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I had really bad nausea and pain, went to my doctor, who said I likely had a kidney stone, and the next step was to get an MRI. I was between jobs with no insur

I had really bad nausea and pain, went to my doctor, who said I likely had a kidney stone, and the next step was to get an MRI. I was between jobs with no insurance and few funds, so I asked what it cost. The doctor had someone in his office call the hospital and got a quote for $1,500. I got the MRI knowing only that. A month later I got a bill for $3,500. I drove out to the hospital (2 hours) to ask wtf. They didn't help at all, wouldn't budge. So I went home and wrote them a check for $1,500, marked as paid in full, with a cover letter explaining my side of it. It worked. They cashed the check and I never heard another word. I've done further business there with no problem. It's well worth pushing back.

MattGaiser 5y ago
Isn't this fairly typical? I had an emergency visit when I visited the USA once and was flat out told that the insurance bill was about $3000, but they could take $600 if I paid right away. I had out of country insurance, so had to pay upfront anyway, so I chose the $600 option. I was flat out offered the cheap cash settlement.
- aaomidi 5y ago
  Typical doesn't mean we should accept it and move on. Which is why we should keep talking about this and keep the pressure up.
- suzzer99 5y ago
  Yes it's typical. Our healthcare is basically the equivalent of Moroccan rug shopping. It's great.
- mason55 5y ago
  I wonder if they recognized you were from out of country and so they’d have no way to collect if you just left, and that’s why they offered the cash deal up front.
- MeinBlutIstBlau 5y ago
  Part of that is why HSA's are heavily promoted since you get pre-tax dollars to go toward an account you can use specifically for these reasons. So in essence, that "out of pocket" money would be coming from your HSA. In practice however, that's not really the norm.
  - danaris 5y ago
    Unfortunately, I've never been offered an HSA that's not "use it or lose it", meaning I have to know my medical expenses for the entire next year during the open enrollment period in the fall in order to properly benefit from it.
    - lotsofpulp 5y ago
      HSA is legally yours, and no one can make you lose it. What you are referring to is a health FSA, which have no reason to exist anymore. Any employer that does not offer HSA eligible plans is shafting their employees. An HSA is a 401K, but better, since you can withdraw without penalty at any time for any healthcare expenses you had at any time in the past. And you can invest it into anything you want (just rollover your funds to a Fidelity HSA every year).
      - danaris 5y ago
        I mean, this was admittedly 10 years ago, but it was definitely described to me as an HSA at the time in all the literature I had access to.
      - Amezarak 5y ago
        This is great in theory, but HSAs are only offered with HDHPs, which means that every other year or so, despite contributing the IRS max, I spend out the entire account.
        lotsofpulp 5y ago
        Assuming you have sufficient income, you should pay for expenses today with post tax dollars, and let the HSA money grow tax exempt as long as possible. The premium difference and the deductible difference between HDHP and non HDHP plan cancels out, generally. You either pay more premiums on an ongoing basis, or more at one time for the expense. Unfortunately, there is no getting around actually having a lot of healthcare expenses. But spending ~$6k out of pocket on healthcare every two years probably puts you a couple standard deviations above average spend category unless you are old.
codegeek 5y ago
stories like this clearly prove what a racket our health insurance/billing system is.
- teeray 5y ago
  It always amazes me when I go to the vet with my dog, I get an itemized bill for medical services immediately. That really exposes the BS of figuring out prices once they’ve sent it to insurance, months go by, and then finally you get a final bill. It doesn’t have to be that way.
benjohnson 5y ago
I'm glad it worked! As I understand it, marking your check "paid in full" combined with the cover letter is what potentially worked for you. Simply writing "paid in full" on the check generally isn't sufficient. More info form real attorneys (unlike me) https://www.lawyers.com/legal-info/consumer-protection/banking-and-loans/paid-in-full-check-memo.html https://www.lawyers.com/legal-info/consumer-protection/banki...
- thaumasiotes 5y ago
  That link doesn't support your interpretation at all: > If you try this approach on a credit card debt, it’s unlikely to work. Why? Because you probably won’t be able to show that the amount owed is uncertain. You’ll be held responsible for the amount that you charged—a number that’s likely relatively simple to figure out. On the other hand, if you’re working with a contractor and you disagree about how many hours it took to finish a job or the supplies necessary to complete a project, you might be able to satisfy this requirement. The article makes no mention of a cover letter. They stress two things: 1. The amount owed must be subject to dispute. The hospital obviously satisfies that requirement. 2. The phrase "paid in full" was visible in an obvious manner. That's it.
  - bluefirebrand 5y ago
