15 ms·

Surgery estimated cost $1,300. Then the Bill Came: $229,000

257 points by 8bitsrule 4y ago

tromp 4y ago
> Before her surgery, Ms. French signed two service agreements promising to pay “all charges of the hospital.” > In Centura’s view, the service agreements “were unambiguous and French’s agreement to pay ‘all charges’ ‘could only mean’ the predetermined rates set by Centura’s chargemaster,” the court said. > But the court found that Ms. French wasn’t responsible for paying those rates because she didn’t know the chargemaster even existed and hadn’t agreed to its terms. > “Indeed, Centura representatives testified that the chargemaster was not provided to patients, and in this very litigation, Centura refused to produce its chargemaster to French, contending that it was proprietary and a trade secret,” Justice Richard L. Gabriel wrote. Beyond ludicrous...
- pevey 4y ago
  It’s amazing that any of these “agreements” are ever upheld by courts. As standard procedure, you have to agree to any and all charges, but in most cases they refuse to give any estimate of what those charges might be. They are “trade secrets.” But if you don’t agree, you cannot get lifesaving care. It is unconscionable. In this case, she is lucky they gave her that insurance estimate. Usually they refuse specifically for the reason of what happened in this case. They expect you to agree to pay whatever they decide later. And people keep trying to argue the US has a great healthcare system. It is beyond broken. The very rich don’t have to worry, the very poor don’t have to worry. The rest of us can get screwed if we have the very bad luck of being US citizens who happen to get sick or into an accident.
  - user3939382 4y ago
    Totally agree. All these agreements are signed under duress and ask the signer to agree to pay an amount while making it impossible for the signer to know whether that’s possible.
    - babyshake 4y ago
      If you don't sign and you need treatment to live, aren't doctors obligated to treat you per the Hippocratic oath?
      - cool_dude85 4y ago
        Are you dying, like, right now? Or are you just going to die in a few months? Come back when you're dying.
  - 88913527 4y ago
    You can always try a different hospital for better service. Of course this won't work in situations where timing is critical, but most surgery is scheduled. We might as well treat it for the business that it is. If they can't give you a reasonable estimate up front, then don't sign the paperwork. If they care about earning your money they will negotiate with you, and it's always better to negotiate terms up front proactively than deal with it reactively. The strongest power a consumer has is to vote with their money.
    - est31 4y ago
      > If they can't give you a reasonable estimate up front, then don't sign the paperwork. That's the issue, they don't give you estimates that they are actually bound by.
      - 88913527 4y ago
        And if you're an hour away from being in the operating theater, and they have all the specialists there, and in that moment you choose not to sign-- it's more their problem than yours.
        FredPret 4y ago
        …no it isn’t? You need to get surgery, they want to provide surgery
        crooked-v 4y ago
        That's what makes it your problem. They can just say 'no' until you sign the document agreeing to pay whatever they bill you later.
        OJFord 4y ago
        I think GGP commentor typo'd - it says the opposite at time of writing.
        4y ago
  - agiamas 4y ago
    agreed. You are under huge distress and don't have a viable alternative and your life is in danger and you sign what is really, a contract to pay with the amount to be paid being blank. So essentially and legally speaking, how is this different than blackmail?
    - SemanticStrengh 4y ago
      is there a limit? Can you legally enforce a hidden 1 billion dollar debt to someone?
      - drdec 4y ago
        It would be dischargeable in bankruptcy so there is a practical limit.
      - JJMcJ 4y ago
        Usually courts won't uphold "unconscionable" charges. Charge someone $1 billion to change a tire. Nope, nope, nope, as an example.
        SemanticStrengh 4y ago
        but somehow 229K is Okay? Where is the limit
        JJMcJ 4y ago
        Hospitals seem to have the world hypnotized.
  - prepend 4y ago
    > And people keep trying to argue the US has a great healthcare system. I’ve never heard anyone argue this. The common argument is that it really sucks and that proposed changes suck as well. So the argument isn’t “don’t change because it’s great.” The argument is “It’s terrible and I’m worried that if you change it, it will get worse.”
    - tomxor 4y ago
      I've come across a number of HN commenters claiming US healthcare is better than the EU or UK. I'd argue it's pretty broken compared to both. The UK's NHS is far from perfect yet serves the majority of people well without bankrupting them. Countries of the EU will have varying quality of healthcare, yet I'd still trust them over the US due to my fear of the US's highly profit driven system (which can cost you more than money). I suspect those claiming US healthcare is superior are able to pay quarter of a million without blinking - however they still run the risk of unnecessary surgery and aggressive prescription of addictive substances.
      - BobbyJo 4y ago
        I think we can separate the administration of the care from the are itself. I believe the US has among the best care. I also believe our administration of said care is among the worst, if not the worst.
        tomxor 4y ago
        True, I wouldn't be surprised if the US was amongst the lead in quality of medical procedures - when that procedure is necessary... but beyond administration, there have been numerous instances of doctors being exposed for electing patients for unnecessary procedures driven by profits, and other procedures being recommended when scientific evidence suggest the procedure has no clear benefit - no matter the quality of surgery, it always comes at significant risk and cost to your body, it's not a magic wand; it's a traumatic intervention that requires your body to go through a lot of recovery with possible lasting effects. This can be true to a lesser extent for less severe medical interventions too. So my point is, what use is excellent "care" if not only it's life endingly expensive, but it's also prescribed immorally to the point of actually causing harm!
  - chimeracoder 4y ago
    > And people keep trying to argue the US has a great healthcare system I've never heard anyone argue that the billing and payment aspects of the US healthcare system are great. I have heard people argue that the quality of care (by various metrics) or availability of services are great, but that's a different argument, and not mutually incompatible with having a broken payment and billing infrastructure. > The very rich don’t have to worry, the very poor don’t have to worry. I'm not sure how you're arriving at the conclusion that "the very poor don't have to worry"
- bshep 4y ago
  I wonder what would happen if a patient swapped the form with an identical looking form with different verbiage, making the hospital responsible for any overage past what insurance would pay. I very much doubt anyone would catch it until the bill was contested later. What would a court say? Would it be as legally binding as the standard document? Edit: Or imagine a disgruntled employee in the copy room changing the form?
  - Peku 4y ago
    There is a story is someone doing something similar with their credit card [1]. Not sure how well something like this would fly in the states, but it would be interesting. [1] https://www.nasdaq.com/articles/updated-russian-man-turns-tables-on-bank-changes-fine-print-in-credit-card-agreement-then https://www.nasdaq.com/articles/updated-russian-man-turns-ta...
  - Vecr 4y ago
    It would have to be signed by both sides to count. I've done it before, but you can't just try to sneak things through if they don't sign.
