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One of the most unfair characteristics of US healthcare is that if the health insurance company does not cover a claim, then the patient is responsible for the

One of the most unfair characteristics of US healthcare is that if the health insurance company does not cover a claim, then the patient is responsible for the payment. It is unrealistic in practice for a patient to know or understand the process by which claims are made (since they are made by an error prone and disinterested provider administrator, and are made in a non-transparent and highly complex way), and also unrealistic for a patient to be able to do anything about a denied claim, since there is virtually no competition in the market for health insurance, and because a patient would almost never have the means to sue a health insurance company for damages. All this creates a very poor system that rewards administrators and shareholders at the expense of patients.

shakezula 6y ago
And even if you can contest the denial, it can take days to months to get it back, meanwhile you’re shouldered with the burden of paying full price for your treatment with the _hope_ that they’ll reimburse you later. My fiancée has cancer, and we regularly joke that dealing with insurance companies is worse than the actual stage 3 cancer she has. They constantly deny her coverage for medications she’s been on for years, they will randomly require new tests to make sure she still has cancer (megalolz), they’ll decide they don’t want to cover procedures just for fun until we call and argue with a representative for a few hours and then all of a sudden it’s a “billing mistake” that can be reversed. It’s a racket, plain and simple. Medical care should never be tied to personal wealth, period.
- FpUser 6y ago
  >"It’s a racket, plain and simple. Medical care should never be tied to personal wealth, period." In agreement. Still Government covered medical care has their own methods of avoiding / delaying procedures. In the end it all comes down to money.
  - simonh 6y ago
    You may not have meant it to come across this way, but "The alternative isn't absolutely perfect in every way, therefore both options are equivalent" isn't a useful contribution.
    - FpUser 6y ago
      I meant exactly what I said. Basically nothing is perfect. And while I completely support the idea of free universal healthcare I know on my own experience that Government is on a constant lookout to cut those expenses and does it at the first opportunity. Bunch of warriors with the downvoting clubs is not going to change anything. Frankly I do not give a s..t about being downvoted. I am not here to accumulate karma. Just for the record: personally I have never downvoted even single post. I believe that all this voting system is very unhealthy.
      - xnyan 6y ago
        Nobody is trying to change your mind, it's just that most people disagree with you.
        FpUser 6y ago
        Disagreement and karma are two different things.
- Aerroon 6y ago
  It's inevitable that medical care in some way is tied to personal wealth. Some treatments are so expensive and/or niche that public programs likely wouldn't cover them. Such treatments will probably always exist. (And if they didn't, then that could he a problem by itself.) But at least basic modern healthcare (things that existed ~20 years ago) should be provided as (mostly) free to the patient. We need people to not worry about going to the doctor - there should be minimal paperwork and cost. More people going to healthcare earlier would hopefully pay off through better preventative care.
  - arcticbull 6y ago
    > It's inevitable that medical care in some way is tied to personal wealth. Some treatments are so expensive and/or niche that public programs likely wouldn't cover them. Such treatments will probably always exist. (And if they didn't, then that could he a problem by itself.) Not in a single-payer state, no. It's also not really a problem in and of itself. You'll find that if cancer treatments are actually cheaper and more effective than the status quo as demonstrated by a study that a single payer state will quickly take them up. [edit] Frequently you'll find these eccentric or fringe treatments that are incredibly expensive aren't actually better per se. There is a point of diminishing returns in everything. If you paid $200K for cancer treatment, would you get a better outcome? $1M? $10M? $1B? No. We know what we know, and we have the tools we have. Healthcare isn't a pay-to-win game. Generally if you find a way to pay more to get better care you're just bumping someone else down the priority list. That may be acceptable in America but it's not in much of the rest of the world.
    - etaioinshrdlu 6y ago
      Extremely rich people in non-USA countries can still travel elsewhere and pay exorbitant amounts for exotic treatment if they so desire. Some of those might be lifesaving.
      - arcticbull 6y ago
        Some (who don't understand the value of money) may even visit the US. My question is do you have some good examples of this, particularly where efficacy is disproportionately better?
- alphabettsy 6y ago
  It’s intentional. They save billions using this practice because some people don’t have the time, knowledge or resources to dispute.
  - tlrobinson 6y ago
    Are there services that will handle this nonsense for you?
    - rangibaby 6y ago