    The cover letter illustrates that the amount is in dispute in writing. It is likely important in order to satisfy 1.
    - thaumasiotes 5y ago
      No, the phrase "paid in full" illustrates that the amount _is_ in dispute. What you need is for the amount to be subject to dispute. See how the example they give of an invalid attempt to do this is a credit card bill, specifically because the amount of the claim is fully objective? The cover letter doesn't add anything there.
shiftpgdn 5y ago
A "normal" business doing this at scale would be investigated for fraud. Yet somehow it's normal when it's a hospital.
- MeinBlutIstBlau 5y ago
  It's definitely not the hospitals fault. It's insurance companies getting involved since paying out of pocket is abnormal. So when you do pay out of pocket, you're paying what the insurance company pays and the hospital billing department is most likely very apathetic to that. Since they operate as non-profits, they often are willing to negotiate. Which is most likely why they can get away with this as opposed to a for profit entity.
  - lotsofpulp 5y ago
    There was no insurance company involved in the above story. > So when you do pay out of pocket, you're paying what the insurance company pays and the hospital billing department is most likely very apathetic to that. This has nothing to do with a health insurance company. > Since they operate as non-profits, they often are willing to negotiate. Which is most likely why they can get away with this as opposed to a for profit entity. This has nothing to do with non profit tax status. Car dealerships negotiate too.
    - xahrepap 5y ago
      I think your parent is saying that the quote was given ASSUMING insurance. So when the bill was formally given, it didn't match the quote because the quote was given under false-assumptions (about insurance).
      - lotsofpulp 5y ago
        That could be a possibility, which is still completely the hospital’s responsibility and does not involve an insurance company at all.
    - RandallBrown 5y ago
HarryHirsch 5y ago
You talk as if haggling over prices during a medical emergency was normal and are proud you got a good deal. That's what normalization of deviance looks like.
- f6v 5y ago
  Someone is ought to bring Europe up. Yeah, you’d get it for free in Belgium or Germany. The wait times though… could anything from couple weeks to half a year.
  - johnday 5y ago
    For a medical emergency? This is simply false.
    - klyrs 5y ago
      I live in Canada, and I've seen people put on 6+ month waitlists for (a) MRI after a concussion to make sure there's no internal bleeding (which can kill in a single day), (b) MRI after a stroke to diagnose the root cause, (c) ACL replacement surgery. Universal healthcare is great, but when you're in a 2-party system and one party undermines it whenever they're in power, the result is terrible.
      - johnday 5y ago
        I'm sorry to hear that, but it's not quite relevant to the point that the parent was making about Europe. For what it's worth, I live in the UK which has similar woes to how you describe Canada's two-party system. However we do normally get seen quickly for things which are a threat to life---but elective operations can take much longer. Mental health issues are also dealt with sluggishly at best.
    - f6v 5y ago
      Describe emergency. Sure, you’ll get an MRI after a car crash. But you could be in this state where you’re not dying, but still very uncomfortable. The wait list is pretty long then.
ridethebike 5y ago
I went to hospital and they assured me my procedure was covered by insurance and I wouldn't need to worry about that and in worst case scenario insurance would contact me. Couple of days later this hospital sent me $400 bill. It took me several phone calls to get them to acknowledge that they sent it by mistake. Exactly same situation happened year later but with ~$800 bill. Although doctors and medical staff themselves are ok, the US healthcare system as a whole is some incompetent clown mafia.
- jandrese 5y ago
  I get sent a deceptive bill every time I use the hospital. I think the idea is to show you what they are billing your insurance (not what insurance pays in the end), but it is always marked as "payment due" even though the insurance is going to foot the bill.
  - codegeek 5y ago
    Yea and that's also part of the problem. Most of us ignore this stuff because we have insurance but this is why the racket keeps going. But ultimately, someone pays for it somewhere.
- pydry 5y ago
  Incompetence isn't quite how I'd describe this.
  - Gibbon1 5y ago
    There is nothing about the system that rewards competence on the financial side of healthcare. Billing is based on what they can force people to pay. Not on what services actually cost. One downside of that is they have no control on how much things cost.
- codegeek 5y ago
  I wonder if there is any law here that protects consumers ? It is atrocious that a hospital/doctor/clinic can send you any absurd bill/amount and then it is on YOU to fight and prove that it was incorrect. I have done it many times myself.
ryneandal 5y ago
The majority of Americans aren't in a position to cut a $1,500 check like that. That's one of the major issues here.
- MeinBlutIstBlau 5y ago
