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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 hospi

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.
    - lotsofpulp 5y ago
      Of course, I think doctors who were lobbying to restrict supply overplayed their hands and many future doctors are now stuck "supervising" 10 NP/PA. Whoever or whatever was preventing supply of doctors from increasing for the past few decades really did the doctors who worked 1980s to 2010s a big favor, but a big disservice to pretty much all future doctors.
- snarfy 5y ago
  "How much does it cost?" "How much you got?" Mobsters.
  - mellavora 5y ago
    Huh, sounds like how they price tuition for my daughter's college education (private college w/ a good name). They also talk about how they are making it more affordable for everyone.
  - themaninthedark 5y ago
    But isn't this what we have been advocating for on some levels? Everyone pays according to their ability? Rich pay more and poor pay less.
    - colejohnson66 5y ago
      Except that the rich people have insurance that can negotiate a lower rate than the poor people
- SkeuomorphicBee 5y ago
  The simple solution to this is to completely disconnect insured patients from hospital billing. If a person is insured then they only pay to the insurance company, a specific dollar amount copay they previously agreed on their insurance contract, all hospital billing should be handled by the insurance company.
Turing_Machine 5y ago
I've got power of attorney for an elderly relative who is in a nursing facility and just got one of these -- a bill from "PDQ Medical, Inc." (not the actual name) with no other information on it. Their web site lets you log in with the patient name and date of birth, but there's also no information there. Just the amount that is supposedly due. I'll be calling them Monday and telling them that unless they send me an itemized bill detailing what doctor (or other medical professional) she saw, what the treatment date was, and what service was provided, I'm not paying squat. Frankly, she's got more important things to worry about than an account getting sent to collections, and I'm legally responsible for how I spend her money. I'm not going to pay bills from any rando who feels like sending one. Not gonna happen.
- Spooky23 5y ago
  I had a similar issue with my dad at a rehab facility. In his case, the mysterious bill was for a psychiatric session from a doctor we had never heard of. We kept digging and had to threaten the facility with a referral to the Medicare inspector general to get information. Turned out that the guy prescribed some random drugs and billed for a “3 hour evaluation”, which supposedly took place on a day where my dad was accompanied by family members or in physical therapy for the entire day. (Context: he had a stroke and was unable to speak) The doc just showed up and wrote random scripts. We didn’t get the feds to care, but the state medical licensing people did censure the doctor. Good luck. These facilities aren’t very forthright and will retaliate against your helpless relative.
  - vkou 5y ago
    > but the state medical licensing people did censure the doctor. Censure? In the sense that he's doing five-to-ten stamping license plates for wire fraud?
    - Spooky23 5y ago
      Nope, more like a mean letter in his permanent record and lost hospital privileges due to higher insurance rates.
exhilaration 5y ago
I've got a story that might explain what happened. So when my kid was born in 2011, at Morristown Hospital in New Jersey, he was several weeks premature and spent 18 days in the NICU. At some point during his time there, they came to us and told that they did not participate in any insurance network; they would still bill our insurance but the full amount would have to be paid, either by us or the insurance, since they were not subject to a negotiated rate. I was confused, why would this be the case since the hospital was in-network? It turns out the entire NICU department - inside the hospital - was run by a separate, independent physician group with its own billing department and its own (non-existent) insurance relationships. Of course nobody mentioned this during the hospital tour. I mean why would the NICU docs give up their revenue by signing up for insurance rates when the families using their services have zero choice about where to go? I've heard anesthesiologists in the labor and delivery department are like this too. Your wife's screaming in pain during labor, are you really going to jump on your phone and check to see if the anesthesiologist in front of you is in-network? And what do you do if s/he's not? So that's one reason why you might get a bunch of different bills from a bunch of different entities when you go to the hospital: all the doctors there may have the same hospital logo on their badges but some may be independent contractors. Edit: for the curious, the final bill for 18 days in the NICU was ~$94,000. The insurance paid all but ~$10,000. We spent several months appealing that, arguing that "we had no choice", and they kept denying the appeals. Finally we gave up and called the rogue physician's group to arrange for a payment plan... and they told us the insurance had paid the balance.
- larkost 5y ago
  I am sad to say this, but the insurance probably did not pay for the last $10K, that probably magically disappeared after the insurance paid for what they paid for. Again the explanation in the form of an example: My wife's dentist always puts in big bills to our insurance company. We then get a check in the mail along with records detailing how much the dentist billed, and then how much they are paying (though us). We then send the check along, and every time that we have then talked to them they say that we don't have to pay the remainder. This is just a negotiation tactic between our dentist and the insurance company. They are just trying to make sure that they capture every dollar that the insurance company will possibly pay. They never expected to get everything that they billed, that was more like an opening position in bargaining.
lotsofpulp 5y ago
