13 ms·

Many surprise medical bills are now illegal

249 points by rawgabbit 5y ago

dataflow 5y ago
> Out-of-network doctors may ask patients to sign a form that waives their protections. What prevents this from becoming standard practice as a part of all the other stuff you have to sign?
- benttoothpaste 5y ago
  Yeah that looks like a big loophole that is ripe for abuse.
temikus 5y ago
It’s not everyday we hear something good about American healthcare. Kudos to those who worked on this bill!
- hirako2000 5y ago
  this push has been going for years now. One decisive factor is how the structure of these systems have been better understood by people outside the system and outrages across the country erupted, people are getting more educated on the matters, thanks to the Internet in many ways, social media has its benefit in also fast spreading genuine information and facilitate healthy discussions. kudo to everyone who has contributed to this incredible outcome indeed. I think as the understanding of the health system continues to spread, it will become more and more difficult for certain unethical practices to survive the backslash.
  - olliej 5y ago
    Seriously. Isn't it only relatively recently they've even had to show us prices? And so draw attention to the $15 bandaids, etc? (I've never had any actual hospital stays while living in the US so have never seen a receipt, and so don't know the progression)
    - lotsofpulp 5y ago
      You have always been able to see that, even before ACA I remember seeing itemized healthcare provider bills with inflated figures. It just so happened that the meteoric rise in healthcare costs came to a head when the social media and the internet was also blowing up. Even without the internet, it was still well known enough to be a sufficiently important political flashpoint to actually result in Affordable Care Act passing. But I remember Clinton debating about healthcare costs in the 90s on national TV, it just had not effected sufficient number of voters yet to become a big enough issue. I also assume it has something to do with baby boomers reaching the age where they start experiencing healthcare costs and so you have a huge portion of the US population gaining experience for the first time of how much money they will have to spend on healthcare.
      - olliej 5y ago
        Thanks!
hsbauauvhabzb 5y ago
It’s purely insane that the term ‘financial ruin’ is even in TFA. I’m glad I live in a country where I can’t wake up from a coma a million dollars in debt.
- Victerius 5y ago
  The comment thread that is soon to follow is predictable. Someone will reply: Medical costs are responsible for X% of personal bankruptcies in America. Someone will reply: Most Americans don't have to worry about medical bills because they have coverage through their employer. Someone will concur: Yeah, I have fantastic benefits with my company. Someone will provide a counter anecdote: I also have great benefits with my employer. But I still have to pay a $5000 deductible before coverage kicks in. Someone will reply to the parent with: The US has the best health care in the world. Why do you think people fly from overseas to receive treatment in the US? Then someone will reply: The US has the best health care ... if you can afford it. The last time I saw my doctor, he looked at me for five minutes and prescribed me a bottle of aspirin. Someone will reply: You need a new doctor. I once had an experience like yours. I found a new doctor, who truly cares about my health and well being. Someone else will reply to the comment two spots above: > The US has the best health care ... if you can afford it. "No, the US has the best health care in the world, including for middle class people and poor people. I once injured myself in [insert first world country] and their health care system was practically third world." _______
  - Turing_Machine 5y ago
    Poor people are eligible for Medicaid, which means they pay nothing. It's the middle class that takes it in the neck.
    - kadoban 5y ago
      As of ~5 years ago, you could be cripplingly poor and still not qualify for Medicaid. I've lived it.
      - 5y ago
kelnos 5y ago
This is truly a great improvement, but not including ground ambulances in this is messed up. And reeks of a special-interest lobbying group pushing for it. This also really bothers me: > Out-of-network doctors also must inform patients about what their care might cost, and they may ask patients to sign a form that waives their protections. (Be leery of signing this, consumer rights experts say.) It's a very weak law when you can still sign away your rights to someone who has the stronger end of a power/information imbalance. Emergency care is supposed to be covered by this law, but if you're in bad shape and show up at the ER, you might sign anything just to get care.
- GhostVII 5y ago
  The form makes it very clear that signing it is totally optional, and still requires the hospital to provide a cost estimate.
  - joenathanone 5y ago
    Signing something when you are in the ER is the definition of duress.
- jmugan 5y ago
  Yeah, you'll get in there, and it will be one of 20 forms you have to sign.
- olliej 5y ago
  Especially with last minute doctor allocations. Arrive for your critical surgery that must be done ASAP and get met by an anesthesiologist (thank you spellchecker) who says "by the way I'm out of network, do you agree to pay me an arbitrary amount? If not, your surgery is cancelled." Then if you do say no, could the hospital then charge you for cancelling surgery at late notice? Especially given insurance generally doesn't cover such fees. Honestly any law that doesn't say "if the facility is in network, the insurance company must cover all costs as in network" and get rid of this bullshit concept of "out of network" people in an in network facility is fundamentally insufficient.
truffdog 5y ago
As long as this is done via Congress passing laws to cover up loopholes, it's not going to work. It takes too many years to push through legislation, and the health care industry can reorient to bilk their customers some other way too fast. A competently run agency with a ton of authority is required. Not sure that you could get that past the Supreme Court, or run it competently over the long term given our depressing partisan split on health care, but you know. If this were Canada, that would be the way to make this work.
