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HHS announces rule to protect consumers from surprise medical bills

204 points by ThaDood 5y ago

treyfitty 5y ago
Anecdotal: my dad had a heart attack and was in the hospital for 6 months due to complications. After a certain amount of time, the bills started to rack up and we were being charged for services that we thought would be covered under “health insurance coverage.” Instead of being covered, the health insurance provided coverage for standard hospital care, but we were charged every time a non network doctor stepped into his room. Then, the non-covered machines that were used. Then, stupid things like “staying in an ICU longer than allowed by coverage.” My father passed away before making it home, but when all was said and done, insurance was billed $10 million in total, of which the various doctors and hospitals billed the estate $2 million. My dad didn’t have an estate because he had no assets. But imagine your life + childrens’ lives being ruined for having insurance yet filled with invisible asterisks. At the time, NJ laws were onerous in this regard and favored insurance companies so we had no recourse. The state had a process for dealing with issues like this, but it was more of a cursory “jobs done here boss” type process and didn’t provide consumers with relief. Because of that, I moved my family out of NJ. When all contingency plans are filled with asterisks, do you really have insurance/protection?
- ryandrake 5y ago
  Sorry for your loss. This is one of the things that tends to get overlooked when discussing how awful the US health care industry is. You always hear: "US health care is terrible unless you have insurance!" But, it's also terrible when you have insurance! There are all kinds of ways doctors, hospitals, and insurance companies conspire to drain your pockets or your loved ones' estate's pockets, and they're all likely documented somewhere in a 100 page policy. The system is irredeemably beyond repair.
  - nrmitchi 5y ago
    It more and more feels like the difference between not having insurance, and having insurance when something bad actually happens is "do I get a massive bill that I can't afford now, or do I get a massive bill that I can't afford later?". The only real benefit of having "insurance" in the US is having reasonable access to basic preventative care. Don't get me wrong, it is a massive advantage to have default access to basic preventative care (without it being a cost-benefit tradeoff each time), but that is in no way/shape/form "insurance" in the typical meaning of the term.
    - majormajor 5y ago
      Most of the time the system works for people who have good coverage. The tragedy is that "having good coverage" is a hard-to-control combination of luck in employer and/or wealth. It's terrible that these things happen at all, and we CERTAINLY need to improve the US healthcare system, but exaggerations like "the only benefit of insurance in the US is access to preventative care" doesn't help. If people were regularly getting fucked like that the system wouldn't have the entrenched support it does from the "but I want to keep my insurance" camp, and so speaking in generalities like that just makes you appear uninformed to the millions who regularly see doctors, get treatment, have surgery, etc, without these problems. It also cheapens the inequality problem: the gap isn't just "has access to preventive care" vs "doesn't have that access." The gap is "has hundreds of thousands of dollars, or even millions, of bills turn into nothing" vs "bankrupt if they seek treatment for any serious problem."
      - NationalPark 5y ago
        I've had "good" coverage for my 15 year career and it does not work most of the time, or even half of the time. I've paid bills out of pocket because I didn't have time to untangle payer/insurance situations. I was taken to the ER unconscious once after a freak accident and ended up paying thousands for the ambulance. I've had to do provider paperwork myself and submit it to insurers myself because they refused to help me help them get paid. The system is simply not functional for people who don't have huge amounts of free time, patience, and money.
  - lotsofpulp 5y ago
    >There are all kinds of ways doctors, hospitals, and insurance companies conspire to drain your pockets People also want cutting edge care from some of the smartest and most highly educated people in the world (which is in short supply) for cheap.
    - heavyset_go 5y ago
      When I lived in Manhattan and worked with some really wealthy clients, they'd fly to France, Israel and elsewhere for care when they could have easily gotten the best care the US has to offer right down the street.
    - Arrath 5y ago
      There is a pretty large continuum of potential value between the 'cheap' care that people want, and the ruinous bills that get charged.
      - Goronmon 5y ago
        There is a pretty large continuum of potential value between the 'cheap' care that people want, and the ruinous bills that get charged. That can't be true, everyone knows that people are only greedy and stupid, and it's really the citizens' fault for the prices of the current healthcare setup. The industry itself is all made up of kind-hearted super heroes who would never think of manipulating prices to syphon more money from patients.
      - lotsofpulp 5y ago
        Ruinous bills are frequently used to cover the costs of routine procedures. It’s another situation where 10% of the healthcare consumes 90% of the resources. It’s the person who needs 6 months in the hospital, the 2 month premature baby in NICU, the hemophiliac that needs $1M medication that balloon all the costs. And no one can really afford that, but instead of spreading the costs around to all taxpayers, we were spreading it around by inflating everything else. ACA helps with this, but today’s announcement about out of network care will help more too.
    - Goronmon 5y ago
  - dave_aiello 5y ago
    My wife is a primary care doctor in the United States. Saying that disqualifies me in some people's minds from having an opinion about the quality and cost of health care in this country. But I am willing to give an opinion regardless. There are plenty of medical practices and institutions that function well and deliver good value to the patient. But there are many that do not. As someone who doesn't have friends inside the health care industry, it can be extremely difficult to figure out what to do in an emergency. Quite often your options are limited especially if you are caring for a loved one rather than yourself. The best advice I can give is to find good doctors before you need them, and when conversations come up about someone else's medical care, be willing to ask, who is your doctor and how good are they? Or, which hospital did you go to, and do you feel you had a good experience? Often there is little out-of-pocket difference between the cost of excellent medical care and lower quality care, if you have good insurance. If you don't have good insurance and you are looking at a potentially significant medical procedure, ask to speak to someone about financial assistance. Good practices and good hospital systems are not looking to bankrupt their patients.
    - lmeyerov 5y ago
      am hàppy to see HHS moving forward, long overdue! most US doctors are part of a bigger group in order to provide more comprehensive coverage (and due to systematic buyouts), which in turn have preferred insurance providers and additional out-of-network providers, and emergency services are generally for wherever an ambulance takes you. your physician may be great, but they are just a tiny cog in a broken machine one of the only outs, afaict, is something like working & living near a big & strong HMO like kaiser. but that comes at the cost of pretty firm boundaries on what services they allow: capped care (my SO is also a physician at one of the nation's best hospitals, and despite that, patients struggle w the broader system outside of her practical daily control)
- plank_time 5y ago
  Do the children have to pay off the bills of the parent? That doesn’t seem reasonable to me. It sounds like the best thing to do before getting too old is to transfer all your assets out so that if you die you won’t have it robbed by hospitals, etc.
  - knz_ 5y ago
    No, but they can legally take everything the estate has and leave the children with no inheritance.
  - bpodgursky 5y ago
    No, children aren't responsible for bills. It can only come from your estate. Transferring assets isn't crazy but you do need to be careful if you want to do it in a non-taxable manner (you can't just give your kid $500k cash without them counting it as income).
    - drewg123 5y ago
      I could be wrong, but I thought that the $500K would not count as income for them, but would deduct from your lifetime estate tax exclusion. See https://www.nerdwallet.com/article/taxes/gift-tax-rate https://www.nerdwallet.com/article/taxes/gift-tax-rate
    - memling 5y ago
      > No, children aren't responsible for bills. It can only come from your estate. I think it's worth noting that while this may be true if you're dead, it's not the case when you're still alive.[1] Filial responsibility laws mean that adult children can be legally required to pay their impoverished parents' medical bills. The above cites a case where a man was required by the courts to pay $93,000 for his mother's rehabilitation.[2] From what I've read, Pennsylvania may be particularly onerous compared to other states, but it's not a slam dunk kids won't be on the hook. [1]: https://en.wikipedia.org/wiki/Filial_responsibility_laws https://en.wikipedia.org/wiki/Filial_responsibility_laws [2]: https://abcnews.go.com/Business/pennsylvania-son-stuck-moms-93000-nursing-home-bill/story?id=16405807 https://abcnews.go.com/Business/pennsylvania-son-stuck-moms-...
- heavyset_go 5y ago
  Where did you move to that has better protections for patients regarding health coverage?
