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I had an odd but successful experience with medical billing recently. My daughter went to urgent care for an urgent problem; after things were mostly cleared u

by dekhn 1y ago

I had an odd but successful experience with medical billing recently. My daughter went to urgent care for an urgent problem; after things were mostly cleared up, they transferred her by ambulance to an ER (even though there was no emergency). Both the urgent care and ER were handled by our insurance but the ambulance company sent us a large bill ($4K for a short drive) which felt too large to us (they had already tried to get my insurance to pay, but insurance said it wasn't covered). My wife was going to call the ambulance company to try to negotiate it down, but I recalled that I had recently received a random piece of mail saying that my employer subscribed to a service that could negotiate medical bills. We contacted the service and provided our info (the context of the situation, the billing information, the actions we'd taken so far, etc) and a couple weeks later, the service reported that they had converted the ambulance ride from an uncovered insurance to covered by insurance (since the transport was between a covered urgent care to a covered EHR) and had our insurance cover the majority- we ended up paying $500 to the ambulance company. While I am not surprised that such a service exists, what did surprise me is that it's just a division of my insurance company: they literally have a division that negotiates with another part of the insurance cmpany to get better coverage for patients. I was pretty lucky to notice the mail about this- there's nothing on my employer's site saying we have this coverage(!) and the vast majority of people in the US likely don't have this service. If there is anything that will bankrupt the US, it's excessive medical charges and a lack of knowledge of how to address them. Maybe AI will help, but I really doubt it long term.

protocolture 1y ago
>While I am not surprised that such a service exists, what did surprise me is that it's just a division of my insurance company: they literally have a division that negotiates with another part of the insurance cmpany to get better coverage for patients. I was pretty lucky to notice the mail about this- there's nothing on my employer's site saying we have this coverage(!) and the vast majority of people in the US likely don't have this service. 100 years ago I used to work for the fruit company in phone support. My KPI's were 100% customer satisfaction. However, I needed to get approval from another team to advance any kind of free/gratis repairs replacements or gifts. That team's KPIs were opaque to me, but my understanding is that they were find as long as they offered some resistance. Between those two pillars we got a lot of good done for customers. I dont think theres anything necessarily wrong with having internal friction like that if its designed correctly. Its probably better than having both responsibilities in a single person. In terms of health insurance however it seems ghoulish.
Geeek 1y ago
Whats the service that negotiates medical bills?
whimsicalism 1y ago
as long as we have a significant portion of healthcare users who are basically fully price insensitive but not subject to any rationing, absurd US medical costs will continue.
- sixothree 1y ago
  Hard to believe you say we aren't subject to rationing when pre-authorization is as big as it is. You should see some of the proposed rules. Pre-authorization will start to use a medical language called CQL and there will be literally thousands of queries EHRs will need to implement to ensure their customers can get the care they need.
  - whimsicalism 1y ago
    > Hard to believe you say we aren't subject to rationing when pre-authorization is as big as it is. If you want to see true rationing, look to the UK (especially) or Canada (less so) where I know plenty of people who have to wait over a year to see a specialist even after doctor referral. Meanwhile, my parents in the US at a hospital get a CT scan, MRI 'just in case' immediately (or close-to for the MRI) and pay nothing for it.
    - foldr 1y ago
      In the US care like that is rationed by wealth rather than by need. Your parents are getting MRI scans that they may not really need, while uninsured Americans aren't getting MRI scans that they may actually need. I bet we could cut down NHS waiting lists a fair bit if we arbitrarily decided that ~10% of the population were no longer entitled to a wide range of non-emergency treatments.
      - whimsicalism 1y ago
        This is true to an extent, but with the massive age-based confounder that is medicare, which renders the elderly close to price insensitive as well as by far the largest utilizers. I think there are lessons to learn and improvements from both systems - for instance, catastrophic healthcare is a disaster in the US (in terms of cost), but we are better at timely care and providing incentives for pharma R&D.
sixothree 1y ago
> we ended up paying $500 to the ambulance company. I'm sure people from first world countries would be stunned by this number. And that makes it even sadder. > Maybe AI will help, but I really doubt it long term. I'm guessing it will help up until the point where hospitals start using AI for this process.
- ryandrake 1y ago
  The idea of an injured patient having to pay at all for an emergency ambulance ride to a hospital should stun any normal human being living in a civilized society.
  - RiverStone 1y ago
    Then who pays? If your argument is that we should socialize the cost of that ambulance ride across all Americans, they won’t go for that. Americans don’t want more taxes, but more importantly, Americans deeply mistrust their fellow citizens, and don’t want to feel like they’re paying for someone else’s life decisions. America doesn’t have the same kind of social cohesion as most countries. We’re a nation of individualists. The general feeling here (rightly or wrongly) is that healthcare costs are largely driven by your choices in life, and Americans don’t want to feel like they’re on the hook for other people’s bad choices.
thebruce87m 1y ago
> had an odd but successful experience > we ended up paying $500 to the ambulance company I get where you’re coming from but that’s still a loss to me from the perspective of the broken system.
codegeek 1y ago
I hear you that you didn't have to pay something crazy but the fact that you ultimately paid $500 for a short ride and you think it was "successful experience" is how they fool us. You think you got a deal when they are still laughing all the way to the bank for charging you $500 for a short ride.
- dekhn 1y ago
  I don't know, I don't run an ambulance company- what should the cost be (either to me, my insurance company, or to the government)? Can't be cheap to fully staff an ambulance with EMTs.
  - hshdhdhehd 1y ago
    Zero to you. Whatever it reasonably costs to government. A bit from you later in tax, but much more from Bezos.
  - chinathrow 1y ago
    What's "short" in your context? 20min?
    - dekhn 1y ago
      Yes, but I'm talking about the costs of actually running a 24/7 emergency vehicle operation- even completely idle, the emergency vehicle has significant costs that they need to cover.

