5 ms·

> Appreciate the complexity of billing codes, these are not created by hospitals but by by the American Medical Association, Center for Medicaid/Medicare and a

> Appreciate the complexity of billing codes, these are not created by hospitals but by by the American Medical Association, Center for Medicaid/Medicare and a soup of other organizations. Indeed. This "complexity" hides so many obvious scams. Errr...well, rather, it sometimes hides these scams. For example, they billed my wife for an "ER Visit" when she gave birth. Even though the ER was in another building. (Well, except for a little sign that said "ER" over the door to the admitting room. We spent 5 minutes in that room, but it resulted in a multi thousand dollar bill.) This happens regularly and intentionally. Sure, there's the unexpected things that happen. But, the complexity of billing lets the experts (hospital administrators) deceptively game the system, and get away with it without any recourse. Enough things happen on a recurring basis that its shockingly easy for them to create "policies" about what to code and when to code -- policies explicitly designed to maximize revenue. (Even if they're stretching the truth.)

temporallobe 4y ago
> This happens regularly and intentionally. And there are absolutely zero consequences for this, which is why it will never stop. It’s not even negligence, it’s straight up fraud; and if you refuse to pay, your credit can be ruined, so in effect you’re being intimidated and coerced into just paying it “or else”. I sure wish I had the power to send someone a bill for non-existent goods or services and that it could be legally backed by governments and corporations.
fhsm 4y ago
It never crossed my mind that OB ERs would be seen as fraud instead of specialized care for readily identified special populations. I guess this is a major case of YMMV but with three* lifetime trips to an emergency room under my belt I think the separate OB ER is a fantastic idea. The OB ER provided rapid definitive care vs the regular adult ED which was a hellscape. *the third trip, like you, was passing through the OB ER on the way to delivery and I’d never count it normally… then again unlike you my total cost out of pocket was $5. The financial experience of childbirth has been one of the most useful tools in reframing my understanding of total comp as something very different than salary.
- andelink 4y ago
  > The financial experience of childbirth has been one of the most useful tools in reframing my understanding of total comp as something very different than salary. Sorry, can you elaborate on this? Childbirth costs and TC vs salary? I’m really intrigued but not totally understanding
  - fhsm 4y ago
    caveat emptor: rando on the Internet... TL;DR: consumption of healthcare on a gold plated health plan meant that my total comp was more than I've ever gotten in salary on the FAANG RSU train and whereas its easy to talk about RSUs its hard to talk about 'golden EOBs'. The eye opening has roughly two versions all of which you can see in a peer group when babies start landing: 1. The tail event Lets say you're a SWE making $500k/yr then you have a child and run up a $2m NICU bill and then a $2m cochlear implant bill after that... most people look at your $500k in 'salary' (base + bonus + stock) and say 'wow you're well paid' in reality what they should look at is your $5 copay and $1k total annual and say 'wow you're well paid' (an extra $1,999k in consumption enabled by your work). Remember it's even more extreme than raw numbers b/c your $1m in wages over these two consumption events gets squeezed through an income tax that (in CA) is ~50% vs. your employer sponsored plan paying the $4m in bills (granted crazy hospital Monopoly dollars) without that tax drag. 2. The ordinary frustration boplicity and I consumed the same service (OB ER triage) and boplicity ended up unhappy to be out 'multi thousand dollars' in user fees whereas I was happy to be out $5. When a peer groups starts having children this first - for many - substantial engagement with the healthcare system shows just how different 'good' employer sponsored plans are. In my peer group share of cost, network of options, extent of benefits were all meaningfully different even among prestige employer plans. The fear of infinity $ as an upper limit paired with the loss of agency involved in infirmity causes a lot of consternation about the money and choice. It's hard to price the absence of that worry and feeling you got the short straw in the relative buying power game devalues your prestige employment. For my part, I felt fortunate to be on a plan that exposed me to ~zero financial risk or sense of network loss during a healthcare consumption event. This was not always so. As a healthy single 25 y/o with that first package I ignored 'fringe.' It didn't even make the xls doc from the HR people a free gym you use with your boss's boss is hard to price anyway. Now having worked through the GFC / COVID & consumed some healthcare the RSUs are harder to budget and health insurance reads like a deranged lottery ticket that could asymptotically approach 100% of total comp. Finally, whether any of this 'ought' to be is a separate question. As a practical matter, today, it is so - my employer can buy things I cannot and can do so with dollars I cannot match 1:1. Sometimes I value them and sometimes I do not. If the person sitting next to me values these more than I do then I am are being under compensated. If HR tried to close that gab with salary we'd have pay equity problem. As such, I believe the present tax / insurance system means we can have any two of diversity of employee preference, pay equity, comp equity (in theory ... in practice it seems we can have zero of three). Anyway, hopefully that clarifies my thinking a bit. As I said, wouldn't put much weight on it.