- antattack 5y ago
  We (society) cannot afford to pay for everyone's 10 million dollar hospital bills so how do we decide who gets their bills paid? EDIT: Some argue here that it'll average out, however at what cost to others? [1]Here's article about African Americans getting limbs amputated as their treatment for diabetes. [1]https://features.propublica.org/diabetes-amputations/black-american-amputation-epidemic/ https://features.propublica.org/diabetes-amputations/black-a...
  - 908B64B197 5y ago
    Rather, were services purchased really worth 10 million dollars? How much of that are salaries for underperforming, bloated structures in charge of "management" and billing?
    - antattack 5y ago
      Canadians spend 220k (in 2013) per person per lifetime. It's very unlikely you can shrink 10 million dollar bill to anywhere close to that. [1]https://www.theglobeandmail.com/life/health-and-fitness/health/canadians-use-average-of-220000-in-public-health-care-over-lifetime/article11913571/ https://www.theglobeandmail.com/life/health-and-fitness/heal...
      - yladiz 5y ago
        What makes Americans that much more expensive than Canadians?
        slownews45 5y ago
        It's mostly end of life care (relative to other countries). So during your life - broken bones etc - roughly equal. But if you are stuck in ICU for a year when 75+ - that's uniquely American and incredibly expensive. "Numerous articles on EOL costs show that a large proportion of Medicare expenditures occur during the last 6 months of life.1-9 This phenomenon has continued for many years as the number of Medicare decedents has increased with the aging American population. Medicare expenditures for EOL have increased dramatically from 1983 to 2016, primarily because of the increase in the number of decedents. Other articles compare EOL expenditures in the United States to other countries10,11 or focus on Medicare expenditures for specific diseases.12-14 A recent development in the literature challenges the idea that EOL costs are responsible for a high percentage of health-care costs.15 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610551/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610551/
- ohazi 5y ago
  > having insurance yet filled with invisible asterisks. "Invisible asterisks" captures the reality perfectly. The asterisks are invisible and infinite. I think even Kafka would be horrified. We've turned medical billing into an impenetrable Byzantine hellscape, and I fear that the only way to fix it would be to nuke it from orbit and start over.
  - cwkoss 5y ago
    Medicare For All is the single most important policy in American politics right now, IMO, for this exact reason. People complain that all the people in private insurance will be put out of their jobs - I view that as a feature, not a bug.
    - ixacto 5y ago
      This needs to happen. The medical billing industry is literal cancer. They sent me a bill for $350 then I called up to complain and suddenly the bill goes away because it’s billed to my other insurance that I didn’t even think I had anymore. If I sent a client a random bill for $$$ things would not go nearly as nicely, but they have so captured the regulators and politicians that this is the world we live in now. I want nothing to do with many of the policies of the left, but this would make things so much easier for small businesses and people Changing jobs in the labor market.
- JMTQp8lwXL 5y ago
  It's important to know some assets avoid probate and go directly to the beneficiary. These include things like a life insurance policy, or a 401(k) with a beneficiary information you can input, and possibly even update online (low friction). The health bill can go to the estate, but the estate also isn't comprised of the retirement account.
  - slumdev 5y ago
    This should be common knowledge (but, unfortunately, isn't.) A primary breadwinner should carry at least 10x his family's annual living expenses in term life insurance coverage. Once the size of his retirement accounts exceeds this, he can start thinking about reducing the insurance. Both will pay directly to beneficiaries in the event of his death.
  - mindslight 5y ago
    You can setup a simple trust with the right form/software, and a visit to your bank for notarization. I don't know if a revocable living trust would protect your heirs against healthcare shakedowns, and it would likely depend on the state. But if the current corrupt system continues much longer, I can see irrevocable trusts becoming popular to protect yourself even while alive.
- irrational 5y ago
  > imagine your life + childrens’ lives being ruined A parent’s debts cannot be put on to their children. Once your father died, anything not covered by his estate had to be written off by everyone.
  - RobRivera 5y ago
    true but what of inheritance? I suppose thats what life insurance policies are for.
    - irrational 5y ago
      OP said the father had no assets, so there was no inheritance forthcoming.
      - dharmab 5y ago
        If that had happened to my parents, my sibling who lives with them would have lost their home and had to move in with me. Just because OP's situation was different doesn't make that good.
  - DoktorDelta 5y ago
    I'm not sure how many people know that though, and the moment you make a payment towards that bill it's legally your debt.
  - simtel20 5y ago
    You are correct about the debt and the parent post clearly knows that, having lived through it'l. However the further point being that any assets that had accumulated with the intention of leaving them to the family, and which they relied on, would have been in jeapordy if they hit probate. If he owned a businessnor a house I'm not sure of the rules, but definitely savings, other assets etc. would be up for grabs.
    - dharmab 5y ago
      The rules vary by state and can change depending on if a written will exists. Parents, talk to an attorney while you're healthy. Some of the states have rules that will surprise you.
- gnopgnip 5y ago
  Was this before 2010?
- seandoe 5y ago
  Without knowing anything, 10 million seems excessive, but 6 months in a hospital will no doubt be expensive. I don't want to stir up bad feelings, I'm just curious, was there a good chance that your dad was going to make it out of the hospital? What was EOL talks like with the doctors? This story brings back the article here not too long ago, regarding the average hospital stay of a doctor at EOL vs the general public. I'm not sure of all the influencing factors regarding EOL procedure, but it does seem like a huge amount of resources are used for the very short end of a large amount of people's lives. Once again, no offense intended, it just got me thinking.
  - t3rabytes 5y ago
    Anecdata: I spent 5 days in ICU in 2018 and had a $350k bill from a California hospital, which my insurance company paid $200k for after adjustments and discounts. I wouldn’t say $10m for 6 months is far off.
    - seandoe 5y ago
      Yea that sentence came off wrong. I don't doubt the OP's claim at all. I was trying to acknowledge that billing that amount to anyone isn't right and looking to make the point that healthcare is expensive and how "we" choose to allocate resources is an important discussion.
  - treyfitty 5y ago
    No offense taken. In hindsight, it should have been clear that every day spent in the ICU past 3 months was not a good sign of my dad ever making it out of there. However, we 100% believed he was going to get better all throughout the process. Idk what this assessment was based on, but reflecting back for the first time in a long time, I now realize just how much emotions cloud sensible outlook & probability assessment.
- ezoe 5y ago
  10 million USD in 6 months? 10M? So I immediately imagine an absurd nonsense like "liquid gold transfusion", then I realized it's 800g gold per day in the current gold price. My pathetic mind can't even imagine the how absurd that is.
tehwebguy 5y ago
Great but without legislation this probably goes away in ~3-5 years Edit: I'm wrong, it's been legislated! Link in reply below
- justinc8687 5y ago
  This is regulation implementing legislation passed last year[1], so they should be relatively safe. 1. https://www.nytimes.com/2020/12/20/upshot/surprise-medical-bills-congress-ban.html https://www.nytimes.com/2020/12/20/upshot/surprise-medical-b...
- bingidingi 5y ago
  that’s 3-5 years of some people not getting absolutely crushed by medical bills… which is still a huge win. Why is the “it will change in 4 years“ argument so popular these days?
  - deleted 5y ago
    [deleted]
  - vladTheInhaler 5y ago
    Because it makes the point that congress is completely paralyzed on most major issues, largely because of of the filibuster. They are leaving it to the executive branch and the courts to effectively write the laws. This is an enormous systemic failure, and Democrats shouldn't be high-fiving because they kicked the can down the road a little way. Why do we even have a congress if they aren't going to actually legislate?
ohples 5y ago
Universal Healthcare, free at the point of use.
- deregulateMed 5y ago
  This doesn't solve the Taxi medallion system that physicians lobbied for to keep the supply of physicians scarce.
  - SamoyedFurFluff 5y ago
    It doesn’t because it isn’t meant to. That’s a separate problem that can be tackled on its own merits.
    - ohples 5y ago
      Agreed
- spaetzleesser 5y ago
  Just reliable and consistent pricing would go a long way. Right now they are doing everything they can to make the system as opaque and complex as possible. It’s an elaborate system with traps designed to extract money from the patient.
- jaywalk 5y ago
  Unicorns and lollipops available on every street corner, free to all.
  - ohples 5y ago
    If every other developed nation was able to provide unicorns and lollipops to its citizens regardless of their ability to pay, and the United States couldn't I would also be asking for Universal unicorns and lollipops.