      In rich countries outside of the US it’s called “the government”
      - ant6n 6y ago
        Other countries are slipping, though. For example, Germany does not actually have a single-payer system, but instead a "system" of public and private health insurance companies. As an employee you`re usually in the public system, which can be more expensive for higher-earners because the fees are based on your income (although the health taxes are regressive, capped above like 65K income per year). Self-employed people are often in the private system, and higher income earners can also opt into the private system. The problem is you can´t easily opt back into the public system once you´re out (especially once you´re old), so there are tens of thousands (if not hundreds), that get stuck in the private system without being able to pay the fees because they´ve become poor (possibly because of health reasons), and then they get denied coverage and thus access to medical services. Immigrants can fall through the cracks in the over-complicated system as well. The problem is not as insane as in the US, happens "at the fringes", but it still affects thousands and is mostly outside of the perception of society, since everybody just assumes they got the best system in the world.
        yladiz 6y ago
        Please. Let’s not turn this into whataboutery. This isn’t about other countries doing things poorly, and more specifically Germany was not named by the parent commenter. This is about the US doing things significantly worse than basically any other developed country. I live in Germany, and know that the German healthcare system is not perfect, but I also know, as an American, that it is significantly better by essentially any metric than the US, and it’s unfair to pretend otherwise. I’m glad I don’t live in a society anymore in which I have to worry about taking an ambulance for an emergency because I can’t afford the fucking $500 price.
- whymauri 6y ago
  >My fiancée has cancer, and we regularly joke that dealing with insurance companies is worse than the actual stage 3 cancer she has. You know what's crazy? This isn't even the first time I've heard this. Literally had the same conversation with a close friend last year. Thankfully it wasn't Stage Three and their spouse is in remission, but the financial ordeal was more stressful than the diagnosis.
  - cultus 6y ago
    It's so heartbreaking to see people who are very sick or even dying have to stress about bills. It's just not something a moral society does. It's not just mental, cortisol really knocks down your immune system.
- ashtonkem 6y ago
  A woman got her face bit off by a wild animal (bear I think) and did an AMA a while back; she said that the worst part of the experience was dealing with Blue Cross.
- cryptonym 6y ago
  Treatment and part of my income was insured by public actors (not US). No issue, everything is automatic, didn't had to pay a single thing and it would even be possible to get unlimited free taxi rides from home to hospital, free public transport, wig, sport... even a tax cut. I'm really thankful for this. Other part of my income was insured by a private company. They lost my files, claimed I didn't fill the forms and after months of fight and involving my employer, they magically found papers I previously sent and paid. Private companies seek profit and would basically do anything to keep your money. You cannot build a good (fair) insurance company with this logic.
  - metters 6y ago
    What's the name of that insurer?
    - gambiting 6y ago
      Not OP, but when my dad had cancer in Poland, the national health fund covered his entire treatment over 8 years. Few operations, monthly dose of Glivec(google the cost of Glivec treatment in the US to see how insane that is), hospital stays, and like OP said - he would get reimbursed for travelling to the hospital and back. And this treatment was never tied to his employment, he never had to prove to anyone that he definitely has cancer still, we've never seen a single bill for any of it, I simply have no idea how much this treatment has cost over the years. Which is the point of it all I think - if you need treatment, you simply get it, a regular person never has to worry about billing, dealing with insurers or anything like that. The only interactions you need to have are the doctors telling you when to appear for the operation, and the pharmacy calling you to let you know your drugs are ready to pick up. That's about it. I know there are outliers in that system, but for my dad's entire 8-year long treatment I'd consider the way this all works as 10/10.
      - lotsofpulp 6y ago
        The Gleevec was probably an order of magnitude cheaper or more for the Polish government than in the US: https://www.statista.com/statistics/312011/prices-of-gleevec-by-country/ https://www.statista.com/statistics/312011/prices-of-gleevec... And doctors in Poland are probably not earning a few hundred thousand USD per year, and similar for nurses wages and all the other people in the healthcare chain. Quick googling shows wages might be an order of magnitude cheaper also. I assume healthcare providers in Poland are also not subject to the legal liability they would be in the US. Yes, the US has some extra administrative costs due to the billing nonsense of non taxpayer funded healthcare and overhead of health insurance companies, but bottom line is healthcare costs more in the US because everyone earns more top to bottom in the US, and supply of healthcare and medicine is constrained.