- vmception 5y ago
  Congress can delegate authority to any existing or new agency. The real court case to upend this country would be one that limits or nullifies the delegation capability. But at least we’ll have small government again lol.
  - truffdog 5y ago
    They are currently fighting about Chevron deference, which would functionally be a way for the courts to squash agency independence. Clarence Thomas has this bit where he says "you guys are doing all these crazy contortions to do stare decisis on these old New Deal decisions that enable the modern administrative state, but the real answer is that they were never constitutional to begin with and should be reversed." This would clearly be a giant disaster, but I think his argument is probably correct. We don't really do constitutional amendments any more though, so I'm not sure if there are any answers other than court packing to ensure continuous Constitutional Calvinball.
    - vmception 5y ago
      Yeah, I reached the same conclusion myself, a long time ago. Most of the New Deal was gutted by the courts in the 1930s and 1940s and everything else that remains from it just has never been challenged, mostly from a lack of inspiration, lack of awareness, or distraction by other causes. I would be skeptical of anything we’ve just assumed is American that came about from the New Deal. I’ve got a couple full agencies in my crosshairs, and I’m excited about that. Sure, its going to be a disaster, and I’m empathic about people losing other civil rights they have gotten used to that this court is going to re-evaluate, but I’m glad I can leave and that my particular causes will give me the openings I want.
etempleton 5y ago
It will be interesting to see if this changes anything on my next visit to the hospital. When my child was born we asked in advance both insurance and the hospital for a cost estimate. No one could provide one. We were then proceeded to be sent bills from various parties for over a year. We had no idea if we were to pay it, insurance was to pay it, if we had already paid it and there was an accounting error. Each bill was as vague as the next with only the company name to go off of. The whole thing is/was perposterous. Can the hospital not act as a mediary and collate all of the charges on a single line itemed bill? Because that is how everything else in the world works. From what I can gather.there is some sinister game hospitals and medical insurance play, but you would think that, oh, I don’t know, it would save time and money for them both to just come up with some agreed upon pricing and save some administrator overhead.
- lbotos 5y ago
  In the US the game comes from the fact that different people pay difference pricing depending on what combination of cash and insurance they have. Basically "list" vs "actual" pricing depending on what "discounts" you are eligible for.
  - lotsofpulp 5y ago
    Because the end game is expanding access to healthcare by increasing supply of less qualified (or lower quality) healthcare providers, and then price segmenting different populations to different qualities of healthcare. You pay more, you get higher probability of access to MDs. You pay less, you get higher probability of access to PA/NP. And many other variations of that. You can accomplish the goal of politically expanding access to healthcare, but without the costs of getting everyone access to the same healthcare.
    - erosenbe0 5y ago
      We could just train more MDs and/or make that training process more efficient like Germany. Also, medical training and residency need not infringe on the health and safety of pregnant women and the unborn for no purpose whatsoever with 24 hour shifts and other complete nonsense for internist trainees. As some budding doctors would like to have 5 or 6 children in their twenties. Edit: we could also generally waste less human potential and train more people by you know, having college kids go to school 48 weeks a year instead of 36, like real adults who enlist in the military or trades.
vmception 5y ago
This is just a stop gap solution. Data collection so that the opposition party has less legs to stand on, until there is no further support for it. The people behind many representatives don’t know or care enough. This helps more of them know and care.
causi 5y ago
Quite often it seems like laws only protect people wealthy enough to hire a lawyer to enforce them.
black_13 5y ago
faangiq 5y ago
Jail time and asset forfeiture are the only real solutions to these problems. (For hospital and govt staff, of course.)
trembonator 5y ago
keeptrying 5y ago
A friend once had a an emergency appendix removed and was hit with a $10000 bill because doctor was out of network. Ridiculous.
tluyben2 5y ago
It sounds like a nice day for the US but the comments don't look optimistic. I cannot help to continue to think that we, as humanity, need to remove perverse incentives for critical infrastructure. How can an insurance company, which needs to make profit, have your interest at heart? I am for state Healthcare without insurance and sure, I know a lot of people whine about the quality in countries where they have this, but it seems people whine about stuff in their bubble regardless. They don't actually compare with countries that do not have this. I had a young-stroke (as they called it) when I was thinner and fitter than I had ever been, but I was stressed at that time (company was burning over 1m a month and our biggest clients left; shortly after the 2000 crash). They did not find anything wrong with me and the team of experts (what I had was rare apparently so I am a university case study) spent 100s of 1000s euros of perceived care (where I live now this costs a fraction of that) on me to prove it was not stress. I am sure it was and they could not find anything else. All was practically free for me (total was less than 300 euros for tons of mri's, blood panels, hospital bed and 15 experts visiting me daily) but I cannot get private insurance because of it. Hopefully someone will jump in there as I now have the same chance as anyone of this returning but