Maybe, maybe not. A new patient visit and a routine annual aren't necessarily the same thing where insurance is concerned, and it's not the doc's fault if she's got a copay/deductible.
That said, if she can prove this bit:
> “They tried to drag my start-up wine-and-spirits technology business into it … They posted my entire medical record, including notes about my mental health, my bills, my insurance info, my driver’s license, birth date and home address,” she said.
Personally I've discovered quite a few restaurants that I enjoyed quite a bit thanks to Yelp. Google reviews are starting to become more common and comparable, but back then the Google reviews were very sparse and usually only people talking about bad experiences, whereas Yelp was more mixed.
Yelp remains very helpful to me in many ways. Looking up the restaurants in an area, filtering by various things (are they open? do they take reservations? what's the noise level?), making reservations, etc.
I know Yelp has a shady underbelly, but pretending that it doesn't have anything to offer is just being intellectually dishonest.
I visited Spain last summer and my family would typically just walk around where we were looking for a restaurant that seemed good, and almost always got stuck in tourist traps with bad Americanized food at high prices. When we started using Yelp to find places to eat we found little hole-in-the-wall tapas places with absolutely no American influence and amazing food that we still talk about to this day.
Yes, same here. I used Yelp during a US West Coast trip and always found good too great places to eat near any place we drove through. The highlight was finding an amazing, fresh Vietnamese on a concrete island in some random part of Fresno.
Their coverage is not uniform across different countries (Germany is not bad but still occasionally spotty) but it's a great filter of the crap restaurants.
I disagree. Though it is not Yelp, I have seen business develop from customers who would have been out of reach to them if not for the Internet. Particularly in the hospitality business.
I think that we tend to only hear the horror stories. I've never really used yelp, but I know many that have and found it useful as at least a barometer of an area. I'm a contrarian so I find I'm happier if I don't know how others feel about things.
I have found Yelp to be better than Google Maps at telling me what the options are for grabbing a bite to eat nearby. I hardly ever read the reviews.
Actually, I used to read the Yelp complaints about the ice cream place near me, which had a famously cranky owner. Those often made me laugh; does that count as joy?
> “They tried to drag my start-up wine-and-spirits technology business into it … They posted my entire medical record, including notes about my mental health, my bills, my insurance info, my driver’s license, birth date and home address,” she said.
That screams HIPAA violation, to me. The practice could (and should) be shut down over it.
Because a common tabloid tactic is posting technically true statements in a misleading manner.
For example, the woman's statement could apply to having introduced her medical records into the court transcripts, which would be entirely normal practice. The wording in the article leaves us thinking they uploaded her records and driver's license in a Yelp reply or something, but I think that's unlikely.
There's no HIPAA breach in the publishing of the article unless the information is being provided by a covered entity or business associate. Most notably, patients can disclose anything they desire about themselves.
> [The doctor's office] posted my entire medical record, including notes about my mental health, my bills, my insurance info, my driver’s license, birth date and home address.
even if this is not accurate and the woman exaggerated her claims, just look at all the comments in this post. She already got the effect she was looking for.
People freak out the moment they hear privacy violation. They get angry and stop thinking. The comment above from AdmiralAsshat already says "the practice should be shut down". Some comments above say "it's an open and shut case" without even knowing the details of the proceedings.
Can you imagine if as a doctor, you kept your patient's info private, but a patients says you "posted her medical record" even though it was sealed for her court proceedings? Wow
Almost certainly the medical details were shared with the court, under seal, rather than posted to (for example) a public internet forum.
At issue here is a disagreement over what services were performed, so it makes perfect sense that the court would require access to these documents.
The reporting is incredibly one-sided here considering that the case is still unresolved. No doubt it will be damaging to the doctor's reputation even if he is cleared of wrongdoing.
...which is why he is an idiot, with an idiot lawyer, for poking this hornets' nest. I say that even if we stipulate that his medical performance was exemplary. You don't fight with disgruntled customers. Spend a couple of minutes to see if you can easily satisfy them, and then forget the whole mess. Recover any products they received, give them their money back, and write off the service you performed. Period.
Perhaps this was not just a disgruntled customer. She's accused of posting multiple reviews that say allegedly libelous things. This was not, according to the complaint, a situation where someone just left a bad review.
