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> 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, fo

> 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.
    - tesseract 6y ago
      It's perfectly fine in a technical context: "bacterial growth is retarded by refrigeration" or something of that nature. But that's not how the commenter used the word. There are other, far less ambiguous and far more polite words to refer to a general lack of progress... old-fashioned, primitive, backwards, antediluvian, obstinate, ...
    - deleted 6y ago
      [deleted]
  - campl3r 6y ago
    How so?
  - hellonoko 6y ago
    Take a read about "The Euphemism Treadmill"
    - adkadskhj 6y ago
      It's not wrong. Imo the issue isn't the treadmill - that's natural, and will always happen with or without PC police. Unacceptable words existed long before PC police (in the modern sense) existed. Communities have long self moderated acceptable words. The real debate is about how fast the treadmill moves.
- Dirlewanger 6y ago
  Americans are taught that they can do anything they want, which includes fucking over others if they can get away with it. We're educated to only be leery of the government, but are clueless on how corporations run the country. Many don't care. They'll defend it as their right to do so or through some other contrived coping gymnastics.
- dang 6y ago
  Nationalistic flamebait is not allowed here, regardless of country. You've posted like this before, too (https://news.ycombinator.com/item?id=25016561 https://news.ycombinator.com/item?id=25016561) — that's not ok on this site, so please don't do it again. We're trying to avoid the tedious, nasty flamewars this kind of thing leads to. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
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?

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.
  - tesseract 6y ago
    It's perfectly fine in a technical context: "bacterial growth is retarded by refrigeration" or something of that nature. But that's not how the commenter used the word. There are other, far less ambiguous and far more polite words to refer to a general lack of progress... old-fashioned, primitive, backwards, antediluvian, obstinate, ...
  - deleted 6y ago
    [deleted]
- campl3r 6y ago
  How so?
- hellonoko 6y ago
  Take a read about "The Euphemism Treadmill"
  - adkadskhj 6y ago
    It's not wrong. Imo the issue isn't the treadmill - that's natural, and will always happen with or without PC police. Unacceptable words existed long before PC police (in the modern sense) existed. Communities have long self moderated acceptable words. The real debate is about how fast the treadmill moves.
Dirlewanger 6y ago
Americans are taught that they can do anything they want, which includes fucking over others if they can get away with it. We're educated to only be leery of the government, but are clueless on how corporations run the country. Many don't care. They'll defend it as their right to do so or through some other contrived coping gymnastics.
dang 6y ago
Nationalistic flamebait is not allowed here, regardless of country. You've posted like this before, too (https://news.ycombinator.com/item?id=25016561 https://news.ycombinator.com/item?id=25016561) — that's not ok on this site, so please don't do it again. We're trying to avoid the tedious, nasty flamewars this kind of thing leads to. https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html

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?