  The majority of americans also don't know that there is a concept called "saving money." I mean I understand why it is some people are broke and it's not their fault and I get that. However, I've more than encountered people living above their means more than I have people in poverty beyond their control. This is speaking as someone whose worked in banking for about 5 years. Too many people with FOMO end up ruining their lives.
- caturopath 5y ago
  Note that the median net worth of an American household is ~120k. Obviously $1500 is a lot of money and it's not easy to come up with for normal folks and obviously there are millions of poor people, but the US is one of the wealthiest nations on Earth, and it's sometimes overemphasized how broke the average American is. Other than a few small European countries, the US has the highest median household incomes in the world, higher than any other large country like Germany, France, the UK, Canada, Japan, or Australia.
  - sofixa 5y ago
    > Note that the median net worth of an American household is ~120k That sounds pretty decent, but the grouped by age/location/education level medians are show that there are still a lot ( as a percentage) of people with low net worths in certain groups. And even then, net worth doesn't mean money in the bank - most people wouldn't and shouldn't have to sell their house or car to be able to afford a medical emergency ( even though i agree that if you have a $120k net worth, you should be able to save money on the side, but i wouldn't be surprised if there are situations where that's hard ( e.g. house bought years ago, a household member without a job, friend/family/only remaining job are in the area)). https://www.businessinsider.com/personal-finance/average-american-net-worth?IR=T#average-net-worth-by-age https://www.businessinsider.com/personal-finance/average-ame...
maxmcd 5y ago
Yes, I've also heard that alternatively you can just wait for them to send it to a debt collector and they will happily negotiate with you as well.
- caturopath 5y ago
  If they've sold the debt to a debt collector, don't interact with them at all unless they literally sue you. There's really nothing to be gained by paying a debt collector.
benlivengood 5y ago
The reason this works is that bad debt, sold off to collection companies, is worth about 3 cents on the dollar. You can get much better discounts by talking to the hospital's business/billing office and demonstrating difficulty to pay.
jrochkind1 5y ago
Good luck getting a price like this in writing in advance. I have not been able to get doctors or hospitals to tell me what a procedure would cost in advance at all. "So you're telling the only way to find out how much it will cost is to get it done and then see the bill?" "Right". An actually useful law might be: Before an elective procedure, they need to give you the price in writing. The actual price transparency law does not seem to have resulted in any price transparency.
- ddingus 5y ago
  Medical risks and unknowns are very high, and to make profit metrics, they need to push all risk onto the patient.
  - Spivak 5y ago
    If only there was a financial instrument I or the hospital could purchase where to amortize that risk over a long period of time by paying a fixed cost at some interval.
    - ddingus 5y ago
      And when everyone buys in, the costs and risks are well distributed. Makes sense for everyone, healthy or not. After all, we are healthy, until we aren't.
muttantt 5y ago
You over paid even with the $1,500. You could have waited a few months and they would have been happy with $400.
JohnWhigham 5y ago
As sad as this request may be, does anyone have a checklist or something of strategies to try with hospitals for bill negotiation?
- bufordtwain 5y ago
  Step 1: don't pay the bill Step 2: wait... Step 3: continue to not pay the bill step 4: when you've waited a very long time, offer a tiny amount of money
- kingnothing 5y ago
  Contact them and have a discussion with their finance department.
hackeraccount 5y ago
Hospitals have incentives to have a high sticker price - it benefits everyone. The insurance companies negotiate to something closer to the "real" price. That makes them happy. Government through Medicaid/Medicare has a way of giving money to hospitals. Customers only care about the out of pocket cost - indeed if they happen to notice the sticker price it'll only be after they know what they're actually paying - so that will actually make them happy. There's a very small group. 5% or so of people, those who don't have private insurance and aren't on the public insurances - edicare/Medicaid/VA - . Those people are actually in a position where they get to see the sticker price but might have to actually pay it. Which sucks. But I don't see how that changes. The people getting abused are - despite what you might hear - are small in number, typically healthy and not particularly poor or old. The ACA actually went after those people - that was what the mandate was about - and tried to get them to buy a lot of insurance. More insurance then they wanted - and the end result was that the mandate's been effectively gotten rid of.
- zerd 5y ago
  Plus out of network emergency visits, which isn't uncommon https://www.kff.org/health-costs/press-release/about-1-in-6-emergency-visits-and-hospital-stays-had-at-least-one-out-of-network-charge-in-2017/ https://www.kff.org/health-costs/press-release/about-1-in-6-...
- noelsusman 5y ago
