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The US healthcare system is just a completely broken mess. When things go smooth, you are lucky! However, when you have a major procedure, life event or sicknes
by avgDev 6y ago
The US healthcare system is just a completely broken mess. When things go smooth, you are lucky! However, when you have a major procedure, life event or sickness things can get messy quick.
We had a child 10 months ago, billing was screwed up by the hospital, then by insurance and we are still in process of getting it resolved. I have now spent at least 8 hours on the phone.
I had a surgery, called insurance and verified it was pre-approved and in-network. After procedure I receive $22k bill. I was young and did not care about my credit back then and never paid. 5 years later I received a new bill, for $300 as the provider sued the insurance company.
I hate going to the hospital and AWAITING a shower of bills. This grinds my gears SO hard. Every hospital stay and bills just keep coming for a few months.
As someone who likes to budget and plant expenses, I just cannot stand the US medical system. I never know how much a simple wart removal my cost. $100 or $2000? I'm happy to have good insurance, don't require to use the medical system a lot and have enough money. However, if you are extremely ill you seriously need to move to a "FIRST" world nation or have a good insurance with low max out of pocket. However, you still are going to deal with bills like its your full time job.
- kshacker 6y agoIt is not a 'broken mess'. It is an 'engineered mess'. The difference is in intent.
- danaris 6y agoFraming it this way is probably inaccurate, and if inaccurate, unhelpful. From decades of observing the system, it seems extremely unlikely to me that it was deliberately engineered to be this way. Rather, different parts of it grew and changed organically and the parts and changes that benefitted moneyed interests in power stayed, while those that did not were discarded. It does not take a deliberate will behind something for it to be pulled toward this sort of inequality, and presenting it as if that's what's happened suggests that if we could only defeat the Evil People who "engineered" it this way, we could make it better. It's a very compelling idea, and it makes for a nice dramatic narrative, and humans love good stories. Unfortunately, it's not the case. In order to make it better, we need to take a good, comprehensive look at many aspects of our systems of economics and government, and redesign them deliberately and with a strong intention to inhibit the flow of money upward from the 99% to the 1%. It's hard, it will take a long time, the people with the most wealth and power will fight us every step of the way, and there's no silver bullet, but there's also very little that's more worth doing.
- cwwc 6y agoAgree in part — but there has been some engineering due to the moneyed interests. Few other industries have the perverse incentive structure where you cannot “shop around” to keep costs low. Also, the tax code was most assuredly engineered: tax code, as insurance that pays for medical procedures is tax-free to workers. But if they want to pay for the same procedure out of pocket, they have to pay tax on it. This leads to more insurance coverage and less consumer control.
- Retric 6y agoSure, nobody sat down 50 years ago and said this is how we want things to happen, but each individual part was created and the direct interactions are intentional. For example insurance pays for procedures not the process of doctors filling out insurance forms. That’s by design and ends up having horrifying implications for the healthcare system as doctors often spend more time dealing with insurance than the patient actually needing treatment.
- DoubleDerper 6y agoThe intent is to maintain status-quo despite evidence that it's a broken system for medical users. Profits are being made based on the system we have. It's boards & c-suite executives keeping their fiduciary responsibility to their investors by lobbying against structural change. The intent is clearly there.
- munk-a 6y agoThe intent is socially entrenched though - it's not just c-level executives calling for keeping the government out of healthcare. America has a real problem with anything that even smells like socialism or egalitarianism.
- maxerickson 6y agoAnybody who thinks the US government isn't already neck deep in health care should just be disregarded out of hand. It's literally a preposterous thing to believe, deeply revealing.
- deleted 6y ago[deleted]
- ArtDev 6y agoIt's a racket and that is why the industry does everything it can to avoid having to adhere to basic capitalism. There is no other industry like it except, perhaps, the mafia.
- missedthecue 6y agoWho is making the profits? Most health insurance orgs, mine included, are not for profit. BCBS, Kaiser, Wellmark, etc
- candiddevmike 6y agoThe executives, board members, and middle management at all of these companies. I've worked with some of the companies you named, they have lavish offices and gravy train jobs for everyone and their crony friends. Yes, they're "not for profit", but that doesn't mean no one gets (insane) bonuses. Checkout their 990s sometime to get an idea at the excess of cash being pocketed.
- simple_phrases 6y agoEmployers and owners of practices, hospitals, clinics etc. Shareholders of pharmaceutical and medical device companies. Executives and administrative roles are paid well, too.