    - jaywalk 5y ago
codazoda 5y ago
I once called 911 when my wife had an Asthma attack that left her unable to speak or stand. She was transfered from an ambulance to a paramedic about half way to the hospital. My insurance covered one as in-network but not the other. My wife was released a few hours later. I was young and it took me about 10 years to pay off the dept I owed. I am extremely hesitant to call an ambulance if the person can be encouraged to move under their own power. So much so, that I was asked to sign papers when a family physician suggested an ambulance. This rule looks like it helps.
- cure 5y ago
  Ugh, that's horrible, sorry to hear that. Note that ground ambulances are excluded from the legislation that Congress passed last year, cf. https://www.nytimes.com/2020/12/22/upshot/ground-ambulances-left-off-surprise-medical-bill-law.html https://www.nytimes.com/2020/12/22/upshot/ground-ambulances-....
  - LorenPechtel 5y ago
    Yup--gotta let the mostly government funded ambulances shaft the patients.
- slownews45 5y ago
  No kidding. "Family Gets $18,000 Hospital Bill After Their Son Was Treated with a Bottle of Formula and a Nap" That kind of stuff stresses folks out!
  - kzrdude 5y ago
    A good health system should deliver better quality of life to all the people of the country. That includes not just doing actual health, but acting as an insurance, giving actual peace of mind - if something happens, it might not be the end of the world.
  - bonzini 5y ago
    Wait, that's not the Onion?
deregulateMed 5y ago
Hahaha I'm not holding my breath. It's multiple cartels vs us. These cartels have spent literally 2 billion dollars on lobbying politicians. So the real question is, how does this hurt us? How is this helping physicians build mansions, hospitals get record profits, etc...
- spaetzleesser 5y ago
  Don’t forget sports cars and yachts are expensive too.
- agentdrtran 5y ago
  This doesn't hurt you directly, it's meant to placate people from demanding a substantial solution.
- cwkoss 5y ago
  With the number of mass shootings we have in America, I'm surprised I've never seen a story about a terminally ill person with astronomical medical debt going on a rampage at their insurance company's corporate office. Would probably make for a good movie concept - kind of a modernization of Falling Down.
Someone1234 5y ago
Out-of-network was always just a sketchy way for insurance to avoid paying what they should have paid. Let's say you get a hypothetical procedure. Insurance has already agreed to pay in-network providers between $1-3K for this procedure. But you got this procedure out-of-network. Why is insurance's liability suddenly $0 instead of whatever the lowest in-network fee schedule would be ($1K in this example)? See I can understand insurance not wanting to foot substantially higher bills than in-network providers charge, but I cannot understand why it drops to $0 reimbursed when you leave network. It seems like an immoral "gotcha." But then again I'd like to see insurance discounts/agreements banned. Make everything and nothing in-network and also normalize the insured/uninsured prices. No more "$100 for a band-aid, -$99 discount" shenanigans. Obviously single-payer would be better yet still, but if we must keep using this broken private employer-linked insurer system let us at least keep band-aid fixing it until we can get enough political support to scrap it.
- deregulateMed 5y ago
  Just a note, it's possible to lose money accepting some Medicaid insurances. Specifically if you need to hire a translator. $40/hr payout for physical therapy + translator contactor.
- bradstewart 5y ago
  Totally agreed. My favorite is when you add this scenario to physically being somewhere without any in-network doctors. I cut my hand open climbing in northern New Mexico, bandaids and gauze weren't stopping the bleeding, so I went to the nearest town clinic/urgent care. Ultimately got 8 stitches. My insurance denied (almost) everything. They would later explain that I was supposed to drive myself several hours to Albuquerque to get my hand looked at instead. I say almost because the covered $70 for the lidocaine shot, but literally nothing else. Why they deemed the lidocaine necessary but not the stitches could not be explained. Clearly they had a way to pay the clinic, so wasn't that. Another whacky thing I discovered: the insurance company gets to decide how much, if any, of your uncovered, out-of-pocket bill counts towards your deductible. In this case they deemed $109 of $832 to be the right number, with no explanation as to how they arrived at that sum.
kevmo 5y ago
The entire insurance industry should just get axed. USA is dumping twice as much money in as Canada/Europe for worst outcomes. Warren Buffet has described our insurance system as the "tapeworm of the American economy".
- spaetzleesser 5y ago
  Makes you wonder how many non rich people who could start businesses and stuff are working for corporations just fir the health insurance. I think it’s many and it’s a huge drain on innovation. On the other had it keeps the little guys dependent on corporations so I guess it’s a welcome feature for the upper class.
  - heavyset_go 5y ago
    Rates of entrepreneurship are higher in Scandinavian countries[1]. I believe that comes down to the fact that in those countries, you don't have to already be wealthy enough to afford the $36k in premiums alone each year in order to just insure a family with one kid on the individual insurance market. That $36k doesn't include the $18k+ yearly deductible, nor the co-pays or cost of care or medicine when actually utilizing the insurance. [1] https://www.oecd.org/sdd/business-stats/EAG-2018-Highlights.pdf https://www.oecd.org/sdd/business-stats/EAG-2018-Highlights....
- slownews45 5y ago
  Part of this is we also agree to spend high amounts of money for things like end of life car. Other countries simply do not spend $10M on you at end of life - period.
  - manuel_w 5y ago
    Well, they don't have to, because it simply doesn't cost $10M there. My understanding is that the United States medical system foremost goal is to generate profit (for shareholders?), and I think that artifically inflates the prices. Many people share the oppinion that there's no need for the medical system to make profit -- not incuring loss is enough for it being sustainable.
spaetzleesser 5y ago
I find it really hard to believe that US citizens are allowing this abuse and many even defend it. Markets may even be workable if the patient actually had necessary information and hospitals, insurers and multiple middlemen couldn’t design these elaborate bureaucracies that are optimized to confuse people while extracting maximum money. I can’t imagine any other industry getting away with this. I wish the Democrats had had any courage to go for Medicare for all. It’s an established system that could be tweaked to expand coverage. Instead Biden will make some half assed moves which will immediately be obstructed by the republicans. And so this travesty will keep going for many years more. And it seems there is no hope for change.
- lotsofpulp 5y ago
  >I find it really hard to believe that US citizens are allowing this abuse and many even defend it. Because US citizens know that increasing the amount of healthcare provided will increase taxes. This whole game is being played because we want to have our cake and eat it too, with many in the middle and upper deciles betting that they will be better off without a universal healthcare type system. >I wish the Democrats had had any courage to go for Medicare for all. We are lucky the Democrats are even trying, and that ACA even got passed, with the compromises that had to be made. They simply do not have the numbers in Congress (and will not based on population trends) to do any more.
  - 8ytecoder 5y ago
    There-in lies the problem. You overestimate the tax increase and underestimate what you end up paying if you ever get sick. And yes, the bigger issue is reducing hospital bills. Again, look at the line items and you'll see a big large number next to admin costs of processing insurance. Add the cost of profit for the insurance company and their cost of running the business and you know where this is going.
  - chris_wot 5y ago
    Then they know wrongly. There are plenty of countries who already have health care systems much better than the U.S. with similar levels of taxation.
golover721 5y ago
Seems like a good step. Last year had to have a medical procedure done by an oral surgeon. For some reason there are no in network oral surgeons when it comes to medical insurance. Paid a significant amount up front. Painful but thought that it was all done. Six months later received an itemized bill for another significant amount. The worst part about it is theres no way to know if the bill is correct, or if insurance should of covered one of those line items. They really could just make up whatever they want as the system is so opaque, no one knows how much anything should cost.
duffpkg 5y ago
I wrote Hacking Healthcare for Orielly, created ClearHealth, yada yada... Devil is always in the details of these rules but on the surface it looks like a good attempt. It is a sort of a bandaid though. To understand why this occurs know that most jurisdictions have certain staffing requirements for service lines. You must have X many neurologists covering X shifts. There is almost universally a shortage of these folks for other reasons, so you end up with a lot of non-staff doctors to fill the coverage requirements. Those non-staff often have different insurance relationships than staff doctors and so are "out of network". The two serious changes that would have a more durable impact on this are to free the lock the AMA has on residencies that exacerbates doctor shortages and to dramatically streamline the way insurance program enrollment is done for doctors. Further opening up interstate health insurance would also probably help.
- cool_dude85 5y ago