  Part of the issue is that Medicare and especially Medicaid pay providers below cost for services. That money needs to be made up somewhere. Private insurers pay above cost, but they have too much leverage to get squeezed by the hospitals. That leaves uninsured patients to hold the bag. They could try to cut costs, but that puts them at a competitive disadvantage because most patients don't actually care about how much their care costs, they only care about how much they have to pay. If you're an uninsured patient who isn't in poverty then hospitals are going to squeeze you for as much as they can get away with. It's how they keep the lights on. None of this makes any real sense, but hospitals are just doing what they have to do to survive in the system we've created for them.
cdumler 5y ago
I ended up learning this accidentally and have used it ever since: I knew that hospitals charge ridiculous prices at first and then insurance jumps in. At the time, the insurance that I was on seemed to have a policy of "first let the hospital bill the patient and see if he/she pays then we'll get in involved." My procedure was $3,000+. That was a joke, but it also wasn't wholly inexpensive. I figured I'd end up for my deductible at about $800 or so. Hospital sent me the bill for $3,500. I expected insurance to chime in, but didn't. A month went by, I got an other bill, only lower. I call the hospital why this wasn't being resolved, and they said "looks like we didn't mark the procedure correctly. Ignore the bill, we'll fix this." Another month goes by, another bill, still lower. The bills still come and they kept changing. Eventually, it gets coded correctly and insurance did their part, and I owed $600. I forget it about, though. I get a call on the phone with the hospital saying, "we're going to send you to collections unless we can get some level of payment on this." I ask what the bill is if I pay in full. She says, "Pay in full and it's $380." I said, "I can make that happen." The U.S. is quite corrupt like any other "third-world" country. Just in different places. Our places are acceptable, though because "deregulation" or "gun rights" or "free speech".
- knubie 5y ago
  You must be joking if you think U.S. healthcare is deregulated. It’s one of the most regulated sectors in the economy, which explains why it’s such nightmare to deal with.
  - rundevilrun 5y ago
    americans really live in another dimension
  - ryathal 5y ago
    Its not just heavily regulated, it's also one of the most indirect markets that exists. People often have no idea how much their health insurance actually costs in the first place, and they have no idea how much their insurance may or may not pay for any given procedure, or how much a procedure will be billed for, or even if a single procedure will result in 1-10+ different bills. Since the people giving care often have to provide care irrespective of ability to pay, they have no idea what anything costs. Since Insurance companies generally aren't paid by individual people that use their service, and have discretion in what they pay the process is as difficult as possible for providers and users of medical services to navigate.
JJMcJ 5y ago
Most emergency room bills can get 1/2 or more knocked off just by asking.
jollybean 5y ago
It's worth mentioning this is not a fraud deigned by the doctor per say. They are removed from all of that, and don't care about prices. It's beyond them. So they just give you a number. Because there is this big 'goodwill' aspect to healthcare, the professions don't think about it as capitalist, but the hospital is actually pretty aggressive and take advantage of the goodwill aspect. The US needs a massive overhaul there and it's not about socialism or capitalism, but about simple and hard regulations.
baron816 5y ago
I wonder if you could’ve written a check for $350 (or any amount), marked as “paid in full,” and would have the same outcome. I bet either 1) no one actually looks at the checks or 2) $3,500 is not significant enough for them to fight for at all when a bunch of people are delinquent on $350,000 bills.
onetimemanytime 5y ago
>>So I went home and wrote them a check for $1,500, marked as paid in full, with a cover letter explaining my side of it. It worked. They cashed the check and I never heard another word I hope it ends as you say (think of collection agencies)
rsyring 5y ago
FYI, there are usually non-hospital businesses that do xrays and MRIs for substantially less than a hospital charges. They usually know their fees, expect payment at time of service for the uninsured, and have no surprises. Example: https://priorityradiology.com/ https://priorityradiology.com/ Xrays were under $250 and MRI was $600 last time my family needed it.
sgerenser 5y ago
Just read an entire book on the topic of how broken our medical system is: https://www.goodreads.com/book/show/42373033-the-price-we-pay https://www.goodreads.com/book/show/42373033-the-price-we-pa... A bit repetitive at times, but also some amazing stories. There’s a hospital in New Mexico that sends out hugely inflated bills to its uninsured patients then sues them and garnishes their wages when they can’t pay.
redis_mlc 5y ago
FYI: standalone MRI clinics in Los Altos charge $500, no surprises. In SE Asia, they're as low as $100, but if you want a US doctor to look at it, get the Rx from them first to get the right signal levels. Note that some people are allergic to the contrast dyes used, which will nuke your kidneys. So go easy on MRIs.

