6 ms·

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

by 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.
    - AlecSchueler 3y ago
      I'm not based in the US, so my servers are paid a wage directly by the restaurant.
      - beaeglebeached 3y ago
        That makes sense, but the ah ah ah this isn't the US card comes unexpected on an analogy developed specifically alongside a US based topic.
        AlecSchueler 3y ago
        I'm sorry? I was only asking a question about another culture.
  - John23832 3y ago
    Because the legalities of chef/restaurant malpractice are orders of magnitude less important than those of doctor/anesthesiologist/hospital.
  - devilbunny 3y ago
    Because historically doctors were in private practices. I still am, as an anesthesiologist. Many of the surgeons I work with are also private. So, since neither of us is employed by the hospital, we do our own billing. If we were hospital employees, we could indeed do unified billing. That's a better analogy; your chefs are expecting to be paid by the restaurant, so it collects the bill. I am not paid by the hospital except a stipend for taking call for them - not for any specific services I provide to patients. It's frustrating for patients and families, it's annoying for us, but it's the price of legal independence for us. If my hospital collapsed overnight (and they sometimes do), my group could go out and start working other sources of income right away, because we already have the business setup to do our own billing.
    - petre 3y ago
      It's still better than billing to the hospital and the hospital billing to the patient, piling up taxes and comissions. The patient is also getting more cost transparency instead of a bundled bill one can never make sense of.
      - ddoolin 3y ago
        I don't agree with the last point and I think this thread is evidence of that. We cannot make sense of the myriad of bills we get from all the different providers, particularly since many or all of them are also being dealt with by our insurance and may have already been negotiated by the time we get the bills in the mail. To that point, I went to the ER a few months ago and I've probably received ten or so mailings for unpaid bills, only one of which I actually ended up owing, but my insurance didn't make the claims visible until they were settled which was months after the fact. To make matters worse, I can still log in and pay bills which were settled by my insurance. And I've received bills in the mail -- late I assume -- after they were paid by me or settled by insurance, confounding matters further.
      - Aloisius 3y ago
        Transparency would be far more useful if it came before the service being rendered. Obviously there are some practical limits in exceptional cases, but I can't think of another industry that has high-price services where providing estimates isn't standard.
- taeric 3y ago
  This doesn't endear me to the situation. :(
- plagiarist 3y ago
  Not seeing these bills would be incredible. Having them all covered in the same way would be fantastic. Instead, for us, states need to enact surprise billing laws since each provider can mysteriously be out-of-network despite working within a hospital that is in-network. The in-network concept is complete bullshit to start with, but then you have to have complete documentation of every person involved in whatever care you are getting.
  - plants 3y ago
    This is what infuriates me the most about healthcare in the US. I give someone my card, they enter the numbers with no indication of whether or not everything will be covered by insurance (they assume you just know). Then, a month later, I receive a bill indicating a routine procedure that I assumed out of ignorance was covered by insurance (since they took my card and entered the numbers without saying anything to the contrary) for $500 (or, god forbid, more). If I knew a salad at a restaurant were $200, I probably wouldn’t order it. There is no basic transparency in medical billing, and that needs to change.
    - lazide 3y ago
      It’s actually even worse. If you (or the Dr’s) could reliably tell how it was even going to be coded (aka categorized/identified) in the system in advance, it would already be a huge step up. Then you’d only have a handful of different prices you might have to pay.
- jimmygrapes 3y ago
  Sounds like the way hair salons and strip clubs are run in the U.S.
hotpotamus 3y ago
It all feels quite postmodern to me; like it's all made up as you go along. Try to ask how much something is going to cost in a medical context and they'll usually look at you like you're stupid (and I mean like a shoulder x-ray, not something that involves a team of people and maybe some unknowns when they cut you open). Well fine, but if you can't tell me how much something is going to cost, then I can't tell you if I'm able to pay it, so I guess we'll find out together.
ahi 3y ago
I've been getting those separate bills recently and it's driving me nuts. For one small out patient procedure I have received bills from the hospital, the doctor, the anesthesiologist, anesthesiologist nursing company, and a random surgeon I have never met that the doctor asked in for a 30 second consult (I know how long the procedure took) while I was under. Seriously considering ignoring some of these whotf-are-you bills out of spite.
- freetime2 3y ago
  > Seriously considering ignoring some of these whotf-are-you bills out of spite. Then they will sell your debt to a collections agency who will make it their business to harass you to the maximum extent legally allowed (and sometimes more than that). This may include impacting your credit score - although I think some states at least have protections against that.
  - toomuchtodo 3y ago
    https://www.consumerfinance.gov/about-us/newsroom/cfpb-kicks-off-rulemaking-to-remove-medical-bills-from-credit-reports/ https://www.consumerfinance.gov/about-us/newsroom/cfpb-kicks... ("CFPB Kicks Off Rulemaking to Remove Medical Bills from Credit Reports") https://www.consumerreports.org/money/debt-collection/fight-when-contacted-by-a-debt-collector-for-medical-bill-a8932597676/ https://www.consumerreports.org/money/debt-collection/fight-... ("How to Fight Back When Contacted by a Debt Collector for a Medical Bill") https://www.patientadvocate.org/ https://www.patientadvocate.org/
- Buttons840 3y ago
  I'm surprised medical billing scams aren't rampant, considering it's 100% normal to have a bill from from an unknown company show up asking for payment for unclear reasons for a procedure done a year ago.
  - NoMoreNicksLeft 3y ago
