6 ms·

Coming from India, I have really come to hate the medical system here in the US. There are countless times I have been screwed over by the lack of transparency

Coming from India, I have really come to hate the medical system here in the US. There are countless times I have been screwed over by the lack of transparency in cost and the layer of bureaucracy and BS imposed by having to deal with an insurance company rather than __the doctor/hospital who treated me__!! It has been a few months since I have seen a doctor, but I still receive some new goddamn bill every other day. They are usually cryptic and leave me wondering what the hell they are for, and why they were not just presented to me on the day of the test. Don't even bother asking anyone what a procedure costs. Hospital staff will redirect you to someone who deals exclusively with insurance (completely unnecessary if we just had simple bills like any other transaction FFS), and the insurance people don't have enough specifics to ever really give you an answer, not to mention the time it will take waiting on hold etc. When you are getting multiple procedures, its just not worth the time. So you are practically forced to go in completely blind about potential costs. To top it all off, my insurance coverage has expired as I recently graduated. So my options are to either pay $600 for 30 days of medicine that I need, or get the exact same medicine shipped to me from India, for $10-$20. They produce it by the millions in blister packs. This should not be so difficult! If we just had realistic prices in the first place instead of inflating them and bringing them down with insurance, this crap would not happen. And don't even get me started on "pre-existing conditions". What that means for me is constantly lying to doctors and being unable to give them a complete medical history - otherwise I'll have f* "pre-existing condition" stamped on my head and never get sane rates again. I fail to see why health care is not treated more like a series of simple business transactions in an economic system instead of this colossal mess. /rant