  >Further opening up interstate health insurance would also probably help. Can't wait to race to the bottom on this one. Which state wants to roll out the red carpet for insurers most? If I ever have a problem with Montana BCBS I'm sure, once I fly over, I'll be able to explain to the arbitrator in Butte exactly what my issues are and get a fair hearing.
dahdum 5y ago
Wow, on the face this looks like a really great rule. I suspect there's going to be an ton of irate specialists (especially anesthesiologists) who were making fortunes from surprise billing.
maerF0x0 5y ago
This bill misses a big point. IMO should be there is only one price. Insured, in/out of network, regardless. A lot of times the reason an out of network rate is so high is because these providers are charging so much more for the same thing. Additionally it seems we have a supply vs demand issue if healthcare providers have such pricing power. Maybe it's time to open up the training supply and let folks with a 3.3GPA become doctors? EDIT: looks like maybe the supply issue is more about residency than med school https://www.fiercehealthcare.com/practices/more-medical-students-than-ever-but-more-residency-slots-needed-to-solve-physician https://www.fiercehealthcare.com/practices/more-medical-stud...
chris_wot 5y ago
Can this be right? “ Two-thirds exit disclaimer icon of all bankruptcies filed in the United States are tied to medical expenses” From someone living in a country (Australia)with proper government medical support, this seems insane!
intricatedetail 5y ago
A lot of US policies were shaped by former Nazis. US healthcare and drug laws are just disguised eugenics. I am glad it is slowly being reversed.
- akeck 5y ago
  Citation?
  - deleted 5y ago
    [deleted]
duxup 5y ago
It's straight up not possible to be an informed consumer in the US and avoid this stuff when it comes to health insurance. There's no market of rational decision makers, no choices you can make and really know the outcome when it comes to health insurance. My health insurance is pretty good and yet they randomly send me letters saying that they think the procedure should be covered by some other insurance they THINK I might have. In the meantime they stop covering things and the providers send me bills with no health insurance coverage .... They do this about every 18 months, I think hoping I just pay the bills and not notice.
- ihumanable 5y ago
  One time I called my insurance to check if they would cover something that I could only find an out-of-network provider for. They said that I had out-of-network coverage after a $750 deductible they would pick up 80% and I would be responsible for 20%. The out-of-network provider had quoted me $6700 for the service, so my responsibility should be $750 + (20% * ($6700 - $750)) = $750 + $1,190 = $1,940. I wasn't happy about having to shell out nearly two grand while having the best possible employer provided healthcare, Anthem PPO where we paid the most per month to have low deductibles and high coverage. At the end of the call, I tell the insurance company my understanding of what my responsibility is and what their responsibility is. Then they drop this on me, "Well we will pay 80% of the allowable price for the billing code the out-of-network provider submits." Good thing I asked, this was the first time they said anything about an "allowable price" so I describe the service and ask "what's the allowable price for that?" "Depends on how they code it" So I go back to the out-of-network provider and ask them for the billing code, which being a doctor that doesn't do their own billing, they have no idea. So I wait a few weeks to get back the billing code, and I'm back on the phone with my insurance company. "Hey, I have this billing code someone out-of-network will be doing, what's the allowable price on this?" "We can't tell you that, you'll have to submit a claim." "But when I submit the claim you will have this billing code and my member id and you will know the allowable price so you can figure out how much you are going to pay, you have that information now. What's the allowable price for this billing code, performed by someone out-of-network, with my plan?" It took them 2 weeks to come back and say that their "allowable price" was $1,658. So to summarize, it took me nearly two months of phone calls between myself, the insurance company, and the provider to find out what this service would actually cost. I only avoided accidentally getting hit by a massive surprise bill because of a combination of persistence and luck. It is nearly impossible to have any reasonable idea how much anything will cost, much less to comparison shop, when it takes months to get answers to basic questions.
asdfasgasdgasdg 5y ago
If it sticks, this is great! I wonder what law gives them the authority to just make a rule like this, though. I imagine the lawsuits about this issue will go for some years, as we have learned that the whole business model of some healthcare systems in this country is sticking users with these surprise bills.
legitster 5y ago
We took our son to an emergency room visit 2 1/2 years ago. The hospital was in network and we had insurance. It was a simple case of croup, we were out in a few hours. We just got a bill last month for $300. This was on top of 3 other bills we have already paid over the years for the same visit. The insurance company said they only knew about it a few days before us. So it was a surprise to them too. But by nature of their agreement with the hospital, they were not allowed to fight it. I still wonder how many more bills we can expect.
aabaker99 5y ago
> Bans other out-of-network charges without advance notice. Health care providers and facilities must provide patients with a plain-language consumer notice explaining that patient consent is required to receive care on an out-of-network basis before that provider can bill at the higher out-of-network rate. This seems like a really big loophole. I was just at the hospital for the birth of my daughter. My wife and I checked in at the OB desk where they asked for acknowledgment that we may be seen physicians that aren't part of the hospital (out of network). We acknowledged, so surprise medical bills are fair game now?
throwawayboise 5y ago
From the announcement: "Bans high out-of-network cost-sharing for emergency and non-emergency services. Patient cost-sharing, such as co-insurance or a deductible, cannot be higher than if such services were provided by an in-network doctor, and any coinsurance or deductible must be based on in-network provider rates." This to me seems to just completely eliminate the difference between in-network and out-of-network billing. What am I missing?
- dmeeker 5y ago
  My read of the fourth bullet is that if you're receiving non-emergency service from an out-of-network provider, they can still balance bill you as long as you've signed the plain-language consent. (Presumably with such signature being a pre-requisite to receiving services.)
  - jsmith45 5y ago
    Agreed. They are making in network and out of network the same from the the cost sharing perspective. To avoid screwing over out of network providers, they allow out of network balance billing, but only with consent. The actual rule also goes into things like consent to be balance billed for your knee surgery, is not consent to be balance billed for the ICU care when that surgery goes wrong and you nearly bleed out, and suffer major organ damage, etc... This consent option is not always available, an in those circumstances, balance billing is simply prohibited, and in network and out of network are fully equivlent in those cases from a patients' perspective.
mchusma 5y ago
I don't love this solution to the problem. This doesn't help anyone paying cash for services, and it really just invests more into the current broken system. I think the solution is that all healthcare providers must provide upfront pricing for you. Right now, almost all medical billing is surprise billing. It's basically the only sector where this is true.
- pavon 5y ago
  Agreed. I think the biggest problem is that the providers themselves are as much in the dark as the customers when it comes to knowing what insurance will actually pay. So they submit some highball number and see what comes back. I think what is needed more than anything else is to require insurers to provide an API to providers that will give a legally binding coverage quote instantly, before services are provided, not months later. There will be some qualifiers to that, like the provider must indicate what conditions the patient is being treated for to qualify for the procedure, and if the patient doesn't actually have that condition, then whoever falsified the information (or was grossly negligent in diagnosing) is stuck with the bill. Once that is in place, then you can require the providers to give quotes beforehand.
peter303 5y ago
I would think you would need legislation to implement this rather than a regulation. The inurance-hospital-doctor lobby is rich and strong. When Colorado was considering a public insurance option, this lobby ran non-stop Fear TV commercials saying this new insurance would kill babies and seniors. (Despite seniors are on Medicare)
- dmeeker 5y ago
  These regulations stem from legislation: > Today's interim final rule with request for comments implements the first of several requirements passed with bipartisan support in title I (the "No Surprises Act") of division BB of the Consolidated Appropriations Act, 2021.
jbd0 5y ago
What I do: Ask the doctor/PA/nurse how much EVERY LITTLE THING they want to do costs before they do it. Sure, it's really annoying and not 100% foolproof, but it has saved me alot of money.
only_as_i_fall 5y ago
If congress keeps raising the regulatory burden on insurers without actually addressing the root problem it's just going to cause prices to rise until the bottom falls out. Maybe not bad in the long run but that must be the least efficient possible way to solve this problem.

