7 ms·

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 sp

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.
- gfxgirl 5y ago
  My dentist charges me the full amount. I then get a check for about 1/3rd from the insurance company. The dentist got the full amount. I work for a FAAMG company so supposedly my dental insurance is considered good. She billed $3000 for a deep cleaning and a crown and I paid her $3000. I got back $1162 from insurance
  - lotsofpulp 5y ago
    Dental insurance is really weak insurance. It is mostly a mechanism that allows employers that can afford the paperwork of offering benefits to give you the benefit of being able to pay for your dental expenses with pre tax money. The maximum benefit amount is usually $1k to $2k. Maybe $3k at a generous employer. So if you ever had a really bad dental problem that exceeded those amounts, you are not insured from having to spend on dental problems that cost a lot of money. Contrast with health insurance, where due to out of pocket maximums, you can suffer a very expensive healthcare event, and you are insured against having to pay $500k for the bypass surgery or NICU stay.
    - hamburglar 5y ago
      Yes, as someone with extreme outlier dental costs, I have come to the realization that dental insurance is not insurance at all, it’s simply a routine maintenance plan. The point of insurance is to act as a buffer for large unexpected expenses, and dental explicitly excludes those from coverage.
    - gumby 5y ago
      I was hit on my bike and had some broken teeth and such. The dentist asked for my regular insurance carrier to pay for the work.
- throwawayboise 5y ago
  That confirms my suspicion that the business of present-day medicine is milking insurance companies and patients for every dollar that can be billed. The incentive is to keep patients sick, but alive, for as long as possible, hopefully managing to time the patient's death with the exhaustion of benefits/assets. I'm not saying that doctors have this goal. I am saying that this is what the system incentives are, and we all know how systems respond to incentives.
throw0101a 5y ago
> 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? I think it was the economist Kenneth Arrow that used situations like this as an example of why health care cannot be treated like other markets. Free Markets™ require information by buyers, and there tends to be asymmetry in this regard in medicine more than in many other markets. * https://web.stanford.edu/~jay/health_class/Readings/Lecture01/arrow.pdf https://web.stanford.edu/~jay/health_class/Readings/Lecture0... Usually when buying a product or service you know the price ahead of time, but with medical treatment this is often impossible for non-elective / emergency procedures.

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.

gfxgirl 5y ago
My dentist charges me the full amount. I then get a check for about 1/3rd from the insurance company. The dentist got the full amount. I work for a FAAMG company so supposedly my dental insurance is considered good. She billed $3000 for a deep cleaning and a crown and I paid her $3000. I got back $1162 from insurance
- lotsofpulp 5y ago
  Dental insurance is really weak insurance. It is mostly a mechanism that allows employers that can afford the paperwork of offering benefits to give you the benefit of being able to pay for your dental expenses with pre tax money. The maximum benefit amount is usually $1k to $2k. Maybe $3k at a generous employer. So if you ever had a really bad dental problem that exceeded those amounts, you are not insured from having to spend on dental problems that cost a lot of money. Contrast with health insurance, where due to out of pocket maximums, you can suffer a very expensive healthcare event, and you are insured against having to pay $500k for the bypass surgery or NICU stay.
  - hamburglar 5y ago
    Yes, as someone with extreme outlier dental costs, I have come to the realization that dental insurance is not insurance at all, it’s simply a routine maintenance plan. The point of insurance is to act as a buffer for large unexpected expenses, and dental explicitly excludes those from coverage.
  - gumby 5y ago
    I was hit on my bike and had some broken teeth and such. The dentist asked for my regular insurance carrier to pay for the work.
throwawayboise 5y ago
That confirms my suspicion that the business of present-day medicine is milking insurance companies and patients for every dollar that can be billed. The incentive is to keep patients sick, but alive, for as long as possible, hopefully managing to time the patient's death with the exhaustion of benefits/assets. I'm not saying that doctors have this goal. I am saying that this is what the system incentives are, and we all know how systems respond to incentives.

throw0101a 5y ago

> 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? I think it was the economist Kenneth Arrow that used situations like this as an example of why health care cannot be treated like other markets. Free Markets™ require information by buyers, and there tends to be asymmetry in this regard in medicine more than in many other markets. * https://web.stanford.edu/~jay/health_class/Readings/Lecture01/arrow.pdf https://web.stanford.edu/~jay/health_class/Readings/Lecture0... Usually when buying a product or service you know the price ahead of time, but with medical treatment this is often impossible for non-elective / emergency procedures.