- IG_Semmelweiss 6y agoThe administration & C suite. Non for profit is a nice smokescreen. Nonprofit status is a nice little windfall fir the permanent bureaucrat class at payors and hospitals. Starting from cancer children's hospitals that do all kinds of tricks to energize fundraisers and draw donations.. which amount to a paltry 30% of their CEO's salary.... To payors colluding with hospitals to raise "gross" prices in order to get more government payments for medicare disproportionate share funding (DCH) https://en.wikipedia.org/wiki/Disproportionate_share_hospital https://en.wikipedia.org/wiki/Disproportionate_share_hospita... THe profits go to the permanent administration. Is it any surprise that admins then balk at putting prices online, with an argument that can be summed up as "OMG, you make us put online the price from 2000 contracts!! Its too hard! " Here is a little nugget. Nonprofit designation for hospital is a recent development. It didn't exist before 1900. The designation was effectively "compensation" by the government to hospitals, so the latter would agree to admit patients regardless of ability to pay. Quid pro quo. Dont feel bad for hospitals and their "curse" of nonpaying patients. They got their pound of flesh. Nonprofit status its not just federal exemption.. its ALL Taxes (state, local, real estate, commercial, etc). Imagine your life if you didn't have to pay sale tax? Property tax? State tax ? FICA, FUTA SDI? That is the life nonprofit hospitals enjoy.
- wincy 6y agoOur first daughter was born right as the hospital was changing ownership. They billed the c-section as a natural birth. Cool. Then a year later they called and told us we had to pay the full cost because they’d messed up the paperwork. My wife said that was their problem and she wasn’t going to pay. The hospital maternity ward closed down, and the bill vanished and has never shown up on our credit report six years later, so that’s cool I guess. Telling people you won’t pay and to gleaned you alone works sometimes. I was unemployed for our second daughters birth (I started a new job a week after she was born) and her birth and subsequent care was all covered by Medicaid. So I guess the best financial decision is to time job changes for births, which really shows how messed up the system is.
- bluedino 6y agoForget the hospital, let’s talk doctors office. I saw a PA for barely ten minutes, I got a $326 bill. When my wife takes our baby in for a visit, we wait 2-4 hours and get a $200 bill for a routine visit. We get charged if we cancel an appointment with notice or late. They are always fumbling around with bills. Pay $150 at the visit and get a $80 bill in the mail, and then they bring up a $60 charge from last time.
- civilized 6y agoOnce I paid a bill that came the usual 3-6 months after the appointment. A few months later they send me a check in the mail for the same amount as that bill. Then a few months after that, another bill for the same amount as the check.
- quasirandom 6y ago\
- bpodgursky 6y agoI don't mean to blame you, but for the sake of anyone reading this -- you could absolutely have negotiated this down with the hospital by pleading financial hardship. I'm not trying to justify the system overall, but please don't take a $150k bill at face value, if you can't reasonably afford to pay it.
- kgin 6y agoHospitals' bar for reasonably afford is low, in my experience. They want proof that you make poverty line wages or below to write it off, below 300% of poverty line (around 38k) for reductions.
- TylerE 6y agoTo totally write off, sure. But they will often vastly reduce and/or over 0% interest long term payment plans.
- deleted 6y ago[deleted]
- ska 6y ago> if you can't reasonably afford to pay it. It's true you can negotiate, but it's also true their bar for "reasonably afford to pay it" absolutely can include emptying your savings and other assets.
- christophilus 6y agoI just got a $3k bill in the mail for my 6 month old son’s delivery. This is about 4 months after they incorrectly billed us for part of it. I have the money, but am thinking of fighting it even though it’s such a small sum. Either their accounting is incompetent or fraudulent, but either way, I’m annoyed enough to push back. I suspect they are trying to fleece as many people as possible to make up for the 2020 budget hit they took.
- pxeboot 6y agoI disputed essentially every bill after my first child was born. Magically, every one was reduced by a substantial amount. There were literally made up charges they admitted to billing everybody for, but can waive if somebody's insurance doesn't cover it. No idea how they get away with this stuff. Every hospital in America must have some very good lawyers on staff.
- websites2323 6y agoAlways always always challenge it. In the American medical system is that the first bill is a first position. Expect to negotiate down, even with insurance, by at least 20%. It’s time consuming, and confusing, and people will fob you off. But it’s necessary unless you want to get taken for a ride.
- Rickasaurus 6y agoSimilar here. Had a baby 9 months ago, the doctor took the insurance, but it turned out later the hospital didn't. Bill was over 100K and it wasn't covered at all.
- jjeaff 6y agoI knew about that little caveat/scam going in. So I spoke with hospital billing and confirmed that the hospital did accept our insurance. But I also discovered that any other doctor that works on you during the birth will bill separately and will need to accept your insurance. I asked the hospital who the anesthesiologist would be and they said they had no way of knowing because you use whoever is on duty when you give birth. So there was literally no way to figure out if all of the birth would be covered. And it turns out, the anesthesiologist that happened to be working that day was not accepted on our plan. They billed us for $4k (even though he botched the epidural, causing us to need an emergency c section.) We had to decline to pay it a few times before they said they would work it out and accept the lower amount from our insurance.
- fractionalhare 6y agoHoly shit. Did you pay it? What the fuck...