- roenxi 6y ago
  > Medical care should never be tied to personal wealth, period. There is literally no limit to how much effort society can put into one person's healthcare. In the absurd extreme, we could reshape society into doctors, farmers and medical manufacturers in a mad quest for best possible medical care. At some point we have to ration healthcare and decide when to put more resources towards something else. If not personal wealth, what do you want to use for the rationing process? Age? A lottery? Unless there is some really amazing alternative, money is one of the best proxies available for for contribution to society. A bunch of edge cases exist, but they are edge cases. It is a fair way of rationing healthcare.
  - Areading314 6y ago
    > Unless there is some really amazing alternative, money is one of the best proxies available for for contribution to society This is an absolutely ridiculous assertion. Many people inherit, luck out, or get wealthy by other means. Personal wealth is a terrible way to determine "societal value". It is deeply disturbing to me that there are people with these types of views. I hate to assume but my impression is that you have not had to personally experience much hardship, would you say that is accurate?
    - roenxi 6y ago
      > This is an absolutely ridiculous assertion. What do you think is a better proxy?
      - dxdm 6y ago
        You seem to be assuming that "contribution to society" should be the only factor when portioning out health care, and that there should be only one "best" proxy to measure such a factor. Why?
        roenxi 6y ago
        I'm assuming that while people don't like rationing things based on wealth, their objection is to the rationing more than the wealth. There are alternatives to rationing things by wealth. All the ones I can think of are arbitrary, unfair, or unworkable (raising interesting and difficult questions too, eg, a fun example would be should highly contentious politicians be first in line for the best healthcare due to their mass popularity or last in line due to mass condemnation?). I think that people are happy to call me ridiculous but not actually able to say how we should be deciding who gets time from a doctor. I'm very doubtful of the alternatives, I suspect that many of them involve magical thinking that wealthy people are somehow hiding hundreds of doctors in their cellars that will suddenly appear and literally cure everyone's ills if only the government mandates it. There are a lot of problems with US healthcare. It costs too much, and there are too many restrictions that stop one person trying to help another. But the fundamental "pay money, get service" aspect isn't something that is as easy to improve on as people try to believe. It is reasonable for wealthy people to get a much better standard.
- trungdq88 6y ago
  my god, that sounds horrible
- sillysaurusx 6y ago
  I'm so sorry to hear about your fiancee. We don't know each other, but I can only imagine what that'd be like. Wishing you both a good 2021!
unishark 6y ago
> One of the most unfair characteristics of US healthcare is that if the health insurance company does not cover a claim, then the patient is responsible for the payment. As a general rule this is not an unusual characteristic. Get a procedure done in another country that turns out not not be covered and they presumably will bill you for it. The mess comes about because of attempting to control prices with networks and pre-approvals, which is a fairly recent mess as they tried to control prices and govt layers requirements and escapes/loopholes on them. It would be better to just wipe that all away and get policies that say if you get sick you get a flat payment to spend as you wish. I.e., actual insurance.
- arcticbull 6y ago
  In many places there aren't non-covered services on offer. And where there are, a fee schedule is published, publicly, in advance.
  - unishark 6y ago
    > And where there are, a fee schedule is published, publicly, in advance. So you're saying the patient is responsible for the payment when the service is not covered...
    - arcticbull 6y ago
      There's a bit more nuance to it than that. 1. What services are medically necessary that you think aren't covered by the health service in another country? You'd likely be hard pressed to find any in the first place. I think that's an important aspect. 2. But say you had non-medically-necessary surgery, that isn't somehow covered by the health system. In that case... a. The prices are actually listed ahead of time. b. Who is owed the money may vary: it's not necessarily the service provider who may be owed, it could be the health system. But yeah, in case 2, the patient is ultimately responsible, though my point is in most countries case (2) either doesn't exist or is extremely limited, or limited only to non-medically-necesary procedures. > I.e., actual insurance. Medical insurance isn't insurance. Insurance is something you get to cover you in the event of an unexpected cost. Humans will get sick, they will get cancer, they will get heart attacks and they will die. Something that pays for that isn't insurance, it's more of a structured payment plan. Your house probably won't burn down. You almost certainly, if all goes well, will die of cancer.
unabst 6y ago
