4 ms·

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

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...
- cvalka 3y ago
  This bill is a masterpiece! The arbitration pricing provision is a beauty!
- duffpkg 3y ago
  To clarify my point, your insurer spells this out to you, though you as a patient may not understand it to be the case. There is no surprise, its the expected behavior reading the literal minutiae of the giant packet your health insurer offers you. It's just that many people do not understand they have multiple additive deductibles for certain types of care.
mynameisnoone 3y ago
Except you're tone deaf trivializing systemic evil as a banal "business misunderstanding". I was roadtripping through Redding, CA several years back. While in line at a coffee, I ran across a young lady with a nasal infusion pump tube taped to her face arranging some paperwork. After chatting, she informed me she had Stage IV cancer and the hospitals and doctors were coming after her for every cent she had while she was dying, and it forced her into bankruptcy. The paperwork was for her bankruptcy hearing across the way. This is what happens when for-profit health insurance and hospitals are allowed to exist because every other sensible advanced economy in the world has universal healthcare. The disconnect is American patients don't know how bad they have it: their financial liability is essentially unlimited, they pay far more, and have worse outcomes.
- beaeglebeached 3y ago
  A nasty truth is when people are terminally ill, the vultures emerge. With animals too. In socialist paradise your kids dispossessed because inheritance is immoral. In capitalist paradise, dispossessed because the hospital can charge the captive buyer limitlessly. Doesn't matter what system, the order of life plays out. Humans are chimps with high order skills to do the same chimp shit and explain it away with various fictions.
  - StockHuman 3y ago
    No, the American system is measurably worse. Dying destitute of a preventable cause is a uniquely American phenomenon contrasted to Western nations with socialized healthcare within capitalist frameworks. And as far as I know, Cubans have inheritance.
- rayiner 3y ago
  > This is what happens when for-profit health insurance and hospitals are allowed to exist because every other sensible advanced economy in the world has universal healthcare Many of those universal systems have for-profit insurance and for-profit hospitals too.
wolverine876 3y ago
> most hospital systems are not evil profit seeking corpratons but just trying to keep the lights on Why are they struggling so much more now than 10 or 20 years ago (when health care costs were already soaring)? I read about a non-profit childrens hospital in some large US city that paid its CEO $7 million.
- lazide 3y ago
  The one who figures out how to scam everyone the best is worth the extra money?
- duffpkg 3y ago
  If you go back and read the various dicussions, arguments and controversies from around 1984 regarding the enactment of HMOs it is my opinion that things aren't dramatically worse than at that point. Executive compensation is an issue in a lot more industries than healthcare. I think that there are big problems there. The structure of hospitals as a medico-legal entity is a complicated business in most states. When you say "CEO of a hospital" it typically does not bear much relation to what you say when you say "CEO of Disney". In healthcare there is among other complicated things "corporate practice of medicine" laws which prohibit non-medical ownership of medical organizations. So a "Hospital CEO" may often be the head or a chairman of a foundation or entity that owns the real estate that a hospital uses or sometimes is just the practicing head of medice of a medical organization or any of a myriad of other byzantine structures. That doesn't make excess compensation any better but it's important to identify what someones role actually is and what they are compensated for. Most hospital systems are a little more like medical malls than any singular beast.
lp0_on_fire 3y ago
To be fair, when you see these giant corporations buy up every private medical practice from one side of the state to the other it’s hard not to see them as evil and profit seeking. When you walk into the lobby of the hospital and it’s guilded with marble floors, vaulted ceilings, and chandeliers with large spacious “offices” for the billing departments, it’s hard not to see them as evil and profit seeking. When you can’t get a straight answer out of anyone at the facility regarding cost of a simple procedure, it’s hard not to see them as evil and profit seeking. When you see the executives of these hospitals wining and dining with the insurance executives then suddenly next year your premiums and deductibles get raised, it’s hard not to see them as evil and profit seeking. Do I think that all medical professionals are evil and profit seeking? No. Do I think that many of them are content to live under an umbrella of plausible deniability as long as their paychecks increase? Absolutely.
- duffpkg 3y ago
  I want to be clear that I agree there are significant problems. I understand this commonly held perception but more than 29 states make it outright illegal for a regular for-profit corporation to own anything which engages in the practice of medicine. Look up "corporate practice of medicine" laws. That isn't to say there aren't problems. As a former hospital executive I can tell you first hand there is no love lost between hospital systems and insurers. A lot of hospital systems operate with a level of incompetence and dysfunction that it is truly difficult for regular people to appreciate. In many many cases a medical provider may not have a clear picture or be able to get a clear picture of what they will actually be compensated by your insurance for a given procedure. I understand that sounds crazy but it's a real thing. Competent organizations handle that situation a lot better than incompetent ones.