MattGaiser 5y ago

Isn't this fairly typical? I had an emergency visit when I visited the USA once and was flat out told that the insurance bill was about $3000, but they could take $600 if I paid right away. I had out of country insurance, so had to pay upfront anyway, so I chose the $600 option. I was flat out offered the cheap cash settlement.

aaomidi 5y ago
Typical doesn't mean we should accept it and move on. Which is why we should keep talking about this and keep the pressure up.
suzzer99 5y ago
Yes it's typical. Our healthcare is basically the equivalent of Moroccan rug shopping. It's great.
mason55 5y ago
I wonder if they recognized you were from out of country and so they’d have no way to collect if you just left, and that’s why they offered the cash deal up front.
MeinBlutIstBlau 5y ago
Part of that is why HSA's are heavily promoted since you get pre-tax dollars to go toward an account you can use specifically for these reasons. So in essence, that "out of pocket" money would be coming from your HSA. In practice however, that's not really the norm.
- danaris 5y ago
  Unfortunately, I've never been offered an HSA that's not "use it or lose it", meaning I have to know my medical expenses for the entire next year during the open enrollment period in the fall in order to properly benefit from it.
  - lotsofpulp 5y ago
    HSA is legally yours, and no one can make you lose it. What you are referring to is a health FSA, which have no reason to exist anymore. Any employer that does not offer HSA eligible plans is shafting their employees. An HSA is a 401K, but better, since you can withdraw without penalty at any time for any healthcare expenses you had at any time in the past. And you can invest it into anything you want (just rollover your funds to a Fidelity HSA every year).
    - danaris 5y ago
      I mean, this was admittedly 10 years ago, but it was definitely described to me as an HSA at the time in all the literature I had access to.
    - Amezarak 5y ago
      This is great in theory, but HSAs are only offered with HDHPs, which means that every other year or so, despite contributing the IRS max, I spend out the entire account.
      - lotsofpulp 5y ago
        Assuming you have sufficient income, you should pay for expenses today with post tax dollars, and let the HSA money grow tax exempt as long as possible. The premium difference and the deductible difference between HDHP and non HDHP plan cancels out, generally. You either pay more premiums on an ongoing basis, or more at one time for the expense. Unfortunately, there is no getting around actually having a lot of healthcare expenses. But spending ~$6k out of pocket on healthcare every two years probably puts you a couple standard deviations above average spend category unless you are old.

codegeek 5y ago

stories like this clearly prove what a racket our health insurance/billing system is.

teeray 5y ago
It always amazes me when I go to the vet with my dog, I get an itemized bill for medical services immediately. That really exposes the BS of figuring out prices once they’ve sent it to insurance, months go by, and then finally you get a final bill. It doesn’t have to be that way.

benjohnson 5y ago

I'm glad it worked! As I understand it, marking your check "paid in full" combined with the cover letter is what potentially worked for you. Simply writing "paid in full" on the check generally isn't sufficient. More info form real attorneys (unlike me) https://www.lawyers.com/legal-info/consumer-protection/banking-and-loans/paid-in-full-check-memo.html https://www.lawyers.com/legal-info/consumer-protection/banki...

thaumasiotes 5y ago
That link doesn't support your interpretation at all: > If you try this approach on a credit card debt, it’s unlikely to work. Why? Because you probably won’t be able to show that the amount owed is uncertain. You’ll be held responsible for the amount that you charged—a number that’s likely relatively simple to figure out. On the other hand, if you’re working with a contractor and you disagree about how many hours it took to finish a job or the supplies necessary to complete a project, you might be able to satisfy this requirement. The article makes no mention of a cover letter. They stress two things: 1. The amount owed must be subject to dispute. The hospital obviously satisfies that requirement. 2. The phrase "paid in full" was visible in an obvious manner. That's it.
- bluefirebrand 5y ago
  The cover letter illustrates that the amount is in dispute in writing. It is likely important in order to satisfy 1.
  - thaumasiotes 5y ago
    No, the phrase "paid in full" illustrates that the amount _is_ in dispute. What you need is for the amount to be subject to dispute. See how the example they give of an invalid attempt to do this is a credit card bill, specifically because the amount of the claim is fully objective? The cover letter doesn't add anything there.

shiftpgdn 5y ago

A "normal" business doing this at scale would be investigated for fraud. Yet somehow it's normal when it's a hospital.

