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Majority of debtors to US hospitals now people with health insurance

183 points by grecy 3y ago

jseliger 3y ago
It's very expensive being sick for any extended period of time; I had my first partial glossectomy surgery (removal of a piece of my tongue) in October 2022 (https://jakeseliger.com/2023/07/22/i-am-dying-of-squamous-cell-carcinoma-and-the-treatments-that-might-save-me-are-just-out-of-reach/ https://jakeseliger.com/2023/07/22/i-am-dying-of-squamous-ce...), and there are at least three major components to being sick for a long time: health itself; financial viability; and managing the healthcare team. I've been lucky with the generosity of friends and strangers regarding the second one due a successful Go Fund Me, but I've also gotten walloped with some gnarly bills, most notably for Signatera blood tests for cancer particles and for genetic testing of the tumor itself. United Healthcare considers those experimental and thus uncovered. But the genetic testing of the tumor is essential because it might lead to targeted treatments. Legislation has supposedly limited surprise out-of-network bills, but, even with insurance, costs can be very high, and those combined with not being able to work effectively leads to problems.
- plagiarist 3y ago
  I'd like to see insurers be sued for malpractice since they feel entitled to make medical decisions for people.
  - beaeglebeached 3y ago
    That will raise the price of insurance even more. Now you have to cover the cost of risk of suing your own insurance pool.
    - plagiarist 3y ago
      Alternatively, they could consider not having lone employees mass-denying procedures from a spreadsheet. Or at least stop using the AI that gets it wrong so often it's indistinguishable from intentional.
      - beaeglebeached 3y ago
        I think biggest problem is health insurance is now more like a weird HSA where insurer owns the money and operates as cartel. It might be cheaper for some to not even have it and just go to Mexico, maybe some minimal insurance only for emergency room. Hard to call it insurance, when so much used for known chronic ongoing costs.
        tenebrisalietum 3y ago
        A friend of mine had gastric bypass revision surgery in Mexico because it was cheaper.
    - wing-_-nuts 3y ago
      As opposed to a single 'doctor' mass denying 1000's of requests a day? That should be illegal.
      - beaeglebeached 3y ago
        Profit margins are like 4% on health insurance. Insurance companies introduce a lot of cost and waste, but there's no evidence to me these mass denials are anything but the market not bearing real insurance that covers things reasonably under current regulatory conditions. Could it be the consumer is too poor to pay for a bloated system that covers what it does, plus the mass denials? The whole system is fucked and the even more fucked part is mass denials may be a symptom of the madness of the inefficient rube Goldberg machine and not even a profit driver.
        antisthenes 3y ago
        > Profit margins are like 4% on health insurance. If I tell you my cost of a bottle of water is $96,000 and sell it to you for $100,000 in the middle of the desert, my profit margin is only 4%.
        beaeglebeached 3y ago
        You would also get a nice visit from the IRS.
        antisthenes 3y ago
        I'd rather pay taxes on $4000 than $0.40
        beaeglebeached 3y ago
        I honestly thought the jig here was lying about the 96k. If the bottle actually costs 96k then I don't begrudge the 4% risk for hauling to the desert.
- StockHuman 3y ago
  The old Onion joke about a nation with a GoFundMe-based healthcare system rings true.
Kon-Peki 3y ago
It's probably impossible to know the full extent of this, but some percentage of hospital debt comes from people that can fully afford their healthcare but are using the payment plans as no-interest loans while their money is invested elsewhere. The HSA accounts you get with the high-deductible plans allow you to park the money in self-directed IRA accounts for your entire life. In fact, tax law encourages you to do this.
- zepton 3y ago
  I don't think amounts that are on a payment plan would qualify as "bad debt" though - if someone is paying as agreed on a payment plan the debt isn't uncollectible.
  - Kon-Peki 3y ago
    Yes, very good point. However... The linked report states: > And as sudden operational cost pressures (including nursing shortages and higher wages) frustrate hospital financial leaders, an inability to collect all expected revenue further challenges razor-thin operating margins. > This increase creates new challenges for providers to collect higher balances that are more difficult for patients to pay either prior to services or during the typical 120-day collection window after the insurance balance has been resolved. I think they are being intentionally vague here. Are they saying they're having trouble collecting the money within the 120-day window (so their quarterly reports aren't screwed), or ever? I feel like they want you to believe that it is the latter, when in fact it is the former.
- marcus0x62 3y ago
  I’d like to know the full extent of this. I’d eat my shoe if it was more than a tenth of a percent of outstanding healthcare debt.
tiahura 3y ago
It’s called a deductible. People don’t pay their bills anymore, unless they absolutely have to.
- Supermancho 3y ago
  Generally this is true. For anything over a thousand, I try to negotiate. Most of the time they rather compromise than fight/sell it at a % to collections.
  - aantix 3y ago
    I’m curious too - what’s your best strategy for lowering?
    - tiahura 3y ago
      Call and tell them you cant pay. Will they accept (whatever 20% of the bill is). They will say no, but they will take X. Say, sorry I can't pay X how about (30%)....
  - robterrell 3y ago
    How exactly do you negotiate? After you get a bill, you call their billing number and just ask for a lower number?
    - Supermancho 3y ago
      I have simply had to say, I can't pay this* (*despite the fact it's simply violating my budget). What's the process for after a bill's due date expires? Sometimes the response is: it gets a penalty added. I reply, I can't pay that either. Can we work something out? Usually, I get connected to someone who will either offer a discount or payment plan. Sometimes this isn't going to be any better (payments for the total amount over time), but it's often interest free...since the whole point is that you can't manage it. Sometimes they are firm and say it will go to collections. At the heart of it, it's a matter of game theory. You don't get 100% of the discounts you don't pursue. For my health provider, I currently have an otherwise unmentioned number I can call for my medical bills that I can pay immediately, that gets me 25% off whatever the bill is. I would never have known about it, had I not said I couldn't pay a particularly large one.
darth_avocado 3y ago
I have good insurance and I have unpaid medical bills for the following reason: 1. Visited a doctor 4 months ago, got a bill 3 months after the visit, paid it, then got a surprise second bill, which I have put off paying because I need to find time during my work hours to follow up on with the hospital + insurance. 2. Didn’t get bills for some of the visits I made in the last 3 months. 3. Insurance randomly denied claims, so need to follow up with them and the hospital. 4. Despite insurance covering 70-90% on different services, one visit for my spouse cost us thousands. We decided to pay it off as installments instead of one time because we got a really good deal.
- throwway120385 3y ago
  This was us for my wife's pregnancy and delivery. Some of the bills were denied by Cigna for things that were covered according to their book. So we had to fight that. Cigna can take months to reprocess claims, which basically puts you into default with the hospital while you wait for the insurance to pay out for services that were supposed to be covered. We've done this after every medical event because Cigna always denies something that should be covered. And their accounting system doesn't work correctly which is something that is constantly your problem because they won't accumulate your out of pocket max or coinsurance correctly, so you CONSTANTLY have to call them about everything because it's always wrong. Cigna is the worst insurance company I've ever had the displeasure of dealing with. United Healthcare was slightly better but only slightly. For a surprise bill, my wife got fired as a patient by the biggest clinic network in our area for a bill that she didn't know she had and that the agent she talked to wouldn't provide any evidence or itemization. The agent's response when asked was "you know what this is for you should just pay it." Sounds scammy, right? They keep buying clinics we're going to and then she stops being able to see her doctors afterward. Private equity is destroying our healthcare system.