If you are insured, you should assume your annual out of pocket maximum is the cost at in network providers. If you are insured, supposedly there are measures to limit costs due to out of network providers, but I am not sure if you are entitled to find out the costs beforehand. I presume you are entitled to get a “good faith estimate”. https://www.cms.gov/nosurprises/consumer-protections/What-are-the-new-protections https://www.cms.gov/nosurprises/consumer-protections/What-ar... If you are not insured, healthcare providers are obliged to give you a “good faith estimate” upfront now: https://www.cms.gov/nosurprises/consumers/understanding-costs-in-advance https://www.cms.gov/nosurprises/consumers/understanding-cost... https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bills https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bill...
lhuser123 5y ago
Had a similar experience & some of those bills turned out to be scams. I think some scammers somehow obtain that info & rush to send you fake bills.
beckler 5y ago
It's straight greed on every level... Providers and hospitals will bill the absolute maximum allowed for each item and they track everything extensively. Insurance companies do their hardest to find literally any excuse to not cover claims, while also barely fulfilling their contractual obligations to members. Unfortunately, hospitals will never be able to consolidate or pass-thru bills from all providers, because admins would want a cut of the amount paid, plus they would know what everyone is charging and use that info strategically. So no provider in their right mind would go for it. Sending bills directly cuts out any middleman and increase their margins.
swaggyBoatswain 5y ago
I did nasal surgery (deviated septum) and I asked around for quotes on how much it'd cost. I was verbally quoted about $2500 out of pocket expenses. I have a really good hdhp plan that covers $1500 hdhp before a 10k max coverage at 90% coinsurance. I ended up costing close to $7000 out of pocket anyhow... The medical insurance system is really stupid in America. It's basically fraud. Coinsurance coverage doesn't work as intended because the hospital can charge any amount they want, meaning your forced to pay close to your max coverage even if you have a high % coverage. Your forced to sign a "please bill me on anything you want" to get medical services rendered. I got billed $400 per post visit just for a camera to be shoved up my nose. The anesthesia was out of network and didn't get covered by insurance
- Zircom 5y ago
  >The anesthesia was out of network and didn't get covered by insurance This actually is specifically illegal, it's a pain in the ass to fight it against both the hospital and your insurance but if you insist hard enough they will cover it and you'll only pay what you would normally through your insurance. As long as the hospital itself is in network they aren't allowed to play "gotcha" with specific doctors/providers just not being in network all the sudden.
  - lotsofpulp 5y ago
    I thought this was only just made illegal as of Jan 1, 2022.
    - Zircom 5y ago
      So for any kind of emergency care they are not allowed to "gotcha" with out of network providers at in network hospitals, this has always been the case. However, according to my quick Google research apparently anything else is state-law dependent so what I said doesn't apply equally in the country.
  - ir123 5y ago
    This is soo strange! Why do _you_ have to insist for anything? Why is this thing even legal?
refurb 5y ago
I had surgery and actually had a good experience. My hospital would provide a cost estimate prior by actually contacting my insurance. The estimate was pretty close. But I’m kind of surprised that hospitals don’t try and get ahead of it. If I had two options for hospitals and one provided financial management (say guaranteed a final cost) and the other was like “fuck off, call your insurance”, I’d opt for the former easily.
2Gkashmiri 5y ago
In India at least, the healthcare is not as super advanced but the public healthcare is free. Private hospitals have 2 modes. Either pay cash or cashless insurance. If you have a heath insurance card, you just pick one and you are done. If you are paying by cash, you ask for a price. Then you price shop all hospitals. There are no "surprises" as hospitals expect customers to pay upfront the cost of procedure and or a deposit for room/incidentals. The good thing with this is, you say "hey hospital A, how much for a cataract surgery", same for all hospitals. The bad thing is, if you don't have the cash, you either have to borrow or sell off property which throws people into poverty faster. Recently government made a public insurance scheme where every family is covered for like 1200 procedures and is cashless. The good about it is, even poorest of poor can get private healthcare and hospitals get a steady revenue stream, albeit at a lower profit but in the long run they are expected to turn a profit. In India, health insurance and insurance in general is missold. Agents sell " return of premium" and "money back" instead of risk cover because they get a fatter commission. I have talked to dozens of agents and they dislike term life insurance like the plague. "Why would you do that, its stupid. Yuck. Ew". Same for medical, the result being only rich could afford good care till now.
feupan 5y ago
It doesn't save them money if you save money. This idiotic way of doing things is obviously very lucrative for them, no collating needed!
champagnois 5y ago
Medicine is the only profession that seems to have its own specialized "coding and billing" co-professions with schools around the country that train only "medical code and billing" to their pupils. Any other business in the country would just have products / services and prices without any of these games. Had the same experience as you, FWIW.
christophilus 5y ago
I recently took two of my kids to the emergency room, after I found an empty box of children’s Tylenol. Their blood levels turned out to be normal, thankfully, but we were kept there for around 4 hours as a precaution. That empty box of Tylenol cost me $6k.
vkou 5y ago
> Can the hospital not act as a mediary and collate all of the charges on a single line itemed bill? No, because the status quo allows the various providers to extract every penny of value that they can out of you.
Handytinge 5y ago
> 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. Hello. I'm from the rest of the world, and I or my family have never received a bill from a hospital. The idea seems crazy. Just providing a perspective.
- mh- 5y ago
  From the US. Neither has mine, except when we forgot to pay our copay during an ER visit once. We got a bill for that exact amount a couple of months later from our insurance company. It was $100.