MeinBlutIstBlau 5y ago
It's definitely not the hospitals fault. It's insurance companies getting involved since paying out of pocket is abnormal. So when you do pay out of pocket, you're paying what the insurance company pays and the hospital billing department is most likely very apathetic to that. Since they operate as non-profits, they often are willing to negotiate. Which is most likely why they can get away with this as opposed to a for profit entity.
- lotsofpulp 5y ago
  There was no insurance company involved in the above story. > So when you do pay out of pocket, you're paying what the insurance company pays and the hospital billing department is most likely very apathetic to that. This has nothing to do with a health insurance company. > Since they operate as non-profits, they often are willing to negotiate. Which is most likely why they can get away with this as opposed to a for profit entity. This has nothing to do with non profit tax status. Car dealerships negotiate too.
  - xahrepap 5y ago
    I think your parent is saying that the quote was given ASSUMING insurance. So when the bill was formally given, it didn't match the quote because the quote was given under false-assumptions (about insurance).
    - lotsofpulp 5y ago
      That could be a possibility, which is still completely the hospital’s responsibility and does not involve an insurance company at all.
  - RandallBrown 5y ago

HarryHirsch 5y ago

You talk as if haggling over prices during a medical emergency was normal and are proud you got a good deal. That's what normalization of deviance looks like.

f6v 5y ago
Someone is ought to bring Europe up. Yeah, you’d get it for free in Belgium or Germany. The wait times though… could anything from couple weeks to half a year.
- johnday 5y ago
  For a medical emergency? This is simply false.
  - klyrs 5y ago
    I live in Canada, and I've seen people put on 6+ month waitlists for (a) MRI after a concussion to make sure there's no internal bleeding (which can kill in a single day), (b) MRI after a stroke to diagnose the root cause, (c) ACL replacement surgery. Universal healthcare is great, but when you're in a 2-party system and one party undermines it whenever they're in power, the result is terrible.
    - johnday 5y ago
      I'm sorry to hear that, but it's not quite relevant to the point that the parent was making about Europe. For what it's worth, I live in the UK which has similar woes to how you describe Canada's two-party system. However we do normally get seen quickly for things which are a threat to life---but elective operations can take much longer. Mental health issues are also dealt with sluggishly at best.
  - f6v 5y ago
    Describe emergency. Sure, you’ll get an MRI after a car crash. But you could be in this state where you’re not dying, but still very uncomfortable. The wait list is pretty long then.

ridethebike 5y ago

I went to hospital and they assured me my procedure was covered by insurance and I wouldn't need to worry about that and in worst case scenario insurance would contact me. Couple of days later this hospital sent me $400 bill. It took me several phone calls to get them to acknowledge that they sent it by mistake. Exactly same situation happened year later but with ~$800 bill. Although doctors and medical staff themselves are ok, the US healthcare system as a whole is some incompetent clown mafia.

jandrese 5y ago
I get sent a deceptive bill every time I use the hospital. I think the idea is to show you what they are billing your insurance (not what insurance pays in the end), but it is always marked as "payment due" even though the insurance is going to foot the bill.
- codegeek 5y ago
  Yea and that's also part of the problem. Most of us ignore this stuff because we have insurance but this is why the racket keeps going. But ultimately, someone pays for it somewhere.
pydry 5y ago
Incompetence isn't quite how I'd describe this.
- Gibbon1 5y ago
  There is nothing about the system that rewards competence on the financial side of healthcare. Billing is based on what they can force people to pay. Not on what services actually cost. One downside of that is they have no control on how much things cost.
codegeek 5y ago
I wonder if there is any law here that protects consumers ? It is atrocious that a hospital/doctor/clinic can send you any absurd bill/amount and then it is on YOU to fight and prove that it was incorrect. I have done it many times myself.

ryneandal 5y ago

The majority of Americans aren't in a position to cut a $1,500 check like that. That's one of the major issues here.