whatever. It's one of the first exclusion boxes on the form for insurance. In Spain and Portugal I had much better care without insurance; I know people cry how bad it is (see above). As someone who had things (including cancer) I can tell you, it is lovely compared to the nhs or Dutch healthcare; far less clinical, overstaffed, you can have a fecking beer when they told you it's going to be rough etc. And you can view the sea from your bed (where I am) instead of an airconditioner filled wall. It feels just nicer even when you are ill. And that helps making you better I think, at least it helped me. My wife could sleep there 247, screw visiting hours. You just need to know how to navigate the system. The surgeons, oncologists and internists working for the public Healthcare might moonlight for the private ones, but the care is most excellent. I like the US for obvious reasons; nature, freedom, startups, VCs but without this fixed, I would never consider it and that's a shame. I would love to live with the many people I know there and build companies.
purpleidea 5y ago
/me laughs in Canadian Seriously though, stop trying to patch a broken system... There's a better way...
danielrpa 5y ago
One thing I've always been curious about: what insurance plan, if any, do the rich use in the US? I'm not talking about the 1% but the 0.1%. Let's say, a famous movie actor or singer. Do they use fully non-insurance, out of pocket healthcare for primary physicians and specialists? What about surgeries? I wonder if there is in practice a separate health care system for them.
- tylergetsay 5y ago
  In my experience, they have the same doctors and insurance; the difference is they have their doctors cell numbers and hang out on the weekends. Doctors want the perks of billionaire friends too.
- gumby 5y ago
  I’m far from in the .1% but can afford to self insure. I still carry a high end insurance plan because if I break my leg on the ski slopes I don’t want to end up being triaged into the “indigent” bucket at the ER (this happened to me once, luckily with something less serious than a broken leg). Likewise it’s hard to get into some specialists unless you are in network. This isn’t a case when a call from my primary can’t get me an appointment (that call has gotten me seen even by docs who are “not accepting new patients”) but because the hospital administration doesn’t like cash payers even though they are charged the most. The real differences lie elsewhere. For example my primary doctor simply doesn’t accept insurance of any sort. I see her, I pay the bill as I leave. She chooses tests and therapies based on whether she thinks they are worth it (risk vs informative value), and has the time to discuss with me. The longest I’ve had to wait for an appointment was once when I called in the morning and couldn’t be seen until the afternoon. She seems to be friends with the heads of various departments of a few local hospitals which cuts through red tape. The wealthy 1%ers and 0.1%ers have special areas of high end hospitals and various sherpas who can make sure the patient gets the attention they want. I wonder how that system is operating these days in light of what COVID has done to the hospital infrastructure. Apart from my primary care physician, I’ve had better care from more egalitarian systems in Europe and Australia. Even there though, the informal networks are quite valuable.
  - 5y ago
short12 5y ago
There have been a few times I got some surprise medic bills. At the time they went to soft collections before I was even notified and even then took 6 months for the first notification. I inquired a out the bill and the agency was firm. I literally told them "there is no fucking way I will ever pay this and I can wait out the 7 years" a couple times. They just disappeared into thin air faster than they appeared. There is some policy I didn't agree to that allows them to bill me 6+ months later My policy is your request for payment is denied. Damn the costs
lnxg33k1 5y ago
*Out-of-network doctors also must inform patients about what their care might cost, ___________________and they may ask patients to sign a form that waives their protections. (Be leery of signing this, consumer rights experts say.)* Why is it even possible to have forms that allow dodging laws?
grumple 5y ago
This seems like a step in the right direction. It establishes the principle that the government has a say in healthcare pricing and patients must be held unharmed. Obviously it doesn't cover all cases. But it does bring us closer to a single-payer system or at least a cost-regulated system, which I think is demonstrably a good thing based on its success in other parts of the world, and more importantly, the abject failure of the American system to both protect from financial ruin and provide the best care. I hope to see the day when nobody avoids care - preventative and acute - due to cost. It costs lives, and in other cases diminishes lives. I avoid care myself, despite having health insurance and being relatively high income, because you can mysteriously get a $1250 "room fee" added onto a $300 bill to stick a camera up your nose for 5 seconds when an ENT casually suggests it, which actually happened to my partner during a simple consult recently (you can buy a similar camera to hook up to a smartphone display for $10). This sort of "surprise bill" and outsized costs for trivial diagnostics with almost no cost to the providers needs to end. When I made less money and had no insurance, I didn't just avoid care, I went without it entirely for years. We should avoid that as a society, it comes with high costs - the cost of more significant care later, the loss of labor force, and the loss of quality of life and family.
MichaelRazum 5y ago
I were recently in the US for vacation. One of us had to go to the hospital (Thanksgiving - no doctor open). At the hospital, they just did a flut test. Positive result, got tamiflu. We asked for a bill. They refused. Finally they somehow calculated it and said it was about 900$, we payed. BUT then they send another bill for 3000$ more (guess just for the registration at the hospital), on the bill we payed it was stated that it is not the final bill. To be precise the insurance payed. But it is obviously a rip off.