  - darth_avocado 3y ago
    Cigna was also the culprit in our case for stuff where covered items were being rejected for no reason.
  - 3y ago
taeric 3y ago
That has included me, in the past. It is stupid easy to accidentally have a debt to a hospital. For families, sensible privacy rules at clinics can mean that it is very hard to choke point bills to a single person. To the point that I asked every time if I owed money when I did checkups to be told that we did not. Only to later find that my family did, in fact, have a bill due. For a while. Recently I'm getting it with the stupid "anesthesia is billed separate from the surgery" nonsense. At least this time I noticed the bill. Why is that not a single bill, though? Imagine having to pay the cook, cleaner, server, and attendants all separately. So frustrating.
- retrac 3y ago
  I would point out that the attending surgeon, the anaesthesiologist, and the hospital all bill the patient separately here for a surgery, in Ontario, Canada. (Most people will never see these bills and it's covered by the public insurance.) The reason is that the service - the contract - is organized in that way. Between the patient and the anaesthesiologist, between the patient and the surgeon, and between the patient and the hospital. So three separate bills. The doctor and hospital will have their own contract. Legally, and in an important way when it comes to decide who to sue for malpractice, the hospital is not the provider or performer of the surgery. They just provide the venue and equipment; the doctors do the surgery.
  - AlecSchueler 3y ago
    But why is done that way? Lots of freelance chefs move between restaurants but the bill is always between the restaurant and the people who dine there.
    - beaeglebeached 3y ago
      Server is better analogy. The wage you pay/owe the waiter is direct and (mostly) separate from meal, albeit informal with only shame as a deterrent for default.
      - 3y ago
beaeglebeached 3y ago
Hospital said I owed debt. Contested claim with debt collectors. Never saw it again and not on my credit report. Know a few people who've done this.
- tlivolsi 3y ago
  My friend did the same thing.
- Turing_Machine 3y ago
  While not great, things are a little better in this area than they were a few years ago. 1) Even if it goes to collections, a medical debt won't appear on your credit report for a full year. 2) Medical debts less than $500 won't ever appear on your credit report. 3) If you pay the debt off later, the entire thing gets expunged from your credit report (i.e, rather than showing you had a debt that went to collections, and then was paid off, it's like the whole thing never happened). These things only apply to medical debts, though, not normal consumer debts. (edit: list formatting)
- paxys 3y ago
  Every single debt should be contested. "Oh but I know I owe this". How do you know you owe it to that specific collector? Can you be sure it wasn't sold twice? Can you be sure the company didn't already write it off? Can you be sure that paying it means it'll actually be marked paid in their system? The entire debt collection industry is a mess, and only the absolute worst players operate in it. If you try and stay honest and moral you will be taken for a ride.
nineplay 3y ago
This is the kind of headline you have to be careful with because as long as there's debt there will be a majority of debtors. Without raw numbers, this could mean more insured people are getting into debt _or_ it could mean that the US has gotten better at providing cost-effective health care for the uninsured. If that's the case, than this headline is something to be celebrated. Let's say last year 100 people were in debt to hospitals - 40 insured, 60 uninsured. This year 70 people are in debt to hospitals - 40 insured, 30 uninsured. Great! (I know that it would be much better if no one was in debt, but that's a separate discussion.) (Also possibly fewer uninsured people are in debt because they all died of treatable conditions but that conclusion will have to wait on more data.)
tptacek 3y ago
This is the only debt I have, because hospital payment systems are fucking impossible to navigate. Thankfully, the Biden administration is drafting plans to make it unlawful to report that debt to credit reporting agencies, so I anticipate soon giving even less of a shit about it than I do now. Figure it out with my insurer, or bill me at the time of service. I'm sure as shit not responding to an invoice.
- mtlynch 3y ago
  I'd love to adopt this strategy as well, but I worry about the clinic eventually forcing me to pay somehow and adding a bunch of penalties on top. Is there a way to mitigate that risk? Or is that risk unlikely in a way I'm not considering?
  - tptacek 3y ago
    I'm not a lawyer, or a financial advisor. So: they could in theory sue you. But they're doing this to everybody, so unless you think they're going to sue everybody, I think it's a pretty safe bet? This has been my stance for over 10 years. I'll gladly pay if you ask me up front (or on the way out). Otherwise, fuck off. I get how this attitude could sound shocking. I have friends who take a similar approach to other things and get away with it; most notably, a friend who refuses on principle to pay parking tickets. I pay parking tickets, and I still get whomped every 5 years or so with some absurd backlog of missed tickets and a boot, so I don't understand how this works for them. But it does! You probably don't want to get me started on credit scores.
  - toast0 3y ago
    First off: I suggest you pay any reasonable bills you know you incurred and can pay. Don't be a deadbeat. That said... As I understand it, it's pretty typical for these bills to be sold, and once that happens, the originator doesn't really care anymore. They got what they got and it's written off. Maybe they won't see you anymore, because you don't pay your bills; maybe they don't really care because lots of people don't pay their bills; if they were smart, they'd bill you at time of service, but chances are they're not organizationally capable of billing at time of service. If they won't see you anymore and you have limited options for medical care or they're the best option for medical care; you'll need to settle up. If not, the clinic has no means or desire to force you to pay. The debt collectors have a time limited option to take you to court for repayment, but most of the bills aren't worth the effort, so you can probably wait it out. It might ding your credit, but if it comes up, you say 'hey, this bill correct' and it's a medical bill and everyone believes you. If the debt collectors do file a suit, and you have the money to pay, negotiate a payout then.
hanniabu 3y ago
because insurance doesn't pay full amounts, and often are left with a larger bill than if you didn't have insurance due to the "insurance premiums" that are charged because they know insurance won't approve the full amount
- BenjiWiebe 3y ago
  That's what I thought too, but someone who should know told me recently that's illegal (bill more to insurance than what the self-pay amount would be). Is that true or no?
  - hanniabu 3y ago
    I've been told my out of pocket would be a decent amount before, so I'll hang up and a week later call back and say I don't have insurance I'm going to pay cash and I get better rates. I don't know if it's illegal or not but it has worked for me.
nonameiguess 3y ago
The definition is amusing. "Have the ability to pay but don’t." They don't exactly make it easy. I'm usually good about this but am probably on this list right now. My cat got out of the house and bit me on the hand last year around this time and it got infected and swelled up. Went to one of those boutique ERs with no wait, which I specifically did because I have plenty of money and can pay. They still couldn't bill me everything on the spot. Four months later, when I got the rest of the bill, which is only $117, I tried to pay online and their website said my account number was invalid. It's the number on the bill they sent me. So I tried to call to pay and the payment center apparently is staffed by one person and if you call when they're at lunch, you're out of luck. It can be paid by mail, but they don't provide postage and I last sent mail on purpose on any regular basis over a decade ago and don't have any stamps. So oh well, suck it. I'm not going through that much more effort to pay you $117. If you're seriously willing to sell that for $2 to a debt collector, have fun. Even if I ultimately pay, the labor and paperwork on behalf of all involved parties is probably enough that every single participant loses money.