I just changed my insurance to LA Care. The doctor they gave me was with UCLA medical. I called and they said they did not and never have accepted LA Care. I called LA Care. The lady said, "I really wish their clinics stopped doing that." She called the UCLA clinic with me on the line and sorted it out. I was then left to give them the rest of my info... At the last step when they asked for my ID, they insisted it was too short and that they couldn't run my insurance. I called LA Care. They said that's the only number and it's not too short. My appointment is tomorrow. The common voice of a receptionist that's been denying patients all day. They're trained to not help you. To think this is the system that's responsible for keeping us all alive.
- Folcon 6y ago
  Sorry, for those of us not in the know, what is it about La Care that provokes this response?
  - unabst 6y ago
    UCLA and Cedars-Sinai are both world class providers, but take little to no insurance available on Covered California. LA Care is a rare "public option" run by LA county. When I switched from Oscar to LA Care this year, I did so because both UCLA and Cedars showed up as "in network" for LA Care. And when they assigned a UCLA clinic physican down the street as our primary, I was pleasantly surprised to say the least. But I knew not to celebrate prematurely, and I was right. LA Care did pull through, and our appointment this morning went great. I'm still holding my breath until I see the bill and it's not wrong. I checked the LA Care provider directory yesterday, and there were no Cedars doctors. I can only assume there's something up with that. I had Blue Cross a few years ago, and I still have PTSD from the three way call between them and Covered California where their rep flat out contradicted an email they had sent me, even after I read it out word for word. She was also trained to not help me. This training is ass-backwards.
    - Folcon 6y ago
      Thanks for the additional info =)...
gnopgnip 6y ago
If you are at an in network provider, the provider is required to accept the insurance negotiated rate and not pursue the patient. If your insurance denies the bill, the provider can't pursue the patient. In many states surprise billing and balance billing laws prevent out of network providers from billing you for the balance, in excess of what medicare or your insurance pays.
- tehwebguy 6y ago
  Those laws do not prevent it from happening, they just offer a small stick for anyone getting screwed to attempt to use in court. Meanwhile your insurance company can just wait for you to die while you try to hash it out. Plus, every calendar year that passes while you’re desperately trying to get them to cover services is another shot at them avoiding any responsibility for the next service you need.
dusted 6y ago
And here my "socialist" ass was thinking the most unfair characteristic of the US "healthcare system" was that not all citizens have the basic right to the same, best-effort treatment.
- leetcrew 6y ago
  > same, best-effort treatment no matter how enlightened the society is, you can still pick at most one of these.
  - dusted 6y ago
    that'd be nitpicking the wording, the best-effort is resource-constrained, this is not what's happening in the US, the resources exist but policy is to only make them available to a minority of the population.
zelos 6y ago
My one experience of private health care in the UK was bad enough: the medical care was great, it was relatively minor elective surgery, I verified everything as carefullly as I could, but I accidentally used an out-of-network aneasthetist and ended up having to pay £300 out of my own pocket because the insurance wouldn't cover it. Scaling that up to something like cancer care, where the patient is by definition not in a good way and the care is vastly more complex and I find it kind of incomprehensible.
erentz 6y ago
So I currently have over $480,000 in denied claims. (I am fairly hopeful it will be resolved shortly, thanks to a complex work around my employer organized since it’s a self funded plan.) I made sure that the treatment was preauthorized. Got a copy of the preauthorization. And I have a recording and email of the insurance company confirming the providers are all in network. But they denied the claims for being out of network anyway. The part of the insurance network that provides the authorization is Blue Shield of CA. Even though I live in WA the authorization gets sent to Blue Shield CA. And that’s how they want it done. They approve it. They somehow look up and say provider is in network (multiple times). The provider themselves confirms all this too calling them. Then after treatment, when the claims are submitted, Blue Shield CA denies as out of network and tells the provider to submit to the Blue Shield franchise in WA (Regence). Now somehow the provider (an infusion pharmacy) isn’t in network with Regence, they are with Blue Shield CA. And so clearly in the Blue Shield nationwide network but not specifically with Regence. So Regence also denies it as out of network. Then they tell me this is somehow all correct and it’s my problem. There is literally NO WAY for anyone to avoid this kind of trap. I was told they were in network multiple times, and they explicitly authorized the treatment knowing full well my home address and home state. PS: the $480,000 is the magical inflated pricing, in real pricing ends up being <$100,000.