swamp40 12y ago
I don't disagree with your rant, but Obamacare eliminated all the pre-existing conditions clauses.
yodsanklai 12y ago
> And don't even get me started on "pre-existing conditions". What that means for me is constantly lying to doctors I don't know if it's a good idea. I have a related anecdote: My mother forgot (or omitted) to mention a pre-existing condition when she contracted a mortgage insurance. She died a few years later from causes totally unrelated to the pre-existing condition. Somehow, the insurance company found out and legally canceled the insurance.
- russum 12y ago
  Sorry for your loss. I don't really know how all that works but just curious - is it documented / can they prove that the pre-existing condition wasn't mentioned at that time? Sounds pretty convenient for the insurance company to purposely "forget" something like this and then abuse that information when the time comes since, unfortunately, the person who could argue it is no longer alive.
  - yodsanklai 12y ago
    In that case, it was pretty clear. She had to answer a questionary so yes it was documented. And the contract stipulated very clearly that in case of mistake or omission the contract would be void. I can't really blame the insurance company even though it seemed unfair at the time.
stefan_kendall3 12y ago
Narcolepsy?
yutah 12y ago
All hospitals should probably be required to do something like this: http://www.surgerycenterok.com/pricing/ http://www.surgerycenterok.com/pricing/ ...
chimeracoder 12y ago
> And don't even get me started on "pre-existing conditions". First, I would delete the sentence after this if I were you, since it could come back to haunt you legally[0]. Second, unless things are different for foreigners in the US (which AFAIK is not the case), this is not how pre-existing conditions actually work (anymore), post-ACA. [0] (I am not a lawyer, I am not your lawyer, and this is not legal advice.) > So you are practically forced to go in completely blind about potential costs. This (price transparency) is actually the real problem more than the sticker prices themselves. If patients had the ability to know expected prices beforehand, market forces would work to bring prices down. As it stands, we have a very awkward situation in which insurers compete to keep premiums down to attract customers, and therefore negotiate lower prices with providers, but patients are completely blind to this entire process and are unable to "vote with their wallets", because the prices that patients pay and the prices that insurers pay are not always directly linked in practice.
- crag 12y ago
  "If patients had the ability to know expected prices beforehand, market forces would work to bring prices down." If patients knew to ask. Really. If you are covered by insurance (including medicare/tri-care/etc) you won't get an answer. But if you are paying out of pocket (and most hospitals require credit if you are doing something serious - like open heart)you can negotiate the price. Let me say again, the hospital will negotiate. The doctors and labs (not done in the hospital) are another matter. Also, if you see an aspirin on your bill costing $75 you need to call. You'd be surprised how effective this is. Most Americans never question the price of anything. Even cars these days people take at face value. Of course, if you in the ER with chest pain, I'll admit, the last thing on your mind is the bill. And the hospitals know that. So what's the lesson here? In America have insurance. Even if you are 20 years old. A simple care wreck can destroy you financially. You think student loans are bad? Try a drug overdose. Or a heart attack. Or a fractured back ( a car wreck). If you young, insurance is cheap. Dirt cheap.
  - maxxxxx 12y ago
    I haven't had much success getting prices when I had a high deductible insurance. Most doctors won't tell you anything or they will quote you one price today and 5 times as much tomorrow. You certainly won't get a binding quote you can plan with.
chaosmonkey 12y ago
> It has been a few months since I have seen a doctor, but I still receive some new goddamn bill every other day. I went to a single visit to a hospital once and after the treatment, I got 4 different bills. I was amused why I was getting bills from places I had no idea about. Then I realized each entity had a different billing department - the hospital's bill, the doctor's bill, the tester's bill, etc. all related to the single visit to the same hospital. I had to call each of the 4 departments and deal with insurance. It was a nightmare!
- curun1r 12y ago
  It's not always like that. There are insurers like Kaiser that are vertically integrated that make the whole experience much smoother. At my last checkup, my doctor gave he an immunization, ordered blood tests and prescribed medication. The blood tests and pharmacy were both in the same building, so I just had to make two stops on my way out of the building that took an extra ~15 minutes. The immunization and checkup were covered by my insurance and I paid my copay for the blood work and prescription up-front just before having my blood taken and getting my medication. It was all very affordable, quick and easy and I never saw a total bill. I only got a receipt for my copay. I've never needed any major health care from them, but I have a parent that has had both hips and a shoulder replaced with Kaiser who had a similarly simple experience.
- danielweber 12y ago
  I'm generally not in favor of single-payer, but take this as an argument against my position. My mom had some big treatments last year. My dad is a probably-undiagnosed-autistic guy who loves spreadsheets. He set up a spreadsheet for every single visit, correlating exactly how much was paid, exactly how much insurance (including Medicare) paid, and when each provider was marking the bills as paid. He's retired, so this was his full-time hobby. He still got continuously yanked around by every single provider, some claiming paid in full (which my dad filed dutifully in a binder) and then later asking for more money. It's a freaking mess.
  - pstuart 12y ago
    So why doesn't this make you generally in favor of single-payer?
cordite 12y ago
It is unrealistic on how a sponge in surgery costs $45 or a set of 3 small towels (x2) costs $380. Also, the optimizations in health care over the last couple decades actually have gotten it to cost more overall, mostly due to processing overheads and bureaucracy. When it comes to getting multiple bills, part of that has to do with their standards with insurance agencies. Usually you have CPT (R) codes, HCPCS, ICD codes and so on (at least in the US, international places do not use CPT often.) There is professional billing, which generally involves physicians or specialists time and expertise. While hospital billing involves staffing, reduction of capacity (like taking up a room or a bed), and all supplies, materials, and labs performed while admitted. Another thing that is standard in the industry is that it actually costs more to consult someone than to refer a patient to them. Part of this has come due to insurance agencies being more supportive of consulting which means that the specialist can benefit more patients with less responsibility transfer and time.
- jleader 12y ago
  Keep in mind that hospital "costs" are largely fictional. When the bill says $45 for a sponge, the insurance company has negotiated a much lower rate for the whole procedure, and if you go to the hospital and say "I'm a cash patient", they'll typically also give you a substantial discount (though probably not as low as the insurance company gets, and only if you're able to pay the whole amount right away). As far as I can tell, the inflated prices (that almost no one pays) are mostly just so the hospital can report how much they're "losing" treating uninsured patients who can't pay.
  - chimeracoder 12y ago
    > As far as I can tell, the inflated prices (that almost no one pays) are mostly just so the hospital can report how much they're "losing" treating uninsured patients who can't pay. Actually, it's because they lose money (on average) on patients on public insurance (Medicare[0] and Medicaid patients), so they need to charge private insurers more to cover the gap[1]. Insurers negotiate "discounted" rates with certain "preferred" hospitals in exchange for sending them more volume, but in this case "discounted" means "still overpriced, but closer to the actual marginal cost". The other private insurers still pay the exorbitant rates. This is why hospitals are completely willing to lower your bill if you are uninsured and paying cash if you ask - they don't care about the money they're getting from you; they care about the money they're getting from the private insurers. The amount of money they make off of patients who are uninsured and paying out of pocket is negligible in this calculus. Many hospitals are not at all secretive about this; executives talk about this pricing model fairly openly. [0] For simplicity, I'm ignoring Medicare Advantage plans here. [1] The ratio of this is HIGHLY dependent on the patient demographics of the particular hospital, but the general trend holds throughout.