249 points by rawgabbit 5y ago

> Out-of-network doctors may ask patients to sign a form that waives their protections. What prevents this from becoming standard practice as a part of all the other stuff you have to sign?

benttoothpaste 5y ago
Yeah that looks like a big loophole that is ripe for abuse.

temikus 5y ago

It’s not everyday we hear something good about American healthcare. Kudos to those who worked on this bill!

hirako2000 5y ago
this push has been going for years now. One decisive factor is how the structure of these systems have been better understood by people outside the system and outrages across the country erupted, people are getting more educated on the matters, thanks to the Internet in many ways, social media has its benefit in also fast spreading genuine information and facilitate healthy discussions. kudo to everyone who has contributed to this incredible outcome indeed. I think as the understanding of the health system continues to spread, it will become more and more difficult for certain unethical practices to survive the backslash.
- olliej 5y ago
  Seriously. Isn't it only relatively recently they've even had to show us prices? And so draw attention to the $15 bandaids, etc? (I've never had any actual hospital stays while living in the US so have never seen a receipt, and so don't know the progression)
  - lotsofpulp 5y ago
    You have always been able to see that, even before ACA I remember seeing itemized healthcare provider bills with inflated figures. It just so happened that the meteoric rise in healthcare costs came to a head when the social media and the internet was also blowing up. Even without the internet, it was still well known enough to be a sufficiently important political flashpoint to actually result in Affordable Care Act passing. But I remember Clinton debating about healthcare costs in the 90s on national TV, it just had not effected sufficient number of voters yet to become a big enough issue. I also assume it has something to do with baby boomers reaching the age where they start experiencing healthcare costs and so you have a huge portion of the US population gaining experience for the first time of how much money they will have to spend on healthcare.
    - olliej 5y ago
      Thanks!

hsbauauvhabzb 5y ago

It’s purely insane that the term ‘financial ruin’ is even in TFA. I’m glad I live in a country where I can’t wake up from a coma a million dollars in debt.

