4 ms·

This occurs because it's the area you can get hit with totally extraordinary out of network bills your insurer may have to pay. Super lucrative for hospital / p

This occurs because it's the area you can get hit with totally extraordinary out of network bills your insurer may have to pay. Super lucrative for hospital / physician / transport providers. Your kid bumps their head. "There was no blood, but the baby was inconsolable. Jang and her husband worried he might have an injury they couldn’t see, so they called 911, and an ambulance took the family — tourists from South Korea — to Zuckerberg San Francisco General Hospital (SFGH). The doctors at the hospital quickly determined that baby Jeong Whan was fine. He took a short nap in his mother’s arms, drank some infant formula and was discharged a few hours later with a clean bill of health. ... the bill finally arrived at their home: They owed the hospital $18,836, the bulk of which was for a mysterious fee for $15,666 labeled trauma activation" Hahah. For the insurance companies this happens over and over. Of course, the lobby groups will get everyone riled up over this and HN contributors will be calling UnitedHealth scumbags / capitalist pigs.

gotostatement 5y ago
the insurance companies have posted record profits. They're not having money trouble "UHC’s parent company UnitedHealth Group posted a 35 percent year-over-year jump in operating profits in the first quarter of 2021"
- slownews45 5y ago
  This is in part COVID driven. * Significant reductions in demand for standard services. * Generous compensation for COVID services.
  - gotostatement 5y ago
    this has been going on since before COVID https://www.fiercehealthcare.com/payer/big-name-payers-earned-35-7-billion-2019-here-s-one-common-thread-their-reports https://www.fiercehealthcare.com/payer/big-name-payers-earne... In particular see the chart that shows 2018 and 2019 profits
    - slownews45 5y ago
      These will generally be also tied to various govt programs that are getting milked and are not market driven. You'll have honest / primary care providers going bust under Medicare / Medical and folks who get aggressive on billing / switch to lucrative areas (medicare advantage is mentioned) and milk like crazy. Large corps shop and cost shift to employees who also shop on price etc so margins are poorer there (where the issue in article is more relevant).
      - gotostatement 5y ago
        None of what you're saying has anything to do with the issue. The situation is that UHC is posting record profits but they are trying to implement a cost-cutting policy that will punish patients who make the "mistake" of not retroactively knowing their symptoms did not represent an emergency. All your points are about unscrupulous doctors but this policy punishes the patients, not the doctors.
pavlov 5y ago
Why doesn't this problem exist anywhere else in the world? The insurance companies have contributed to making American healthcare so dysfunctional. They are not the victims here.
- pkaye 5y ago
  One thing I read is public hospitals seem to be overwhelmed with uninsured patients who often come for emergency care because they have no other options. Private hospitals are able to grab the insured patients. Medicaid funding is not enough to pay for the cost of care for low income patients so hospitals survive on those private insurers to balance the books. There was a recent Frontline documentary about this. https://www.pbs.org/video/the-healthcare-divide-rv6npd/ https://www.pbs.org/video/the-healthcare-divide-rv6npd/
  - hallway_monitor 5y ago
    So the "free" healthcare provided to ingident people because it's mandated by law causes insane costs on hospital bills for those that actually can pay. As always, obscure requirements and incentives lead to incomprehensibly perverse outcomes. This is why the libertarian standpoint holds so much attraction - anything the government becomes involved in always gets worse.
    - pavlov 5y ago
      What’s the libertarian solution to healthcare? Let people die in the street in front of the hospital if their credit card can’t handle an $18k charge?
      - slownews45 5y ago
        Most other countries offer a baseline of health care that DOES NOT go to extraordinary lengths (ie, 10M) that is free to everyone. They pay those doctors a salary, often also cover the medical education for them etc. Then people can and do pay on top of that for private care. Super wealthy are in their own system, many others go for basic stuff to public option but might pay privately for speed / fancier results. This mirrors libertarian model in most cases. The US is a bit unique. For example, end of life care is both fully covered in most cases and insanely expensive - we spend far more than many other countries on things like last 3-6 months of life doing "heroic" measures, full intensive care etc etc. Again very lucrative to hospitals so don't see it stopping, but yes, other countries do not do this unless you pay yourself.
matwood 5y ago
I had mallet finger once. Went to a doctor in a nearby hospital (this is pre-doctor's care places on every corner). He saw me, gave me a plastic splint and said don't let your finger bend for 8 weeks and it should be fine. It was. Then I got the bill which insurance paid. The hospital decided to code it as a broken limb and everything that goes along with it, xrays (which I didn't have), plaster cast (which I didn't have), etc... Even though insurance paid, this sort of thing just pisses me off. So, I spent hours on the phone getting it fixed which made the bill maybe 1/4 of what is was originally.
- handrous 5y ago
  Having dealt with them enough, now, I'm entirely sure that the average hospital billing department sufficiently resembles an organized criminal enterprise that a whole bunch of the people involved would be behind bars, in any remotely just world. There is no fucking way the rate of "errors" they commit can be accounted for by actual, honest mistakes.
  - matwood 5y ago
    Oh, I have more lol. I had a legitimate ER visit for some stitches. At the visit I gave them my insurance, credit card, address, etc... When leaving I asked if there was anything else I owed? Nope. Fast forward 12 months and I get a letter from collections for ~$500. WTF is this? I never received a bill from the hospital. It took me a bit to even realize where this might be coming from. Once again, this type of stuff annoys me, so I call collections. "It's not much just pay it" - they cut it like $100. Not going to happen. So I wrote them and the hospital asking for the bill details which neither could produce and the delinquent bill was cleared. I rarely go to any ER type care and I have 2 stories of bills being f'd up. So yeah, the rate of errors seems beyond that of simple mistakes.
safdafh 5y ago
The counter point to this, is that I know of a family member went to the ER after passing out (after the 2nd incident) and was able to diagnose a life threatening condition. If they had a healthcare plan like this, they would have probably not gotten care and would be at risk, because the only reason the diagnosis happened was due to symptoms that only show up immediately after their incident. The risk here is having patients doing their own triaging. If the insurance company really wants to reduce costs, they can partner with a network of ERs who commit to triaging and transferring to lower cost providers if the issue is not an emergency. The patient is not qualified to make that decision. I worked at a health tech company where we analyzed bringing down costs through claims data, I can tell you that there are actually hundreds of ways insurance companies can reduce costs that won't risk patient safety, but do not. For example, there are billing mistakes all the time, but insurers do not give a crap. We tried building features to help identify billing mistakes but we never could get insurers to care about it. The amount of times I saw insurers undermine patient safety for "costs" was staggering so I'm really skeptical that the insurers are doing the right thing here. As another example, we saw insurers build "Centers of Excellence" and push patients towards taking care there. Basically what they did was find crappy hospital systems who were willing to take lower rates and they would tailor their insurance plan to push patients that way. Unfortunately when we analyzed claims and outcomes we found these Centers of "Excellence" actually had way worse patient outcomes. We raised this point with the insurers and again, they did not give a crap.
- slownews45 5y ago
  Not arguing insurers care about patient health at all. But being charged $18,000 for a doctor to look at you for 15 minutes? If people paid out of pocket these bills would be uncollectible.