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.
  - lotsofpulp 5y ago
    Of course, I think doctors who were lobbying to restrict supply overplayed their hands and many future doctors are now stuck "supervising" 10 NP/PA. Whoever or whatever was preventing supply of doctors from increasing for the past few decades really did the doctors who worked 1980s to 2010s a big favor, but a big disservice to pretty much all future doctors.
snarfy 5y ago
"How much does it cost?" "How much you got?" Mobsters.
- mellavora 5y ago
  Huh, sounds like how they price tuition for my daughter's college education (private college w/ a good name). They also talk about how they are making it more affordable for everyone.
- themaninthedark 5y ago
  But isn't this what we have been advocating for on some levels? Everyone pays according to their ability? Rich pay more and poor pay less.
  - colejohnson66 5y ago
    Except that the rich people have insurance that can negotiate a lower rate than the poor people
SkeuomorphicBee 5y ago
The simple solution to this is to completely disconnect insured patients from hospital billing. If a person is insured then they only pay to the insurance company, a specific dollar amount copay they previously agreed on their insurance contract, all hospital billing should be handled by the insurance company.

Turing_Machine 5y ago

I've got power of attorney for an elderly relative who is in a nursing facility and just got one of these -- a bill from "PDQ Medical, Inc." (not the actual name) with no other information on it. Their web site lets you log in with the patient name and date of birth, but there's also no information there. Just the amount that is supposedly due. I'll be calling them Monday and telling them that unless they send me an itemized bill detailing what doctor (or other medical professional) she saw, what the treatment date was, and what service was provided, I'm not paying squat. Frankly, she's got more important things to worry about than an account getting sent to collections, and I'm legally responsible for how I spend her money. I'm not going to pay bills from any rando who feels like sending one. Not gonna happen.