So she is "super-disgruntled". If anything that makes fighting with her even more foolish. Most of these sites (certainly yelp and google) allow service providers to respond to reviews. Leave a single note, "We're sorry this patient wasn't satisfied with our service, and have refunded all fees. Since most of our patients are happy, we rarely need to do this." [0] Actually even that note is too confrontational, but maybe there has to be a sort of compromise between one's emotions and one's business. There's no way a patient with a complaint about fees gets a lawyer on contingency or a guest column in the paper if she already has been offered a refund. This is different than a malpractice injury case, which would need to be handled more carefully. (Although even in those cases, getting the patient to accept a refund is golden.) Still, the attorney from your malpractice insurer would also advise against this scorched-earth bullshit. This physician must be on a bare-bones malpractice plan, that his dipshit attorney hasn't already been banished by competent legal representation.
[0] if the provider has to issue such refunds all the time, there are other problems to address...
> Leave a single note, "We're sorry this patient wasn't satisfied with our service, and have refunded all fees. Since most of our patients are happy, we rarely need to do this." [0] Actually even that note is too confrontational
She accused him of committing felonious fraud; seeing the doctor respond by giving her her money back and saying "most people don't have a problem" would not cast that doctor in a good light at all, to me. I'm not really sure if there's any kind of response they could have left that would feel reassuring to me: recommending the client contact law enforcement like someone else suggested might help a little, but not that much. The presence of a review with accusations like that that the doctor shrugged off or dealt with casually would be infinitely more offputting to me than hearing the doctor had previously won a libel case against a former client.
Let's stipulate that there is nothing the physician could say in response to a fraud accusation that would cause you personally to doubt that accusation. That seems a novel combination of the judgmental and the credulous, but life takes all sorts. It would still be better for the physician, for you to have this reaction while reading Yelp than for hundreds of thousands of newspaper readers to be reading TFA.
The longterm difference seems pretty minimal to me: they google his name and see reviews accusing him of fraud or they google his name and see tabloid articles about this story that say the same thing the reviews did, but add that the person making the accusations was sued for libel, alongside followup reports that the court decided the woman was lying. In the second case, the bad reports jump out more, but they're accompanied with notes that a court decided they were false, whereas with your Yelp responses the doctor wasn't even denying them. I don't think your approach is obviously better for the doctor when someone's looking up reviews of him in 5 years.
> They posted my entire medical record, including notes about my mental health, my bills, my insurance info, my driver’s license, birth date and home address,” she said.
wow. That violates HIPAA law. The counter-sue is going to be huge.
Also, I had a related issue where a doctor threatened to sue based on my yelp review. I cut the review back to verifiable facts instead of opinion and asked if that compromise was ok, he said it wasn't and started claiming it was defamation. I cut off contact and that was that. I wondered if it was possible to be dragged into court by something like this, apparently I may have dodged a bullet. Scary stuff.
That is awful, and they should be punished severely for that.
This reveals a predicament for businesses that have to protect customer privacy. If a restaurant owner thinks a customer is lying, they can call the person out on all kinds of media and say they're a liar. Alamo Drafthouse made a set of videos to play before movies making fun of a customer complaint call, telling her to eff off.
If a doctor believe a patient is lying or doing a detriment to their business, they can't call them back out on social media. Their only remediation, if they think the statements are false, is a lawsuit to have the force of law take lies down.
This is why, at least in the UK, there are several pathways to resolve disputes - both in the hospital trust and above it, which is in part to avoid this kind of scenario. If that doesn't resolve it the patient usually approaches a lawyer to seek compensation, and most times this is settled out of court and in private. When patients and family hit social media, the hospital/doctors are not able to publicly talk about the grievances, or can only put out a very limited public statement with permission (like the recent Alfie case).
I had a friend of mine who refused a request by a patient out of the country, while on-call one weekend. I'll leave out the details apart from it involved shipping a large quantity of a very expensive medication to another country - as the hospital did not have this medication available. He had already sent enough of this medication to cover for at least a week (at huge cost to the NHS, as the medication had to be couriered by plane) when a second request was received 2 days later. A huge internet hate-mob appeared on Facebook saying all sorts of things about this doctor by name, to which he had no ability to respond.
I'm for making healthcare more transparent, but I wonder if, as a doctor, we'd be pressurised into pleasing the patient more than treating the patients correctly, with the threat of negative yelp reviews, though that's obviously a risk with any sort of profession and review system.
Not to discount your point, because it's mostly relevant, but in the Alamo Drafthouse case I don't ever think they reveal the name of the girl who makes the call.
Though I guess if a phone call had protected HIPAA information and you could tell who it was through their voice it might be a violation?