shakezula 6y ago

And even if you can contest the denial, it can take days to months to get it back, meanwhile you’re shouldered with the burden of paying full price for your treatment with the _hope_ that they’ll reimburse you later. My fiancée has cancer, and we regularly joke that dealing with insurance companies is worse than the actual stage 3 cancer she has. They constantly deny her coverage for medications she’s been on for years, they will randomly require new tests to make sure she still has cancer (megalolz), they’ll decide they don’t want to cover procedures just for fun until we call and argue with a representative for a few hours and then all of a sudden it’s a “billing mistake” that can be reversed. It’s a racket, plain and simple. Medical care should never be tied to personal wealth, period.

FpUser 6y ago
>"It’s a racket, plain and simple. Medical care should never be tied to personal wealth, period." In agreement. Still Government covered medical care has their own methods of avoiding / delaying procedures. In the end it all comes down to money.
- simonh 6y ago
  You may not have meant it to come across this way, but "The alternative isn't absolutely perfect in every way, therefore both options are equivalent" isn't a useful contribution.
  - FpUser 6y ago
    I meant exactly what I said. Basically nothing is perfect. And while I completely support the idea of free universal healthcare I know on my own experience that Government is on a constant lookout to cut those expenses and does it at the first opportunity. Bunch of warriors with the downvoting clubs is not going to change anything. Frankly I do not give a s..t about being downvoted. I am not here to accumulate karma. Just for the record: personally I have never downvoted even single post. I believe that all this voting system is very unhealthy.
    - xnyan 6y ago
      Nobody is trying to change your mind, it's just that most people disagree with you.
      - FpUser 6y ago
        Disagreement and karma are two different things.
Aerroon 6y ago
It's inevitable that medical care in some way is tied to personal wealth. Some treatments are so expensive and/or niche that public programs likely wouldn't cover them. Such treatments will probably always exist. (And if they didn't, then that could he a problem by itself.) But at least basic modern healthcare (things that existed ~20 years ago) should be provided as (mostly) free to the patient. We need people to not worry about going to the doctor - there should be minimal paperwork and cost. More people going to healthcare earlier would hopefully pay off through better preventative care.
- arcticbull 6y ago
  > It's inevitable that medical care in some way is tied to personal wealth. Some treatments are so expensive and/or niche that public programs likely wouldn't cover them. Such treatments will probably always exist. (And if they didn't, then that could he a problem by itself.) Not in a single-payer state, no. It's also not really a problem in and of itself. You'll find that if cancer treatments are actually cheaper and more effective than the status quo as demonstrated by a study that a single payer state will quickly take them up. [edit] Frequently you'll find these eccentric or fringe treatments that are incredibly expensive aren't actually better per se. There is a point of diminishing returns in everything. If you paid $200K for cancer treatment, would you get a better outcome? $1M? $10M? $1B? No. We know what we know, and we have the tools we have. Healthcare isn't a pay-to-win game. Generally if you find a way to pay more to get better care you're just bumping someone else down the priority list. That may be acceptable in America but it's not in much of the rest of the world.
  - etaioinshrdlu 6y ago
    Extremely rich people in non-USA countries can still travel elsewhere and pay exorbitant amounts for exotic treatment if they so desire. Some of those might be lifesaving.
    - arcticbull 6y ago
      Some (who don't understand the value of money) may even visit the US. My question is do you have some good examples of this, particularly where efficacy is disproportionately better?
alphabettsy 6y ago
It’s intentional. They save billions using this practice because some people don’t have the time, knowledge or resources to dispute.
- tlrobinson 6y ago
  Are there services that will handle this nonsense for you?
  - rangibaby 6y ago
    In rich countries outside of the US it’s called “the government”
    - ant6n 6y ago
      Other countries are slipping, though. For example, Germany does not actually have a single-payer system, but instead a "system" of public and private health insurance companies. As an employee you`re usually in the public system, which can be more expensive for higher-earners because the fees are based on your income (although the health taxes are regressive, capped above like 65K income per year). Self-employed people are often in the private system, and higher income earners can also opt into the private system. The problem is you can´t easily opt back into the public system once you´re out (especially once you´re old), so there are tens of thousands (if not hundreds), that get stuck in the private system without being able to pay the fees because they´ve become poor (possibly because of health reasons), and then they get denied coverage and thus access to medical services. Immigrants can fall through the cracks in the over-complicated system as well. The problem is not as insane as in the US, happens "at the fringes", but it still affects thousands and is mostly outside of the perception of society, since everybody just assumes they got the best system in the world.
      - yladiz 6y ago
        Please. Let’s not turn this into whataboutery. This isn’t about other countries doing things poorly, and more specifically Germany was not named by the parent commenter. This is about the US doing things significantly worse than basically any other developed country. I live in Germany, and know that the German healthcare system is not perfect, but I also know, as an American, that it is significantly better by essentially any metric than the US, and it’s unfair to pretend otherwise. I’m glad I don’t live in a society anymore in which I have to worry about taking an ambulance for an emergency because I can’t afford the fucking $500 price.
whymauri 6y ago