    - bshep 4y ago
      In my experience these forms are only signed by patients, so why are they valid in those cases?
      - lisper 4y ago
        The signatures per se don't really matter. What matters in contract law is if there was an actual agreement. The signatures are just evidence that there was an actual agreement. They are neither necessary nor sufficient. This is why verbal agreements can be binding contracts, it's just that these are harder to enforce because it's harder to show that a verbal agreement was actually entered into.
        DennisP 4y ago
- Chris2048 4y ago
  > contending that it was proprietary and a trade secret surely once a patient gets a bill (preferably itemized) the secret price of something is no longer secret. Further, what ensures there even is a consistent price if they refuse to disclose it?
- deleted 4y ago
  [deleted]
upbeat_general 4y ago
These are the extreme cases but this happens all the time, including to myself (albeit only for a few hundred dollars). It’s shocking that somehow the system we’ve come to amounts to “we don’t know the cost, we’ll talk to your insurance after and bill you some amount.”
- BlackjackCF 4y ago
  Yeah, it's either that or "we'll cover what we think is a reasonable amount for your zip code". Which is usually SEVERELY UNDER the market rate in that area. As an American, I was shocked when I lived in Ireland and saw prices for stuff upfront.
  - Fernicia 4y ago
    Getting stuff done privately in Ireland is great and fairly cheap. But relying on the HSE can leave you waiting years for basic treatment.
- nopenopenopeno 4y ago
  It’s not that shocking if we take seriously the logical conclusions of a society that mediates relations between people by way of their relations to capital, i.e. capitalism. Insofar as the domestic American economy functions as the core of a global empire, it is uniquely prone to these seemingly nonsensical conclusions. The United States is on its 4th generation into being the most unchecked industrial capitalist empire in history. I think it would actually be more surprising if we had a sensical healthcare system.
  - dahfizz 4y ago
    When my car breaks, a mechanic can give me a detailed estimate which is very close to the final cost every time. There is no reason inherint to capitalism that healthcare couldn't work the same. Every other industry under capitalism has sane billing practices. Regardless, healthcare is far from being an "unchecked" free market. The government deals more in healthcare than any other market, except maybe student loans.
asperous 4y ago
The disappointing thing to me is all the time spent on this case: lawyers, administrators, jury members, and so on that could be doing something different, hopefully more meaningful to society. People blame the hospitals but this the game they have to play in order to cover their costs [1]. Just seems like a tremendous waste of resources and social cost. https://truecostofhealthcare.org/hospital_financial_analysis/ https://truecostofhealthcare.org/hospital_financial_analysis...
- macintux 4y ago
  I'd be curious how much money is spent each year on the bureaucracy of healthcare, from employees who do little besides manage health insurance, insurance company employees, billing specialists in medical establishments, etc, etc, etc.
- ktzar 4y ago
  Private medical services are a very profitable business for certain professions that buzz around doctors and nurses. People without knowledge about medicine and whose only interest is a private company's benefit.
- PaywallBuster 4y ago
  > Hospitals over-bill persistently and excessively to the point where hospital billing charges have ceased to have much meaning beyond their ability to shock and frighten people. The > While Medicare and Medicaid control their costs by tying their payments to the actual cost of medical services, private insurance companies appear to be just paying a fixed percentage of what they’re billed. That alone gives hospitals a strong motivation to inflate their billing charges by more each year independent of their costs.
  - geoduck14 4y ago
    Medicare isn't that great, too. My wife worked health care and Medicare patients were difficult because of the weird paperwork
  - lr4444lr 4y ago
albertopv 4y ago
There are many things for which I envy USA, health care system is not one of them, not at all.
temp8964 4y ago
If you read the article, the hospital made a mistake, didn’t know she’s an out-of-network patient, so got the insurance wrong. If you only read the title, it sounds like the hospital scammed her. All the reports on this news sound this way. The downvotes are crazy. I in no way indicated that the woman should pay the full amount because of the hospital’s mistake. Also, if you have an open mind, you could see another perspective: her insurance is amazingly good, cutting $23k bill to $1.3k.
- mlyle 4y ago
  > If you only read the title, it sounds like the hospital scammed her. All the reports on this news sound this way. Well, personally: if I'm told that something will cost me $1300, and then there's a mistake, and they'll actually consult a big pile of papers that I'm not allowed to see to decide what to charge me... that sounds like a scam. With an accurate estimate and correct information about the hospital not being in network, she would have chosen a different provider for her surgery. > Also, if you have an open mind, you could see another perspective: her insurance is amazingly good, cutting $23k bill to $1.3k. ? Hospital estimated $1300 after her insurance, and provided no other info. Then she was billed $229,000. No one cut her bill to $1.3k, other than the legal system requiring the hospital to honor its original estimate after litigation.
- spywaregorilla 4y ago
  One should not need to pay $230k for back surgery regardless of circumstances.
  - temp8964 4y ago
    What’s your point against my comment?
- adra 4y ago
  Let's say I bought a server from Dell. They quote me a cost of $6000. Maybe they assumed I was part of an MVP program that I hadn't been aware of. I have it delivered and installed and later the rep invoices me the price at 1 million dollars for the server because they made a "mistake" on the discount. I may have signed a resale agreement telling them that I'd pay for the hardware sent to me, so tell me how this is fair and equitable trade practices? It may be viable to ship the server back and call the sale a wash, but there's no rolling back medical treatment.
Threeve303 4y ago
Imagine going grocery shopping because you need food to live. You see the prices posted and you pay at the register. Then a few months later Trader Joes sends you a bill for $200,000… The entire Health care system is absolutely insane.
- ketanmaheshwari 4y ago
  These kind of overly simplified comparisons are tired and doesn't help anyone. Healthcare billing is insane yes but is not same as buying groceries.
  - HFguy 4y ago
    But here's the thing...it could be made to be that simple.
  - geoduck14 4y ago
    Let me give you a comparison from my personal experience. My wife was pregnant. The hospital she chose to give birth in specialized in giving birth. Our health plan was administered by a large company, and was used by over 10k employees at our company. During the pregnancy, I tried multiple times to determine how much the pregnancy would cost. Neither the hospital nor the insurance could tell me any estimate for the cost. I had no way to price shop or save or budget. I was completely at the whims of the hospital and insurance. Also. They over charged me for at least one procedure.
    - peter422 4y ago
      My wife gave birth at a hospital in our network, but our daughter needed ICU care (in their opinion). We were given no choice in the matter and our child was taken to the ICU. And surprise, surprise, the ICU doctor we had no choice in selecting was not in network, and a low 5-figure bill was racked up for care we didn't really want and our child almost certainly didn't need. Also a very difficult thing to fight when you've got a newborn.