204 points by ThaDood 5y ago

Anecdotal: my dad had a heart attack and was in the hospital for 6 months due to complications. After a certain amount of time, the bills started to rack up and we were being charged for services that we thought would be covered under “health insurance coverage.” Instead of being covered, the health insurance provided coverage for standard hospital care, but we were charged every time a non network doctor stepped into his room. Then, the non-covered machines that were used. Then, stupid things like “staying in an ICU longer than allowed by coverage.” My father passed away before making it home, but when all was said and done, insurance was billed $10 million in total, of which the various doctors and hospitals billed the estate $2 million. My dad didn’t have an estate because he had no assets. But imagine your life + childrens’ lives being ruined for having insurance yet filled with invisible asterisks. At the time, NJ laws were onerous in this regard and favored insurance companies so we had no recourse. The state had a process for dealing with issues like this, but it was more of a cursory “jobs done here boss” type process and didn’t provide consumers with relief. Because of that, I moved my family out of NJ. When all contingency plans are filled with asterisks, do you really have insurance/protection?

ryandrake 5y ago
Sorry for your loss. This is one of the things that tends to get overlooked when discussing how awful the US health care industry is. You always hear: "US health care is terrible unless you have insurance!" But, it's also terrible when you have insurance! There are all kinds of ways doctors, hospitals, and insurance companies conspire to drain your pockets or your loved ones' estate's pockets, and they're all likely documented somewhere in a 100 page policy. The system is irredeemably beyond repair.
- nrmitchi 5y ago
  It more and more feels like the difference between not having insurance, and having insurance when something bad actually happens is "do I get a massive bill that I can't afford now, or do I get a massive bill that I can't afford later?". The only real benefit of having "insurance" in the US is having reasonable access to basic preventative care. Don't get me wrong, it is a massive advantage to have default access to basic preventative care (without it being a cost-benefit tradeoff each time), but that is in no way/shape/form "insurance" in the typical meaning of the term.
  - majormajor 5y ago
    Most of the time the system works for people who have good coverage. The tragedy is that "having good coverage" is a hard-to-control combination of luck in employer and/or wealth. It's terrible that these things happen at all, and we CERTAINLY need to improve the US healthcare system, but exaggerations like "the only benefit of insurance in the US is access to preventative care" doesn't help. If people were regularly getting fucked like that the system wouldn't have the entrenched support it does from the "but I want to keep my insurance" camp, and so speaking in generalities like that just makes you appear uninformed to the millions who regularly see doctors, get treatment, have surgery, etc, without these problems. It also cheapens the inequality problem: the gap isn't just "has access to preventive care" vs "doesn't have that access." The gap is "has hundreds of thousands of dollars, or even millions, of bills turn into nothing" vs "bankrupt if they seek treatment for any serious problem."
    - NationalPark 5y ago
      I've had "good" coverage for my 15 year career and it does not work most of the time, or even half of the time. I've paid bills out of pocket because I didn't have time to untangle payer/insurance situations. I was taken to the ER unconscious once after a freak accident and ended up paying thousands for the ambulance. I've had to do provider paperwork myself and submit it to insurers myself because they refused to help me help them get paid. The system is simply not functional for people who don't have huge amounts of free time, patience, and money.
- lotsofpulp 5y ago
  >There are all kinds of ways doctors, hospitals, and insurance companies conspire to drain your pockets People also want cutting edge care from some of the smartest and most highly educated people in the world (which is in short supply) for cheap.
  - heavyset_go 5y ago
    When I lived in Manhattan and worked with some really wealthy clients, they'd fly to France, Israel and elsewhere for care when they could have easily gotten the best care the US has to offer right down the street.
  - Arrath 5y ago
    There is a pretty large continuum of potential value between the 'cheap' care that people want, and the ruinous bills that get charged.
    - Goronmon 5y ago
      There is a pretty large continuum of potential value between the 'cheap' care that people want, and the ruinous bills that get charged. That can't be true, everyone knows that people are only greedy and stupid, and it's really the citizens' fault for the prices of the current healthcare setup. The industry itself is all made up of kind-hearted super heroes who would never think of manipulating prices to syphon more money from patients.
    - lotsofpulp 5y ago
      Ruinous bills are frequently used to cover the costs of routine procedures. It’s another situation where 10% of the healthcare consumes 90% of the resources. It’s the person who needs 6 months in the hospital, the 2 month premature baby in NICU, the hemophiliac that needs $1M medication that balloon all the costs. And no one can really afford that, but instead of spreading the costs around to all taxpayers, we were spreading it around by inflating everything else. ACA helps with this, but today’s announcement about out of network care will help more too.
  - Goronmon 5y ago
- dave_aiello 5y ago
  My wife is a primary care doctor in the United States. Saying that disqualifies me in some people's minds from having an opinion about the quality and cost of health care in this country. But I am willing to give an opinion regardless. There are plenty of medical practices and institutions that function well and deliver good value to the patient. But there are many that do not. As someone who doesn't have friends inside the health care industry, it can be extremely difficult to figure out what to do in an emergency. Quite often your options are limited especially if you are caring for a loved one rather than yourself. The best advice I can give is to find good doctors before you need them, and when conversations come up about someone else's medical care, be willing to ask, who is your doctor and how good are they? Or, which hospital did you go to, and do you feel you had a good experience? Often there is little out-of-pocket difference between the cost of excellent medical care and lower quality care, if you have good insurance. If you don't have good insurance and you are looking at a potentially significant medical procedure, ask to speak to someone about financial assistance. Good practices and good hospital systems are not looking to bankrupt their patients.
  - lmeyerov 5y ago
    am hàppy to see HHS moving forward, long overdue! most US doctors are part of a bigger group in order to provide more comprehensive coverage (and due to systematic buyouts), which in turn have preferred insurance providers and additional out-of-network providers, and emergency services are generally for wherever an ambulance takes you. your physician may be great, but they are just a tiny cog in a broken machine one of the only outs, afaict, is something like working & living near a big & strong HMO like kaiser. but that comes at the cost of pretty firm boundaries on what services they allow: capped care (my SO is also a physician at one of the nation's best hospitals, and despite that, patients struggle w the broader system outside of her practical daily control)
plank_time 5y ago
Do the children have to pay off the bills of the parent? That doesn’t seem reasonable to me. It sounds like the best thing to do before getting too old is to transfer all your assets out so that if you die you won’t have it robbed by hospitals, etc.
- knz_ 5y ago
  No, but they can legally take everything the estate has and leave the children with no inheritance.
- bpodgursky 5y ago
  No, children aren't responsible for bills. It can only come from your estate. Transferring assets isn't crazy but you do need to be careful if you want to do it in a non-taxable manner (you can't just give your kid $500k cash without them counting it as income).
  - drewg123 5y ago
    I could be wrong, but I thought that the $500K would not count as income for them, but would deduct from your lifetime estate tax exclusion. See https://www.nerdwallet.com/article/taxes/gift-tax-rate https://www.nerdwallet.com/article/taxes/gift-tax-rate
  - memling 5y ago
    > No, children aren't responsible for bills. It can only come from your estate. I think it's worth noting that while this may be true if you're dead, it's not the case when you're still alive.[1] Filial responsibility laws mean that adult children can be legally required to pay their impoverished parents' medical bills. The above cites a case where a man was required by the courts to pay $93,000 for his mother's rehabilitation.[2] From what I've read, Pennsylvania may be particularly onerous compared to other states, but it's not a slam dunk kids won't be on the hook. [1]: https://en.wikipedia.org/wiki/Filial_responsibility_laws https://en.wikipedia.org/wiki/Filial_responsibility_laws [2]: https://abcnews.go.com/Business/pennsylvania-son-stuck-moms-93000-nursing-home-bill/story?id=16405807 https://abcnews.go.com/Business/pennsylvania-son-stuck-moms-...
heavyset_go 5y ago
Where did you move to that has better protections for patients regarding health coverage?
antattack 5y ago
We (society) cannot afford to pay for everyone's 10 million dollar hospital bills so how do we decide who gets their bills paid? EDIT: Some argue here that it'll average out, however at what cost to others? [1]Here's article about African Americans getting limbs amputated as their treatment for diabetes. [1]https://features.propublica.org/diabetes-amputations/black-american-amputation-epidemic/ https://features.propublica.org/diabetes-amputations/black-a...
- 908B64B197 5y ago
  Rather, were services purchased really worth 10 million dollars? How much of that are salaries for underperforming, bloated structures in charge of "management" and billing?
  - antattack 5y ago
    Canadians spend 220k (in 2013) per person per lifetime. It's very unlikely you can shrink 10 million dollar bill to anywhere close to that. [1]https://www.theglobeandmail.com/life/health-and-fitness/health/canadians-use-average-of-220000-in-public-health-care-over-lifetime/article11913571/ https://www.theglobeandmail.com/life/health-and-fitness/heal...
    - yladiz 5y ago
      What makes Americans that much more expensive than Canadians?
      - slownews45 5y ago
        It's mostly end of life care (relative to other countries). So during your life - broken bones etc - roughly equal. But if you are stuck in ICU for a year when 75+ - that's uniquely American and incredibly expensive. "Numerous articles on EOL costs show that a large proportion of Medicare expenditures occur during the last 6 months of life.1-9 This phenomenon has continued for many years as the number of Medicare decedents has increased with the aging American population. Medicare expenditures for EOL have increased dramatically from 1983 to 2016, primarily because of the increase in the number of decedents. Other articles compare EOL expenditures in the United States to other countries10,11 or focus on Medicare expenditures for specific diseases.12-14 A recent development in the literature challenges the idea that EOL costs are responsible for a high percentage of health-care costs.15 - https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610551/ https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6610551/
ohazi 5y ago
> having insurance yet filled with invisible asterisks. "Invisible asterisks" captures the reality perfectly. The asterisks are invisible and infinite. I think even Kafka would be horrified. We've turned medical billing into an impenetrable Byzantine hellscape, and I fear that the only way to fix it would be to nuke it from orbit and start over.
- cwkoss 5y ago
  Medicare For All is the single most important policy in American politics right now, IMO, for this exact reason. People complain that all the people in private insurance will be put out of their jobs - I view that as a feature, not a bug.
  - ixacto 5y ago
    This needs to happen. The medical billing industry is literal cancer. They sent me a bill for $350 then I called up to complain and suddenly the bill goes away because it’s billed to my other insurance that I didn’t even think I had anymore. If I sent a client a random bill for $$$ things would not go nearly as nicely, but they have so captured the regulators and politicians that this is the world we live in now. I want nothing to do with many of the policies of the left, but this would make things so much easier for small businesses and people Changing jobs in the labor market.
JMTQp8lwXL 5y ago
It's important to know some assets avoid probate and go directly to the beneficiary. These include things like a life insurance policy, or a 401(k) with a beneficiary information you can input, and possibly even update online (low friction). The health bill can go to the estate, but the estate also isn't comprised of the retirement account.
- slumdev 5y ago
  This should be common knowledge (but, unfortunately, isn't.) A primary breadwinner should carry at least 10x his family's annual living expenses in term life insurance coverage. Once the size of his retirement accounts exceeds this, he can start thinking about reducing the insurance. Both will pay directly to beneficiaries in the event of his death.
- mindslight 5y ago
  You can setup a simple trust with the right form/software, and a visit to your bank for notarization. I don't know if a revocable living trust would protect your heirs against healthcare shakedowns, and it would likely depend on the state. But if the current corrupt system continues much longer, I can see irrevocable trusts becoming popular to protect yourself even while alive.
irrational 5y ago
> imagine your life + childrens’ lives being ruined A parent’s debts cannot be put on to their children. Once your father died, anything not covered by his estate had to be written off by everyone.
- RobRivera 5y ago
  true but what of inheritance? I suppose thats what life insurance policies are for.
  - irrational 5y ago
    OP said the father had no assets, so there was no inheritance forthcoming.
    - dharmab 5y ago
      If that had happened to my parents, my sibling who lives with them would have lost their home and had to move in with me. Just because OP's situation was different doesn't make that good.
- DoktorDelta 5y ago
  I'm not sure how many people know that though, and the moment you make a payment towards that bill it's legally your debt.
- simtel20 5y ago
  You are correct about the debt and the parent post clearly knows that, having lived through it'l. However the further point being that any assets that had accumulated with the intention of leaving them to the family, and which they relied on, would have been in jeapordy if they hit probate. If he owned a businessnor a house I'm not sure of the rules, but definitely savings, other assets etc. would be up for grabs.
  - dharmab 5y ago
    The rules vary by state and can change depending on if a written will exists. Parents, talk to an attorney while you're healthy. Some of the states have rules that will surprise you.
gnopgnip 5y ago
Was this before 2010?
seandoe 5y ago
Without knowing anything, 10 million seems excessive, but 6 months in a hospital will no doubt be expensive. I don't want to stir up bad feelings, I'm just curious, was there a good chance that your dad was going to make it out of the hospital? What was EOL talks like with the doctors? This story brings back the article here not too long ago, regarding the average hospital stay of a doctor at EOL vs the general public. I'm not sure of all the influencing factors regarding EOL procedure, but it does seem like a huge amount of resources are used for the very short end of a large amount of people's lives. Once again, no offense intended, it just got me thinking.
- t3rabytes 5y ago
  Anecdata: I spent 5 days in ICU in 2018 and had a $350k bill from a California hospital, which my insurance company paid $200k for after adjustments and discounts. I wouldn’t say $10m for 6 months is far off.
  - seandoe 5y ago
    Yea that sentence came off wrong. I don't doubt the OP's claim at all. I was trying to acknowledge that billing that amount to anyone isn't right and looking to make the point that healthcare is expensive and how "we" choose to allocate resources is an important discussion.
- treyfitty 5y ago
  No offense taken. In hindsight, it should have been clear that every day spent in the ICU past 3 months was not a good sign of my dad ever making it out of there. However, we 100% believed he was going to get better all throughout the process. Idk what this assessment was based on, but reflecting back for the first time in a long time, I now realize just how much emotions cloud sensible outlook & probability assessment.
ezoe 5y ago
10 million USD in 6 months? 10M? So I immediately imagine an absurd nonsense like "liquid gold transfusion", then I realized it's 800g gold per day in the current gold price. My pathetic mind can't even imagine the how absurd that is.

