ambulances, though not ground ambulances. From 2022 and no ambulances. This is a joke..

silentsea90 6y ago
Optimists here would claim that this is slightly less of a joke than the status quo.
lawn 6y ago
How come it covers air ambulances but not ground ambulances? I know the answer is probably that the ambulance companies lobbied (bribed) the hell out of these laws, but with the ambulance costs this is comical.

2Gkashmiri 6y ago

In India you have these government run hospitals. Entry is essentially free and so is the emergency / opd treatment. For procedures they charge peanuts compared to private sector. The only thing, there is a waiting list and hygeine is not always a priority. There is an AIIMS hospital in Delhi and I had the misfortune of taking a relative there for treating surgical infection. It was brutal. We got in line around 9 am. Had to put the patient on a gurney and wait. Around 3 pm slowly our place reached to the inside emergency ward. Around 7 pm we finally were attended by an intern. Took 6 pricks to insert a catather then a senior resident was called in to help. Around an hour later the medication started to do some work. Around 10 pm more medication was administered. We ended up asking the doctor to let us go because it was 12 am and we needed to consume some food, pee. Never again. This was around 5 years ago and I hope things have improved for the sake of patients.

silentsea90 6y ago
Public services in India, especially ones interacting with people en masse are terrible. No recourse but to go to private hospitals.
- 2Gkashmiri 6y ago
  they are terrible because they are too less. other than that i would rather get treated in a government run hospital because they employ only the most capable of doctors, senior and otherwise. the problem isnt in the doctors. its infrastructure. i think people got my comment wrong way. i am very much in support of these hospitals. just that i want them to be in every major district rather than being restricted to major cities. its not like these places would remain empty
  - selimthegrim 6y ago
    What is happening with Ayushman Bharat in held Kashmir?

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OminousWeapons 6y ago

I was working on a health insurance related startup for awhile so I would say I know more than the average person about the space, and even I get surprised on a regular basis by the absurdity in this field. For example, I was finishing up an advanced degree program between September and January and my University decided to terminate my health insurance in September. Without telling me. In the middle of a pandemic. When I discovered this last week, I attempted to buy health insurance directly from insurers and was informed that I could not get coverage until January 1st of 2021 as I was "outside the eligibility window". They literally won't sell active coverage to me at any price. Apparently you only have two months after losing your insurance to be able to buy new insurance before having to wait until specific times in the year. I can buy home insurance, liability insurance, car insurance, and any other type of insurance whenever I want but god forbid I try to buy health insurance 61 days after an arbitrary point in the year. I effectively cannot go outside until January 1st as if I get covid and have to go to the hospital I'm screwed.

crazcarl 6y ago
Just as a heads up in case you or anyone else reading this is in this position. For the uninsured, if your treatment is directly related to Covid-19, you would be covered under the Covid-19 HRSA program described here. https://www.hrsa.gov/CovidUninsuredClaim https://www.hrsa.gov/CovidUninsuredClaim
- OminousWeapons 6y ago
  This is a huge relief; thank you for bringing this to my attention!
zaroth 6y ago
The intent here is to prevent people from gaming the system by buying insurance only right after a serious diagnosis. There are several qualifying events to be able to enroll outside the eligibility window if you’ve had a job change for example.
- mrlala 6y ago

HeyImAlex 6y ago

I had to provide a urine sample to get my ADHD medication. It was sold to me under the auspices of drug testing, even though ADHD meds are out of your system in 48h. A month later I received an explanation of benefits from my insurance company that said they received a 14k bill and had paid 4k of it, so I was on the hook for the other 10k. Furious I went to my psych. They casually said “we’ve taken care of it, you shouldn’t receive an actual bill”. Uh, that’s not the point? The point is why was it necessary to send my urine for 14k in testing in the first place? You cannot convince me they weren’t getting kickbacks from this program. Finding a new psych is difficult, so the next time they asked me to pee in a cup I asked if they’d charge my insurance the same way again. I haven’t been asked for a urine sample since, which is odd considering they have signs clearly posted saying drug tests are mandatory. I guess not _that_ mandatory, huh? It’s wild that individuals are forced to navigate this system, much less fight it when they’re being fucked. The idea that there are people who’s sole purpose is designing beurocratic gears to grind money out of sick people makes me sick. And they employ an army of low wage call center folks to do their bidding, work that I can’t imagine is super rewarding. How much better would the world be if we tore down these machines and paid all of those people to do literally anything else?