      - 4y ago
rdxm 4y ago
paulgb 4y ago
I don’t understand how hospitals can ever expect a contract with such ambiguous terms to be valid. Contract law requires a “meeting of the minds” — if they withhold price information until after the service is performed, and the final price is orders of magnitude higher than the expectation it’s clear that hasn’t happened. Contract law is often seen as existing to protect the seller from non-payment, but it equally exists to protect the buyer from stuff like this, and it’s absurd that these companies expect the protection of contract law without giving their customers the same benefit.
- jopsen 4y ago
  I suspect healthcare providers won't give you a price before they are done, because they don't know what it'll cost. If they open you up, they might have a complication or run into some other issue that must be fixed before closing you down. Say allergic reaction to drugs or something that require extra care. I suppose one could argue that healthcare providers should assume this liability and give you a price upfront, factoring into it the risk of complications, etc. But in the end, if you don't pay for your own bad luck, then you might as well have universal healthcare :)
  - paulgb 4y ago
    That makes sense, but even nailing down a price for lab bloodwork turns out to be elusive. I’m dealing with a bill that I discussed with the doctor beforehand that turned out to be 4x what we discussed. I don’t blame the doctor, I don’t think he had access to the true cost either.
    - BenjiWiebe 4y ago
      Depending on the blood work, it might be worth it to get it done via walkinlabs.com or a competitor. Up front with the pricing and usually cheaper than the alternatives as well.
  - TomSwirly 4y ago
    None of your hypotheticals actually happened in this situation. The hospital clerk wrote down that she was "in-network", gave her a quote and then after the procedure, the hospital discovered she was not, and upped the quote by $200k. Hospitals do whatever dishonest stuff they feel like all time, and the worst consequence to them is that they don't get their $200k and consequentially ruin someone's life with debt collectors. If every time hospitals tried to steal from someone - because that's what this is - one of their senior managers did a year in the penitentiary, such brazen dishonesty would cease overnight.
pcurve 4y ago
In the U.S., insurance would reimburse upwards of $100k to hospital for this procedure. The same procedure in Germany would cost $20-$30k. I guess that's why some insurance companies are paying for medical tourism.
Havoc 4y ago
US healthcare is a cruel joke. You even see this in international coverage - global except for US. Though my current one excludes canada and caribbean too for reasons I don't quite understand. Tainted by proximity perhaps
throwaway742 4y ago
Actual quoted cost was 1,337. Nice.
spaetzleesser 4y ago
It's hard to understand that the most predatory industry in the US is health care and people are OK with it. It's easier to deal with loan sharks or used car dealers vs hospitals and health insurance.
- DangitBobby 4y ago
  I don't think people are okay with it. It seems very likely that our politicians are bought and paid for and that's why there's no one truly representing the public's interest.
deleted 4y ago
[deleted]
lifeisstillgood 4y ago
Ok this is a silly question but would a simple law that's says "you must provide an estimate before any medical procedure and cannot charge over that". And these charges must be available on your website and fixed for 60 days. then you might see some competition ? I mean my NHS - born heart hurts at the idea but still ...
mobilio 4y ago
Archive: https://archive.ph/9ezo4 https://archive.ph/9ezo4
akomtu 4y ago
It is this reason why I compare the US hospitals to white-shoe mexican cartels. The latter use simple intimidation to take what they want. Our hospitals identify a potential victim in need who needs immediate help, and thus can't negotiate, force you to sign a blank check (using verbal intimidation), force you to waive your right for protection from racket (binding arbitration), lie about costs (they call it a good faith estimate), then estimate your net worth and demand half of that. When you refuse, they send their white-shoe gangsters (lawyers) and take that half. A carnival of greed and moral depravity.
- indymike 4y ago
  > A carnival of greed and moral depravity. This seems to sum up the US healthcare system perfectly.
  - visarga 4y ago
    Apparently the top goal in US medicine is profit. Providing health care is secondary.
- DangitBobby 4y ago
  > force you to sign a blank check (using verbal intimidation), Well, in many cases it's more than just verbal intimidation; it's threat of imminent physical harm. You know that you won't get better terms by shopping around, either.
x-shadowban 4y ago
It would be nice if this was the public debate we were having. Recently they dragged oil company execs in for a light video chat based grilling in the house. I would prefer to see the medical insurance companies pilloried, but and for those pillorings to yield something of substance. I imagine that every minute of talk about abortion or immigration has the insurance companies and its benefactors thinking "wow, we're still getting away with it!"
- spaetzleesser 4y ago
  "I imagine that every minute of talk about abortion or immigration has the insurance companies and its benefactors thinking "wow, we're still getting away with it!"" That's how the US political system works. We are only allowed to debate a small range of issues that don't affect the income of the capitalists.
ed25519FUUU 4y ago
No good precedent set with this case. Hospitals will simply update their service terms to be really clear that you’re agreeing to what the “chargemaster” says you owe. They’ll mention it like 5 times so they don’t lose on these terms again. Really a shame.
- DangitBobby 4y ago
  The judge specifically mentioned that they chargemaster is not shared with the patient as a protected trade secret, so I think this sets a precedent that you can't be held to terms about price if you aren't going to disclose the price.
PragmaticPulp 4y ago
Some good news: As of 2022, we have a new "No Surprise Billing" law that covers many of these surprise billing scenarios. There is a specific provision for being charged significantly ($400) more than a "good faith estimate" More detail about the No Surprise Billing law here: https://www.cms.gov/newsroom/fact-sheets/no-surprises-understand-your-rights-against-surprise-medical-bills https://www.cms.gov/newsroom/fact-sheets/no-surprises-unders... Sadly this case occurred prior to the law going into effect.
- JamesUtah07 4y ago
  I’m worried that the hospital forms will start to include a clause to agree to “waive” the affects of this bill
  - ceejayoz 4y ago
    Yes, and it’ll be done via that little electronic signature pad that doesn’t show what you’re signing for.
    - iordachej 4y ago
      Agree with you, I always felt frustrated by signing on pads and not only on Hospitals but Banks as well. I tried to fix this by building a platform for using iPad where one can see the whole document, something like docusign but focused on tablet-based signing. We’ll see how it goes
- DangitBobby 4y ago
  Seems to me that ultimately this will have little to no effect since they gave them an escape route. > Require that health care providers and facilities give you an easy-to-understand notice explaining the applicable billing protections, who to contact if you have concerns that a provider or facility has violated the protections, and that patient consent is required to waive billing protections (i.e., you must receive notice of and consent to being balance billed by an out-of-network provider). All hospitals will simply make you wave your rights as part of their onboarding process. These rights need to be something that cannot be waived or they actually just add more work for hospitals (ie, more cost for patients) and more work for patients. Edit: After further reading, in all emergency care scenarios and certain non-emergency care scenarios, they cannot ask you to waive these protections. Though, I wonder who gets to decide if it was an emergency? Certainly not the patient.