tehwebguy 5y ago

Great but without legislation this probably goes away in ~3-5 years Edit: I'm wrong, it's been legislated! Link in reply below

justinc8687 5y ago
This is regulation implementing legislation passed last year[1], so they should be relatively safe. 1. https://www.nytimes.com/2020/12/20/upshot/surprise-medical-bills-congress-ban.html https://www.nytimes.com/2020/12/20/upshot/surprise-medical-b...
bingidingi 5y ago
that’s 3-5 years of some people not getting absolutely crushed by medical bills… which is still a huge win. Why is the “it will change in 4 years“ argument so popular these days?
- deleted 5y ago
  [deleted]
- vladTheInhaler 5y ago
  Because it makes the point that congress is completely paralyzed on most major issues, largely because of of the filibuster. They are leaving it to the executive branch and the courts to effectively write the laws. This is an enormous systemic failure, and Democrats shouldn't be high-fiving because they kicked the can down the road a little way. Why do we even have a congress if they aren't going to actually legislate?

ohples 5y ago

Universal Healthcare, free at the point of use.

deregulateMed 5y ago
This doesn't solve the Taxi medallion system that physicians lobbied for to keep the supply of physicians scarce.
- SamoyedFurFluff 5y ago
  It doesn’t because it isn’t meant to. That’s a separate problem that can be tackled on its own merits.
  - ohples 5y ago
    Agreed
spaetzleesser 5y ago
Just reliable and consistent pricing would go a long way. Right now they are doing everything they can to make the system as opaque and complex as possible. It’s an elaborate system with traps designed to extract money from the patient.
jaywalk 5y ago
Unicorns and lollipops available on every street corner, free to all.
- ohples 5y ago
  If every other developed nation was able to provide unicorns and lollipops to its citizens regardless of their ability to pay, and the United States couldn't I would also be asking for Universal unicorns and lollipops.
  - jaywalk 5y ago

codazoda 5y ago

I once called 911 when my wife had an Asthma attack that left her unable to speak or stand. She was transfered from an ambulance to a paramedic about half way to the hospital. My insurance covered one as in-network but not the other. My wife was released a few hours later. I was young and it took me about 10 years to pay off the dept I owed. I am extremely hesitant to call an ambulance if the person can be encouraged to move under their own power. So much so, that I was asked to sign papers when a family physician suggested an ambulance. This rule looks like it helps.