MeinBlutIstBlau 5y ago
The majority of americans also don't know that there is a concept called "saving money." I mean I understand why it is some people are broke and it's not their fault and I get that. However, I've more than encountered people living above their means more than I have people in poverty beyond their control. This is speaking as someone whose worked in banking for about 5 years. Too many people with FOMO end up ruining their lives.
caturopath 5y ago
Note that the median net worth of an American household is ~120k. Obviously $1500 is a lot of money and it's not easy to come up with for normal folks and obviously there are millions of poor people, but the US is one of the wealthiest nations on Earth, and it's sometimes overemphasized how broke the average American is. Other than a few small European countries, the US has the highest median household incomes in the world, higher than any other large country like Germany, France, the UK, Canada, Japan, or Australia.
- sofixa 5y ago
  > Note that the median net worth of an American household is ~120k That sounds pretty decent, but the grouped by age/location/education level medians are show that there are still a lot ( as a percentage) of people with low net worths in certain groups. And even then, net worth doesn't mean money in the bank - most people wouldn't and shouldn't have to sell their house or car to be able to afford a medical emergency ( even though i agree that if you have a $120k net worth, you should be able to save money on the side, but i wouldn't be surprised if there are situations where that's hard ( e.g. house bought years ago, a household member without a job, friend/family/only remaining job are in the area)). https://www.businessinsider.com/personal-finance/average-american-net-worth?IR=T#average-net-worth-by-age https://www.businessinsider.com/personal-finance/average-ame...

maxmcd 5y ago

Yes, I've also heard that alternatively you can just wait for them to send it to a debt collector and they will happily negotiate with you as well.

caturopath 5y ago
If they've sold the debt to a debt collector, don't interact with them at all unless they literally sue you. There's really nothing to be gained by paying a debt collector.

benlivengood 5y ago

The reason this works is that bad debt, sold off to collection companies, is worth about 3 cents on the dollar. You can get much better discounts by talking to the hospital's business/billing office and demonstrating difficulty to pay.

jrochkind1 5y ago

Good luck getting a price like this in writing in advance. I have not been able to get doctors or hospitals to tell me what a procedure would cost in advance at all. "So you're telling the only way to find out how much it will cost is to get it done and then see the bill?" "Right". An actually useful law might be: Before an elective procedure, they need to give you the price in writing. The actual price transparency law does not seem to have resulted in any price transparency.

ddingus 5y ago
Medical risks and unknowns are very high, and to make profit metrics, they need to push all risk onto the patient.
- Spivak 5y ago
  If only there was a financial instrument I or the hospital could purchase where to amortize that risk over a long period of time by paying a fixed cost at some interval.
  - ddingus 5y ago
    And when everyone buys in, the costs and risks are well distributed. Makes sense for everyone, healthy or not. After all, we are healthy, until we aren't.

muttantt 5y ago

You over paid even with the $1,500. You could have waited a few months and they would have been happy with $400.

JohnWhigham 5y ago

As sad as this request may be, does anyone have a checklist or something of strategies to try with hospitals for bill negotiation?

bufordtwain 5y ago
Step 1: don't pay the bill Step 2: wait... Step 3: continue to not pay the bill step 4: when you've waited a very long time, offer a tiny amount of money
kingnothing 5y ago
Contact them and have a discussion with their finance department.

hackeraccount 5y ago

Hospitals have incentives to have a high sticker price - it benefits everyone. The insurance companies negotiate to something closer to the "real" price. That makes them happy. Government through Medicaid/Medicare has a way of giving money to hospitals. Customers only care about the out of pocket cost - indeed if they happen to notice the sticker price it'll only be after they know what they're actually paying - so that will actually make them happy. There's a very small group. 5% or so of people, those who don't have private insurance and aren't on the public insurances - edicare/Medicaid/VA - . Those people are actually in a position where they get to see the sticker price but might have to actually pay it. Which sucks. But I don't see how that changes. The people getting abused are - despite what you might hear - are small in number, typically healthy and not particularly poor or old. The ACA actually went after those people - that was what the mandate was about - and tried to get them to buy a lot of insurance. More insurance then they wanted - and the end result was that the mandate's been effectively gotten rid of.

zerd 5y ago
Plus out of network emergency visits, which isn't uncommon https://www.kff.org/health-costs/press-release/about-1-in-6-emergency-visits-and-hospital-stays-had-at-least-one-out-of-network-charge-in-2017/ https://www.kff.org/health-costs/press-release/about-1-in-6-...
noelsusman 5y ago
Part of the issue is that Medicare and especially Medicaid pay providers below cost for services. That money needs to be made up somewhere. Private insurers pay above cost, but they have too much leverage to get squeezed by the hospitals. That leaves uninsured patients to hold the bag. They could try to cut costs, but that puts them at a competitive disadvantage because most patients don't actually care about how much their care costs, they only care about how much they have to pay. If you're an uninsured patient who isn't in poverty then hospitals are going to squeeze you for as much as they can get away with. It's how they keep the lights on. None of this makes any real sense, but hospitals are just doing what they have to do to survive in the system we've created for them.