yes_really 4y ago
The most revolting part of the US medical system IMO is the complete lack of transparency in prices. In the ideal case, people would know what they would pay in each hospital when they are still deciding where to go.
jokoon 4y ago
It still boggles my mind how the US is the "first world power", and yet there is so much gun violence, those healthcare problems, homelessness, high co2 per capita, obesity, the prison system (especially in Louisiana where it's almost still slavery for inmates), money in politics, inability to get abortion... All those issues are usually found in third world of developing countries, so I'm often quite confused...
- 22SAS 4y ago
  >Obesity Sadly, in the US, there're obese people who're strongly into nonsensical movements like HAES (Healthy At Every Size), fat positivity. They think being obese is good, healthy, and doing nothing to address is a great thing. If one so happens to tell them about the health risks due to obesity, they are termed as fatphobic.
  - jokoon 4y ago
    On one side, the food industry is largely responsible for this, and the other side, fat people are ill, but they're often being told they're responsible for their weight. It's a bit like telling depressed people they're responsible for their mental illness.
  - DangitBobby 4y ago
    Surpisingly it's easier to just un-learn what you know about personal health to protect your self-image than it is to lose weight and keep it off. I say this as someone who has lost weight and kept it off.
- DangitBobby 4y ago
  From the inside, it very much feels like the decline of an empire. We're really getting it from all sides, and people just in general seem pretty unhinged.
- masonic 4y ago
  >the US is the "first world power", and yet there is so much gun violence, those healthcare problems, homelessness, high co2 per capita, obesity, the prison system (especially in Louisiana where it's almost still slavery for inmates), money in politics, inability to get abortion... Exactly. It's horrible here, so people should stop emigrating to the US for starters.
s0rce 4y ago
The fact that the "chargemaster" (never heard of this) is a proprietary trade secret is absurd.
czhu12 4y ago
Can anyone in healthcare on HN comment on how a surgery could cost 229k? Really curious how that number breaks down in terms of equipment, salary, medications, etc.
- ceejayoz 4y ago
  It doesn’t. Chargemaster rates are meant to be slashed 50-90% when they get to the insurance company. We got a bill for $560 today that $500 worth just… disappeared when insurance said “nah”, because that’s the deal the two of them have. If you don’t have insurance, or they pull the “it’s not covered” you get to fight the hospital yourself.
danielschonfeld 4y ago
What will it finally take to cut this cancer called “healthcare” in the United States? There is nothing promoting health or care in it
quadrifoliate 4y ago
The biggest problem here is this "full cost, because it was out-of-network" nonsense. I don't understand how healthcare networks are legal – they essentially create two separate medical systems, one of might not accept your so-called "insurance" at all. I know that universal coverage is a pipe dream in the US, but making these coverage networks illegal and forcing insurers to cover procedures at the same rate regardless of network would be a good first step. And it should be a bipartisan issue as well, somehow I don't see conservatives clamoring to keep paying higher prices for ambiguously defined "networks".
punnerud 4y ago
I studied in US and one of my classmates from Norway was mildly hit by a car when she was biking. Just to be sure she did not break the leg she took an x-ray. The bill accidentally was send to her address with a request for $8000 (luckily covered by insurance). We almost don’t pay anything in Norway in comparison, I think the maximum yearly amount is $150 if you have to go a lot to the hospital. I have operated my arms several times after different action sports accidents as a child, with no cost (under 18years you don’t even pay the $150). Such a peace of mind to know we have good health service if we need it. Possible reasons why we kick ass in winter sports? Healthcare could be better compared to some of the most advanced cancer treatments in US, but not sure if most Americans can get them?
schappim 4y ago
What would it take to “fix” the US hospital system, and prevent others (the UK’s NHS, Australia’s public hospital’s etc), from falling into the same trap?
wafriedemann 4y ago
"hospital (...) told her she would be personally responsible for paying about $1,337" LUL 1337 scammers
motohagiography 4y ago
We need a better black market for medical services at least there is some honor among gangsters. These hospitals seem to be set up to find people in duress and not merely rob them, but loot their net worth. It's predation. Seriously, as a manual skill, how hard are 80% of superficial surgeries really compared to learning an instrument or classical music, learning to code, baking, cultivating a respectable golf handicap, or getting good at a sport? It's hard to reconcile stories like this with talking about health care workers as heroes, when it sounds like people who work in US health care, if they are not themselves, they at least work for someone who they know is in fact, dispicable.
- dennis_jeeves1 4y ago
  You are correct the vast majority of medicine as is normally practiced are skill that can be easily picked up, but you know good old humans, they make a mountain out of a mole hill, so they make a bunch of regulations...
- bastawhiz 4y ago
  Skilled piercers and body modification artists already perform lots of "superficial" cosmetic procedures, sometimes for orders of magnitude less than plastic surgeons would (which are, of course, not covered by insurance). I've even seen some artists correcting procedures that "real" doctors botched and wanted even more money to fix—a common one is keloid removal.
ryanSrich 4y ago
There have been lots of discussions lately on various crypto scams, but the biggest scam no one wants to fix is the American health system. Until you’ve experienced it yourself it almost sounds unbelievable how bad it is. Calling it a scam is an understatement.
eecc 4y ago
Ah thankfully it’s not a Libertarian world yet, where the State’s only purpose is to guarantee the rule of law, and the freedom to engage in whatever contract.
- whiddershins 4y ago
  No one knows what that would look like … wait, Dentists. Mexico. Thailand. Singapore. The obvious reality is that something structural is causing this massive price inflation, and the government is heavily involved in this structure already.
otikik 4y ago
Single player now
Ekaros 4y ago
This whole insurance getting discounts seems pure insanity. Maybe simplest would be to mandate single price or range for any operation. Can't ever give discount on that. If you want to do charity cases set entity that you sponsor to pay for things and maybe legislate that receiving such support is tax free.
janjanmax 4y ago
Leave it to the New York Times and its editors to omit the fact MEDICARE FOR ALL would eliminate this egregious charges to everyone all the time. You already paid it with taxes and save your self from bankruptcy. They don’t even mention it. They are not the arbitres of truth. Our healthcare is awful.
whiddershins 4y ago
In New York State, if your insurance covers the procedure, it is illegal for the hospital to bill you above and beyond that amount. All these complicated solutions, Medicare for all, etc. and one law solves this.