- petre 3y ago
  > My cat got out of the house and bit me on the hand last year around this time and it got infected and swelled up. Always have betadine on hand. My cat scratched and bit be numerous times, never had an issue, always washed with plenty of soap and water and disinfected the wounds with betadine. Indoor cats also go crazy. I'm never keeping another cat indoors without free roaming access.
  - alan-hn 3y ago
    I generally oppose declawing cats but it may help in this situation. Free roaming and outdoor cats decimate local bird populations, that's the primary reason I kept my cat totally indoors.
    - petre 3y ago
      We a have free roaming cat at the office. It doesn't bother with birds or mice, as it has learned to bug humans to feed it and it's quite succesful at it. So there's no need for declawing = amputating its fingers. Very active cats like the common European are not fit as indoor pets and might develop a stress disorder if kept inside at all times.
aantix 3y ago
Do the debts get reported to the credit bureaus if you don't pay?
hospitalJail 3y ago
I bill Blue Cross Blue Shield and the cost of a service was $125. A different insurance was $70. The medicaid patients are $40 (and our company would collapse if we only had these patients). They are basically break even, or a loss when they call off. Now we aren't part of the hospital or physicians cartel, we are a tiny offshoot with no lobbying power... yet. Medical is a legal squeeze, not a technical one. Sorry for playing the game too. You need to fight against Medical.
black6 3y ago
The cool thing about health insurance is that you pay a lot of money every month, then when you get sick or injured you pay a lot more money.
JohnMakin 3y ago
I have been fighting these battles for much of the last ten years and this article fails to explain a dynamic that is happening here, at least where I am (california). I'll give my most recent thing that ended up in collections (which you can easily ignore, it doesn't affect your credit at all in some states). I had a pretty intensive surgery. I had a copay, which was shown to me before the surgery. I signed it, paid, think everything is good. However, in the background, which happens often, the insurance company and the hospital/doctor are still haggling about who owes what. Eventually they can't come to a decision, and the hospital punts it to the patient or collections. Even better - say you do pay this “surprise” bill. Sometimes the insurer eventually pays up. Guess what happens then? Does the doctor/hospital notify you then that you overpaid? Very rarely. For me it was a $800 bill on top of the thousands I already paid for anasthesia (and some other stuff). Hospitals and insurers are putting patients in the middle of their disputes and it rarely ends up well for the patient. Hospitals acting like they're somehow the victim here is extremely rich from my perspective, they are at least half of the entire problem. I recommend letting them go to collections and then disputing it there. Lots of times these collections agencies use shady practices that give you some good leverage, or it's a double billing scenario like I described above.
- deleted 3y ago
  [deleted]
- onlypassingthru 3y ago
  I recently had success using CA's Dept of Insurance to assist me in convincing a health insurance company to pay a health provider what it says on my policy. I filled out the form online[0] and in less than a month, the insurance company decided to pay the full amount I expected. I only wish I had used the DOI service sooner as I wasted months getting shuffled between insurance company departments in their never ending quest to make me go away. [0]https://www.insurance.ca.gov/01-consumers/101-help/index.cfm https://www.insurance.ca.gov/01-consumers/101-help/index.cfm
alwa 3y ago
Buried midway down, they mention that the commercial health plans available to people without conventional employers (Obamacare) can (and routinely do) set deductibles as high as $9,450. And that’s in addition to the premium-which, in New York City for example, starts at $618/month for the very worst plan for an individual. Sure, that’s subsidized for lower-income households — but who among those has a spare $10K lying around to spend out of pocket before they actually benefit from the insurance? When you’ve budgeted the $7,400 to pay for premiums whether or not you use healthcare, and the insurance doesn’t even kick in until you’ve spent a total of $16,800 on medical care in a given year, it doesn’t come as a huge surprise to me that people feel like they’ve already paid enough, and that the payers and providers should sort it out amongst themselves. There’s economic, contractual, and policy reality; but then, even among people who might be able to afford it, there’s the gut feeling of “I’ve already paid way too much for this 5-minute checkup, I’m not paying more.”
- slfnflctd 3y ago
  We should've gotten single payer. The insurance lobby is just too strong, I guess. In several recent years, I would've been better off not having insurance and paying out of pocket because I never (or just barely) hit the deductible. Even when my deductible was lower, if you added up my premiums against what was covered I still probably overpaid most years. So all I've been doing is subsidizing someone else's bills while paying my own on top of it. Yes, I know this is how insurance works, but it doesn't feel great to keep paying out so much money while getting nothing for it but vague promises they likely won't have to keep which expire every year.
  - paxys 3y ago
    Insurance companies are very much to blame, sure, but that doesn't change the fact that >50% of the country rejects these systems because "socialism". If we can't get over that hurdle first then nothing will ever change.
    - nojvek 3y ago
      Socialism is such a stupid argument because we pool our taxes for common things such as Transportation infrastructure, defense, port immigration, and other social benefits. Australia charges 2% for medicare (I'm sure other countries have something similar). Because the money is pooled, they can negotiate prices for common procedures and medicine down. I'd rather pay 2% extra tax for not having to deal with getting new insurance when I switch jobs. An x-ray shouldn't cost in $1000s. Australia still has private insurance and special surgeons. The deal is that the 2% covers most common basic heathcare related things. Imagine if we had to pay separate tax for going on each highway. Middlemen sitting and ripping off based on demand and supply. Getting billed for each highway use and having those bills come months later. Because it is so expensive to travel, we'd need highway and flight insurance. That's the absurdity of US healthcare. Play stupid games, win stupid prizes.
charonn0 3y ago
I've been contacted by collection agencies over an ER bill that I paid up front and in full. The system isn't even designed for that possibility.
GrinningFool 3y ago
At any given time I have a few hundred dollars of unpaid medical bills because they are so inconsistent. Some don't show up for months. Some show up right away. Some are tracked in the providers' proprietary apps. Some are sent by mail. Some, I don't learn about until they're in collections. Did I miss an email/notification/mail? No idea and no way to tell. Incredibly frustrating situation.
- lp0_on_fire 3y ago
  There should be a provision in law that mandates the presentation of a final bill within x number of days of services rendered. Right now they want to have their cake and eat it, too. “We can’t tell you how much it will cost ahead of time because it would be too difficult”. But also “ we can randomly bill you at some point from now until the end of time until we decide that your debt is paid.”
duffpkg 3y ago