cure 5y ago
Ugh, that's horrible, sorry to hear that. Note that ground ambulances are excluded from the legislation that Congress passed last year, cf. https://www.nytimes.com/2020/12/22/upshot/ground-ambulances-left-off-surprise-medical-bill-law.html https://www.nytimes.com/2020/12/22/upshot/ground-ambulances-....
- LorenPechtel 5y ago
  Yup--gotta let the mostly government funded ambulances shaft the patients.
slownews45 5y ago
No kidding. "Family Gets $18,000 Hospital Bill After Their Son Was Treated with a Bottle of Formula and a Nap" That kind of stuff stresses folks out!
- kzrdude 5y ago
  A good health system should deliver better quality of life to all the people of the country. That includes not just doing actual health, but acting as an insurance, giving actual peace of mind - if something happens, it might not be the end of the world.
- bonzini 5y ago
  Wait, that's not the Onion?

deregulateMed 5y ago

Hahaha I'm not holding my breath. It's multiple cartels vs us. These cartels have spent literally 2 billion dollars on lobbying politicians. So the real question is, how does this hurt us? How is this helping physicians build mansions, hospitals get record profits, etc...

spaetzleesser 5y ago
Don’t forget sports cars and yachts are expensive too.
agentdrtran 5y ago
This doesn't hurt you directly, it's meant to placate people from demanding a substantial solution.
cwkoss 5y ago
With the number of mass shootings we have in America, I'm surprised I've never seen a story about a terminally ill person with astronomical medical debt going on a rampage at their insurance company's corporate office. Would probably make for a good movie concept - kind of a modernization of Falling Down.

Someone1234 5y ago

Out-of-network was always just a sketchy way for insurance to avoid paying what they should have paid. Let's say you get a hypothetical procedure. Insurance has already agreed to pay in-network providers between $1-3K for this procedure. But you got this procedure out-of-network. Why is insurance's liability suddenly $0 instead of whatever the lowest in-network fee schedule would be ($1K in this example)? See I can understand insurance not wanting to foot substantially higher bills than in-network providers charge, but I cannot understand why it drops to $0 reimbursed when you leave network. It seems like an immoral "gotcha." But then again I'd like to see insurance discounts/agreements banned. Make everything and nothing in-network and also normalize the insured/uninsured prices. No more "$100 for a band-aid, -$99 discount" shenanigans. Obviously single-payer would be better yet still, but if we must keep using this broken private employer-linked insurer system let us at least keep band-aid fixing it until we can get enough political support to scrap it.

deregulateMed 5y ago
Just a note, it's possible to lose money accepting some Medicaid insurances. Specifically if you need to hire a translator. $40/hr payout for physical therapy + translator contactor.
bradstewart 5y ago
Totally agreed. My favorite is when you add this scenario to physically being somewhere without any in-network doctors. I cut my hand open climbing in northern New Mexico, bandaids and gauze weren't stopping the bleeding, so I went to the nearest town clinic/urgent care. Ultimately got 8 stitches. My insurance denied (almost) everything. They would later explain that I was supposed to drive myself several hours to Albuquerque to get my hand looked at instead. I say almost because the covered $70 for the lidocaine shot, but literally nothing else. Why they deemed the lidocaine necessary but not the stitches could not be explained. Clearly they had a way to pay the clinic, so wasn't that. Another whacky thing I discovered: the insurance company gets to decide how much, if any, of your uncovered, out-of-pocket bill counts towards your deductible. In this case they deemed $109 of $832 to be the right number, with no explanation as to how they arrived at that sum.

kevmo 5y ago

The entire insurance industry should just get axed. USA is dumping twice as much money in as Canada/Europe for worst outcomes. Warren Buffet has described our insurance system as the "tapeworm of the American economy".

spaetzleesser 5y ago
Makes you wonder how many non rich people who could start businesses and stuff are working for corporations just fir the health insurance. I think it’s many and it’s a huge drain on innovation. On the other had it keeps the little guys dependent on corporations so I guess it’s a welcome feature for the upper class.
- heavyset_go 5y ago
  Rates of entrepreneurship are higher in Scandinavian countries[1]. I believe that comes down to the fact that in those countries, you don't have to already be wealthy enough to afford the $36k in premiums alone each year in order to just insure a family with one kid on the individual insurance market. That $36k doesn't include the $18k+ yearly deductible, nor the co-pays or cost of care or medicine when actually utilizing the insurance. [1] https://www.oecd.org/sdd/business-stats/EAG-2018-Highlights.pdf https://www.oecd.org/sdd/business-stats/EAG-2018-Highlights....
slownews45 5y ago
Part of this is we also agree to spend high amounts of money for things like end of life car. Other countries simply do not spend $10M on you at end of life - period.
- manuel_w 5y ago
  Well, they don't have to, because it simply doesn't cost $10M there. My understanding is that the United States medical system foremost goal is to generate profit (for shareholders?), and I think that artifically inflates the prices. Many people share the oppinion that there's no need for the medical system to make profit -- not incuring loss is enough for it being sustainable.

spaetzleesser 5y ago

I find it really hard to believe that US citizens are allowing this abuse and many even defend it. Markets may even be workable if the patient actually had necessary information and hospitals, insurers and multiple middlemen couldn’t design these elaborate bureaucracies that are optimized to confuse people while extracting maximum money. I can’t imagine any other industry getting away with this. I wish the Democrats had had any courage to go for Medicare for all. It’s an established system that could be tweaked to expand coverage. Instead Biden will make some half assed moves which will immediately be obstructed by the republicans. And so this travesty will keep going for many years more. And it seems there is no hope for change.

lotsofpulp 5y ago
>I find it really hard to believe that US citizens are allowing this abuse and many even defend it. Because US citizens know that increasing the amount of healthcare provided will increase taxes. This whole game is being played because we want to have our cake and eat it too, with many in the middle and upper deciles betting that they will be better off without a universal healthcare type system. >I wish the Democrats had had any courage to go for Medicare for all. We are lucky the Democrats are even trying, and that ACA even got passed, with the compromises that had to be made. They simply do not have the numbers in Congress (and will not based on population trends) to do any more.
- 8ytecoder 5y ago
  There-in lies the problem. You overestimate the tax increase and underestimate what you end up paying if you ever get sick. And yes, the bigger issue is reducing hospital bills. Again, look at the line items and you'll see a big large number next to admin costs of processing insurance. Add the cost of profit for the insurance company and their cost of running the business and you know where this is going.
- chris_wot 5y ago
  Then they know wrongly. There are plenty of countries who already have health care systems much better than the U.S. with similar levels of taxation.

golover721 5y ago

Seems like a good step. Last year had to have a medical procedure done by an oral surgeon. For some reason there are no in network oral surgeons when it comes to medical insurance. Paid a significant amount up front. Painful but thought that it was all done. Six months later received an itemized bill for another significant amount. The worst part about it is theres no way to know if the bill is correct, or if insurance should of covered one of those line items. They really could just make up whatever they want as the system is so opaque, no one knows how much anything should cost.

duffpkg 5y ago

I wrote Hacking Healthcare for Orielly, created ClearHealth, yada yada... Devil is always in the details of these rules but on the surface it looks like a good attempt. It is a sort of a bandaid though. To understand why this occurs know that most jurisdictions have certain staffing requirements for service lines. You must have X many neurologists covering X shifts. There is almost universally a shortage of these folks for other reasons, so you end up with a lot of non-staff doctors to fill the coverage requirements. Those non-staff often have different insurance relationships than staff doctors and so are "out of network". The two serious changes that would have a more durable impact on this are to free the lock the AMA has on residencies that exacerbates doctor shortages and to dramatically streamline the way insurance program enrollment is done for doctors. Further opening up interstate health insurance would also probably help.