>My fiancée has cancer, and we regularly joke that dealing with insurance companies is worse than the actual stage 3 cancer she has. You know what's crazy? This isn't even the first time I've heard this. Literally had the same conversation with a close friend last year. Thankfully it wasn't Stage Three and their spouse is in remission, but the financial ordeal was more stressful than the diagnosis.
- cultus 6y ago
  It's so heartbreaking to see people who are very sick or even dying have to stress about bills. It's just not something a moral society does. It's not just mental, cortisol really knocks down your immune system.
ashtonkem 6y ago
A woman got her face bit off by a wild animal (bear I think) and did an AMA a while back; she said that the worst part of the experience was dealing with Blue Cross.
cryptonym 6y ago
Treatment and part of my income was insured by public actors (not US). No issue, everything is automatic, didn't had to pay a single thing and it would even be possible to get unlimited free taxi rides from home to hospital, free public transport, wig, sport... even a tax cut. I'm really thankful for this. Other part of my income was insured by a private company. They lost my files, claimed I didn't fill the forms and after months of fight and involving my employer, they magically found papers I previously sent and paid. Private companies seek profit and would basically do anything to keep your money. You cannot build a good (fair) insurance company with this logic.
- metters 6y ago
  What's the name of that insurer?
  - gambiting 6y ago
    Not OP, but when my dad had cancer in Poland, the national health fund covered his entire treatment over 8 years. Few operations, monthly dose of Glivec(google the cost of Glivec treatment in the US to see how insane that is), hospital stays, and like OP said - he would get reimbursed for travelling to the hospital and back. And this treatment was never tied to his employment, he never had to prove to anyone that he definitely has cancer still, we've never seen a single bill for any of it, I simply have no idea how much this treatment has cost over the years. Which is the point of it all I think - if you need treatment, you simply get it, a regular person never has to worry about billing, dealing with insurers or anything like that. The only interactions you need to have are the doctors telling you when to appear for the operation, and the pharmacy calling you to let you know your drugs are ready to pick up. That's about it. I know there are outliers in that system, but for my dad's entire 8-year long treatment I'd consider the way this all works as 10/10.
    - lotsofpulp 6y ago
      The Gleevec was probably an order of magnitude cheaper or more for the Polish government than in the US: https://www.statista.com/statistics/312011/prices-of-gleevec-by-country/ https://www.statista.com/statistics/312011/prices-of-gleevec... And doctors in Poland are probably not earning a few hundred thousand USD per year, and similar for nurses wages and all the other people in the healthcare chain. Quick googling shows wages might be an order of magnitude cheaper also. I assume healthcare providers in Poland are also not subject to the legal liability they would be in the US. Yes, the US has some extra administrative costs due to the billing nonsense of non taxpayer funded healthcare and overhead of health insurance companies, but bottom line is healthcare costs more in the US because everyone earns more top to bottom in the US, and supply of healthcare and medicine is constrained.
roenxi 6y ago
> Medical care should never be tied to personal wealth, period. There is literally no limit to how much effort society can put into one person's healthcare. In the absurd extreme, we could reshape society into doctors, farmers and medical manufacturers in a mad quest for best possible medical care. At some point we have to ration healthcare and decide when to put more resources towards something else. If not personal wealth, what do you want to use for the rationing process? Age? A lottery? Unless there is some really amazing alternative, money is one of the best proxies available for for contribution to society. A bunch of edge cases exist, but they are edge cases. It is a fair way of rationing healthcare.
- Areading314 6y ago
  > Unless there is some really amazing alternative, money is one of the best proxies available for for contribution to society This is an absolutely ridiculous assertion. Many people inherit, luck out, or get wealthy by other means. Personal wealth is a terrible way to determine "societal value". It is deeply disturbing to me that there are people with these types of views. I hate to assume but my impression is that you have not had to personally experience much hardship, would you say that is accurate?
  - roenxi 6y ago
    > This is an absolutely ridiculous assertion. What do you think is a better proxy?
    - dxdm 6y ago
      You seem to be assuming that "contribution to society" should be the only factor when portioning out health care, and that there should be only one "best" proxy to measure such a factor. Why?
      - roenxi 6y ago
        I'm assuming that while people don't like rationing things based on wealth, their objection is to the rationing more than the wealth. There are alternatives to rationing things by wealth. All the ones I can think of are arbitrary, unfair, or unworkable (raising interesting and difficult questions too, eg, a fun example would be should highly contentious politicians be first in line for the best healthcare due to their mass popularity or last in line due to mass condemnation?). I think that people are happy to call me ridiculous but not actually able to say how we should be deciding who gets time from a doctor. I'm very doubtful of the alternatives, I suspect that many of them involve magical thinking that wealthy people are somehow hiding hundreds of doctors in their cellars that will suddenly appear and literally cure everyone's ills if only the government mandates it. There are a lot of problems with US healthcare. It costs too much, and there are too many restrictions that stop one person trying to help another. But the fundamental "pay money, get service" aspect isn't something that is as easy to improve on as people try to believe. It is reasonable for wealthy people to get a much better standard.
trungdq88 6y ago
my god, that sounds horrible
sillysaurusx 6y ago
I'm so sorry to hear about your fiancee. We don't know each other, but I can only imagine what that'd be like. Wishing you both a good 2021!