Reviews are protected speech, this has been litigated multiple times and has precedent in the US. If you live in an area with a SLAPP law I would suggest getting an attorney to file a SLAPP motion for you. The onus is then on the plaintiff to prove they aren't suing you to stifle your speech. If they can't then they have to pay full court costs and your attorney's fees as well as a penalty in many jurisdictions.
In this case the subject is in NY state which has an Anti-SLAPP law and she should apply it and HIPAA.
That's fine but they don't have to pay until after the case and appeals. Meaning you have to be able to front the litigation costs in order to have a chance at recovering them. There is a non-zero risk of losing.
I would suggest using a pseudonym and VPN for any review written on a potentially litigious business unless you have the funds to litigate. Problem is Yelp is much more likely to mark the review as spam.
They can go bankrupt the second judge handles verdict, but this would definitely be out of scope of said person bankrupcy proceedings similar to your education loan cannot be included into bankrupcy. the judge proceeding in bankrupcy claim will clearly see whats this is about.
Physicians with their own practices might have low net worths, but they still have lots of assets to distribute in case of bankruptcy. IANAL, but a patient with a judgement would jump ahead of lots of creditors in such an event.
> "They posted my entire medical record, including notes about my mental health, my bills, my insurance info, my driver’s license, birth date and home address,"
We are hearing one side of the story here. HIPAA violations have teeth -- potentially 10 years imprisonment for intentional leaks for personal gain -- so a vindictive public action is highly unlikely, and certainly some lawyers would take the case on spec. Especially if personal information like driver's license info and home address were leaked.
What likely happened is this quip triggered the mess:
> “I suspect that this doctor gives unnecessary procedure [sic] to a lot of people and then charges the insurance sky high prices and no one knows the difference.
Levine is accusing Song of health care and medical insurance fraud. While there's some ambiguity regarding "unnecessary procedures", insurance fraud is a crime and arguably Levine is accusing Song of criminal behavior
Another user, Siphor, went through the documents in a response on another thread [0]. I think the second paragraph adds some important context, especially in regards to the accusations of Mr. Song committing insurance fraud.
>The most damning thing in there was that the Doctor tested for HHV-6 (something 100% of humans have) and then charged for it and claimed it was HHV-2 (genital herpes). Theres apparently a lab technician available to testify that the Doctor commonly tests for HHV-6. Guy seems sleazy.
That's not entirely correct. There are 2 different forms of HHV6. HHV6B is present in almost 100% of the population[1] (but not quite 100%). HHV6A is less frequent in Japan, North America, and Europe. It can also cause problems for infants when they first acquire it. From the same link:
>HHV-6 primary infections account for up to 20% of infant emergency room visits for fever in the United States
The test can be used to assess viral load, which may indicate other issues, I'm told. (I'm not a doctor, though.) If you have a very high viral load of HHV6, it may indicate something else is going on. However, that doesn't mean it was necessary in this patient's case. But the test exists for legitimate reasons.
Protected or not, the defendant still have many out of pocket cost and distress for defending a lawsuit. Lawyers don’t care. They will get pay. The judge usually don’t read the case until the time of the trial but your expenses is up front and no guarantees of outcome.
I was sued and I pro-se to defend myself. Although the plaintiffs know the lawsuit is frivolous but that doesn’t matter. He said if I don’t apologize and I win the case, he will just spend more money appeal the case and make my life miserable. I apologized and he dismissed the case.
It probably caused him some money, but it had caused me a lot of distress and time reading up the laws.
>Wow. That violates HIPAA law. The counter-sue is going to be huge.
Basically an open and shut case too. Assuming they were smart enough to "correct" the mistake it may not be a Tier 4 ($50,000+) violation, but instead a Tier 3 violation ($10,000 - $50,000 per violation) of willful neglect. I'm not sure if each violation above would be considered a single large violation or multiple small violations ( 1 violation vs 7 violations is a major difference in penalty cost). There's also SLAPP.
If litigation has gone on long enough to cost her $20,000 in legal fees I can't help but feel there is a lot more to this story or my understanding of the legal system is completely out of touch...