257 points by 8bitsrule 4y ago

> Before her surgery, Ms. French signed two service agreements promising to pay “all charges of the hospital.” > In Centura’s view, the service agreements “were unambiguous and French’s agreement to pay ‘all charges’ ‘could only mean’ the predetermined rates set by Centura’s chargemaster,” the court said. > But the court found that Ms. French wasn’t responsible for paying those rates because she didn’t know the chargemaster even existed and hadn’t agreed to its terms. > “Indeed, Centura representatives testified that the chargemaster was not provided to patients, and in this very litigation, Centura refused to produce its chargemaster to French, contending that it was proprietary and a trade secret,” Justice Richard L. Gabriel wrote. Beyond ludicrous...

pevey 4y ago
It’s amazing that any of these “agreements” are ever upheld by courts. As standard procedure, you have to agree to any and all charges, but in most cases they refuse to give any estimate of what those charges might be. They are “trade secrets.” But if you don’t agree, you cannot get lifesaving care. It is unconscionable. In this case, she is lucky they gave her that insurance estimate. Usually they refuse specifically for the reason of what happened in this case. They expect you to agree to pay whatever they decide later. And people keep trying to argue the US has a great healthcare system. It is beyond broken. The very rich don’t have to worry, the very poor don’t have to worry. The rest of us can get screwed if we have the very bad luck of being US citizens who happen to get sick or into an accident.
- user3939382 4y ago
  Totally agree. All these agreements are signed under duress and ask the signer to agree to pay an amount while making it impossible for the signer to know whether that’s possible.
  - babyshake 4y ago
    If you don't sign and you need treatment to live, aren't doctors obligated to treat you per the Hippocratic oath?
    - cool_dude85 4y ago
      Are you dying, like, right now? Or are you just going to die in a few months? Come back when you're dying.
- 88913527 4y ago
  You can always try a different hospital for better service. Of course this won't work in situations where timing is critical, but most surgery is scheduled. We might as well treat it for the business that it is. If they can't give you a reasonable estimate up front, then don't sign the paperwork. If they care about earning your money they will negotiate with you, and it's always better to negotiate terms up front proactively than deal with it reactively. The strongest power a consumer has is to vote with their money.
  - est31 4y ago
    > If they can't give you a reasonable estimate up front, then don't sign the paperwork. That's the issue, they don't give you estimates that they are actually bound by.
    - 88913527 4y ago
      And if you're an hour away from being in the operating theater, and they have all the specialists there, and in that moment you choose not to sign-- it's more their problem than yours.
      - FredPret 4y ago
        …no it isn’t? You need to get surgery, they want to provide surgery
        crooked-v 4y ago
        That's what makes it your problem. They can just say 'no' until you sign the document agreeing to pay whatever they bill you later.
        OJFord 4y ago
        I think GGP commentor typo'd - it says the opposite at time of writing.
      - 4y ago
- agiamas 4y ago
  agreed. You are under huge distress and don't have a viable alternative and your life is in danger and you sign what is really, a contract to pay with the amount to be paid being blank. So essentially and legally speaking, how is this different than blackmail?
  - SemanticStrengh 4y ago
    is there a limit? Can you legally enforce a hidden 1 billion dollar debt to someone?
    - drdec 4y ago
      It would be dischargeable in bankruptcy so there is a practical limit.
    - JJMcJ 4y ago
      Usually courts won't uphold "unconscionable" charges. Charge someone $1 billion to change a tire. Nope, nope, nope, as an example.
      - SemanticStrengh 4y ago
        but somehow 229K is Okay? Where is the limit
        JJMcJ 4y ago
        Hospitals seem to have the world hypnotized.
- prepend 4y ago
  > And people keep trying to argue the US has a great healthcare system. I’ve never heard anyone argue this. The common argument is that it really sucks and that proposed changes suck as well. So the argument isn’t “don’t change because it’s great.” The argument is “It’s terrible and I’m worried that if you change it, it will get worse.”
  - tomxor 4y ago
    I've come across a number of HN commenters claiming US healthcare is better than the EU or UK. I'd argue it's pretty broken compared to both. The UK's NHS is far from perfect yet serves the majority of people well without bankrupting them. Countries of the EU will have varying quality of healthcare, yet I'd still trust them over the US due to my fear of the US's highly profit driven system (which can cost you more than money). I suspect those claiming US healthcare is superior are able to pay quarter of a million without blinking - however they still run the risk of unnecessary surgery and aggressive prescription of addictive substances.
    - BobbyJo 4y ago
      I think we can separate the administration of the care from the are itself. I believe the US has among the best care. I also believe our administration of said care is among the worst, if not the worst.
      - tomxor 4y ago
        True, I wouldn't be surprised if the US was amongst the lead in quality of medical procedures - when that procedure is necessary... but beyond administration, there have been numerous instances of doctors being exposed for electing patients for unnecessary procedures driven by profits, and other procedures being recommended when scientific evidence suggest the procedure has no clear benefit - no matter the quality of surgery, it always comes at significant risk and cost to your body, it's not a magic wand; it's a traumatic intervention that requires your body to go through a lot of recovery with possible lasting effects. This can be true to a lesser extent for less severe medical interventions too. So my point is, what use is excellent "care" if not only it's life endingly expensive, but it's also prescribed immorally to the point of actually causing harm!
- chimeracoder 4y ago
  > And people keep trying to argue the US has a great healthcare system I've never heard anyone argue that the billing and payment aspects of the US healthcare system are great. I have heard people argue that the quality of care (by various metrics) or availability of services are great, but that's a different argument, and not mutually incompatible with having a broken payment and billing infrastructure. > The very rich don’t have to worry, the very poor don’t have to worry. I'm not sure how you're arriving at the conclusion that "the very poor don't have to worry"
bshep 4y ago
I wonder what would happen if a patient swapped the form with an identical looking form with different verbiage, making the hospital responsible for any overage past what insurance would pay. I very much doubt anyone would catch it until the bill was contested later. What would a court say? Would it be as legally binding as the standard document? Edit: Or imagine a disgruntled employee in the copy room changing the form?
- Peku 4y ago
  There is a story is someone doing something similar with their credit card [1]. Not sure how well something like this would fly in the states, but it would be interesting. [1] https://www.nasdaq.com/articles/updated-russian-man-turns-tables-on-bank-changes-fine-print-in-credit-card-agreement-then https://www.nasdaq.com/articles/updated-russian-man-turns-ta...
- Vecr 4y ago
  It would have to be signed by both sides to count. I've done it before, but you can't just try to sneak things through if they don't sign.
  - bshep 4y ago
    In my experience these forms are only signed by patients, so why are they valid in those cases?
    - lisper 4y ago
      The signatures per se don't really matter. What matters in contract law is if there was an actual agreement. The signatures are just evidence that there was an actual agreement. They are neither necessary nor sufficient. This is why verbal agreements can be binding contracts, it's just that these are harder to enforce because it's harder to show that a verbal agreement was actually entered into.
      - DennisP 4y ago
Chris2048 4y ago
> contending that it was proprietary and a trade secret surely once a patient gets a bill (preferably itemized) the secret price of something is no longer secret. Further, what ensures there even is a consistent price if they refuse to disclose it?
deleted 4y ago
[deleted]