Spooky23 5y ago
I had a similar issue with my dad at a rehab facility. In his case, the mysterious bill was for a psychiatric session from a doctor we had never heard of. We kept digging and had to threaten the facility with a referral to the Medicare inspector general to get information. Turned out that the guy prescribed some random drugs and billed for a “3 hour evaluation”, which supposedly took place on a day where my dad was accompanied by family members or in physical therapy for the entire day. (Context: he had a stroke and was unable to speak) The doc just showed up and wrote random scripts. We didn’t get the feds to care, but the state medical licensing people did censure the doctor. Good luck. These facilities aren’t very forthright and will retaliate against your helpless relative.
- vkou 5y ago
  > but the state medical licensing people did censure the doctor. Censure? In the sense that he's doing five-to-ten stamping license plates for wire fraud?
  - Spooky23 5y ago
    Nope, more like a mean letter in his permanent record and lost hospital privileges due to higher insurance rates.

exhilaration 5y ago

I've got a story that might explain what happened. So when my kid was born in 2011, at Morristown Hospital in New Jersey, he was several weeks premature and spent 18 days in the NICU. At some point during his time there, they came to us and told that they did not participate in any insurance network; they would still bill our insurance but the full amount would have to be paid, either by us or the insurance, since they were not subject to a negotiated rate. I was confused, why would this be the case since the hospital was in-network? It turns out the entire NICU department - inside the hospital - was run by a separate, independent physician group with its own billing department and its own (non-existent) insurance relationships. Of course nobody mentioned this during the hospital tour. I mean why would the NICU docs give up their revenue by signing up for insurance rates when the families using their services have zero choice about where to go? I've heard anesthesiologists in the labor and delivery department are like this too. Your wife's screaming in pain during labor, are you really going to jump on your phone and check to see if the anesthesiologist in front of you is in-network? And what do you do if s/he's not? So that's one reason why you might get a bunch of different bills from a bunch of different entities when you go to the hospital: all the doctors there may have the same hospital logo on their badges but some may be independent contractors. Edit: for the curious, the final bill for 18 days in the NICU was ~$94,000. The insurance paid all but ~$10,000. We spent several months appealing that, arguing that "we had no choice", and they kept denying the appeals. Finally we gave up and called the rogue physician's group to arrange for a payment plan... and they told us the insurance had paid the balance.

larkost 5y ago
I am sad to say this, but the insurance probably did not pay for the last $10K, that probably magically disappeared after the insurance paid for what they paid for. Again the explanation in the form of an example: My wife's dentist always puts in big bills to our insurance company. We then get a check in the mail along with records detailing how much the dentist billed, and then how much they are paying (though us). We then send the check along, and every time that we have then talked to them they say that we don't have to pay the remainder. This is just a negotiation tactic between our dentist and the insurance company. They are just trying to make sure that they capture every dollar that the insurance company will possibly pay. They never expected to get everything that they billed, that was more like an opening position in bargaining.

lotsofpulp 5y ago

If you are insured, you should assume your annual out of pocket maximum is the cost at in network providers. If you are insured, supposedly there are measures to limit costs due to out of network providers, but I am not sure if you are entitled to find out the costs beforehand. I presume you are entitled to get a “good faith estimate”. https://www.cms.gov/nosurprises/consumer-protections/What-are-the-new-protections https://www.cms.gov/nosurprises/consumer-protections/What-ar... If you are not insured, healthcare providers are obliged to give you a “good faith estimate” upfront now: https://www.cms.gov/nosurprises/consumers/understanding-costs-in-advance https://www.cms.gov/nosurprises/consumers/understanding-cost... https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bills https://www.cms.gov/nosurprises/Ending-Surprise-Medical-Bill...

lhuser123 5y ago

Had a similar experience & some of those bills turned out to be scams. I think some scammers somehow obtain that info & rush to send you fake bills.

beckler 5y ago

It's straight greed on every level... Providers and hospitals will bill the absolute maximum allowed for each item and they track everything extensively. Insurance companies do their hardest to find literally any excuse to not cover claims, while also barely fulfilling their contractual obligations to members. Unfortunately, hospitals will never be able to consolidate or pass-thru bills from all providers, because admins would want a cut of the amount paid, plus they would know what everyone is charging and use that info strategically. So no provider in their right mind would go for it. Sending bills directly cuts out any middleman and increase their margins.