This seems like a good thread to mention the book "Never Pay The First Bill" by journalist Marshall Allen. I've worked in healthcare for 20+ years. I've been on the collecting side of many bills, it's a good book for patients. Contrary to popular belief most hospital systems are not evil profit seeking corpratons but just trying to keep the lights on, it's still a business though and as a patient you have the right and oppourtunity to negotiate. Most of the time collecting something is better than collecting nothing which is more or less the default. Of course there are exceptions and abuses. One other point I think is important, that I see come up a lot regarding deductibles, is that your deductible is most likely double what you think it is for a lot of situations. Particularly emergencies. This is buried in the minutiae of your insurance and relates to in and out and network/facility/doctor care having seperate deductibles.
- FireBeyond 3y ago
  A lot of this has changed with the No Surprises Act, that specifically covers Emergency situations and others where a patient would be "reasonably expected" to believe that a service was in network. Surprise billing protections apply to most emergency services, including those provided in hospital emergency rooms, freestanding emergency departments, and urgent care centers that are licensed to provide emergency care. The federal law also applies to air ambulance transportation (emergency and non-emergency), but not ground ambulance. It also covers non-emergency services provided by out-of-network providers at in-network hospitals and other facilities. Often, the doctors who work in hospitals don’t work for the hospital; instead they bill independently and do not necessarily participate in the same health plan networks. Doesn't mean your insurer might not deny coverage or apply a deductible that you have to fight. You also cannot waive certain rights. Like some hospitals will try to get you to sign waivers around balance billing, and in/out network discrepancies. Some of these will vary by state, so be aware. > The No Surprises Act (NSA) establishes new federal protections against surprise medical bills that take effect in 2022. Surprise medical bills arise when insured consumers inadvertently receive care from out-of-network hospitals, doctors, or other providers they did not choose. Peterson-KFF and other studies find this happens in about 1 in 5 emergency room visits. In addition between 9% and 16% of in-network hospitalizations for non-emergency care include surprise bills from out-of-network providers (such as anesthesiologists) whom the patient did not choose. Surprise medical bills pose financial burdens on consumers when health plans deny out-of-network claims or apply higher out-of-network cost sharing; consumers also face “balance billing” from out-of-network providers that have not contracted to accept discounted payment rates from the health plan. Source: https://www.kff.org/health-reform/issue-brief/no-surprises-act-implementation-what-to-expect-in-2022/ https://www.kff.org/health-reform/issue-brief/no-surprises-a...
rincebrain 3y ago
My favorite was a reason I stopped going to a major famous hospital's outpatient clinic in my area, which was that their billing department would sell things to a debt collector that were paid, and when I called, they'd say you shouldn't be getting a notice our system says paid in full, and I'd say "well, then why do I have 12 debt collector notices with those IDs". I suspect they were just opportunistically selling it faster than insurance paid them, but the harassment of cleaning that up every so often was exhausting (since the hospital would always say "well it's not on our end"), combined with a bunch of other shady things the place did. The dumbest part was, they were like, $10 bills, so I can only imagine how cheaply they had to have been sold for the debt collector to think they could turn a not-loss on it...
itronitron 3y ago
At some point I hope Americans realize the extent to which they are being taken advantage of by the politicians they elect, and the companies that lobby them.
- trynumber9 3y ago
  Americans do dislike their politicians. They also find them corrupt and ineffectual (possibly that's better than corrupt and effective). https://www.pewresearch.org/politics/2023/09/19/americans-dismal-views-of-the-nations-politics/ https://www.pewresearch.org/politics/2023/09/19/americans-di...
  - tumsfestival 3y ago
    Clearly not enough, otherwise they'd do something about it.
    - yunwal 3y ago
      I think it’ll happen soon. If it doesn’t happen soon with the increasing numbers of unions and labor strikes, it’ll happen when boomers die off and the voting demographic shifts left dramatically.
bparsons 3y ago
The concept of "medical debt" is preposterous.
wolverine876 3y ago
Don't let yourself get caught up in these details. The problem is the unreformed healthcare system; these are just more symptoms of it. It's like the old, failing server at work - people say the problem is the power supply, the outdated driver, etc. - it's not; the problem is we haven't installed a new server. We all can see the US healthcare system is awful. If you aren't doing anything about it, the problem is you. The politicians against healthcare reform are well-known; if you can't persuade people to vote them out, you're not trying (following the example of political leaders who don't try). (And spare me the helplessness routine - that's for losers - generations of Americans and other democracies have managed to get things done.) EDIT: People need to stop debating whether they are powerless, and the 999 ways they are powerless, the hopelessness of powerlessness - and start posting solutions. Another thought: It's another institution or market being funded by the wealthy (donations) for the wealthy (those who can afford it).
- kuczmama 3y ago
  > The politicians against healthcare reform are well-known Who are they specifically?
  - verisimi 3y ago
    Just vote them out. The medical system is the only issue that matters. /s
  - hasty_pudding 3y ago
    We get to pick from the politicians that the DNC and the RNC allow us to pick from.
  - paxys 3y ago
    The answer is the majority of the Republican party and their electorate, but just saying that will get you a barrage of downvotes on HN and other similar forums. We get the system we deserve..
    - horns4lyfe 3y ago
massysett 3y ago
The headline doesn’t say much and the text doesn’t say much more. It could be that such debtors are the majority solely because the number of uninsured has dropped. For instance, if in 2000 there were 2000 debtors with 100 of them being insured, and in 2020 there are 200 debtors with 150 of them being insured, this headline would be true. Which would be ok if the story shed light on this, but it doesn’t.
calamari4065 3y ago
Hospitals love to do this thing where you set up a payment plan for auto-draft, but the moment you get a new bill, they cancel the payment plan with no notice and happily let your account go delinquent. At that point, I just let it go to collections until the collector is willing to settle for a fraction. Or if I get lucky, the debt gets sold seventeen times and it just goes away once I ask for proof that they own my debt. Play stupid games, win stupid prizes I say. If you wanna try and fuck around with me, I'll do my level best to make sure you lose as much money as possible.
CogitoCogito 3y ago
I'm very far from a lawyer, but I've always been a bit confused how hospital bills are enforceable contracts given my rudimentary understanding of contract law. Turns out there are papers by smarter people with similar ideas: > Thus, notwithstanding the type of contract created in a particular case, this article concludes that the proper application of contract law principles dictates that patients are usually required to pay no more than the reasonable market-based value of the health care they receive. The determination of reasonable value is based on the market value—the average actual reimbursement the hospital receives for the care in question—and not on the hospitals unilaterally-set list price or billed charge. From the abstract in: https://ideas.dickinsonlaw.psu.edu/cgi/viewcontent.cgi?article=1080&context=dlr https://ideas.dickinsonlaw.psu.edu/cgi/viewcontent.cgi?artic... Has this been tested in court? I guess the main issue is that the people who receive the big bills are most likely to have the hardest time finding representation since poorer people are more likely to not have insurance. Really it should be illegal for hospitals to send any bill with crazy inflated prices that are negotiated down by all insurance policies.