swamp40 12y ago

I don't disagree with your rant, but Obamacare eliminated all the pre-existing conditions clauses.

yodsanklai 12y ago

> And don't even get me started on "pre-existing conditions". What that means for me is constantly lying to doctors I don't know if it's a good idea. I have a related anecdote: My mother forgot (or omitted) to mention a pre-existing condition when she contracted a mortgage insurance. She died a few years later from causes totally unrelated to the pre-existing condition. Somehow, the insurance company found out and legally canceled the insurance.

russum 12y ago
Sorry for your loss. I don't really know how all that works but just curious - is it documented / can they prove that the pre-existing condition wasn't mentioned at that time? Sounds pretty convenient for the insurance company to purposely "forget" something like this and then abuse that information when the time comes since, unfortunately, the person who could argue it is no longer alive.
- yodsanklai 12y ago
  In that case, it was pretty clear. She had to answer a questionary so yes it was documented. And the contract stipulated very clearly that in case of mistake or omission the contract would be void. I can't really blame the insurance company even though it seemed unfair at the time.

stefan_kendall3 12y ago

Narcolepsy?

yutah 12y ago

All hospitals should probably be required to do something like this: http://www.surgerycenterok.com/pricing/ http://www.surgerycenterok.com/pricing/ ...

chimeracoder 12y ago

> And don't even get me started on "pre-existing conditions". First, I would delete the sentence after this if I were you, since it could come back to haunt you legally[0]. Second, unless things are different for foreigners in the US (which AFAIK is not the case), this is not how pre-existing conditions actually work (anymore), post-ACA. [0] (I am not a lawyer, I am not your lawyer, and this is not legal advice.) > So you are practically forced to go in completely blind about potential costs. This (price transparency) is actually the real problem more than the sticker prices themselves. If patients had the ability to know expected prices beforehand, market forces would work to bring prices down. As it stands, we have a very awkward situation in which insurers compete to keep premiums down to attract customers, and therefore negotiate lower prices with providers, but patients are completely blind to this entire process and are unable to "vote with their wallets", because the prices that patients pay and the prices that insurers pay are not always directly linked in practice.

crag 12y ago
"If patients had the ability to know expected prices beforehand, market forces would work to bring prices down." If patients knew to ask. Really. If you are covered by insurance (including medicare/tri-care/etc) you won't get an answer. But if you are paying out of pocket (and most hospitals require credit if you are doing something serious - like open heart)you can negotiate the price. Let me say again, the hospital will negotiate. The doctors and labs (not done in the hospital) are another matter. Also, if you see an aspirin on your bill costing $75 you need to call. You'd be surprised how effective this is. Most Americans never question the price of anything. Even cars these days people take at face value. Of course, if you in the ER with chest pain, I'll admit, the last thing on your mind is the bill. And the hospitals know that. So what's the lesson here? In America have insurance. Even if you are 20 years old. A simple care wreck can destroy you financially. You think student loans are bad? Try a drug overdose. Or a heart attack. Or a fractured back ( a car wreck). If you young, insurance is cheap. Dirt cheap.
- maxxxxx 12y ago
  I haven't had much success getting prices when I had a high deductible insurance. Most doctors won't tell you anything or they will quote you one price today and 5 times as much tomorrow. You certainly won't get a binding quote you can plan with.