swaggyBoatswain 5y ago

I did nasal surgery (deviated septum) and I asked around for quotes on how much it'd cost. I was verbally quoted about $2500 out of pocket expenses. I have a really good hdhp plan that covers $1500 hdhp before a 10k max coverage at 90% coinsurance. I ended up costing close to $7000 out of pocket anyhow... The medical insurance system is really stupid in America. It's basically fraud. Coinsurance coverage doesn't work as intended because the hospital can charge any amount they want, meaning your forced to pay close to your max coverage even if you have a high % coverage. Your forced to sign a "please bill me on anything you want" to get medical services rendered. I got billed $400 per post visit just for a camera to be shoved up my nose. The anesthesia was out of network and didn't get covered by insurance

Zircom 5y ago
>The anesthesia was out of network and didn't get covered by insurance This actually is specifically illegal, it's a pain in the ass to fight it against both the hospital and your insurance but if you insist hard enough they will cover it and you'll only pay what you would normally through your insurance. As long as the hospital itself is in network they aren't allowed to play "gotcha" with specific doctors/providers just not being in network all the sudden.
- lotsofpulp 5y ago
  I thought this was only just made illegal as of Jan 1, 2022.
  - Zircom 5y ago
    So for any kind of emergency care they are not allowed to "gotcha" with out of network providers at in network hospitals, this has always been the case. However, according to my quick Google research apparently anything else is state-law dependent so what I said doesn't apply equally in the country.
- ir123 5y ago
  This is soo strange! Why do _you_ have to insist for anything? Why is this thing even legal?

refurb 5y ago

I had surgery and actually had a good experience. My hospital would provide a cost estimate prior by actually contacting my insurance. The estimate was pretty close. But I’m kind of surprised that hospitals don’t try and get ahead of it. If I had two options for hospitals and one provided financial management (say guaranteed a final cost) and the other was like “fuck off, call your insurance”, I’d opt for the former easily.

2Gkashmiri 5y ago

In India at least, the healthcare is not as super advanced but the public healthcare is free. Private hospitals have 2 modes. Either pay cash or cashless insurance. If you have a heath insurance card, you just pick one and you are done. If you are paying by cash, you ask for a price. Then you price shop all hospitals. There are no "surprises" as hospitals expect customers to pay upfront the cost of procedure and or a deposit for room/incidentals. The good thing with this is, you say "hey hospital A, how much for a cataract surgery", same for all hospitals. The bad thing is, if you don't have the cash, you either have to borrow or sell off property which throws people into poverty faster. Recently government made a public insurance scheme where every family is covered for like 1200 procedures and is cashless. The good about it is, even poorest of poor can get private healthcare and hospitals get a steady revenue stream, albeit at a lower profit but in the long run they are expected to turn a profit. In India, health insurance and insurance in general is missold. Agents sell " return of premium" and "money back" instead of risk cover because they get a fatter commission. I have talked to dozens of agents and they dislike term life insurance like the plague. "Why would you do that, its stupid. Yuck. Ew". Same for medical, the result being only rich could afford good care till now.

feupan 5y ago

It doesn't save them money if you save money. This idiotic way of doing things is obviously very lucrative for them, no collating needed!

champagnois 5y ago

Medicine is the only profession that seems to have its own specialized "coding and billing" co-professions with schools around the country that train only "medical code and billing" to their pupils. Any other business in the country would just have products / services and prices without any of these games. Had the same experience as you, FWIW.

christophilus 5y ago

I recently took two of my kids to the emergency room, after I found an empty box of children’s Tylenol. Their blood levels turned out to be normal, thankfully, but we were kept there for around 4 hours as a precaution. That empty box of Tylenol cost me $6k.

vkou 5y ago

> Can the hospital not act as a mediary and collate all of the charges on a single line itemed bill? No, because the status quo allows the various providers to extract every penny of value that they can out of you.

Handytinge 5y ago

> 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. Hello. I'm from the rest of the world, and I or my family have never received a bill from a hospital. The idea seems crazy. Just providing a perspective.

mh- 5y ago
From the US. Neither has mine, except when we forgot to pay our copay during an ER visit once. We got a bill for that exact amount a couple of months later from our insurance company. It was $100.