upbeat_general 4y ago

These are the extreme cases but this happens all the time, including to myself (albeit only for a few hundred dollars). It’s shocking that somehow the system we’ve come to amounts to “we don’t know the cost, we’ll talk to your insurance after and bill you some amount.”

BlackjackCF 4y ago
Yeah, it's either that or "we'll cover what we think is a reasonable amount for your zip code". Which is usually SEVERELY UNDER the market rate in that area. As an American, I was shocked when I lived in Ireland and saw prices for stuff upfront.
- Fernicia 4y ago
  Getting stuff done privately in Ireland is great and fairly cheap. But relying on the HSE can leave you waiting years for basic treatment.
nopenopenopeno 4y ago
It’s not that shocking if we take seriously the logical conclusions of a society that mediates relations between people by way of their relations to capital, i.e. capitalism. Insofar as the domestic American economy functions as the core of a global empire, it is uniquely prone to these seemingly nonsensical conclusions. The United States is on its 4th generation into being the most unchecked industrial capitalist empire in history. I think it would actually be more surprising if we had a sensical healthcare system.
- dahfizz 4y ago
  When my car breaks, a mechanic can give me a detailed estimate which is very close to the final cost every time. There is no reason inherint to capitalism that healthcare couldn't work the same. Every other industry under capitalism has sane billing practices. Regardless, healthcare is far from being an "unchecked" free market. The government deals more in healthcare than any other market, except maybe student loans.

asperous 4y ago

The disappointing thing to me is all the time spent on this case: lawyers, administrators, jury members, and so on that could be doing something different, hopefully more meaningful to society. People blame the hospitals but this the game they have to play in order to cover their costs [1]. Just seems like a tremendous waste of resources and social cost. https://truecostofhealthcare.org/hospital_financial_analysis/ https://truecostofhealthcare.org/hospital_financial_analysis...

macintux 4y ago
I'd be curious how much money is spent each year on the bureaucracy of healthcare, from employees who do little besides manage health insurance, insurance company employees, billing specialists in medical establishments, etc, etc, etc.
ktzar 4y ago
Private medical services are a very profitable business for certain professions that buzz around doctors and nurses. People without knowledge about medicine and whose only interest is a private company's benefit.
PaywallBuster 4y ago
> Hospitals over-bill persistently and excessively to the point where hospital billing charges have ceased to have much meaning beyond their ability to shock and frighten people. The > While Medicare and Medicaid control their costs by tying their payments to the actual cost of medical services, private insurance companies appear to be just paying a fixed percentage of what they’re billed. That alone gives hospitals a strong motivation to inflate their billing charges by more each year independent of their costs.
- geoduck14 4y ago
  Medicare isn't that great, too. My wife worked health care and Medicare patients were difficult because of the weird paperwork
- lr4444lr 4y ago

albertopv 4y ago

There are many things for which I envy USA, health care system is not one of them, not at all.

temp8964 4y ago

If you read the article, the hospital made a mistake, didn’t know she’s an out-of-network patient, so got the insurance wrong. If you only read the title, it sounds like the hospital scammed her. All the reports on this news sound this way. The downvotes are crazy. I in no way indicated that the woman should pay the full amount because of the hospital’s mistake. Also, if you have an open mind, you could see another perspective: her insurance is amazingly good, cutting $23k bill to $1.3k.

mlyle 4y ago
> If you only read the title, it sounds like the hospital scammed her. All the reports on this news sound this way. Well, personally: if I'm told that something will cost me $1300, and then there's a mistake, and they'll actually consult a big pile of papers that I'm not allowed to see to decide what to charge me... that sounds like a scam. With an accurate estimate and correct information about the hospital not being in network, she would have chosen a different provider for her surgery. > Also, if you have an open mind, you could see another perspective: her insurance is amazingly good, cutting $23k bill to $1.3k. ? Hospital estimated $1300 after her insurance, and provided no other info. Then she was billed $229,000. No one cut her bill to $1.3k, other than the legal system requiring the hospital to honor its original estimate after litigation.
spywaregorilla 4y ago
One should not need to pay $230k for back surgery regardless of circumstances.
- temp8964 4y ago
  What’s your point against my comment?
adra 4y ago
Let's say I bought a server from Dell. They quote me a cost of $6000. Maybe they assumed I was part of an MVP program that I hadn't been aware of. I have it delivered and installed and later the rep invoices me the price at 1 million dollars for the server because they made a "mistake" on the discount. I may have signed a resale agreement telling them that I'd pay for the hardware sent to me, so tell me how this is fair and equitable trade practices? It may be viable to ship the server back and call the sale a wash, but there's no rolling back medical treatment.

Threeve303 4y ago

Imagine going grocery shopping because you need food to live. You see the prices posted and you pay at the register. Then a few months later Trader Joes sends you a bill for $200,000… The entire Health care system is absolutely insane.

ketanmaheshwari 4y ago
These kind of overly simplified comparisons are tired and doesn't help anyone. Healthcare billing is insane yes but is not same as buying groceries.
- HFguy 4y ago
  But here's the thing...it could be made to be that simple.
- geoduck14 4y ago
  Let me give you a comparison from my personal experience. My wife was pregnant. The hospital she chose to give birth in specialized in giving birth. Our health plan was administered by a large company, and was used by over 10k employees at our company. During the pregnancy, I tried multiple times to determine how much the pregnancy would cost. Neither the hospital nor the insurance could tell me any estimate for the cost. I had no way to price shop or save or budget. I was completely at the whims of the hospital and insurance. Also. They over charged me for at least one procedure.
  - peter422 4y ago
    My wife gave birth at a hospital in our network, but our daughter needed ICU care (in their opinion). We were given no choice in the matter and our child was taken to the ICU. And surprise, surprise, the ICU doctor we had no choice in selecting was not in network, and a low 5-figure bill was racked up for care we didn't really want and our child almost certainly didn't need. Also a very difficult thing to fight when you've got a newborn.
    - 4y ago

rdxm 4y ago

paulgb 4y ago

I don’t understand how hospitals can ever expect a contract with such ambiguous terms to be valid. Contract law requires a “meeting of the minds” — if they withhold price information until after the service is performed, and the final price is orders of magnitude higher than the expectation it’s clear that hasn’t happened. Contract law is often seen as existing to protect the seller from non-payment, but it equally exists to protect the buyer from stuff like this, and it’s absurd that these companies expect the protection of contract law without giving their customers the same benefit.