by dekhn 1y ago

protocolture 1y ago

>While I am not surprised that such a service exists, what did surprise me is that it's just a division of my insurance company: they literally have a division that negotiates with another part of the insurance cmpany to get better coverage for patients. I was pretty lucky to notice the mail about this- there's nothing on my employer's site saying we have this coverage(!) and the vast majority of people in the US likely don't have this service. 100 years ago I used to work for the fruit company in phone support. My KPI's were 100% customer satisfaction. However, I needed to get approval from another team to advance any kind of free/gratis repairs replacements or gifts. That team's KPIs were opaque to me, but my understanding is that they were find as long as they offered some resistance. Between those two pillars we got a lot of good done for customers. I dont think theres anything necessarily wrong with having internal friction like that if its designed correctly. Its probably better than having both responsibilities in a single person. In terms of health insurance however it seems ghoulish.

Geeek 1y ago

Whats the service that negotiates medical bills?

whimsicalism 1y ago

as long as we have a significant portion of healthcare users who are basically fully price insensitive but not subject to any rationing, absurd US medical costs will continue.

sixothree 1y ago
Hard to believe you say we aren't subject to rationing when pre-authorization is as big as it is. You should see some of the proposed rules. Pre-authorization will start to use a medical language called CQL and there will be literally thousands of queries EHRs will need to implement to ensure their customers can get the care they need.
- whimsicalism 1y ago
  > Hard to believe you say we aren't subject to rationing when pre-authorization is as big as it is. If you want to see true rationing, look to the UK (especially) or Canada (less so) where I know plenty of people who have to wait over a year to see a specialist even after doctor referral. Meanwhile, my parents in the US at a hospital get a CT scan, MRI 'just in case' immediately (or close-to for the MRI) and pay nothing for it.
  - foldr 1y ago
    In the US care like that is rationed by wealth rather than by need. Your parents are getting MRI scans that they may not really need, while uninsured Americans aren't getting MRI scans that they may actually need. I bet we could cut down NHS waiting lists a fair bit if we arbitrarily decided that ~10% of the population were no longer entitled to a wide range of non-emergency treatments.
    - whimsicalism 1y ago
      This is true to an extent, but with the massive age-based confounder that is medicare, which renders the elderly close to price insensitive as well as by far the largest utilizers. I think there are lessons to learn and improvements from both systems - for instance, catastrophic healthcare is a disaster in the US (in terms of cost), but we are better at timely care and providing incentives for pharma R&D.

sixothree 1y ago

> we ended up paying $500 to the ambulance company. I'm sure people from first world countries would be stunned by this number. And that makes it even sadder. > Maybe AI will help, but I really doubt it long term. I'm guessing it will help up until the point where hospitals start using AI for this process.

ryandrake 1y ago
The idea of an injured patient having to pay at all for an emergency ambulance ride to a hospital should stun any normal human being living in a civilized society.
- RiverStone 1y ago
  Then who pays? If your argument is that we should socialize the cost of that ambulance ride across all Americans, they won’t go for that. Americans don’t want more taxes, but more importantly, Americans deeply mistrust their fellow citizens, and don’t want to feel like they’re paying for someone else’s life decisions. America doesn’t have the same kind of social cohesion as most countries. We’re a nation of individualists. The general feeling here (rightly or wrongly) is that healthcare costs are largely driven by your choices in life, and Americans don’t want to feel like they’re on the hook for other people’s bad choices.

thebruce87m 1y ago

> had an odd but successful experience > we ended up paying $500 to the ambulance company I get where you’re coming from but that’s still a loss to me from the perspective of the broken system.

codegeek 1y ago

I hear you that you didn't have to pay something crazy but the fact that you ultimately paid $500 for a short ride and you think it was "successful experience" is how they fool us. You think you got a deal when they are still laughing all the way to the bank for charging you $500 for a short ride.

dekhn 1y ago
I don't know, I don't run an ambulance company- what should the cost be (either to me, my insurance company, or to the government)? Can't be cheap to fully staff an ambulance with EMTs.
- hshdhdhehd 1y ago
  Zero to you. Whatever it reasonably costs to government. A bit from you later in tax, but much more from Bezos.
- chinathrow 1y ago
  What's "short" in your context? 20min?
  - dekhn 1y ago
    Yes, but I'm talking about the costs of actually running a 24/7 emergency vehicle operation- even completely idle, the emergency vehicle has significant costs that they need to cover.