cdumler 5y ago

I ended up learning this accidentally and have used it ever since: I knew that hospitals charge ridiculous prices at first and then insurance jumps in. At the time, the insurance that I was on seemed to have a policy of "first let the hospital bill the patient and see if he/she pays then we'll get in involved." My procedure was $3,000+. That was a joke, but it also wasn't wholly inexpensive. I figured I'd end up for my deductible at about $800 or so. Hospital sent me the bill for $3,500. I expected insurance to chime in, but didn't. A month went by, I got an other bill, only lower. I call the hospital why this wasn't being resolved, and they said "looks like we didn't mark the procedure correctly. Ignore the bill, we'll fix this." Another month goes by, another bill, still lower. The bills still come and they kept changing. Eventually, it gets coded correctly and insurance did their part, and I owed $600. I forget it about, though. I get a call on the phone with the hospital saying, "we're going to send you to collections unless we can get some level of payment on this." I ask what the bill is if I pay in full. She says, "Pay in full and it's $380." I said, "I can make that happen." The U.S. is quite corrupt like any other "third-world" country. Just in different places. Our places are acceptable, though because "deregulation" or "gun rights" or "free speech".

knubie 5y ago
You must be joking if you think U.S. healthcare is deregulated. It’s one of the most regulated sectors in the economy, which explains why it’s such nightmare to deal with.
- rundevilrun 5y ago
  americans really live in another dimension
- ryathal 5y ago
  Its not just heavily regulated, it's also one of the most indirect markets that exists. People often have no idea how much their health insurance actually costs in the first place, and they have no idea how much their insurance may or may not pay for any given procedure, or how much a procedure will be billed for, or even if a single procedure will result in 1-10+ different bills. Since the people giving care often have to provide care irrespective of ability to pay, they have no idea what anything costs. Since Insurance companies generally aren't paid by individual people that use their service, and have discretion in what they pay the process is as difficult as possible for providers and users of medical services to navigate.

JJMcJ 5y ago

Most emergency room bills can get 1/2 or more knocked off just by asking.

jollybean 5y ago

It's worth mentioning this is not a fraud deigned by the doctor per say. They are removed from all of that, and don't care about prices. It's beyond them. So they just give you a number. Because there is this big 'goodwill' aspect to healthcare, the professions don't think about it as capitalist, but the hospital is actually pretty aggressive and take advantage of the goodwill aspect. The US needs a massive overhaul there and it's not about socialism or capitalism, but about simple and hard regulations.

baron816 5y ago

I wonder if you could’ve written a check for $350 (or any amount), marked as “paid in full,” and would have the same outcome. I bet either 1) no one actually looks at the checks or 2) $3,500 is not significant enough for them to fight for at all when a bunch of people are delinquent on $350,000 bills.

onetimemanytime 5y ago

>>So I went home and wrote them a check for $1,500, marked as paid in full, with a cover letter explaining my side of it. It worked. They cashed the check and I never heard another word I hope it ends as you say (think of collection agencies)

rsyring 5y ago

FYI, there are usually non-hospital businesses that do xrays and MRIs for substantially less than a hospital charges. They usually know their fees, expect payment at time of service for the uninsured, and have no surprises. Example: https://priorityradiology.com/ https://priorityradiology.com/ Xrays were under $250 and MRI was $600 last time my family needed it.

sgerenser 5y ago

Just read an entire book on the topic of how broken our medical system is: https://www.goodreads.com/book/show/42373033-the-price-we-pay https://www.goodreads.com/book/show/42373033-the-price-we-pa... A bit repetitive at times, but also some amazing stories. There’s a hospital in New Mexico that sends out hugely inflated bills to its uninsured patients then sues them and garnishes their wages when they can’t pay.

redis_mlc 5y ago

FYI: standalone MRI clinics in Los Altos charge $500, no surprises. In SE Asia, they're as low as $100, but if you want a US doctor to look at it, get the Rx from them first to get the right signal levels. Note that some people are allergic to the contrast dyes used, which will nuke your kidneys. So go easy on MRIs.