unishark 6y ago

> One of the most unfair characteristics of US healthcare is that if the health insurance company does not cover a claim, then the patient is responsible for the payment. As a general rule this is not an unusual characteristic. Get a procedure done in another country that turns out not not be covered and they presumably will bill you for it. The mess comes about because of attempting to control prices with networks and pre-approvals, which is a fairly recent mess as they tried to control prices and govt layers requirements and escapes/loopholes on them. It would be better to just wipe that all away and get policies that say if you get sick you get a flat payment to spend as you wish. I.e., actual insurance.

arcticbull 6y ago
In many places there aren't non-covered services on offer. And where there are, a fee schedule is published, publicly, in advance.
- unishark 6y ago
  > And where there are, a fee schedule is published, publicly, in advance. So you're saying the patient is responsible for the payment when the service is not covered...
  - arcticbull 6y ago
    There's a bit more nuance to it than that. 1. What services are medically necessary that you think aren't covered by the health service in another country? You'd likely be hard pressed to find any in the first place. I think that's an important aspect. 2. But say you had non-medically-necessary surgery, that isn't somehow covered by the health system. In that case... a. The prices are actually listed ahead of time. b. Who is owed the money may vary: it's not necessarily the service provider who may be owed, it could be the health system. But yeah, in case 2, the patient is ultimately responsible, though my point is in most countries case (2) either doesn't exist or is extremely limited, or limited only to non-medically-necesary procedures. > I.e., actual insurance. Medical insurance isn't insurance. Insurance is something you get to cover you in the event of an unexpected cost. Humans will get sick, they will get cancer, they will get heart attacks and they will die. Something that pays for that isn't insurance, it's more of a structured payment plan. Your house probably won't burn down. You almost certainly, if all goes well, will die of cancer.

unabst 6y ago

I just changed my insurance to LA Care. The doctor they gave me was with UCLA medical. I called and they said they did not and never have accepted LA Care. I called LA Care. The lady said, "I really wish their clinics stopped doing that." She called the UCLA clinic with me on the line and sorted it out. I was then left to give them the rest of my info... At the last step when they asked for my ID, they insisted it was too short and that they couldn't run my insurance. I called LA Care. They said that's the only number and it's not too short. My appointment is tomorrow. The common voice of a receptionist that's been denying patients all day. They're trained to not help you. To think this is the system that's responsible for keeping us all alive.