Victerius 5y ago
The comment thread that is soon to follow is predictable. Someone will reply: Medical costs are responsible for X% of personal bankruptcies in America. Someone will reply: Most Americans don't have to worry about medical bills because they have coverage through their employer. Someone will concur: Yeah, I have fantastic benefits with my company. Someone will provide a counter anecdote: I also have great benefits with my employer. But I still have to pay a $5000 deductible before coverage kicks in. Someone will reply to the parent with: The US has the best health care in the world. Why do you think people fly from overseas to receive treatment in the US? Then someone will reply: The US has the best health care ... if you can afford it. The last time I saw my doctor, he looked at me for five minutes and prescribed me a bottle of aspirin. Someone will reply: You need a new doctor. I once had an experience like yours. I found a new doctor, who truly cares about my health and well being. Someone else will reply to the comment two spots above: > The US has the best health care ... if you can afford it. "No, the US has the best health care in the world, including for middle class people and poor people. I once injured myself in [insert first world country] and their health care system was practically third world." _______
- Turing_Machine 5y ago
  Poor people are eligible for Medicaid, which means they pay nothing. It's the middle class that takes it in the neck.
  - kadoban 5y ago
    As of ~5 years ago, you could be cripplingly poor and still not qualify for Medicaid. I've lived it.
    - 5y ago

kelnos 5y ago

This is truly a great improvement, but not including ground ambulances in this is messed up. And reeks of a special-interest lobbying group pushing for it. This also really bothers me: > Out-of-network doctors also must inform patients about what their care might cost, and they may ask patients to sign a form that waives their protections. (Be leery of signing this, consumer rights experts say.) It's a very weak law when you can still sign away your rights to someone who has the stronger end of a power/information imbalance. Emergency care is supposed to be covered by this law, but if you're in bad shape and show up at the ER, you might sign anything just to get care.

GhostVII 5y ago
The form makes it very clear that signing it is totally optional, and still requires the hospital to provide a cost estimate.
- joenathanone 5y ago
  Signing something when you are in the ER is the definition of duress.
jmugan 5y ago
Yeah, you'll get in there, and it will be one of 20 forms you have to sign.
olliej 5y ago
Especially with last minute doctor allocations. Arrive for your critical surgery that must be done ASAP and get met by an anesthesiologist (thank you spellchecker) who says "by the way I'm out of network, do you agree to pay me an arbitrary amount? If not, your surgery is cancelled." Then if you do say no, could the hospital then charge you for cancelling surgery at late notice? Especially given insurance generally doesn't cover such fees. Honestly any law that doesn't say "if the facility is in network, the insurance company must cover all costs as in network" and get rid of this bullshit concept of "out of network" people in an in network facility is fundamentally insufficient.

truffdog 5y ago

As long as this is done via Congress passing laws to cover up loopholes, it's not going to work. It takes too many years to push through legislation, and the health care industry can reorient to bilk their customers some other way too fast. A competently run agency with a ton of authority is required. Not sure that you could get that past the Supreme Court, or run it competently over the long term given our depressing partisan split on health care, but you know. If this were Canada, that would be the way to make this work.

vmception 5y ago
Congress can delegate authority to any existing or new agency. The real court case to upend this country would be one that limits or nullifies the delegation capability. But at least we’ll have small government again lol.
- truffdog 5y ago
  They are currently fighting about Chevron deference, which would functionally be a way for the courts to squash agency independence. Clarence Thomas has this bit where he says "you guys are doing all these crazy contortions to do stare decisis on these old New Deal decisions that enable the modern administrative state, but the real answer is that they were never constitutional to begin with and should be reversed." This would clearly be a giant disaster, but I think his argument is probably correct. We don't really do constitutional amendments any more though, so I'm not sure if there are any answers other than court packing to ensure continuous Constitutional Calvinball.
  - vmception 5y ago
    Yeah, I reached the same conclusion myself, a long time ago. Most of the New Deal was gutted by the courts in the 1930s and 1940s and everything else that remains from it just has never been challenged, mostly from a lack of inspiration, lack of awareness, or distraction by other causes. I would be skeptical of anything we’ve just assumed is American that came about from the New Deal. I’ve got a couple full agencies in my crosshairs, and I’m excited about that. Sure, its going to be a disaster, and I’m empathic about people losing other civil rights they have gotten used to that this court is going to re-evaluate, but I’m glad I can leave and that my particular causes will give me the openings I want.