183 points by grecy 3y ago

It's very expensive being sick for any extended period of time; I had my first partial glossectomy surgery (removal of a piece of my tongue) in October 2022 (https://jakeseliger.com/2023/07/22/i-am-dying-of-squamous-cell-carcinoma-and-the-treatments-that-might-save-me-are-just-out-of-reach/ https://jakeseliger.com/2023/07/22/i-am-dying-of-squamous-ce...), and there are at least three major components to being sick for a long time: health itself; financial viability; and managing the healthcare team. I've been lucky with the generosity of friends and strangers regarding the second one due a successful Go Fund Me, but I've also gotten walloped with some gnarly bills, most notably for Signatera blood tests for cancer particles and for genetic testing of the tumor itself. United Healthcare considers those experimental and thus uncovered. But the genetic testing of the tumor is essential because it might lead to targeted treatments. Legislation has supposedly limited surprise out-of-network bills, but, even with insurance, costs can be very high, and those combined with not being able to work effectively leads to problems.

plagiarist 3y ago
I'd like to see insurers be sued for malpractice since they feel entitled to make medical decisions for people.
- beaeglebeached 3y ago
  That will raise the price of insurance even more. Now you have to cover the cost of risk of suing your own insurance pool.
  - plagiarist 3y ago
    Alternatively, they could consider not having lone employees mass-denying procedures from a spreadsheet. Or at least stop using the AI that gets it wrong so often it's indistinguishable from intentional.
    - beaeglebeached 3y ago
      I think biggest problem is health insurance is now more like a weird HSA where insurer owns the money and operates as cartel. It might be cheaper for some to not even have it and just go to Mexico, maybe some minimal insurance only for emergency room. Hard to call it insurance, when so much used for known chronic ongoing costs.
      - tenebrisalietum 3y ago
        A friend of mine had gastric bypass revision surgery in Mexico because it was cheaper.
  - wing-_-nuts 3y ago
    As opposed to a single 'doctor' mass denying 1000's of requests a day? That should be illegal.
    - beaeglebeached 3y ago
      Profit margins are like 4% on health insurance. Insurance companies introduce a lot of cost and waste, but there's no evidence to me these mass denials are anything but the market not bearing real insurance that covers things reasonably under current regulatory conditions. Could it be the consumer is too poor to pay for a bloated system that covers what it does, plus the mass denials? The whole system is fucked and the even more fucked part is mass denials may be a symptom of the madness of the inefficient rube Goldberg machine and not even a profit driver.
      - antisthenes 3y ago
        > Profit margins are like 4% on health insurance. If I tell you my cost of a bottle of water is $96,000 and sell it to you for $100,000 in the middle of the desert, my profit margin is only 4%.
        beaeglebeached 3y ago
        You would also get a nice visit from the IRS.
        antisthenes 3y ago
        I'd rather pay taxes on $4000 than $0.40
        beaeglebeached 3y ago
        I honestly thought the jig here was lying about the 96k. If the bottle actually costs 96k then I don't begrudge the 4% risk for hauling to the desert.
StockHuman 3y ago
The old Onion joke about a nation with a GoFundMe-based healthcare system rings true.

Kon-Peki 3y ago

It's probably impossible to know the full extent of this, but some percentage of hospital debt comes from people that can fully afford their healthcare but are using the payment plans as no-interest loans while their money is invested elsewhere. The HSA accounts you get with the high-deductible plans allow you to park the money in self-directed IRA accounts for your entire life. In fact, tax law encourages you to do this.

zepton 3y ago
I don't think amounts that are on a payment plan would qualify as "bad debt" though - if someone is paying as agreed on a payment plan the debt isn't uncollectible.
- Kon-Peki 3y ago
  Yes, very good point. However... The linked report states: > And as sudden operational cost pressures (including nursing shortages and higher wages) frustrate hospital financial leaders, an inability to collect all expected revenue further challenges razor-thin operating margins. > This increase creates new challenges for providers to collect higher balances that are more difficult for patients to pay either prior to services or during the typical 120-day collection window after the insurance balance has been resolved. I think they are being intentionally vague here. Are they saying they're having trouble collecting the money within the 120-day window (so their quarterly reports aren't screwed), or ever? I feel like they want you to believe that it is the latter, when in fact it is the former.
marcus0x62 3y ago
I’d like to know the full extent of this. I’d eat my shoe if it was more than a tenth of a percent of outstanding healthcare debt.

tiahura 3y ago

It’s called a deductible. People don’t pay their bills anymore, unless they absolutely have to.

Supermancho 3y ago
Generally this is true. For anything over a thousand, I try to negotiate. Most of the time they rather compromise than fight/sell it at a % to collections.
- aantix 3y ago
  I’m curious too - what’s your best strategy for lowering?
  - tiahura 3y ago
    Call and tell them you cant pay. Will they accept (whatever 20% of the bill is). They will say no, but they will take X. Say, sorry I can't pay X how about (30%)....
- robterrell 3y ago
  How exactly do you negotiate? After you get a bill, you call their billing number and just ask for a lower number?
  - Supermancho 3y ago
    I have simply had to say, I can't pay this* (*despite the fact it's simply violating my budget). What's the process for after a bill's due date expires? Sometimes the response is: it gets a penalty added. I reply, I can't pay that either. Can we work something out? Usually, I get connected to someone who will either offer a discount or payment plan. Sometimes this isn't going to be any better (payments for the total amount over time), but it's often interest free...since the whole point is that you can't manage it. Sometimes they are firm and say it will go to collections. At the heart of it, it's a matter of game theory. You don't get 100% of the discounts you don't pursue. For my health provider, I currently have an otherwise unmentioned number I can call for my medical bills that I can pay immediately, that gets me 25% off whatever the bill is. I would never have known about it, had I not said I couldn't pay a particularly large one.

darth_avocado 3y ago

I have good insurance and I have unpaid medical bills for the following reason: 1. Visited a doctor 4 months ago, got a bill 3 months after the visit, paid it, then got a surprise second bill, which I have put off paying because I need to find time during my work hours to follow up on with the hospital + insurance. 2. Didn’t get bills for some of the visits I made in the last 3 months. 3. Insurance randomly denied claims, so need to follow up with them and the hospital. 4. Despite insurance covering 70-90% on different services, one visit for my spouse cost us thousands. We decided to pay it off as installments instead of one time because we got a really good deal.