temporallobe 4y ago

> This happens regularly and intentionally. And there are absolutely zero consequences for this, which is why it will never stop. It’s not even negligence, it’s straight up fraud; and if you refuse to pay, your credit can be ruined, so in effect you’re being intimidated and coerced into just paying it “or else”. I sure wish I had the power to send someone a bill for non-existent goods or services and that it could be legally backed by governments and corporations.

fhsm 4y ago

It never crossed my mind that OB ERs would be seen as fraud instead of specialized care for readily identified special populations. I guess this is a major case of YMMV but with three* lifetime trips to an emergency room under my belt I think the separate OB ER is a fantastic idea. The OB ER provided rapid definitive care vs the regular adult ED which was a hellscape. *the third trip, like you, was passing through the OB ER on the way to delivery and I’d never count it normally… then again unlike you my total cost out of pocket was $5. The financial experience of childbirth has been one of the most useful tools in reframing my understanding of total comp as something very different than salary.

andelink 4y ago
> The financial experience of childbirth has been one of the most useful tools in reframing my understanding of total comp as something very different than salary. Sorry, can you elaborate on this? Childbirth costs and TC vs salary? I’m really intrigued but not totally understanding
- fhsm 4y ago
  caveat emptor: rando on the Internet... TL;DR: consumption of healthcare on a gold plated health plan meant that my total comp was more than I've ever gotten in salary on the FAANG RSU train and whereas its easy to talk about RSUs its hard to talk about 'golden EOBs'. The eye opening has roughly two versions all of which you can see in a peer group when babies start landing: 1. The tail event Lets say you're a SWE making $500k/yr then you have a child and run up a $2m NICU bill and then a $2m cochlear implant bill after that... most people look at your $500k in 'salary' (base + bonus + stock) and say 'wow you're well paid' in reality what they should look at is your $5 copay and $1k total annual and say 'wow you're well paid' (an extra $1,999k in consumption enabled by your work). Remember it's even more extreme than raw numbers b/c your $1m in wages over these two consumption events gets squeezed through an income tax that (in CA) is ~50% vs. your employer sponsored plan paying the $4m in bills (granted crazy hospital Monopoly dollars) without that tax drag. 2. The ordinary frustration boplicity and I consumed the same service (OB ER triage) and boplicity ended up unhappy to be out 'multi thousand dollars' in user fees whereas I was happy to be out $5. When a peer groups starts having children this first - for many - substantial engagement with the healthcare system shows just how different 'good' employer sponsored plans are. In my peer group share of cost, network of options, extent of benefits were all meaningfully different even among prestige employer plans. The fear of infinity $ as an upper limit paired with the loss of agency involved in infirmity causes a lot of consternation about the money and choice. It's hard to price the absence of that worry and feeling you got the short straw in the relative buying power game devalues your prestige employment. For my part, I felt fortunate to be on a plan that exposed me to ~zero financial risk or sense of network loss during a healthcare consumption event. This was not always so. As a healthy single 25 y/o with that first package I ignored 'fringe.' It didn't even make the xls doc from the HR people a free gym you use with your boss's boss is hard to price anyway. Now having worked through the GFC / COVID & consumed some healthcare the RSUs are harder to budget and health insurance reads like a deranged lottery ticket that could asymptotically approach 100% of total comp. Finally, whether any of this 'ought' to be is a separate question. As a practical matter, today, it is so - my employer can buy things I cannot and can do so with dollars I cannot match 1:1. Sometimes I value them and sometimes I do not. If the person sitting next to me values these more than I do then I am are being under compensated. If HR tried to close that gab with salary we'd have pay equity problem. As such, I believe the present tax / insurance system means we can have any two of diversity of employee preference, pay equity, comp equity (in theory ... in practice it seems we can have zero of three). Anyway, hopefully that clarifies my thinking a bit. As I said, wouldn't put much weight on it.