mattkrause 6y ago
At $14k/test, they could nearly afford to buy a used but functional GSMS system system just for you(!).
iaw 6y ago
> You cannot convince me they weren’t getting kickbacks from this program. Given all the problems this caused for the opioid epidemic I'm disappointed (but not surprised) such behaviors are still be legal.
SkyPuncher 6y ago
> I had to provide a urine sample to get my ADHD medication. It was sold to me under the auspices of drug testing, even though ADHD meds are out of your system in 48h. FYI, they weren't checking for your ADHD medication. They were likely checking for marijuana. * Marijuana can introduce side effects that basically make it look like you have ADHD * Most ADHD medications are stimulants, they have counter indications when taken with marijuana * Stimulant prescriptions are under scrutiny right now, so places have been doing more diligence > A month later I received an explanation of benefits from my insurance company that said they received a 14k bill and had paid 4k of it, so I was on the hook for the other 10k. Furious I went to my psych. They casually said “we’ve taken care of it, you shouldn’t receive an actual bill”. Uh, that’s not the point? The point is why was it necessary to send my urine for 14k in testing in the first place? The underlying problem is how a bunch of stuff gets billed. Basically your pysch and insurance company have a pre-negotiated rate for re-imbursement on this - it has little to no bearing on what you actually pay as a patient. It's pretty much all BS because there's a secondary system for resolving those bills.

alexfromapex 6y ago

How about “surprise insurance won’t cover this” situations?

chapium 6y ago

When we had our first child, we carefully selected a pediatrician that was covered by our insurance. It turns out that doctor was only billable to our insurance for delivery, any follow up visits were not covered by the insurer because that same doctor was not considered part of that hospital org. The org she did routine pediatric work was somehow different, yet in the same building. We discovered this as we were leaving the hospital and scheduling a follow up visit. It was very urgent since we had a moderate complication and need a doctor immediately. However our insurer (employer provided) was blacklisted by the doctors group that all doctors in our neighborhood were a part of. Ultimately, on short notice we found a new pediatrician an hour away which began ordering lab work. This is not something you want to go through with a newborn and a new mother. It was also bullshit, because we were hit with a surprise caveat to our researched doctor so late in the process even though we had been trying to do our due diligence to get things squared away months in advance. This was all because our insurer decided that our doctor was billed by different rules depending on what part of the job she was doing for the same patient. I've been an ardent supporter of single payer ever since.

ativzzz 6y ago
You make it sound like it's the doctor group that chose not to work with that insurance company. The fault probably goes both ways.
- chapium 6y ago
  They blacklisted our plan for specific visits. That shouldn't be possible.

zaroth 6y ago

This essentially takes the patient out of the loop if one of the providers is not in-network / being directly reimbursed by insurance. Now the provider and insurance company have to work together to resolve the bill. Most importantly it would be charged against the patient’s in-network deductible. It’s really too bad that this bill was watered down in one particular way. The Senate version of the bill would have set the price as the median in-network price for the procedure/service in that market (which ~5x the price that Medicare would pay). Out of network prices are usually another ~5x higher than in-network prices. House Democrats instead pushed for the rate to be set in arbitration, which is the version that will be enacted. https://www.forbes.com/sites/theapothecary/2020/02/19/house-democrats-capitulation-on-surprise-billing-proves-theyll-never-pass-medicare-for-all/?sh=4e735b9b2538 https://www.forbes.com/sites/theapothecary/2020/02/19/house-...

thesimon 6y ago
I guess a version that would make them pay what Medicare would pay wouldn't fly?
- zaroth 6y ago
  No, that’s significantly less than the in-network rate.

Triv888 6y ago

I don't pay surprise bills ... (and I don't think it affects my credit because I had a couple in the last year and my FICO score is still at about 800) ... I'm not going to pay a random bill that comes 3 months after a doctor's visit that they never told me about and I already paid $400 for the emergency 30-min visit (not sure what the insurance paid)

silentsea90 6y ago

As an aside, do we expect the rise of medical tourism options to put downward pressure on pricing for medical procedures in the US?

adamredwoods 6y ago

I feel most comments here fail to separate hospitals and insurance. And that could be separated even more (pharmaceuticals, for example as a separate category).

flowerlad 6y ago

Another thing that is needed urgently is uniform pricing. Today healthcare providers charge different amounts to different insurers, and if you don't have insurance you pay list price. The list price is a arbitrary large number (often 3x the price insurers pay) that has no relation to reality. So if you don't have insurance, you are hit with a double whammy: You have to pay the bill yourself, and if that isn't bad enough, they charge you 300% of the "real" price, meaning what insurance companies pay for the same procedure.