Folcon 6y ago
Sorry, for those of us not in the know, what is it about La Care that provokes this response?
- unabst 6y ago
  UCLA and Cedars-Sinai are both world class providers, but take little to no insurance available on Covered California. LA Care is a rare "public option" run by LA county. When I switched from Oscar to LA Care this year, I did so because both UCLA and Cedars showed up as "in network" for LA Care. And when they assigned a UCLA clinic physican down the street as our primary, I was pleasantly surprised to say the least. But I knew not to celebrate prematurely, and I was right. LA Care did pull through, and our appointment this morning went great. I'm still holding my breath until I see the bill and it's not wrong. I checked the LA Care provider directory yesterday, and there were no Cedars doctors. I can only assume there's something up with that. I had Blue Cross a few years ago, and I still have PTSD from the three way call between them and Covered California where their rep flat out contradicted an email they had sent me, even after I read it out word for word. She was also trained to not help me. This training is ass-backwards.
  - Folcon 6y ago
    Thanks for the additional info =)...

gnopgnip 6y ago

If you are at an in network provider, the provider is required to accept the insurance negotiated rate and not pursue the patient. If your insurance denies the bill, the provider can't pursue the patient. In many states surprise billing and balance billing laws prevent out of network providers from billing you for the balance, in excess of what medicare or your insurance pays.

tehwebguy 6y ago
Those laws do not prevent it from happening, they just offer a small stick for anyone getting screwed to attempt to use in court. Meanwhile your insurance company can just wait for you to die while you try to hash it out. Plus, every calendar year that passes while you’re desperately trying to get them to cover services is another shot at them avoiding any responsibility for the next service you need.

dusted 6y ago

And here my "socialist" ass was thinking the most unfair characteristic of the US "healthcare system" was that not all citizens have the basic right to the same, best-effort treatment.

leetcrew 6y ago
> same, best-effort treatment no matter how enlightened the society is, you can still pick at most one of these.
- dusted 6y ago
  that'd be nitpicking the wording, the best-effort is resource-constrained, this is not what's happening in the US, the resources exist but policy is to only make them available to a minority of the population.

zelos 6y ago

My one experience of private health care in the UK was bad enough: the medical care was great, it was relatively minor elective surgery, I verified everything as carefullly as I could, but I accidentally used an out-of-network aneasthetist and ended up having to pay £300 out of my own pocket because the insurance wouldn't cover it. Scaling that up to something like cancer care, where the patient is by definition not in a good way and the care is vastly more complex and I find it kind of incomprehensible.

erentz 6y ago

So I currently have over $480,000 in denied claims. (I am fairly hopeful it will be resolved shortly, thanks to a complex work around my employer organized since it’s a self funded plan.) I made sure that the treatment was preauthorized. Got a copy of the preauthorization. And I have a recording and email of the insurance company confirming the providers are all in network. But they denied the claims for being out of network anyway. The part of the insurance network that provides the authorization is Blue Shield of CA. Even though I live in WA the authorization gets sent to Blue Shield CA. And that’s how they want it done. They approve it. They somehow look up and say provider is in network (multiple times). The provider themselves confirms all this too calling them. Then after treatment, when the claims are submitted, Blue Shield CA denies as out of network and tells the provider to submit to the Blue Shield franchise in WA (Regence). Now somehow the provider (an infusion pharmacy) isn’t in network with Regence, they are with Blue Shield CA. And so clearly in the Blue Shield nationwide network but not specifically with Regence. So Regence also denies it as out of network. Then they tell me this is somehow all correct and it’s my problem. There is literally NO WAY for anyone to avoid this kind of trap. I was told they were in network multiple times, and they explicitly authorized the treatment knowing full well my home address and home state. PS: the $480,000 is the magical inflated pricing, in real pricing ends up being <$100,000.