throwway120385 3y ago
This was us for my wife's pregnancy and delivery. Some of the bills were denied by Cigna for things that were covered according to their book. So we had to fight that. Cigna can take months to reprocess claims, which basically puts you into default with the hospital while you wait for the insurance to pay out for services that were supposed to be covered. We've done this after every medical event because Cigna always denies something that should be covered. And their accounting system doesn't work correctly which is something that is constantly your problem because they won't accumulate your out of pocket max or coinsurance correctly, so you CONSTANTLY have to call them about everything because it's always wrong. Cigna is the worst insurance company I've ever had the displeasure of dealing with. United Healthcare was slightly better but only slightly. For a surprise bill, my wife got fired as a patient by the biggest clinic network in our area for a bill that she didn't know she had and that the agent she talked to wouldn't provide any evidence or itemization. The agent's response when asked was "you know what this is for you should just pay it." Sounds scammy, right? They keep buying clinics we're going to and then she stops being able to see her doctors afterward. Private equity is destroying our healthcare system.
- darth_avocado 3y ago
  Cigna was also the culprit in our case for stuff where covered items were being rejected for no reason.
- 3y ago

taeric 3y ago

That has included me, in the past. It is stupid easy to accidentally have a debt to a hospital. For families, sensible privacy rules at clinics can mean that it is very hard to choke point bills to a single person. To the point that I asked every time if I owed money when I did checkups to be told that we did not. Only to later find that my family did, in fact, have a bill due. For a while. Recently I'm getting it with the stupid "anesthesia is billed separate from the surgery" nonsense. At least this time I noticed the bill. Why is that not a single bill, though? Imagine having to pay the cook, cleaner, server, and attendants all separately. So frustrating.

retrac 3y ago
I would point out that the attending surgeon, the anaesthesiologist, and the hospital all bill the patient separately here for a surgery, in Ontario, Canada. (Most people will never see these bills and it's covered by the public insurance.) The reason is that the service - the contract - is organized in that way. Between the patient and the anaesthesiologist, between the patient and the surgeon, and between the patient and the hospital. So three separate bills. The doctor and hospital will have their own contract. Legally, and in an important way when it comes to decide who to sue for malpractice, the hospital is not the provider or performer of the surgery. They just provide the venue and equipment; the doctors do the surgery.
- AlecSchueler 3y ago
  But why is done that way? Lots of freelance chefs move between restaurants but the bill is always between the restaurant and the people who dine there.
  - beaeglebeached 3y ago
    Server is better analogy. The wage you pay/owe the waiter is direct and (mostly) separate from meal, albeit informal with only shame as a deterrent for default.
    - 3y ago

beaeglebeached 3y ago

Hospital said I owed debt. Contested claim with debt collectors. Never saw it again and not on my credit report. Know a few people who've done this.

tlivolsi 3y ago
My friend did the same thing.
Turing_Machine 3y ago
While not great, things are a little better in this area than they were a few years ago. 1) Even if it goes to collections, a medical debt won't appear on your credit report for a full year. 2) Medical debts less than $500 won't ever appear on your credit report. 3) If you pay the debt off later, the entire thing gets expunged from your credit report (i.e, rather than showing you had a debt that went to collections, and then was paid off, it's like the whole thing never happened). These things only apply to medical debts, though, not normal consumer debts. (edit: list formatting)
paxys 3y ago
Every single debt should be contested. "Oh but I know I owe this". How do you know you owe it to that specific collector? Can you be sure it wasn't sold twice? Can you be sure the company didn't already write it off? Can you be sure that paying it means it'll actually be marked paid in their system? The entire debt collection industry is a mess, and only the absolute worst players operate in it. If you try and stay honest and moral you will be taken for a ride.

nineplay 3y ago

This is the kind of headline you have to be careful with because as long as there's debt there will be a majority of debtors. Without raw numbers, this could mean more insured people are getting into debt _or_ it could mean that the US has gotten better at providing cost-effective health care for the uninsured. If that's the case, than this headline is something to be celebrated. Let's say last year 100 people were in debt to hospitals - 40 insured, 60 uninsured. This year 70 people are in debt to hospitals - 40 insured, 30 uninsured. Great! (I know that it would be much better if no one was in debt, but that's a separate discussion.) (Also possibly fewer uninsured people are in debt because they all died of treatable conditions but that conclusion will have to wait on more data.)

tptacek 3y ago

This is the only debt I have, because hospital payment systems are fucking impossible to navigate. Thankfully, the Biden administration is drafting plans to make it unlawful to report that debt to credit reporting agencies, so I anticipate soon giving even less of a shit about it than I do now. Figure it out with my insurer, or bill me at the time of service. I'm sure as shit not responding to an invoice.

mtlynch 3y ago
I'd love to adopt this strategy as well, but I worry about the clinic eventually forcing me to pay somehow and adding a bunch of penalties on top. Is there a way to mitigate that risk? Or is that risk unlikely in a way I'm not considering?
- tptacek 3y ago
  I'm not a lawyer, or a financial advisor. So: they could in theory sue you. But they're doing this to everybody, so unless you think they're going to sue everybody, I think it's a pretty safe bet? This has been my stance for over 10 years. I'll gladly pay if you ask me up front (or on the way out). Otherwise, fuck off. I get how this attitude could sound shocking. I have friends who take a similar approach to other things and get away with it; most notably, a friend who refuses on principle to pay parking tickets. I pay parking tickets, and I still get whomped every 5 years or so with some absurd backlog of missed tickets and a boot, so I don't understand how this works for them. But it does! You probably don't want to get me started on credit scores.
- toast0 3y ago
  First off: I suggest you pay any reasonable bills you know you incurred and can pay. Don't be a deadbeat. That said... As I understand it, it's pretty typical for these bills to be sold, and once that happens, the originator doesn't really care anymore. They got what they got and it's written off. Maybe they won't see you anymore, because you don't pay your bills; maybe they don't really care because lots of people don't pay their bills; if they were smart, they'd bill you at time of service, but chances are they're not organizationally capable of billing at time of service. If they won't see you anymore and you have limited options for medical care or they're the best option for medical care; you'll need to settle up. If not, the clinic has no means or desire to force you to pay. The debt collectors have a time limited option to take you to court for repayment, but most of the bills aren't worth the effort, so you can probably wait it out. It might ding your credit, but if it comes up, you say 'hey, this bill correct' and it's a medical bill and everyone believes you. If the debt collectors do file a suit, and you have the money to pay, negotiate a payout then.

hanniabu 3y ago

because insurance doesn't pay full amounts, and often are left with a larger bill than if you didn't have insurance due to the "insurance premiums" that are charged because they know insurance won't approve the full amount

BenjiWiebe 3y ago
That's what I thought too, but someone who should know told me recently that's illegal (bill more to insurance than what the self-pay amount would be). Is that true or no?
- hanniabu 3y ago
  I've been told my out of pocket would be a decent amount before, so I'll hang up and a week later call back and say I don't have insurance I'm going to pay cash and I get better rates. I don't know if it's illegal or not but it has worked for me.