- banana_giraffe 6y agoI have good insurance through a major company. My SO tripped, and hit their head on a curb on a busy road. I wasn't there, but by happenstance an EMT was there, witnessed the event, and came to offer aid. The EMT was concerned enough my SO ended up going to the hospital. Several scans, and a few hours later, my SO was discharged. I then got to spend something like 30 hours on the phone over the course of a couple of months fighting a bill for around $100k because of a typo during the admissions to the hospital. That's bad enough on the face of it, but there were real Kafkaesque moments. Like where I was explaining to the insurance company that this was not an automobile incident just because there were cars nearby, not once, not twice, but five times, once with a form that asked for pictures of the intersection and made me describe why cars would be stopped at a red light.
- tomrod 6y agoAlways ask for the billing and procedure codes, also known as DGN, ICD10, and CPT/HPCPS Medical transcribing has a high error rate.
- banana_giraffe 6y agoFair point. In this case, though, the error was a transcription error in the birthdate. That caused a mess.
- tomrod 6y agoHow rough! Sorry man.
- munk-a 6y agoYou're not wrong but this is a sign of a very broken system and the people least able to deal with it on even footing are people who may be in extreme pain or delirious from their injury. The US healthcare system is immoral.
- newsclues 6y ago
- javiramos 6y agoFunny that you mention wart removal. I once got a $450 bill for wart removal cryosurgery. “Cryosurgery” meant a one second spray of the wart with liquid nitrogen. Outrageous.
- Black101 6y ago> The US healthcare system is just a completely broken mess. That's why I got hospitalization-only insurance as soon as Trump allowed it... Obama-care was a joke... except for the pre-existing condition clause, maybe.
- jjeaff 6y agoThere is a very valid reason that hospitalization only insurance was not allowed. The whole point of requiring everyone to get insurance is so that you don't have just the sickliest and oldest people getting insurance. Insurance is meant to spread the risk amongst everyone who pays premiums. Additionally, not having insurance for primary and non-emergency care will make it much less likely that people will even end up in the emergency room. (No checkups, no outpatient) Even worse, having emergency room coverage only encourages people to use the emergency room more often than they should. Though I wouldn't expect our last president to have much of a handle on economics and business, considering his track record. Either that, or he was purposely trying to destroy the program (he was, but it was probably both reasons).
- Black101 6y ago> The whole point of requiring everyone to get insurance is so that you don't have just the sickliest and oldest people getting insurance. Insurance is meant to spread the risk amongst everyone who pays premiums. So why did it make the insurance costs skyrocket?
- biaachmonkie 6y agoWell another provision of the ACA was the 80/20 rule, Insurance Companies have to spend 80% of premiums on care or refund the customers. So their overhead, salaries, etc was limit to the remaining 20%. Sounds great until you think it through a bit and realize that for them to increase their profits they need to increase premiums, they also then have to increase the payouts and the Hospitals, Doctors, Anesthesiologists, etc.. are all fine with getting paid more. So there you go higher premiums to cover their increased $ value of their 20%. Everyone in the system except the patient benefits from increasing prices.
- 0xmohit 6y agoThe mess is by design. Goldman Sachs asks in biotech research report: ‘Is curing patients a sustainable business model?’ <https://www.cnbc.com/2018/04/11/goldman-asks-is-curing-patients-a-sustainable-business-model.html https://www.cnbc.com/2018/04/11/goldman-asks-is-curing-patie...>
- agumonkey 6y ago> ‘Is curing patients a sustainable business model?’ this is some quote... what's next: "people, what is their true ROI.."
- JamesBarney 6y agoShould we be upset that people can't afford to provide cures we don't want to pay for? When I work, I get paid. I expect pharmaceutical companies feel the same way. And if you look at how the world dealt with the hep c cure, it was pretty much trying as hard as possible to pay as little for a cure because the cost was front loaded.
- jnsie 6y agoWe should certainly be upset that a giant bank is effectively advising them not to create cures.
- JamesBarney 6y agoThe math is fairly simple. (Monthly drug price) * (number of months they take it) > (one time cost) Unless that one time cost is huge.
- nandhinianand 6y agoAh... the problem here is not that the pharma companies aren't getting paid.. The problem is there's a bunch of banks and government subsidies and a lot of middle-people creating cost on top of enabling the funds flow. I am not sure what's the solution, but there really are a lot of administrative middle-people involved..
- Geezus_42 6y agoLike when you go for a normal doctor's appointment, pay on your way out the door and the other get three bills in the mail "because they didn't know how much the insurance would cover when you paid". I have great insurance, this is pure bullshit.
- phreack 6y agoIn a moment of levity, check out Dogen's dramatization of having a child in Japan as a westerner. https://m.youtube.com/watch?v=Rl5WSGs5bGs https://m.youtube.com/watch?v=Rl5WSGs5bGs