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javier10e6 6y ago

Humana Healthcare CEO Bruce Broussard base salary in 2016 was $1.24 million. No surprise there.

my_usernam3 6y ago
I'm actually ok with that salary as they have over 50B in revenue. However, I'm sure he and all the other execs receive exorbitant bonuses and stocks plans that make that salary look like peanuts.

Moodles 6y ago

As an immigrant coming to America, honestly the most shocking and surprising thing (apart from the state of homeless in San Francisco being tolerated as normal) is the medical care expenses. How on Earth is it that I can walk into a doctor's office or hospital to get medical treatment and have no idea how much it's going to cost? $10? $100? $1000? Who knows. I had an ear infection once, went to the doctor who looked at it for a minute and said "give it a few days". I assumed this would cost maybe $20 or something? Nope. $400. There's just no way of even knowing. In no other industry would you buy something without knowing the price ahead of time. With medical care it's even more screwed up because, well, it's your health? You're generally more desperate for services now, so it's not like shopping around for clothes or something.

deleted 6y ago
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henrikschroder 6y ago
It's pretty tragic that there are so many people like you and me, immigrants who have experienced several different healthcare systems, and we can all testify that the US system sucks on every level compared to other systems. And yet, there's a huge amount of Americans who have only ever lived in the US, who are certain the US system is the best in the world, and who believe all the scary stories that are designed to make you think so. You could listen to the people who have actual real-world experience, or you can listen to the lobbyists who are paid to preserve the lucrative US system. How is this even a thing?
- Moodles 6y ago
  I wouldn't say it sucks on every level. The actual quality of care is usually good.

uberdru 6y ago

Imagine buying a car when the salesman cannot tell you the price, and the lender cannot tell you the interest rate, until after you have driven the car off the lot.

wmeredith 6y ago
Now imagine you'll die or be permanently maimed if you don't buy the car in the next 15 minutes.

sebastien_b 6y ago

Not being in the US, I have to wonder - Why aren't the personnel at a hospital not considered part of 'in-network' while performing their duties at that hospital? If being "in-network" is an important thing, it seems like having "out-of-network" personnel is rather deceitful (I would almost say fraudulent).

astrophysician 6y ago

As the recipient of a $25,000 bill for an emergency visit to an out-of-network hospital that I have been fighting for two years (still ongoing), this is such an overdue blessing. FYI -- many individual states ban "balance billing" i.e. hospitals sending you the leftover bill that insurance didn't cover (btw -- hospitals can charge a special "out-of-network" rate, in my case 10x the average cost around the area for the services I received). Problem is, if you are on a "self-insured" plan (your card should say this, these are plans you'll get at university or when working for a large company), the state law can't do anything, and there has been no federal law banning this practice. It's absolutely inhumane.

mLuby 6y ago

[US]: "Stop the surprise prices!" [Hospitals]: "Okay, here's our menu of services: Saline $300, Specialist Consultation (20min) $1K, Ambulance Ride $15K." [Health Insurers]: "If you join our club and pay dues, you get exclusive menu prices: saline $15, consultation $50, ambulance $200." The problem is different people being charged dramatically different prices to continue living, because of which health insurance (if any) they have, and not being able to change that fact (except once a year). The solution is that hospitals—and IMO businesses in general—must not charge different prices to different groups of customers (which single payer accomplishes, as I understand it).