    > I'm surprised medical billing scams aren't rampant, considering it's 100% normal to The difference between honest-to-god scams, and just these meaningless me-too bills that accompany every medical procedure or test... well, is there a difference? If a scam is some scheme or trick to get you to pay for something you never agreed to pay for and wouldn't agree to pay for if it were said up front, through deception strategies like opaque policies and maneuvering you to a point where you can no longer back out of it... Then pretty much all of it is a scam. That the people performing the scams have professional degrees in medicine, that they're gainfully employed as hospital and medical company employees, and so on, that doesn't really change the nature of it. Originally, the "scammy" behavior was developed (and not deliberately) to try to coerce the insurance companies into paying. But the insurance companies could afford employees to counter all those tactics. This didn't mean the experise was wasted though, they simply turned that onto the patients themselves. The crazy thing to remember is that none of that expertise will go away, no matter what happens. Maybe they'll turn it on the government too, at some point, if we ever get universal healthcare. That could be a hoot, couldn't it?
freetime2 3y ago
I agree this is so frustrating. One thing that I’ve found in the US is that in addition to having fewer out of pocket costs, being on an HMO plan can significantly simplify billing vs a PPO plan. We switched over to an HMO plan from PPO during my wife’s pregnancy and we went from getting a new bill in the mail every week to just paying a fixed co-pay at the doctor’s office every visit. It saved us so much stress, and in our case we were able to keep the exact same doctors, facilities, etc. We also saved a bunch of money, but the simplicity ended up being the thing that I valued most. Years after our child was born, I ended up getting a scary letter from a collections agency. Turns out I had missed some $20 bill from the time when we were on the PPO plan. So they say, at least - it seems equally plausible that it was a billing error on their side (of which we found many), and they never once mentioned it during any of our visits. But at that point I was not willing to fight over $20 and just paid it.
wing-_-nuts 3y ago
One thing my mom has been dealing with recently is where the insurance EOB and the bill differs substantially. My mom called the hospital to ask for an explanation and poof the bill is magically lowered by a several hundred dollars. How the heck is this not criminal fraud? Why are people allowed to simply bill whatever they feel like it, and why is my mother getting 'balance billed' for random amounts? They're still doing all this dirty underhanded stuff and when they get called out on it, it's 'Oopsie! Our mistake' when they know most people they do this to will naively pay it
- FireBeyond 3y ago
  Depending on the state you are in, balance billing can be outright illegal, and, in many cases, despite facilities potentially trying to get you to sign a waiver against your protection from balance billing, that right can't be waived except in limited circumstances.
- toomuchtodo 3y ago
  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...
  - yunwal 3y ago
    From what I’ve experienced, having an open dispute doesn’t prevent healthcare providers from sending you to collections and permanently ruining your credit.
    - CogitoCogito 3y ago
      It’s unfortunate the government doesn’t fine hospitals engaging in such practices into bankruptcy.
- forward1 3y ago
  > How the heck is this not criminal fraud? It may surprise you to learn criminal fraud occurs on a regular basis and the simple act of acknowledging it does nothing to address it. > Why are people allowed to simply bill whatever they feel like it Pretty simple economics: they have something you want (healthcare) which no one else can provide. Supply and demand - they dictate the terms.
redleggedfrog 3y ago
I, and my family, are now literally asking on every single thing, "Is that covered by my insurance? Will I be billed extra for that?" Like, over and over. Stupid system, stupid questions. At a recent minor surgery I must have asked it 10 times, and once for these little grippy socks they wanted to give me for my bare feet. And yup, they cost extra. So, get 'em out.
- smileysteve 3y ago
  You'll eventually run into a hospital that will 1) refuse to answer if it is covered by insurance because they have so many providers they won't know. 2) a "3rd party" like a MRI tech that is not in network
  - AniseAbyss 3y ago
    Not in network is something that I'm facing in my country despite "universal healthcare". You have to go to a website to find out if the hospital or clinic has a contract with your insurance company. But at least emergency care is exempt.
oooyay 3y ago
Same. I about lost my mind when I was hospitalized, given a wrong diagnosis, and then received a bill from the hospital, provider, and the lab in separate bills. At the time it felt like it would never end. The worst part is it doesn't feel like they really have a cap on the time they have to get their shit together and send you a bill.
smileysteve 3y ago
I had an issue with an ambulance bill that was billed separately from everything else. Despite me being conscious, handing them my current id - they found an address from 2+ year prior - so I never received a bill until the collections notice. I spent the better part of 5 years resolving it; I got them a check from my previous health insurer at year 1 when I got the notice, but since they had already sent it to collections - and I had denied the debt they never removed it from my file; then they changed billing 3rd party providers. So i spent 4 years calling once a year -- until I called an administrator for 2 weeks straight until she got fed up and fixed it.
theonething 3y ago
I like Kaiser in that sense. None of this separate bills monkey business. In fact, for my plan, no bills at all. Just upfront co-pays and then you're done paying.
- charlie0 3y ago
  I really like Kaiser as well, but afaik, they are one of the most expensive providers out there. I've only had Kaiser once, many years ago and the company dropped them because the cost to insure each person was significantly more expensive per person than everyone else. This was in a place where the average age was less than 35. I can only imagine what it costs now, especially for companies with a higher age average.
  - rayiner 3y ago
    > I really like Kaiser as well, but afaik, they are one of the most expensive providers out there. Yeah, but what would you pay in taxes in a country with universal healthcare? In Maryland, I pay a similar total tax rate on a top 1% income as our German au pair did at her entry level desk job. Germany’s tax to gdp ratio is 39%. Ours is just 28%.