gotostatement 5y ago

the insurance companies have posted record profits. They're not having money trouble "UHC’s parent company UnitedHealth Group posted a 35 percent year-over-year jump in operating profits in the first quarter of 2021"

slownews45 5y ago
This is in part COVID driven. * Significant reductions in demand for standard services. * Generous compensation for COVID services.
- gotostatement 5y ago
  this has been going on since before COVID https://www.fiercehealthcare.com/payer/big-name-payers-earned-35-7-billion-2019-here-s-one-common-thread-their-reports https://www.fiercehealthcare.com/payer/big-name-payers-earne... In particular see the chart that shows 2018 and 2019 profits
  - slownews45 5y ago
    These will generally be also tied to various govt programs that are getting milked and are not market driven. You'll have honest / primary care providers going bust under Medicare / Medical and folks who get aggressive on billing / switch to lucrative areas (medicare advantage is mentioned) and milk like crazy. Large corps shop and cost shift to employees who also shop on price etc so margins are poorer there (where the issue in article is more relevant).
    - gotostatement 5y ago
      None of what you're saying has anything to do with the issue. The situation is that UHC is posting record profits but they are trying to implement a cost-cutting policy that will punish patients who make the "mistake" of not retroactively knowing their symptoms did not represent an emergency. All your points are about unscrupulous doctors but this policy punishes the patients, not the doctors.

pavlov 5y ago

Why doesn't this problem exist anywhere else in the world? The insurance companies have contributed to making American healthcare so dysfunctional. They are not the victims here.