etempleton 5y ago

It will be interesting to see if this changes anything on my next visit to the hospital. When my child was born we asked in advance both insurance and the hospital for a cost estimate. No one could provide one. We were then proceeded to be sent bills from various parties for over a year. We had no idea if we were to pay it, insurance was to pay it, if we had already paid it and there was an accounting error. Each bill was as vague as the next with only the company name to go off of. The whole thing is/was perposterous. Can the hospital not act as a mediary and collate all of the charges on a single line itemed bill? Because that is how everything else in the world works. From what I can gather.there is some sinister game hospitals and medical insurance play, but you would think that, oh, I don’t know, it would save time and money for them both to just come up with some agreed upon pricing and save some administrator overhead.

lbotos 5y ago
In the US the game comes from the fact that different people pay difference pricing depending on what combination of cash and insurance they have. Basically "list" vs "actual" pricing depending on what "discounts" you are eligible for.
- lotsofpulp 5y ago
  Because the end game is expanding access to healthcare by increasing supply of less qualified (or lower quality) healthcare providers, and then price segmenting different populations to different qualities of healthcare. You pay more, you get higher probability of access to MDs. You pay less, you get higher probability of access to PA/NP. And many other variations of that. You can accomplish the goal of politically expanding access to healthcare, but without the costs of getting everyone access to the same healthcare.
  - erosenbe0 5y ago
    We could just train more MDs and/or make that training process more efficient like Germany. Also, medical training and residency need not infringe on the health and safety of pregnant women and the unborn for no purpose whatsoever with 24 hour shifts and other complete nonsense for internist trainees. As some budding doctors would like to have 5 or 6 children in their twenties. Edit: we could also generally waste less human potential and train more people by you know, having college kids go to school 48 weeks a year instead of 36, like real adults who enlist in the military or trades.

vmception 5y ago

This is just a stop gap solution. Data collection so that the opposition party has less legs to stand on, until there is no further support for it. The people behind many representatives don’t know or care enough. This helps more of them know and care.

causi 5y ago

Quite often it seems like laws only protect people wealthy enough to hire a lawyer to enforce them.

black_13 5y ago

faangiq 5y ago

Jail time and asset forfeiture are the only real solutions to these problems. (For hospital and govt staff, of course.)

trembonator 5y ago

keeptrying 5y ago

A friend once had a an emergency appendix removed and was hit with a $10000 bill because doctor was out of network. Ridiculous.

tluyben2 5y ago

It sounds like a nice day for the US but the comments don't look optimistic. I cannot help to continue to think that we, as humanity, need to remove perverse incentives for critical infrastructure. How can an insurance company, which needs to make profit, have your interest at heart? I am for state Healthcare without insurance and sure, I know a lot of people whine about the quality in countries where they have this, but it seems people whine about stuff in their bubble regardless. They don't actually compare with countries that do not have this. I had a young-stroke (as they called it) when I was thinner and fitter than I had ever been, but I was stressed at that time (company was burning over 1m a month and our biggest clients left; shortly after the 2000 crash). They did not find anything wrong with me and the team of experts (what I had was rare apparently so I am a university case study) spent 100s of 1000s euros of perceived care (where I live now this costs a fraction of that) on me to prove it was not stress. I am sure it was and they could not find anything else. All was practically free for me (total was less than 300 euros for tons of mri's, blood panels, hospital bed and 15 experts visiting me daily) but I cannot get private insurance because of it. Hopefully someone will jump in there as I now have the same chance as anyone of this returning but whatever. It's one of the first exclusion boxes on the form for insurance. In Spain and Portugal I had much better care without insurance; I know people cry how bad it is (see above). As someone who had things (including cancer) I can tell you, it is lovely compared to the nhs or Dutch healthcare; far less clinical, overstaffed, you can have a fecking beer when they told you it's going to be rough etc. And you can view the sea from your bed (where I am) instead of an airconditioner filled wall. It feels just nicer even when you are ill. And that helps making you better I think, at least it helped me. My wife could sleep there 247, screw visiting hours. You just need to know how to navigate the system. The surgeons, oncologists and internists working for the public Healthcare might moonlight for the private ones, but the care is most excellent. I like the US for obvious reasons; nature, freedom, startups, VCs but without this fixed, I would never consider it and that's a shame. I would love to live with the many people I know there and build companies.