jopsen 4y ago
I suspect healthcare providers won't give you a price before they are done, because they don't know what it'll cost. If they open you up, they might have a complication or run into some other issue that must be fixed before closing you down. Say allergic reaction to drugs or something that require extra care. I suppose one could argue that healthcare providers should assume this liability and give you a price upfront, factoring into it the risk of complications, etc. But in the end, if you don't pay for your own bad luck, then you might as well have universal healthcare :)
- paulgb 4y ago
  That makes sense, but even nailing down a price for lab bloodwork turns out to be elusive. I’m dealing with a bill that I discussed with the doctor beforehand that turned out to be 4x what we discussed. I don’t blame the doctor, I don’t think he had access to the true cost either.
  - BenjiWiebe 4y ago
    Depending on the blood work, it might be worth it to get it done via walkinlabs.com or a competitor. Up front with the pricing and usually cheaper than the alternatives as well.
- TomSwirly 4y ago
  None of your hypotheticals actually happened in this situation. The hospital clerk wrote down that she was "in-network", gave her a quote and then after the procedure, the hospital discovered she was not, and upped the quote by $200k. Hospitals do whatever dishonest stuff they feel like all time, and the worst consequence to them is that they don't get their $200k and consequentially ruin someone's life with debt collectors. If every time hospitals tried to steal from someone - because that's what this is - one of their senior managers did a year in the penitentiary, such brazen dishonesty would cease overnight.

pcurve 4y ago

In the U.S., insurance would reimburse upwards of $100k to hospital for this procedure. The same procedure in Germany would cost $20-$30k. I guess that's why some insurance companies are paying for medical tourism.

Havoc 4y ago

US healthcare is a cruel joke. You even see this in international coverage - global except for US. Though my current one excludes canada and caribbean too for reasons I don't quite understand. Tainted by proximity perhaps

throwaway742 4y ago

Actual quoted cost was 1,337. Nice.

spaetzleesser 4y ago

It's hard to understand that the most predatory industry in the US is health care and people are OK with it. It's easier to deal with loan sharks or used car dealers vs hospitals and health insurance.

DangitBobby 4y ago
I don't think people are okay with it. It seems very likely that our politicians are bought and paid for and that's why there's no one truly representing the public's interest.

deleted 4y ago

[deleted]

lifeisstillgood 4y ago

Ok this is a silly question but would a simple law that's says "you must provide an estimate before any medical procedure and cannot charge over that". And these charges must be available on your website and fixed for 60 days. then you might see some competition ? I mean my NHS - born heart hurts at the idea but still ...

mobilio 4y ago

Archive: https://archive.ph/9ezo4 https://archive.ph/9ezo4

akomtu 4y ago

It is this reason why I compare the US hospitals to white-shoe mexican cartels. The latter use simple intimidation to take what they want. Our hospitals identify a potential victim in need who needs immediate help, and thus can't negotiate, force you to sign a blank check (using verbal intimidation), force you to waive your right for protection from racket (binding arbitration), lie about costs (they call it a good faith estimate), then estimate your net worth and demand half of that. When you refuse, they send their white-shoe gangsters (lawyers) and take that half. A carnival of greed and moral depravity.

indymike 4y ago
> A carnival of greed and moral depravity. This seems to sum up the US healthcare system perfectly.
- visarga 4y ago
  Apparently the top goal in US medicine is profit. Providing health care is secondary.
DangitBobby 4y ago
> force you to sign a blank check (using verbal intimidation), Well, in many cases it's more than just verbal intimidation; it's threat of imminent physical harm. You know that you won't get better terms by shopping around, either.

x-shadowban 4y ago

It would be nice if this was the public debate we were having. Recently they dragged oil company execs in for a light video chat based grilling in the house. I would prefer to see the medical insurance companies pilloried, but and for those pillorings to yield something of substance. I imagine that every minute of talk about abortion or immigration has the insurance companies and its benefactors thinking "wow, we're still getting away with it!"

spaetzleesser 4y ago
"I imagine that every minute of talk about abortion or immigration has the insurance companies and its benefactors thinking "wow, we're still getting away with it!"" That's how the US political system works. We are only allowed to debate a small range of issues that don't affect the income of the capitalists.

ed25519FUUU 4y ago

No good precedent set with this case. Hospitals will simply update their service terms to be really clear that you’re agreeing to what the “chargemaster” says you owe. They’ll mention it like 5 times so they don’t lose on these terms again. Really a shame.

DangitBobby 4y ago
The judge specifically mentioned that they chargemaster is not shared with the patient as a protected trade secret, so I think this sets a precedent that you can't be held to terms about price if you aren't going to disclose the price.

PragmaticPulp 4y ago

Some good news: As of 2022, we have a new "No Surprise Billing" law that covers many of these surprise billing scenarios. There is a specific provision for being charged significantly ($400) more than a "good faith estimate" More detail about the No Surprise Billing law here: https://www.cms.gov/newsroom/fact-sheets/no-surprises-understand-your-rights-against-surprise-medical-bills https://www.cms.gov/newsroom/fact-sheets/no-surprises-unders... Sadly this case occurred prior to the law going into effect.

JamesUtah07 4y ago
I’m worried that the hospital forms will start to include a clause to agree to “waive” the affects of this bill
- ceejayoz 4y ago
  Yes, and it’ll be done via that little electronic signature pad that doesn’t show what you’re signing for.
  - iordachej 4y ago
    Agree with you, I always felt frustrated by signing on pads and not only on Hospitals but Banks as well. I tried to fix this by building a platform for using iPad where one can see the whole document, something like docusign but focused on tablet-based signing. We’ll see how it goes
DangitBobby 4y ago
Seems to me that ultimately this will have little to no effect since they gave them an escape route. > Require that health care providers and facilities give you an easy-to-understand notice explaining the applicable billing protections, who to contact if you have concerns that a provider or facility has violated the protections, and that patient consent is required to waive billing protections (i.e., you must receive notice of and consent to being balance billed by an out-of-network provider). All hospitals will simply make you wave your rights as part of their onboarding process. These rights need to be something that cannot be waived or they actually just add more work for hospitals (ie, more cost for patients) and more work for patients. Edit: After further reading, in all emergency care scenarios and certain non-emergency care scenarios, they cannot ask you to waive these protections. Though, I wonder who gets to decide if it was an emergency? Certainly not the patient.

yes_really 4y ago

The most revolting part of the US medical system IMO is the complete lack of transparency in prices. In the ideal case, people would know what they would pay in each hospital when they are still deciding where to go.

jokoon 4y ago

It still boggles my mind how the US is the "first world power", and yet there is so much gun violence, those healthcare problems, homelessness, high co2 per capita, obesity, the prison system (especially in Louisiana where it's almost still slavery for inmates), money in politics, inability to get abortion... All those issues are usually found in third world of developing countries, so I'm often quite confused...