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...

cvalka 3y ago
This bill is a masterpiece! The arbitration pricing provision is a beauty!
duffpkg 3y ago
To clarify my point, your insurer spells this out to you, though you as a patient may not understand it to be the case. There is no surprise, its the expected behavior reading the literal minutiae of the giant packet your health insurer offers you. It's just that many people do not understand they have multiple additive deductibles for certain types of care.

mynameisnoone 3y ago

Except you're tone deaf trivializing systemic evil as a banal "business misunderstanding". I was roadtripping through Redding, CA several years back. While in line at a coffee, I ran across a young lady with a nasal infusion pump tube taped to her face arranging some paperwork. After chatting, she informed me she had Stage IV cancer and the hospitals and doctors were coming after her for every cent she had while she was dying, and it forced her into bankruptcy. The paperwork was for her bankruptcy hearing across the way. This is what happens when for-profit health insurance and hospitals are allowed to exist because every other sensible advanced economy in the world has universal healthcare. The disconnect is American patients don't know how bad they have it: their financial liability is essentially unlimited, they pay far more, and have worse outcomes.

beaeglebeached 3y ago
A nasty truth is when people are terminally ill, the vultures emerge. With animals too. In socialist paradise your kids dispossessed because inheritance is immoral. In capitalist paradise, dispossessed because the hospital can charge the captive buyer limitlessly. Doesn't matter what system, the order of life plays out. Humans are chimps with high order skills to do the same chimp shit and explain it away with various fictions.
- StockHuman 3y ago
  No, the American system is measurably worse. Dying destitute of a preventable cause is a uniquely American phenomenon contrasted to Western nations with socialized healthcare within capitalist frameworks. And as far as I know, Cubans have inheritance.
rayiner 3y ago
> This is what happens when for-profit health insurance and hospitals are allowed to exist because every other sensible advanced economy in the world has universal healthcare Many of those universal systems have for-profit insurance and for-profit hospitals too.

wolverine876 3y ago

> most hospital systems are not evil profit seeking corpratons but just trying to keep the lights on Why are they struggling so much more now than 10 or 20 years ago (when health care costs were already soaring)? I read about a non-profit childrens hospital in some large US city that paid its CEO $7 million.

lazide 3y ago
The one who figures out how to scam everyone the best is worth the extra money?
duffpkg 3y ago
If you go back and read the various dicussions, arguments and controversies from around 1984 regarding the enactment of HMOs it is my opinion that things aren't dramatically worse than at that point. Executive compensation is an issue in a lot more industries than healthcare. I think that there are big problems there. The structure of hospitals as a medico-legal entity is a complicated business in most states. When you say "CEO of a hospital" it typically does not bear much relation to what you say when you say "CEO of Disney". In healthcare there is among other complicated things "corporate practice of medicine" laws which prohibit non-medical ownership of medical organizations. So a "Hospital CEO" may often be the head or a chairman of a foundation or entity that owns the real estate that a hospital uses or sometimes is just the practicing head of medice of a medical organization or any of a myriad of other byzantine structures. That doesn't make excess compensation any better but it's important to identify what someones role actually is and what they are compensated for. Most hospital systems are a little more like medical malls than any singular beast.

lp0_on_fire 3y ago

To be fair, when you see these giant corporations buy up every private medical practice from one side of the state to the other it’s hard not to see them as evil and profit seeking. When you walk into the lobby of the hospital and it’s guilded with marble floors, vaulted ceilings, and chandeliers with large spacious “offices” for the billing departments, it’s hard not to see them as evil and profit seeking. When you can’t get a straight answer out of anyone at the facility regarding cost of a simple procedure, it’s hard not to see them as evil and profit seeking. When you see the executives of these hospitals wining and dining with the insurance executives then suddenly next year your premiums and deductibles get raised, it’s hard not to see them as evil and profit seeking. Do I think that all medical professionals are evil and profit seeking? No. Do I think that many of them are content to live under an umbrella of plausible deniability as long as their paychecks increase? Absolutely.

duffpkg 3y ago
I want to be clear that I agree there are significant problems. I understand this commonly held perception but more than 29 states make it outright illegal for a regular for-profit corporation to own anything which engages in the practice of medicine. Look up "corporate practice of medicine" laws. That isn't to say there aren't problems. As a former hospital executive I can tell you first hand there is no love lost between hospital systems and insurers. A lot of hospital systems operate with a level of incompetence and dysfunction that it is truly difficult for regular people to appreciate. In many many cases a medical provider may not have a clear picture or be able to get a clear picture of what they will actually be compensated by your insurance for a given procedure. I understand that sounds crazy but it's a real thing. Competent organizations handle that situation a lot better than incompetent ones.