purpleidea 5y ago

/me laughs in Canadian Seriously though, stop trying to patch a broken system... There's a better way...

danielrpa 5y ago

One thing I've always been curious about: what insurance plan, if any, do the rich use in the US? I'm not talking about the 1% but the 0.1%. Let's say, a famous movie actor or singer. Do they use fully non-insurance, out of pocket healthcare for primary physicians and specialists? What about surgeries? I wonder if there is in practice a separate health care system for them.

tylergetsay 5y ago
In my experience, they have the same doctors and insurance; the difference is they have their doctors cell numbers and hang out on the weekends. Doctors want the perks of billionaire friends too.
gumby 5y ago
I’m far from in the .1% but can afford to self insure. I still carry a high end insurance plan because if I break my leg on the ski slopes I don’t want to end up being triaged into the “indigent” bucket at the ER (this happened to me once, luckily with something less serious than a broken leg). Likewise it’s hard to get into some specialists unless you are in network. This isn’t a case when a call from my primary can’t get me an appointment (that call has gotten me seen even by docs who are “not accepting new patients”) but because the hospital administration doesn’t like cash payers even though they are charged the most. The real differences lie elsewhere. For example my primary doctor simply doesn’t accept insurance of any sort. I see her, I pay the bill as I leave. She chooses tests and therapies based on whether she thinks they are worth it (risk vs informative value), and has the time to discuss with me. The longest I’ve had to wait for an appointment was once when I called in the morning and couldn’t be seen until the afternoon. She seems to be friends with the heads of various departments of a few local hospitals which cuts through red tape. The wealthy 1%ers and 0.1%ers have special areas of high end hospitals and various sherpas who can make sure the patient gets the attention they want. I wonder how that system is operating these days in light of what COVID has done to the hospital infrastructure. Apart from my primary care physician, I’ve had better care from more egalitarian systems in Europe and Australia. Even there though, the informal networks are quite valuable.
- 5y ago

short12 5y ago

There have been a few times I got some surprise medic bills. At the time they went to soft collections before I was even notified and even then took 6 months for the first notification. I inquired a out the bill and the agency was firm. I literally told them "there is no fucking way I will ever pay this and I can wait out the 7 years" a couple times. They just disappeared into thin air faster than they appeared. There is some policy I didn't agree to that allows them to bill me 6+ months later My policy is your request for payment is denied. Damn the costs

lnxg33k1 5y ago

*Out-of-network doctors also must inform patients about what their care might cost, ___________________and they may ask patients to sign a form that waives their protections. (Be leery of signing this, consumer rights experts say.)* Why is it even possible to have forms that allow dodging laws?

grumple 5y ago

This seems like a step in the right direction. It establishes the principle that the government has a say in healthcare pricing and patients must be held unharmed. Obviously it doesn't cover all cases. But it does bring us closer to a single-payer system or at least a cost-regulated system, which I think is demonstrably a good thing based on its success in other parts of the world, and more importantly, the abject failure of the American system to both protect from financial ruin and provide the best care. I hope to see the day when nobody avoids care - preventative and acute - due to cost. It costs lives, and in other cases diminishes lives. I avoid care myself, despite having health insurance and being relatively high income, because you can mysteriously get a $1250 "room fee" added onto a $300 bill to stick a camera up your nose for 5 seconds when an ENT casually suggests it, which actually happened to my partner during a simple consult recently (you can buy a similar camera to hook up to a smartphone display for $10). This sort of "surprise bill" and outsized costs for trivial diagnostics with almost no cost to the providers needs to end. When I made less money and had no insurance, I didn't just avoid care, I went without it entirely for years. We should avoid that as a society, it comes with high costs - the cost of more significant care later, the loss of labor force, and the loss of quality of life and family.

MichaelRazum 5y ago

I were recently in the US for vacation. One of us had to go to the hospital (Thanksgiving - no doctor open). At the hospital, they just did a flut test. Positive result, got tamiflu. We asked for a bill. They refused. Finally they somehow calculated it and said it was about 900$, we payed. BUT then they send another bill for 3000$ more (guess just for the registration at the hospital), on the bill we payed it was stated that it is not the final bill. To be precise the insurance payed. But it is obviously a rip off.