chaosmonkey 12y ago

> It has been a few months since I have seen a doctor, but I still receive some new goddamn bill every other day. I went to a single visit to a hospital once and after the treatment, I got 4 different bills. I was amused why I was getting bills from places I had no idea about. Then I realized each entity had a different billing department - the hospital's bill, the doctor's bill, the tester's bill, etc. all related to the single visit to the same hospital. I had to call each of the 4 departments and deal with insurance. It was a nightmare!

curun1r 12y ago
It's not always like that. There are insurers like Kaiser that are vertically integrated that make the whole experience much smoother. At my last checkup, my doctor gave he an immunization, ordered blood tests and prescribed medication. The blood tests and pharmacy were both in the same building, so I just had to make two stops on my way out of the building that took an extra ~15 minutes. The immunization and checkup were covered by my insurance and I paid my copay for the blood work and prescription up-front just before having my blood taken and getting my medication. It was all very affordable, quick and easy and I never saw a total bill. I only got a receipt for my copay. I've never needed any major health care from them, but I have a parent that has had both hips and a shoulder replaced with Kaiser who had a similarly simple experience.
danielweber 12y ago
I'm generally not in favor of single-payer, but take this as an argument against my position. My mom had some big treatments last year. My dad is a probably-undiagnosed-autistic guy who loves spreadsheets. He set up a spreadsheet for every single visit, correlating exactly how much was paid, exactly how much insurance (including Medicare) paid, and when each provider was marking the bills as paid. He's retired, so this was his full-time hobby. He still got continuously yanked around by every single provider, some claiming paid in full (which my dad filed dutifully in a binder) and then later asking for more money. It's a freaking mess.
- pstuart 12y ago
  So why doesn't this make you generally in favor of single-payer?

cordite 12y ago

It is unrealistic on how a sponge in surgery costs $45 or a set of 3 small towels (x2) costs $380. Also, the optimizations in health care over the last couple decades actually have gotten it to cost more overall, mostly due to processing overheads and bureaucracy. When it comes to getting multiple bills, part of that has to do with their standards with insurance agencies. Usually you have CPT (R) codes, HCPCS, ICD codes and so on (at least in the US, international places do not use CPT often.) There is professional billing, which generally involves physicians or specialists time and expertise. While hospital billing involves staffing, reduction of capacity (like taking up a room or a bed), and all supplies, materials, and labs performed while admitted. Another thing that is standard in the industry is that it actually costs more to consult someone than to refer a patient to them. Part of this has come due to insurance agencies being more supportive of consulting which means that the specialist can benefit more patients with less responsibility transfer and time.

jleader 12y ago
Keep in mind that hospital "costs" are largely fictional. When the bill says $45 for a sponge, the insurance company has negotiated a much lower rate for the whole procedure, and if you go to the hospital and say "I'm a cash patient", they'll typically also give you a substantial discount (though probably not as low as the insurance company gets, and only if you're able to pay the whole amount right away). As far as I can tell, the inflated prices (that almost no one pays) are mostly just so the hospital can report how much they're "losing" treating uninsured patients who can't pay.
- chimeracoder 12y ago
  > As far as I can tell, the inflated prices (that almost no one pays) are mostly just so the hospital can report how much they're "losing" treating uninsured patients who can't pay. Actually, it's because they lose money (on average) on patients on public insurance (Medicare[0] and Medicaid patients), so they need to charge private insurers more to cover the gap[1]. Insurers negotiate "discounted" rates with certain "preferred" hospitals in exchange for sending them more volume, but in this case "discounted" means "still overpriced, but closer to the actual marginal cost". The other private insurers still pay the exorbitant rates. This is why hospitals are completely willing to lower your bill if you are uninsured and paying cash if you ask - they don't care about the money they're getting from you; they care about the money they're getting from the private insurers. The amount of money they make off of patients who are uninsured and paying out of pocket is negligible in this calculus. Many hospitals are not at all secretive about this; executives talk about this pricing model fairly openly. [0] For simplicity, I'm ignoring Medicare Advantage plans here. [1] The ratio of this is HIGHLY dependent on the patient demographics of the particular hospital, but the general trend holds throughout.