4 ms·

We suddenly woke up in the Kafka-esque purgatory of critical American healthcare billing. We’re in our 50s and had been perfectly healthy, then suddenly we got

We suddenly woke up in the Kafka-esque purgatory of critical American healthcare billing. We’re in our 50s and had been perfectly healthy, then suddenly we got diagnosed with what will be over $500k in treatment over the next 12 months— and multiple millions for the foreseeable future. We have insurance, but many of the required procedures are “out of network” and there’s no way to tell (we have “the best” insurance, supposedly). Even with insurance it will be at least $50k/yr out of pocket But the raw numbers like $200k for this poor gentleman’s heart attack or $500k aren’t the most alarming. It’s the Terry-Gilliam-level of absurdity of the billing process. Absolutely no one will tell you how much things are, and when you ask, they sass you that it is a ridiculous question. Even though one of my providers just recently started offering estimates, those are off by 100-200% , and completely missing for about half of what has been ordered. We are both very strong accountants, and despite trying to do audits of these services, it’s impossible. There are 3-4 levels of referred services, bundled codes, nested codes, complication / technical / professional codes , exceptional status codes . Providers overbill, double bill. On accident and on purpose. When we call to get it corrected there is no way to make corrections. You’ll be asked to take a diagnostic not knowing whether it will cost $10 or $15000 . Even if you try to be responsible and call the provider (who isn’t your doctor, clinic, or hospital ) – they won’t be able to tell you. The point I’m trying to make isn’t to make you sympathetic. It’s to reinforce in all of the great technical minds here that healthcare billing is the most complicated spaghetti code cluster flock of a system that you’ve ever imagined. It’s far worse than any piece of software you’ve ever seen. And we all just accept the bills and pay them. Supply and demand and finding a better vendor doesn’t work. There are some rare exceptions like elective MRIs – but those aren’t the norm. Nearly every service is something time sensitive or your disease will get significantly worse. Moreover, signing up a new provider has $1000+ in billing and a few hours in paperwork to make the transfer. is it worth saving $500 for one MRI when $250k worth of services are unaccountable? The only thing I’m sure of is that there has to be tremendous amounts of incidental and deliberate corruption . Auditing a single patient’s billing is impossible – so a population’s worth is a goldmine .

vjvjvjvjghv 1y ago
The stuff you are describing is what bothers me the most. There is a lot of talk about how we should have a free market system. But there is no real market for patients. Most people can't pick an insurance plan for themselves because the employer picks. Then it's extremely hard to get an estimate for anything. And even if you get an estimate, it's most likely wrong. Then the billing is totally opaque. Insurance and providers constantly make mistakes or lose things. I went through this with my ex after a surgery. It was totally insane to figure out where the numbers are coming from and basically a full time job. Even if we don't want to go to single player or similar, I don't understand why it's not at least possible to mandate clear and binding estimates and billing a normal person can understand. And let the market work its magic through competition.
- tonymet 1y ago
  That’s true. The ideal case of elective MRI or planned surgery (like a hip surgery) are the exception. In most cases you have to make a decision on the spot. In our case we were basically told to move forward within 3 weeks or mortality would be much more likely. Moving to another provider is like starting over with paperwork, records , diagnostics tests, building relationships . We already did one transfer due to insurance requirements and lost about 90 critical days that we can never get back. Images were lost preventing a proper diagnosis. I’m not against free market medicine in principle but the current billing, records and regulations make it impossible with our setup.
kamaal 1y ago
>>It’s the Terry-Gilliam-level of absurdity of the billing process. Absolutely no one will tell you how much things are, and when you ask, they sass you that it is a ridiculous question. Here in India when my dad underwent bypass surgery, I checked the bills the breakdown is insane. This how a charge goes, Nurse comes to see you, so she wears a pair of gloves, that gloves is billed. And often something like 10x the price those are available in the regular pharmacy. Each and everything is billed, and you would be surprised just how many things like these can be be billed. >>You’ll be asked to take a diagnostic not knowing whether it will cost $10 or $15000 . Even if you try to be responsible and call the provider (who isn’t your doctor, clinic, or hospital ) – they won’t be able to tell you. Often some 'visiting doctor' comes to see you. Like in the case of my dad we were billed for a diabetic consultation, despite clearly telling them he wasn't diabetic, even more so, the same doctor came in the day before and had to told the same. We didn't need it. But you will see they bill you like 2000 rupees just for the person to enter the room say 'Hi' and exit. >>The only thing I’m sure of is that there has to be tremendous amounts of incidental and deliberate corruption . Auditing a single patient’s billing is impossible – so a population’s worth is a goldmine . In these situations most people are so stressed and anxious often people just have no mental bandwidth to fight side battles. Its really a corrupt system to the core, and I don't see hospitals and doctors giving all this up anytime soon. Or even ever.

vjvjvjvjghv 1y ago

The stuff you are describing is what bothers me the most. There is a lot of talk about how we should have a free market system. But there is no real market for patients. Most people can't pick an insurance plan for themselves because the employer picks. Then it's extremely hard to get an estimate for anything. And even if you get an estimate, it's most likely wrong. Then the billing is totally opaque. Insurance and providers constantly make mistakes or lose things. I went through this with my ex after a surgery. It was totally insane to figure out where the numbers are coming from and basically a full time job. Even if we don't want to go to single player or similar, I don't understand why it's not at least possible to mandate clear and binding estimates and billing a normal person can understand. And let the market work its magic through competition.

tonymet 1y ago
That’s true. The ideal case of elective MRI or planned surgery (like a hip surgery) are the exception. In most cases you have to make a decision on the spot. In our case we were basically told to move forward within 3 weeks or mortality would be much more likely. Moving to another provider is like starting over with paperwork, records , diagnostics tests, building relationships . We already did one transfer due to insurance requirements and lost about 90 critical days that we can never get back. Images were lost preventing a proper diagnosis. I’m not against free market medicine in principle but the current billing, records and regulations make it impossible with our setup.

kamaal 1y ago

>>It’s the Terry-Gilliam-level of absurdity of the billing process. Absolutely no one will tell you how much things are, and when you ask, they sass you that it is a ridiculous question. Here in India when my dad underwent bypass surgery, I checked the bills the breakdown is insane. This how a charge goes, Nurse comes to see you, so she wears a pair of gloves, that gloves is billed. And often something like 10x the price those are available in the regular pharmacy. Each and everything is billed, and you would be surprised just how many things like these can be be billed. >>You’ll be asked to take a diagnostic not knowing whether it will cost $10 or $15000 . Even if you try to be responsible and call the provider (who isn’t your doctor, clinic, or hospital ) – they won’t be able to tell you. Often some 'visiting doctor' comes to see you. Like in the case of my dad we were billed for a diabetic consultation, despite clearly telling them he wasn't diabetic, even more so, the same doctor came in the day before and had to told the same. We didn't need it. But you will see they bill you like 2000 rupees just for the person to enter the room say 'Hi' and exit. >>The only thing I’m sure of is that there has to be tremendous amounts of incidental and deliberate corruption . Auditing a single patient’s billing is impossible – so a population’s worth is a goldmine . In these situations most people are so stressed and anxious often people just have no mental bandwidth to fight side battles. Its really a corrupt system to the core, and I don't see hospitals and doctors giving all this up anytime soon. Or even ever.