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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 explana

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.
_jal 3y ago
Yeah, they play this game enough that I simply question fucking everything. They will explain every single line item in a way that I can map back to a timeline, or they will take it off. This has to be done in person, where they can't be, uh, accidentally disconnected, but I've found the rate-of-return on that time hard to beat. They discover all sorts of "mistakes" when you're taking up their billing specialists' time. It is a bit like haggling over your car price after you already bought it; the main thing to get over is the social discomfort of being a pain in the ass, so they can't use that against you.
IG_Semmelweiss 3y ago
its not nefarious - most likely the patient statement printed and sent before someone corrected the coordination of benefits (i.e. right insurance, right copay etc), usually triggered by you. So you got a paper that was outdated, that's it. Its actually typical for a patient to have a huge balance, then get sent the amount, so the patient has ownership of the problem. That usually results in patients calling and correcting whatever error they (or staff) made that made balances ballon. Unfortunately, as long as everything including a paper cut is supposed to be covered by a regulated health plan, that's what we are going to get. All you can eat tends to increase the cost to provide it, if someone else is paying for it.
- wing-_-nuts 3y ago
  'Outdated', funny when my mother asked the hospital what the current balance was, that figure was automatically quoted. When she then asked for a breakdown of the charges, they said they'd 'have to get back to her' and then called her later with the new amount. I'm of the strong opinion that the US healthcare system should join the developed world and go single payer. The system we have was clearly set up to exploit patients.
positr0n 3y ago
I had major emergency surgery a couple years ago. The hospital sent me a bill for $9k (out of $135k total) after a few months but the status on my insurance website indicated they were still figuring it out. I called and asked how they had arrived at the numbers in the bill and the person on the phone basically told me "it looks like someone just guessed, go ahead and ignore the bill and we'll send you a correct one later." (Resolution: Thankfully I had excellent health insurance at the time. I think I paid a few hundred bucks to the surgeon and that along with prior expenses filled up my yearly out-of-pocket maximum. I never saw another bill from the hospital)
bobongo 3y ago
> How the heck is this not criminal fraud? It probably is; however, it's probably also not being enforced, since no government agency in the US seems to have the teeth or the will to protect consumer rights to the level they are elsewhere. Also, when they do get a bit too willing, their regulatory activities get shut down or their funding cut because they become a little too visible in the public eye (who has a negative view of government agencies and federal employees in general). Very few government agencies have the courage to take actions that might end up on Washington Post etc.

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.

_jal 3y ago

Yeah, they play this game enough that I simply question fucking everything. They will explain every single line item in a way that I can map back to a timeline, or they will take it off. This has to be done in person, where they can't be, uh, accidentally disconnected, but I've found the rate-of-return on that time hard to beat. They discover all sorts of "mistakes" when you're taking up their billing specialists' time. It is a bit like haggling over your car price after you already bought it; the main thing to get over is the social discomfort of being a pain in the ass, so they can't use that against you.

IG_Semmelweiss 3y ago

its not nefarious - most likely the patient statement printed and sent before someone corrected the coordination of benefits (i.e. right insurance, right copay etc), usually triggered by you. So you got a paper that was outdated, that's it. Its actually typical for a patient to have a huge balance, then get sent the amount, so the patient has ownership of the problem. That usually results in patients calling and correcting whatever error they (or staff) made that made balances ballon. Unfortunately, as long as everything including a paper cut is supposed to be covered by a regulated health plan, that's what we are going to get. All you can eat tends to increase the cost to provide it, if someone else is paying for it.

wing-_-nuts 3y ago
'Outdated', funny when my mother asked the hospital what the current balance was, that figure was automatically quoted. When she then asked for a breakdown of the charges, they said they'd 'have to get back to her' and then called her later with the new amount. I'm of the strong opinion that the US healthcare system should join the developed world and go single payer. The system we have was clearly set up to exploit patients.

positr0n 3y ago

I had major emergency surgery a couple years ago. The hospital sent me a bill for $9k (out of $135k total) after a few months but the status on my insurance website indicated they were still figuring it out. I called and asked how they had arrived at the numbers in the bill and the person on the phone basically told me "it looks like someone just guessed, go ahead and ignore the bill and we'll send you a correct one later." (Resolution: Thankfully I had excellent health insurance at the time. I think I paid a few hundred bucks to the surgeon and that along with prior expenses filled up my yearly out-of-pocket maximum. I never saw another bill from the hospital)

bobongo 3y ago

> How the heck is this not criminal fraud? It probably is; however, it's probably also not being enforced, since no government agency in the US seems to have the teeth or the will to protect consumer rights to the level they are elsewhere. Also, when they do get a bit too willing, their regulatory activities get shut down or their funding cut because they become a little too visible in the public eye (who has a negative view of government agencies and federal employees in general). Very few government agencies have the courage to take actions that might end up on Washington Post etc.