22SAS 4y ago
>Obesity Sadly, in the US, there're obese people who're strongly into nonsensical movements like HAES (Healthy At Every Size), fat positivity. They think being obese is good, healthy, and doing nothing to address is a great thing. If one so happens to tell them about the health risks due to obesity, they are termed as fatphobic.
- jokoon 4y ago
  On one side, the food industry is largely responsible for this, and the other side, fat people are ill, but they're often being told they're responsible for their weight. It's a bit like telling depressed people they're responsible for their mental illness.
- DangitBobby 4y ago
  Surpisingly it's easier to just un-learn what you know about personal health to protect your self-image than it is to lose weight and keep it off. I say this as someone who has lost weight and kept it off.
DangitBobby 4y ago
From the inside, it very much feels like the decline of an empire. We're really getting it from all sides, and people just in general seem pretty unhinged.
masonic 4y ago
>the US is the "first world power", and yet there is so much gun violence, those healthcare problems, homelessness, high co2 per capita, obesity, the prison system (especially in Louisiana where it's almost still slavery for inmates), money in politics, inability to get abortion... Exactly. It's horrible here, so people should stop emigrating to the US for starters.

s0rce 4y ago

The fact that the "chargemaster" (never heard of this) is a proprietary trade secret is absurd.

czhu12 4y ago

Can anyone in healthcare on HN comment on how a surgery could cost 229k? Really curious how that number breaks down in terms of equipment, salary, medications, etc.

ceejayoz 4y ago
It doesn’t. Chargemaster rates are meant to be slashed 50-90% when they get to the insurance company. We got a bill for $560 today that $500 worth just… disappeared when insurance said “nah”, because that’s the deal the two of them have. If you don’t have insurance, or they pull the “it’s not covered” you get to fight the hospital yourself.

danielschonfeld 4y ago

What will it finally take to cut this cancer called “healthcare” in the United States? There is nothing promoting health or care in it

quadrifoliate 4y ago

The biggest problem here is this "full cost, because it was out-of-network" nonsense. I don't understand how healthcare networks are legal – they essentially create two separate medical systems, one of might not accept your so-called "insurance" at all. I know that universal coverage is a pipe dream in the US, but making these coverage networks illegal and forcing insurers to cover procedures at the same rate regardless of network would be a good first step. And it should be a bipartisan issue as well, somehow I don't see conservatives clamoring to keep paying higher prices for ambiguously defined "networks".

punnerud 4y ago

I studied in US and one of my classmates from Norway was mildly hit by a car when she was biking. Just to be sure she did not break the leg she took an x-ray. The bill accidentally was send to her address with a request for $8000 (luckily covered by insurance). We almost don’t pay anything in Norway in comparison, I think the maximum yearly amount is $150 if you have to go a lot to the hospital. I have operated my arms several times after different action sports accidents as a child, with no cost (under 18years you don’t even pay the $150). Such a peace of mind to know we have good health service if we need it. Possible reasons why we kick ass in winter sports? Healthcare could be better compared to some of the most advanced cancer treatments in US, but not sure if most Americans can get them?

schappim 4y ago

What would it take to “fix” the US hospital system, and prevent others (the UK’s NHS, Australia’s public hospital’s etc), from falling into the same trap?

wafriedemann 4y ago

"hospital (...) told her she would be personally responsible for paying about $1,337" LUL 1337 scammers

motohagiography 4y ago

We need a better black market for medical services at least there is some honor among gangsters. These hospitals seem to be set up to find people in duress and not merely rob them, but loot their net worth. It's predation. Seriously, as a manual skill, how hard are 80% of superficial surgeries really compared to learning an instrument or classical music, learning to code, baking, cultivating a respectable golf handicap, or getting good at a sport? It's hard to reconcile stories like this with talking about health care workers as heroes, when it sounds like people who work in US health care, if they are not themselves, they at least work for someone who they know is in fact, dispicable.

dennis_jeeves1 4y ago
You are correct the vast majority of medicine as is normally practiced are skill that can be easily picked up, but you know good old humans, they make a mountain out of a mole hill, so they make a bunch of regulations...
bastawhiz 4y ago
Skilled piercers and body modification artists already perform lots of "superficial" cosmetic procedures, sometimes for orders of magnitude less than plastic surgeons would (which are, of course, not covered by insurance). I've even seen some artists correcting procedures that "real" doctors botched and wanted even more money to fix—a common one is keloid removal.

ryanSrich 4y ago

There have been lots of discussions lately on various crypto scams, but the biggest scam no one wants to fix is the American health system. Until you’ve experienced it yourself it almost sounds unbelievable how bad it is. Calling it a scam is an understatement.

eecc 4y ago

Ah thankfully it’s not a Libertarian world yet, where the State’s only purpose is to guarantee the rule of law, and the freedom to engage in whatever contract.

whiddershins 4y ago
No one knows what that would look like … wait, Dentists. Mexico. Thailand. Singapore. The obvious reality is that something structural is causing this massive price inflation, and the government is heavily involved in this structure already.

otikik 4y ago

Single player now

Ekaros 4y ago

This whole insurance getting discounts seems pure insanity. Maybe simplest would be to mandate single price or range for any operation. Can't ever give discount on that. If you want to do charity cases set entity that you sponsor to pay for things and maybe legislate that receiving such support is tax free.

janjanmax 4y ago

Leave it to the New York Times and its editors to omit the fact MEDICARE FOR ALL would eliminate this egregious charges to everyone all the time. You already paid it with taxes and save your self from bankruptcy. They don’t even mention it. They are not the arbitres of truth. Our healthcare is awful.

whiddershins 4y ago

In New York State, if your insurance covers the procedure, it is illegal for the hospital to bill you above and beyond that amount. All these complicated solutions, Medicare for all, etc. and one law solves this.