pkaye 5y ago
One thing I read is public hospitals seem to be overwhelmed with uninsured patients who often come for emergency care because they have no other options. Private hospitals are able to grab the insured patients. Medicaid funding is not enough to pay for the cost of care for low income patients so hospitals survive on those private insurers to balance the books. There was a recent Frontline documentary about this. https://www.pbs.org/video/the-healthcare-divide-rv6npd/ https://www.pbs.org/video/the-healthcare-divide-rv6npd/
- hallway_monitor 5y ago
  So the "free" healthcare provided to ingident people because it's mandated by law causes insane costs on hospital bills for those that actually can pay. As always, obscure requirements and incentives lead to incomprehensibly perverse outcomes. This is why the libertarian standpoint holds so much attraction - anything the government becomes involved in always gets worse.
  - pavlov 5y ago
    What’s the libertarian solution to healthcare? Let people die in the street in front of the hospital if their credit card can’t handle an $18k charge?
    - slownews45 5y ago
      Most other countries offer a baseline of health care that DOES NOT go to extraordinary lengths (ie, 10M) that is free to everyone. They pay those doctors a salary, often also cover the medical education for them etc. Then people can and do pay on top of that for private care. Super wealthy are in their own system, many others go for basic stuff to public option but might pay privately for speed / fancier results. This mirrors libertarian model in most cases. The US is a bit unique. For example, end of life care is both fully covered in most cases and insanely expensive - we spend far more than many other countries on things like last 3-6 months of life doing "heroic" measures, full intensive care etc etc. Again very lucrative to hospitals so don't see it stopping, but yes, other countries do not do this unless you pay yourself.

matwood 5y ago

I had mallet finger once. Went to a doctor in a nearby hospital (this is pre-doctor's care places on every corner). He saw me, gave me a plastic splint and said don't let your finger bend for 8 weeks and it should be fine. It was. Then I got the bill which insurance paid. The hospital decided to code it as a broken limb and everything that goes along with it, xrays (which I didn't have), plaster cast (which I didn't have), etc... Even though insurance paid, this sort of thing just pisses me off. So, I spent hours on the phone getting it fixed which made the bill maybe 1/4 of what is was originally.

handrous 5y ago
Having dealt with them enough, now, I'm entirely sure that the average hospital billing department sufficiently resembles an organized criminal enterprise that a whole bunch of the people involved would be behind bars, in any remotely just world. There is no fucking way the rate of "errors" they commit can be accounted for by actual, honest mistakes.
- matwood 5y ago
  Oh, I have more lol. I had a legitimate ER visit for some stitches. At the visit I gave them my insurance, credit card, address, etc... When leaving I asked if there was anything else I owed? Nope. Fast forward 12 months and I get a letter from collections for ~$500. WTF is this? I never received a bill from the hospital. It took me a bit to even realize where this might be coming from. Once again, this type of stuff annoys me, so I call collections. "It's not much just pay it" - they cut it like $100. Not going to happen. So I wrote them and the hospital asking for the bill details which neither could produce and the delinquent bill was cleared. I rarely go to any ER type care and I have 2 stories of bills being f'd up. So yeah, the rate of errors seems beyond that of simple mistakes.

safdafh 5y ago

The counter point to this, is that I know of a family member went to the ER after passing out (after the 2nd incident) and was able to diagnose a life threatening condition. If they had a healthcare plan like this, they would have probably not gotten care and would be at risk, because the only reason the diagnosis happened was due to symptoms that only show up immediately after their incident. The risk here is having patients doing their own triaging. If the insurance company really wants to reduce costs, they can partner with a network of ERs who commit to triaging and transferring to lower cost providers if the issue is not an emergency. The patient is not qualified to make that decision. I worked at a health tech company where we analyzed bringing down costs through claims data, I can tell you that there are actually hundreds of ways insurance companies can reduce costs that won't risk patient safety, but do not. For example, there are billing mistakes all the time, but insurers do not give a crap. We tried building features to help identify billing mistakes but we never could get insurers to care about it. The amount of times I saw insurers undermine patient safety for "costs" was staggering so I'm really skeptical that the insurers are doing the right thing here. As another example, we saw insurers build "Centers of Excellence" and push patients towards taking care there. Basically what they did was find crappy hospital systems who were willing to take lower rates and they would tailor their insurance plan to push patients that way. Unfortunately when we analyzed claims and outcomes we found these Centers of "Excellence" actually had way worse patient outcomes. We raised this point with the insurers and again, they did not give a crap.

slownews45 5y ago
Not arguing insurers care about patient health at all. But being charged $18,000 for a doctor to look at you for 15 minutes? If people paid out of pocket these bills would be uncollectible.