nonameiguess 3y ago

The definition is amusing. "Have the ability to pay but don’t." They don't exactly make it easy. I'm usually good about this but am probably on this list right now. My cat got out of the house and bit me on the hand last year around this time and it got infected and swelled up. Went to one of those boutique ERs with no wait, which I specifically did because I have plenty of money and can pay. They still couldn't bill me everything on the spot. Four months later, when I got the rest of the bill, which is only $117, I tried to pay online and their website said my account number was invalid. It's the number on the bill they sent me. So I tried to call to pay and the payment center apparently is staffed by one person and if you call when they're at lunch, you're out of luck. It can be paid by mail, but they don't provide postage and I last sent mail on purpose on any regular basis over a decade ago and don't have any stamps. So oh well, suck it. I'm not going through that much more effort to pay you $117. If you're seriously willing to sell that for $2 to a debt collector, have fun. Even if I ultimately pay, the labor and paperwork on behalf of all involved parties is probably enough that every single participant loses money.

petre 3y ago
> My cat got out of the house and bit me on the hand last year around this time and it got infected and swelled up. Always have betadine on hand. My cat scratched and bit be numerous times, never had an issue, always washed with plenty of soap and water and disinfected the wounds with betadine. Indoor cats also go crazy. I'm never keeping another cat indoors without free roaming access.
- alan-hn 3y ago
  I generally oppose declawing cats but it may help in this situation. Free roaming and outdoor cats decimate local bird populations, that's the primary reason I kept my cat totally indoors.
  - petre 3y ago
    We a have free roaming cat at the office. It doesn't bother with birds or mice, as it has learned to bug humans to feed it and it's quite succesful at it. So there's no need for declawing = amputating its fingers. Very active cats like the common European are not fit as indoor pets and might develop a stress disorder if kept inside at all times.

aantix 3y ago

Do the debts get reported to the credit bureaus if you don't pay?

hospitalJail 3y ago

I bill Blue Cross Blue Shield and the cost of a service was $125. A different insurance was $70. The medicaid patients are $40 (and our company would collapse if we only had these patients). They are basically break even, or a loss when they call off. Now we aren't part of the hospital or physicians cartel, we are a tiny offshoot with no lobbying power... yet. Medical is a legal squeeze, not a technical one. Sorry for playing the game too. You need to fight against Medical.

black6 3y ago

The cool thing about health insurance is that you pay a lot of money every month, then when you get sick or injured you pay a lot more money.

JohnMakin 3y ago

I have been fighting these battles for much of the last ten years and this article fails to explain a dynamic that is happening here, at least where I am (california). I'll give my most recent thing that ended up in collections (which you can easily ignore, it doesn't affect your credit at all in some states). I had a pretty intensive surgery. I had a copay, which was shown to me before the surgery. I signed it, paid, think everything is good. However, in the background, which happens often, the insurance company and the hospital/doctor are still haggling about who owes what. Eventually they can't come to a decision, and the hospital punts it to the patient or collections. Even better - say you do pay this “surprise” bill. Sometimes the insurer eventually pays up. Guess what happens then? Does the doctor/hospital notify you then that you overpaid? Very rarely. For me it was a $800 bill on top of the thousands I already paid for anasthesia (and some other stuff). Hospitals and insurers are putting patients in the middle of their disputes and it rarely ends up well for the patient. Hospitals acting like they're somehow the victim here is extremely rich from my perspective, they are at least half of the entire problem. I recommend letting them go to collections and then disputing it there. Lots of times these collections agencies use shady practices that give you some good leverage, or it's a double billing scenario like I described above.

deleted 3y ago
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onlypassingthru 3y ago
I recently had success using CA's Dept of Insurance to assist me in convincing a health insurance company to pay a health provider what it says on my policy. I filled out the form online[0] and in less than a month, the insurance company decided to pay the full amount I expected. I only wish I had used the DOI service sooner as I wasted months getting shuffled between insurance company departments in their never ending quest to make me go away. [0]https://www.insurance.ca.gov/01-consumers/101-help/index.cfm https://www.insurance.ca.gov/01-consumers/101-help/index.cfm

alwa 3y ago

Buried midway down, they mention that the commercial health plans available to people without conventional employers (Obamacare) can (and routinely do) set deductibles as high as $9,450. And that’s in addition to the premium-which, in New York City for example, starts at $618/month for the very worst plan for an individual. Sure, that’s subsidized for lower-income households — but who among those has a spare $10K lying around to spend out of pocket before they actually benefit from the insurance? When you’ve budgeted the $7,400 to pay for premiums whether or not you use healthcare, and the insurance doesn’t even kick in until you’ve spent a total of $16,800 on medical care in a given year, it doesn’t come as a huge surprise to me that people feel like they’ve already paid enough, and that the payers and providers should sort it out amongst themselves. There’s economic, contractual, and policy reality; but then, even among people who might be able to afford it, there’s the gut feeling of “I’ve already paid way too much for this 5-minute checkup, I’m not paying more.”

slfnflctd 3y ago
We should've gotten single payer. The insurance lobby is just too strong, I guess. In several recent years, I would've been better off not having insurance and paying out of pocket because I never (or just barely) hit the deductible. Even when my deductible was lower, if you added up my premiums against what was covered I still probably overpaid most years. So all I've been doing is subsidizing someone else's bills while paying my own on top of it. Yes, I know this is how insurance works, but it doesn't feel great to keep paying out so much money while getting nothing for it but vague promises they likely won't have to keep which expire every year.
- paxys 3y ago
  Insurance companies are very much to blame, sure, but that doesn't change the fact that >50% of the country rejects these systems because "socialism". If we can't get over that hurdle first then nothing will ever change.
  - nojvek 3y ago
    Socialism is such a stupid argument because we pool our taxes for common things such as Transportation infrastructure, defense, port immigration, and other social benefits. Australia charges 2% for medicare (I'm sure other countries have something similar). Because the money is pooled, they can negotiate prices for common procedures and medicine down. I'd rather pay 2% extra tax for not having to deal with getting new insurance when I switch jobs. An x-ray shouldn't cost in $1000s. Australia still has private insurance and special surgeons. The deal is that the 2% covers most common basic heathcare related things. Imagine if we had to pay separate tax for going on each highway. Middlemen sitting and ripping off based on demand and supply. Getting billed for each highway use and having those bills come months later. Because it is so expensive to travel, we'd need highway and flight insurance. That's the absurdity of US healthcare. Play stupid games, win stupid prizes.

charonn0 3y ago

I've been contacted by collection agencies over an ER bill that I paid up front and in full. The system isn't even designed for that possibility.

GrinningFool 3y ago

At any given time I have a few hundred dollars of unpaid medical bills because they are so inconsistent. Some don't show up for months. Some show up right away. Some are tracked in the providers' proprietary apps. Some are sent by mail. Some, I don't learn about until they're in collections. Did I miss an email/notification/mail? No idea and no way to tell. Incredibly frustrating situation.

lp0_on_fire 3y ago
There should be a provision in law that mandates the presentation of a final bill within x number of days of services rendered. Right now they want to have their cake and eat it, too. “We can’t tell you how much it will cost ahead of time because it would be too difficult”. But also “ we can randomly bill you at some point from now until the end of time until we decide that your debt is paid.”

duffpkg 3y ago

This seems like a good thread to mention the book "Never Pay The First Bill" by journalist Marshall Allen. I've worked in healthcare for 20+ years. I've been on the collecting side of many bills, it's a good book for patients. Contrary to popular belief most hospital systems are not evil profit seeking corpratons but just trying to keep the lights on, it's still a business though and as a patient you have the right and oppourtunity to negotiate. Most of the time collecting something is better than collecting nothing which is more or less the default. Of course there are exceptions and abuses. One other point I think is important, that I see come up a lot regarding deductibles, is that your deductible is most likely double what you think it is for a lot of situations. Particularly emergencies. This is buried in the minutiae of your insurance and relates to in and out and network/facility/doctor care having seperate deductibles.