cool_dude85 5y ago
>Further opening up interstate health insurance would also probably help. Can't wait to race to the bottom on this one. Which state wants to roll out the red carpet for insurers most? If I ever have a problem with Montana BCBS I'm sure, once I fly over, I'll be able to explain to the arbitrator in Butte exactly what my issues are and get a fair hearing.

dahdum 5y ago

Wow, on the face this looks like a really great rule. I suspect there's going to be an ton of irate specialists (especially anesthesiologists) who were making fortunes from surprise billing.

maerF0x0 5y ago

This bill misses a big point. IMO should be there is only one price. Insured, in/out of network, regardless. A lot of times the reason an out of network rate is so high is because these providers are charging so much more for the same thing. Additionally it seems we have a supply vs demand issue if healthcare providers have such pricing power. Maybe it's time to open up the training supply and let folks with a 3.3GPA become doctors? EDIT: looks like maybe the supply issue is more about residency than med school https://www.fiercehealthcare.com/practices/more-medical-students-than-ever-but-more-residency-slots-needed-to-solve-physician https://www.fiercehealthcare.com/practices/more-medical-stud...

chris_wot 5y ago

Can this be right? “ Two-thirds exit disclaimer icon of all bankruptcies filed in the United States are tied to medical expenses” From someone living in a country (Australia)with proper government medical support, this seems insane!

intricatedetail 5y ago

A lot of US policies were shaped by former Nazis. US healthcare and drug laws are just disguised eugenics. I am glad it is slowly being reversed.

akeck 5y ago
Citation?
- deleted 5y ago
  [deleted]

duxup 5y ago

It's straight up not possible to be an informed consumer in the US and avoid this stuff when it comes to health insurance. There's no market of rational decision makers, no choices you can make and really know the outcome when it comes to health insurance. My health insurance is pretty good and yet they randomly send me letters saying that they think the procedure should be covered by some other insurance they THINK I might have. In the meantime they stop covering things and the providers send me bills with no health insurance coverage .... They do this about every 18 months, I think hoping I just pay the bills and not notice.

ihumanable 5y ago
One time I called my insurance to check if they would cover something that I could only find an out-of-network provider for. They said that I had out-of-network coverage after a $750 deductible they would pick up 80% and I would be responsible for 20%. The out-of-network provider had quoted me $6700 for the service, so my responsibility should be $750 + (20% * ($6700 - $750)) = $750 + $1,190 = $1,940. I wasn't happy about having to shell out nearly two grand while having the best possible employer provided healthcare, Anthem PPO where we paid the most per month to have low deductibles and high coverage. At the end of the call, I tell the insurance company my understanding of what my responsibility is and what their responsibility is. Then they drop this on me, "Well we will pay 80% of the allowable price for the billing code the out-of-network provider submits." Good thing I asked, this was the first time they said anything about an "allowable price" so I describe the service and ask "what's the allowable price for that?" "Depends on how they code it" So I go back to the out-of-network provider and ask them for the billing code, which being a doctor that doesn't do their own billing, they have no idea. So I wait a few weeks to get back the billing code, and I'm back on the phone with my insurance company. "Hey, I have this billing code someone out-of-network will be doing, what's the allowable price on this?" "We can't tell you that, you'll have to submit a claim." "But when I submit the claim you will have this billing code and my member id and you will know the allowable price so you can figure out how much you are going to pay, you have that information now. What's the allowable price for this billing code, performed by someone out-of-network, with my plan?" It took them 2 weeks to come back and say that their "allowable price" was $1,658. So to summarize, it took me nearly two months of phone calls between myself, the insurance company, and the provider to find out what this service would actually cost. I only avoided accidentally getting hit by a massive surprise bill because of a combination of persistence and luck. It is nearly impossible to have any reasonable idea how much anything will cost, much less to comparison shop, when it takes months to get answers to basic questions.

asdfasgasdgasdg 5y ago

If it sticks, this is great! I wonder what law gives them the authority to just make a rule like this, though. I imagine the lawsuits about this issue will go for some years, as we have learned that the whole business model of some healthcare systems in this country is sticking users with these surprise bills.

legitster 5y ago

We took our son to an emergency room visit 2 1/2 years ago. The hospital was in network and we had insurance. It was a simple case of croup, we were out in a few hours. We just got a bill last month for $300. This was on top of 3 other bills we have already paid over the years for the same visit. The insurance company said they only knew about it a few days before us. So it was a surprise to them too. But by nature of their agreement with the hospital, they were not allowed to fight it. I still wonder how many more bills we can expect.

aabaker99 5y ago

> Bans other out-of-network charges without advance notice. Health care providers and facilities must provide patients with a plain-language consumer notice explaining that patient consent is required to receive care on an out-of-network basis before that provider can bill at the higher out-of-network rate. This seems like a really big loophole. I was just at the hospital for the birth of my daughter. My wife and I checked in at the OB desk where they asked for acknowledgment that we may be seen physicians that aren't part of the hospital (out of network). We acknowledged, so surprise medical bills are fair game now?

throwawayboise 5y ago

From the announcement: "Bans high out-of-network cost-sharing for emergency and non-emergency services. Patient cost-sharing, such as co-insurance or a deductible, cannot be higher than if such services were provided by an in-network doctor, and any coinsurance or deductible must be based on in-network provider rates." This to me seems to just completely eliminate the difference between in-network and out-of-network billing. What am I missing?

dmeeker 5y ago
My read of the fourth bullet is that if you're receiving non-emergency service from an out-of-network provider, they can still balance bill you as long as you've signed the plain-language consent. (Presumably with such signature being a pre-requisite to receiving services.)
- jsmith45 5y ago
  Agreed. They are making in network and out of network the same from the the cost sharing perspective. To avoid screwing over out of network providers, they allow out of network balance billing, but only with consent. The actual rule also goes into things like consent to be balance billed for your knee surgery, is not consent to be balance billed for the ICU care when that surgery goes wrong and you nearly bleed out, and suffer major organ damage, etc... This consent option is not always available, an in those circumstances, balance billing is simply prohibited, and in network and out of network are fully equivlent in those cases from a patients' perspective.

mchusma 5y ago

I don't love this solution to the problem. This doesn't help anyone paying cash for services, and it really just invests more into the current broken system. I think the solution is that all healthcare providers must provide upfront pricing for you. Right now, almost all medical billing is surprise billing. It's basically the only sector where this is true.

pavon 5y ago
Agreed. I think the biggest problem is that the providers themselves are as much in the dark as the customers when it comes to knowing what insurance will actually pay. So they submit some highball number and see what comes back. I think what is needed more than anything else is to require insurers to provide an API to providers that will give a legally binding coverage quote instantly, before services are provided, not months later. There will be some qualifiers to that, like the provider must indicate what conditions the patient is being treated for to qualify for the procedure, and if the patient doesn't actually have that condition, then whoever falsified the information (or was grossly negligent in diagnosing) is stuck with the bill. Once that is in place, then you can require the providers to give quotes beforehand.

peter303 5y ago

I would think you would need legislation to implement this rather than a regulation. The inurance-hospital-doctor lobby is rich and strong. When Colorado was considering a public insurance option, this lobby ran non-stop Fear TV commercials saying this new insurance would kill babies and seniors. (Despite seniors are on Medicare)

dmeeker 5y ago
These regulations stem from legislation: > Today's interim final rule with request for comments implements the first of several requirements passed with bipartisan support in title I (the "No Surprises Act") of division BB of the Consolidated Appropriations Act, 2021.

jbd0 5y ago

What I do: Ask the doctor/PA/nurse how much EVERY LITTLE THING they want to do costs before they do it. Sure, it's really annoying and not 100% foolproof, but it has saved me alot of money.

only_as_i_fall 5y ago

If congress keeps raising the regulatory burden on insurers without actually addressing the root problem it's just going to cause prices to rise until the bottom falls out. Maybe not bad in the long run but that must be the least efficient possible way to solve this problem.