by taeric 3y ago

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.
  - AlecSchueler 3y ago
    I'm not based in the US, so my servers are paid a wage directly by the restaurant.
    - beaeglebeached 3y ago
      That makes sense, but the ah ah ah this isn't the US card comes unexpected on an analogy developed specifically alongside a US based topic.
      - AlecSchueler 3y ago
        I'm sorry? I was only asking a question about another culture.
- John23832 3y ago
  Because the legalities of chef/restaurant malpractice are orders of magnitude less important than those of doctor/anesthesiologist/hospital.
- devilbunny 3y ago
  Because historically doctors were in private practices. I still am, as an anesthesiologist. Many of the surgeons I work with are also private. So, since neither of us is employed by the hospital, we do our own billing. If we were hospital employees, we could indeed do unified billing. That's a better analogy; your chefs are expecting to be paid by the restaurant, so it collects the bill. I am not paid by the hospital except a stipend for taking call for them - not for any specific services I provide to patients. It's frustrating for patients and families, it's annoying for us, but it's the price of legal independence for us. If my hospital collapsed overnight (and they sometimes do), my group could go out and start working other sources of income right away, because we already have the business setup to do our own billing.
  - petre 3y ago
    It's still better than billing to the hospital and the hospital billing to the patient, piling up taxes and comissions. The patient is also getting more cost transparency instead of a bundled bill one can never make sense of.
    - ddoolin 3y ago
      I don't agree with the last point and I think this thread is evidence of that. We cannot make sense of the myriad of bills we get from all the different providers, particularly since many or all of them are also being dealt with by our insurance and may have already been negotiated by the time we get the bills in the mail. To that point, I went to the ER a few months ago and I've probably received ten or so mailings for unpaid bills, only one of which I actually ended up owing, but my insurance didn't make the claims visible until they were settled which was months after the fact. To make matters worse, I can still log in and pay bills which were settled by my insurance. And I've received bills in the mail -- late I assume -- after they were paid by me or settled by insurance, confounding matters further.
    - Aloisius 3y ago
      Transparency would be far more useful if it came before the service being rendered. Obviously there are some practical limits in exceptional cases, but I can't think of another industry that has high-price services where providing estimates isn't standard.
taeric 3y ago
This doesn't endear me to the situation. :(
plagiarist 3y ago
Not seeing these bills would be incredible. Having them all covered in the same way would be fantastic. Instead, for us, states need to enact surprise billing laws since each provider can mysteriously be out-of-network despite working within a hospital that is in-network. The in-network concept is complete bullshit to start with, but then you have to have complete documentation of every person involved in whatever care you are getting.
- plants 3y ago
  This is what infuriates me the most about healthcare in the US. I give someone my card, they enter the numbers with no indication of whether or not everything will be covered by insurance (they assume you just know). Then, a month later, I receive a bill indicating a routine procedure that I assumed out of ignorance was covered by insurance (since they took my card and entered the numbers without saying anything to the contrary) for $500 (or, god forbid, more). If I knew a salad at a restaurant were $200, I probably wouldn’t order it. There is no basic transparency in medical billing, and that needs to change.
  - lazide 3y ago
    It’s actually even worse. If you (or the Dr’s) could reliably tell how it was even going to be coded (aka categorized/identified) in the system in advance, it would already be a huge step up. Then you’d only have a handful of different prices you might have to pay.
jimmygrapes 3y ago
Sounds like the way hair salons and strip clubs are run in the U.S.