FireBeyond 3y ago
A lot of this has changed with the No Surprises Act, that specifically covers Emergency situations and others where a patient would be "reasonably expected" to believe that a service was in network. Surprise billing protections apply to most emergency services, including those provided in hospital emergency rooms, freestanding emergency departments, and urgent care centers that are licensed to provide emergency care. The federal law also applies to air ambulance transportation (emergency and non-emergency), but not ground ambulance. It also covers non-emergency services provided by out-of-network providers at in-network hospitals and other facilities. Often, the doctors who work in hospitals don’t work for the hospital; instead they bill independently and do not necessarily participate in the same health plan networks. Doesn't mean your insurer might not deny coverage or apply a deductible that you have to fight. You also cannot waive certain rights. Like some hospitals will try to get you to sign waivers around balance billing, and in/out network discrepancies. Some of these will vary by state, so be aware. > The No Surprises Act (NSA) establishes new federal protections against surprise medical bills that take effect in 2022. Surprise medical bills arise when insured consumers inadvertently receive care from out-of-network hospitals, doctors, or other providers they did not choose. Peterson-KFF and other studies find this happens in about 1 in 5 emergency room visits. In addition between 9% and 16% of in-network hospitalizations for non-emergency care include surprise bills from out-of-network providers (such as anesthesiologists) whom the patient did not choose. Surprise medical bills pose financial burdens on consumers when health plans deny out-of-network claims or apply higher out-of-network cost sharing; consumers also face “balance billing” from out-of-network providers that have not contracted to accept discounted payment rates from the health plan. Source: https://www.kff.org/health-reform/issue-brief/no-surprises-act-implementation-what-to-expect-in-2022/ https://www.kff.org/health-reform/issue-brief/no-surprises-a...

rincebrain 3y ago

My favorite was a reason I stopped going to a major famous hospital's outpatient clinic in my area, which was that their billing department would sell things to a debt collector that were paid, and when I called, they'd say you shouldn't be getting a notice our system says paid in full, and I'd say "well, then why do I have 12 debt collector notices with those IDs". I suspect they were just opportunistically selling it faster than insurance paid them, but the harassment of cleaning that up every so often was exhausting (since the hospital would always say "well it's not on our end"), combined with a bunch of other shady things the place did. The dumbest part was, they were like, $10 bills, so I can only imagine how cheaply they had to have been sold for the debt collector to think they could turn a not-loss on it...

itronitron 3y ago

At some point I hope Americans realize the extent to which they are being taken advantage of by the politicians they elect, and the companies that lobby them.

trynumber9 3y ago
Americans do dislike their politicians. They also find them corrupt and ineffectual (possibly that's better than corrupt and effective). https://www.pewresearch.org/politics/2023/09/19/americans-dismal-views-of-the-nations-politics/ https://www.pewresearch.org/politics/2023/09/19/americans-di...
- tumsfestival 3y ago
  Clearly not enough, otherwise they'd do something about it.
  - yunwal 3y ago
    I think it’ll happen soon. If it doesn’t happen soon with the increasing numbers of unions and labor strikes, it’ll happen when boomers die off and the voting demographic shifts left dramatically.

bparsons 3y ago

The concept of "medical debt" is preposterous.

wolverine876 3y ago

Don't let yourself get caught up in these details. The problem is the unreformed healthcare system; these are just more symptoms of it. It's like the old, failing server at work - people say the problem is the power supply, the outdated driver, etc. - it's not; the problem is we haven't installed a new server. We all can see the US healthcare system is awful. If you aren't doing anything about it, the problem is you. The politicians against healthcare reform are well-known; if you can't persuade people to vote them out, you're not trying (following the example of political leaders who don't try). (And spare me the helplessness routine - that's for losers - generations of Americans and other democracies have managed to get things done.) EDIT: People need to stop debating whether they are powerless, and the 999 ways they are powerless, the hopelessness of powerlessness - and start posting solutions. Another thought: It's another institution or market being funded by the wealthy (donations) for the wealthy (those who can afford it).

kuczmama 3y ago
> The politicians against healthcare reform are well-known Who are they specifically?
- verisimi 3y ago
  Just vote them out. The medical system is the only issue that matters. /s
- hasty_pudding 3y ago
  We get to pick from the politicians that the DNC and the RNC allow us to pick from.
- paxys 3y ago
  The answer is the majority of the Republican party and their electorate, but just saying that will get you a barrage of downvotes on HN and other similar forums. We get the system we deserve..
  - horns4lyfe 3y ago

massysett 3y ago

The headline doesn’t say much and the text doesn’t say much more. It could be that such debtors are the majority solely because the number of uninsured has dropped. For instance, if in 2000 there were 2000 debtors with 100 of them being insured, and in 2020 there are 200 debtors with 150 of them being insured, this headline would be true. Which would be ok if the story shed light on this, but it doesn’t.

calamari4065 3y ago

Hospitals love to do this thing where you set up a payment plan for auto-draft, but the moment you get a new bill, they cancel the payment plan with no notice and happily let your account go delinquent. At that point, I just let it go to collections until the collector is willing to settle for a fraction. Or if I get lucky, the debt gets sold seventeen times and it just goes away once I ask for proof that they own my debt. Play stupid games, win stupid prizes I say. If you wanna try and fuck around with me, I'll do my level best to make sure you lose as much money as possible.

CogitoCogito 3y ago

I'm very far from a lawyer, but I've always been a bit confused how hospital bills are enforceable contracts given my rudimentary understanding of contract law. Turns out there are papers by smarter people with similar ideas: > Thus, notwithstanding the type of contract created in a particular case, this article concludes that the proper application of contract law principles dictates that patients are usually required to pay no more than the reasonable market-based value of the health care they receive. The determination of reasonable value is based on the market value—the average actual reimbursement the hospital receives for the care in question—and not on the hospitals unilaterally-set list price or billed charge. From the abstract in: https://ideas.dickinsonlaw.psu.edu/cgi/viewcontent.cgi?article=1080&context=dlr https://ideas.dickinsonlaw.psu.edu/cgi/viewcontent.cgi?artic... Has this been tested in court? I guess the main issue is that the people who receive the big bills are most likely to have the hardest time finding representation since poorer people are more likely to not have insurance. Really it should be illegal for hospitals to send any bill with crazy inflated prices that are negotiated down by all insurance policies.