y-c-o-m-b 6y ago

My state (Oregon) has protection against this. Unfortunately my emergency spinal operation was 2 months prior to the bill going into effect, so I got hit by this. The part that pissed me off was I KNEW about the practice and specifically made a fuss about making sure everyone in that OR was IN NETWORK. I went to an in network facility, my surgeon was in network, and so was the anesthesiologist and every person that entered my hospital room I asked if the OR staff was in network (the answer was always yes). 1 month later I get a bill for a neuro-monitoring team and an assistant-surgeon that were both out of network. The assistant surgeon charged me about $500. The neuro-monitoring team sent a ~$20,000 bill with the promise that they'd lower it to a reasonable value when I called to pay. Furthermore Blue Cross sent me a letter saying it wasn't pre-approved (even though the procedure was) and they would not cover a cent of it. Imagine the feeling of doom wondering just how low could these shysters possibly go from 20k. Thankfully that turned out to be true, the final bill was $800. Which still made me furious because I made such a huge deal out of not getting into this situation. So that was $1300 total out of pocket that I was not expecting to pay. Luckily I'm a software developer with a huge savings, but I made several angry calls anyway and even sent an appeal twice to blue cross (which they denied both times). I'm so glad this crap is finally coming to an end, but the right-leaning supreme court makes me afraid some of these laws will get reversed.

busyant 6y ago
I had a similar experience. * I paid $20K out of pocket for a surgery that my insurer wouldn't cover. * This was supposed to pay for everything (surgery, anesthesia, hospital stay, etc.). * About 2 weeks post surgery, I got ANOTHER $20K bill from the hospital AND ANOTHER $1800 bill from the anesthesia group. * At the same time, I developed a complication from the surgery that put me in EXCRUCIATING pain. * Wife said I should go to the ER for the complication. * I said, "NO WAY. We're gonna get hit with ANOTHER $20K bill because I developed a complication from a procedure that my insurer doesn't cover. I will ride this out." * After 2 weeks of horrific pain, I broke down and went back to the surgical group. * They told me that the bills that I received were probably an error. * I calmly explained to the physician's assistant that I had neglected dealing with the complication as a DIRECT result of receiving those bills and I not-so-subtly implied that there might be a lawsuit coming their way. * Within 20 minutes of leaving the surgical group, I got 3 phone calls from different people at the hospital expressing deep apologies and rescinding the bill.

tehwebguy 6y ago

There is no such thing as a surprise medical bills ban. The only thing that will happen, without a complete overhaul of the way medical services are paid for in the US, is that patients will be given one extra form to sign before being allowed any services by any provider: Patient waives any and all rights granted by [anti-surprise laws] and agrees to indemnify Provider for any related costs. You have to understand it's not just about the rules, medical insurance companies will do plenty to stay compliant but they'll still screw you. Sometimes they'll send you a bill for something they already said was covered, then suddenly it's on you to fight a several billion dollar company into just doing what they promised.

JarlUlvi 6y ago

This is being made out as a win for patients, but it actually IS NOT. I'd describe it more as a win for insurance companies and potentially patients, with the losers being the out-of-network doctors, depending on the situation. This does have the possibility of reducing the quality of care around trauma in the US. We have a few competing forces involved in surprise medical bills (really, out-of-network bills). Insurance companies that negotiate to obtain in-network rates with medical providers (Doctors mainly). Insurance companies regularly negotiate based on a multiple, or fraction of medicare and medicaid rates. Doctors, and practices providing care. Most doctors are either hospital employed (RVU compensation), or in a private practice. Doctors want to get paid fairly for their services, and there are some with extortionary rates, normally because they are handling the shit work that is not profitable with an in-network model. Hospitals that are the locus for much of it via ERs. Hospitals don't want to employ doctors because they are overstaffed on administrators already, and, RVU based compensation does not equal financial viability. They prefer to punt to contracted practices that handle parts of the care, leaving the hospitals with the fat facility fees that provide much of their income. My wife's practice has negotiated in-network rates with every major insurance (and they try to be in-network with everyone) for a multiple between 100% and 200% of medicare. The practice is clearly geared towards reconstructive in-network care and the surgeons work 9 - 8 regularly. One of the nearby plastic surgeons' practice is focused on trauma plastic surgery, and they are completely out of network. They charge between 500 and 2000% of medicare and they don't have regular hours since their trauma plastic surgery work is based on car accidents and workplace injuries which regularly come in at night and odd hours. Whereas the compensation for an 8-5 cancer surgery via medicare rates would have most practices in the red if 100% of the practice, performing them at multiples of medicare rates are sufficient. For a trauma practice though, the regular compensation (based on codes and billing) for a nighttime surgery don't actually reward the surgeon well enough to gear their practice around performing that service. I think what would be a better approach would be to cap out-of-network practices at 500% of in-network rates and call it quits. This would disincentivize the practices shooting for 2000%, and also, not reward the insurance companies that would shoot for a 50% to 75% of Medicaid, not Medicare, if they could get away with it.