hotpotamus 3y ago

It all feels quite postmodern to me; like it's all made up as you go along. Try to ask how much something is going to cost in a medical context and they'll usually look at you like you're stupid (and I mean like a shoulder x-ray, not something that involves a team of people and maybe some unknowns when they cut you open). Well fine, but if you can't tell me how much something is going to cost, then I can't tell you if I'm able to pay it, so I guess we'll find out together.

ahi 3y ago

I've been getting those separate bills recently and it's driving me nuts. For one small out patient procedure I have received bills from the hospital, the doctor, the anesthesiologist, anesthesiologist nursing company, and a random surgeon I have never met that the doctor asked in for a 30 second consult (I know how long the procedure took) while I was under. Seriously considering ignoring some of these whotf-are-you bills out of spite.

freetime2 3y ago
> Seriously considering ignoring some of these whotf-are-you bills out of spite. Then they will sell your debt to a collections agency who will make it their business to harass you to the maximum extent legally allowed (and sometimes more than that). This may include impacting your credit score - although I think some states at least have protections against that.
- toomuchtodo 3y ago
  https://www.consumerfinance.gov/about-us/newsroom/cfpb-kicks-off-rulemaking-to-remove-medical-bills-from-credit-reports/ https://www.consumerfinance.gov/about-us/newsroom/cfpb-kicks... ("CFPB Kicks Off Rulemaking to Remove Medical Bills from Credit Reports") https://www.consumerreports.org/money/debt-collection/fight-when-contacted-by-a-debt-collector-for-medical-bill-a8932597676/ https://www.consumerreports.org/money/debt-collection/fight-... ("How to Fight Back When Contacted by a Debt Collector for a Medical Bill") https://www.patientadvocate.org/ https://www.patientadvocate.org/
Buttons840 3y ago
I'm surprised medical billing scams aren't rampant, considering it's 100% normal to have a bill from from an unknown company show up asking for payment for unclear reasons for a procedure done a year ago.
- NoMoreNicksLeft 3y ago
  > I'm surprised medical billing scams aren't rampant, considering it's 100% normal to The difference between honest-to-god scams, and just these meaningless me-too bills that accompany every medical procedure or test... well, is there a difference? If a scam is some scheme or trick to get you to pay for something you never agreed to pay for and wouldn't agree to pay for if it were said up front, through deception strategies like opaque policies and maneuvering you to a point where you can no longer back out of it... Then pretty much all of it is a scam. That the people performing the scams have professional degrees in medicine, that they're gainfully employed as hospital and medical company employees, and so on, that doesn't really change the nature of it. Originally, the "scammy" behavior was developed (and not deliberately) to try to coerce the insurance companies into paying. But the insurance companies could afford employees to counter all those tactics. This didn't mean the experise was wasted though, they simply turned that onto the patients themselves. The crazy thing to remember is that none of that expertise will go away, no matter what happens. Maybe they'll turn it on the government too, at some point, if we ever get universal healthcare. That could be a hoot, couldn't it?

