5 ms·

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 a

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...
- normaljoe 6y ago
  And this still happens in Texas where it is suppose to be illegal as well. I called provider multiple times and explained the rate from my insurer. They of course sent to collections, but they know they can't enforce it in court, but that doesn't matter. Most people are just going to pay. What really got to me was it was ER visit and the Doc(extortionist) spent maybe 5 minutes with me before having the nurse fix me up. After insurance $250 to hospital, and $2000 bill for the Doc.
jrumbut 6y ago
Regarding how it can be circumvented, insurance companies, in my experience, try to say that this or that service was not actually part of the emergency. For instance, they may want to begin some of the long term maintenance of your new condition while you're still in the hospital. Whether the insurance company is successful or not, they may at least try to say this isn't covered. Eventually, you and your loved one are dealing with one of the worst moments of your life, how much time do you have to fight all their attempts at not paying your benefits? Keep in mind the fights happen during business hours, and you just missed four weeks of work and need the job to keep the insurance you now need more than ever. Laws that reduce the number of ways insurance companies can avoid paying will be helpful.
- iaw 6y ago
  > and you just missed four weeks of work and need the job to keep the insurance you now need more than ever. Just a note, if you're in the US and a loved one is injured or ill there is the Family Medical Leave Act which should protect your job (in the short-term). It's not a huge safety net but if someone needs it it does help.
- bcrosby95 6y ago
  For my wife's emergency surgery, they paid the surgeon. But the surgery room, recovery room, and anesthesiologist - that was all determined to not be medically necessary. And they fought those bills for about 8 months before paying.
jartelt 6y ago
My wife went into anaphylaxis at an urgent care facility. The doctor there administered an epi and then called 911 to get an ambulance to the nearest hospital. We ended up getting a >$2,000 bill for a 10 minute ambulance ride because the ambulance company was out-of-network. The ambulance company then had the audacity to send the bill to collections before the 30 day pay period even expired... So yea, even if you have good insurance you can still get bit by these issues in emergencies! Unfortunately, this new bill does not even address the out of network ambulance issue.

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...

normaljoe 6y ago
And this still happens in Texas where it is suppose to be illegal as well. I called provider multiple times and explained the rate from my insurer. They of course sent to collections, but they know they can't enforce it in court, but that doesn't matter. Most people are just going to pay. What really got to me was it was ER visit and the Doc(extortionist) spent maybe 5 minutes with me before having the nurse fix me up. After insurance $250 to hospital, and $2000 bill for the Doc.

jrumbut 6y ago

Regarding how it can be circumvented, insurance companies, in my experience, try to say that this or that service was not actually part of the emergency. For instance, they may want to begin some of the long term maintenance of your new condition while you're still in the hospital. Whether the insurance company is successful or not, they may at least try to say this isn't covered. Eventually, you and your loved one are dealing with one of the worst moments of your life, how much time do you have to fight all their attempts at not paying your benefits? Keep in mind the fights happen during business hours, and you just missed four weeks of work and need the job to keep the insurance you now need more than ever. Laws that reduce the number of ways insurance companies can avoid paying will be helpful.

iaw 6y ago
> and you just missed four weeks of work and need the job to keep the insurance you now need more than ever. Just a note, if you're in the US and a loved one is injured or ill there is the Family Medical Leave Act which should protect your job (in the short-term). It's not a huge safety net but if someone needs it it does help.
bcrosby95 6y ago
For my wife's emergency surgery, they paid the surgeon. But the surgery room, recovery room, and anesthesiologist - that was all determined to not be medically necessary. And they fought those bills for about 8 months before paying.

jartelt 6y ago

My wife went into anaphylaxis at an urgent care facility. The doctor there administered an epi and then called 911 to get an ambulance to the nearest hospital. We ended up getting a >$2,000 bill for a 10 minute ambulance ride because the ambulance company was out-of-network. The ambulance company then had the audacity to send the bill to collections before the 30 day pay period even expired... So yea, even if you have good insurance you can still get bit by these issues in emergencies! Unfortunately, this new bill does not even address the out of network ambulance issue.