freetime2 3y ago

I agree this is so frustrating. One thing that I’ve found in the US is that in addition to having fewer out of pocket costs, being on an HMO plan can significantly simplify billing vs a PPO plan. We switched over to an HMO plan from PPO during my wife’s pregnancy and we went from getting a new bill in the mail every week to just paying a fixed co-pay at the doctor’s office every visit. It saved us so much stress, and in our case we were able to keep the exact same doctors, facilities, etc. We also saved a bunch of money, but the simplicity ended up being the thing that I valued most. Years after our child was born, I ended up getting a scary letter from a collections agency. Turns out I had missed some $20 bill from the time when we were on the PPO plan. So they say, at least - it seems equally plausible that it was a billing error on their side (of which we found many), and they never once mentioned it during any of our visits. But at that point I was not willing to fight over $20 and just paid it.

wing-_-nuts 3y ago

One thing my mom has been dealing with recently is where the insurance EOB and the bill differs substantially. My mom called the hospital to ask for an explanation and poof the bill is magically lowered by a several hundred dollars. How the heck is this not criminal fraud? Why are people allowed to simply bill whatever they feel like it, and why is my mother getting 'balance billed' for random amounts? They're still doing all this dirty underhanded stuff and when they get called out on it, it's 'Oopsie! Our mistake' when they know most people they do this to will naively pay it

FireBeyond 3y ago
Depending on the state you are in, balance billing can be outright illegal, and, in many cases, despite facilities potentially trying to get you to sign a waiver against your protection from balance billing, that right can't be waived except in limited circumstances.
toomuchtodo 3y ago
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...
- yunwal 3y ago
  From what I’ve experienced, having an open dispute doesn’t prevent healthcare providers from sending you to collections and permanently ruining your credit.
  - CogitoCogito 3y ago
    It’s unfortunate the government doesn’t fine hospitals engaging in such practices into bankruptcy.
forward1 3y ago
> How the heck is this not criminal fraud? It may surprise you to learn criminal fraud occurs on a regular basis and the simple act of acknowledging it does nothing to address it. > Why are people allowed to simply bill whatever they feel like it Pretty simple economics: they have something you want (healthcare) which no one else can provide. Supply and demand - they dictate the terms.

redleggedfrog 3y ago

I, and my family, are now literally asking on every single thing, "Is that covered by my insurance? Will I be billed extra for that?" Like, over and over. Stupid system, stupid questions. At a recent minor surgery I must have asked it 10 times, and once for these little grippy socks they wanted to give me for my bare feet. And yup, they cost extra. So, get 'em out.

smileysteve 3y ago
You'll eventually run into a hospital that will 1) refuse to answer if it is covered by insurance because they have so many providers they won't know. 2) a "3rd party" like a MRI tech that is not in network
- AniseAbyss 3y ago
  Not in network is something that I'm facing in my country despite "universal healthcare". You have to go to a website to find out if the hospital or clinic has a contract with your insurance company. But at least emergency care is exempt.

oooyay 3y ago

Same. I about lost my mind when I was hospitalized, given a wrong diagnosis, and then received a bill from the hospital, provider, and the lab in separate bills. At the time it felt like it would never end. The worst part is it doesn't feel like they really have a cap on the time they have to get their shit together and send you a bill.

smileysteve 3y ago

I had an issue with an ambulance bill that was billed separately from everything else. Despite me being conscious, handing them my current id - they found an address from 2+ year prior - so I never received a bill until the collections notice. I spent the better part of 5 years resolving it; I got them a check from my previous health insurer at year 1 when I got the notice, but since they had already sent it to collections - and I had denied the debt they never removed it from my file; then they changed billing 3rd party providers. So i spent 4 years calling once a year -- until I called an administrator for 2 weeks straight until she got fed up and fixed it.

theonething 3y ago

I like Kaiser in that sense. None of this separate bills monkey business. In fact, for my plan, no bills at all. Just upfront co-pays and then you're done paying.

charlie0 3y ago
I really like Kaiser as well, but afaik, they are one of the most expensive providers out there. I've only had Kaiser once, many years ago and the company dropped them because the cost to insure each person was significantly more expensive per person than everyone else. This was in a place where the average age was less than 35. I can only imagine what it costs now, especially for companies with a higher age average.
- rayiner 3y ago
  > I really like Kaiser as well, but afaik, they are one of the most expensive providers out there. Yeah, but what would you pay in taxes in a country with universal healthcare? In Maryland, I pay a similar total tax rate on a top 1% income as our German au pair did at her entry level desk job. Germany’s tax to gdp ratio is 39%. Ours is just 28%.