Serious, and depressing, answer. They don't. This is why plea bargaining is rampant in America. It isn't necessarily very fair, because for many people this ends up ruining their lives. But facing the choice of POTENTIALLY going to prison for a number of years, and to jail for weeks awaiting trial, or pleading guilty to something that does not put them jail at all, they choose the latter (since a few weeks of absence from the world messes your life up quite a bit if you didn't prepare - you'd lose your job, maybe apartment). Even if that plea forever taints them in the eyes of employers
This is a civil case obviously, so all that jail stuff won't apply to this, but just curious... If cheap litigation is 20K, and "battling out with a judge" is 100K how come the first time I'm hearing about this is in a HN comment? Seems like no one is going up to bat against this stuff until it affects them.
Reminds me of that famous poem "First they came for the ..."
Good point. In civil cases the equivalent is a "settlement offer". Made famous my the RIAA. Pay us $5000/song you downloaded or we'll sue you for $5 million, and you cannot afford that. We might not win, but if we do, you're boned!
Isn't it worse than that -- more like 'we might not win, but you're probably boned either way'? I may be wrong but I have the impression that it's relatively rare to be awarded full costs, and anyway you'll have to pay your lawyers up front.
Peter Thiel got a lot of flak for this comment: "If you’re middle class, if you’re upper middle class, if you’re a single digit millionaire like Hulk Hogan, you have no effective access to our legal system. It costs too much. This was the modus operandi of Gawker in large part, to go after people who had no chance of fighting back."
It's somewhat hard to square with "litigious culture" criticisms of some parts of the country. But the details matter. Filing & defending in small-claims court is pretty cheap without a lawyer (and even with one is "only" in the small thousands) and person-vs-person cases won't be too terrible compared to companies-vs-individuals...
Or rather, the legal system is preventing the market from accessing it, e.g. there are something like 2 U.S. states in which one can currently sit for the state bar without having been awarded a JD.
One (modest) force that coerces the market: you nearly always must attend law school. Unlike Lincoln, John Adams, Marshall, et al, you have to get a degree from a law school in order to become an attorney. Apprenticeship is peanuts compared to getting a degree (provided you can find a sponsor). There's a handful of US states that still permit apprenticeship, but most do not.
Ok, then why is law school so expensive? It seems to me that classes could be offered online without practical problems, and exams could be organized on a national level.
Former trial attorney here...Would really like to know the source of those claims. $20k would cover most civil litigation cases not involving serious injury or death. $100k would cover pretty much any civil or criminal action. Beyond that, you'd have to be employing some extremely expensive specialists.
And that assumes that the lawyer isn't handling the case on contingency.
Generally, the reason people overestimate the costs of trials is because standard contingency fees are 30%-40% of judgements.
If lawyers are like programmers, the fees can easily be 10x different from one to another. I'll bet there are some $50/hr lawyers and some $5,000/hr lawyers.
My divorce should have been an open/shut deal and never went to trial - still cost me > $12,000. I have another pending business lawsuit that I fully expect to cost ~$10,000 for what should be open/shut contract dispute. Lawyers are really good at wasting time while pretending to be doing something meaningful, and as a lay-person I have little recourse other than to play "Go fish!" and try to find another lawyer. So, $20K for anything of any substance doesn't surprise me.
The quote is taken out of context I think (this is a tabloid) the doctor probably posted the information to the court docket under seal at the request of the judge or at least probably in accordance with the law.
haha, that's really interesting to hear. I'm almost certain a Judge is also not allowed access to medical records. He most likely is not a covered entity. Beyond that while it might make sense to request medical records in a criminal trial, there's no place for that in a civil suit.
HIPAA allows health care providers to disclose medical records in response to a court order as long as the order specifies the scope of the records required to be disclosed and is signed by a judge.
I just went through the documents and that doesn't seem to be the case... Doc #43 is a request to the judge to remove Doc #24 due to HIPPA violations. Doc #24s not there anymore. Pretty interesting, and the tabloid seems to be accurate.
The most damning thing in there was that the Doctor tested for HHV-6 (something 100% of humans have) and then charged for it and claimed it was HHV-2 (genital herpes). Theres apparently a lab technician available to testify that the Doctor commonly tests for HHV-6. Guy seems sleazy
You seem like you know what you're talking about. A few years ago, I got a Facebook message from a girl that lived in my town. She said something like "This is really weird, but did you have shoulder surgery by X doctor last October? If so, that surgeon just did my knee and after my rehab told me that she thought you and I would be a good match. Would you want to grab dinner sometime?"
I was really confused. Wasn't this a HIPAA violation? If yes, what do you even do about it? Feels like a cause for concern if your doctor is also trying to play cupid? What should I do/have done?
I work in a tech-related healthcare field where I'm required to undergo HIPAA training and (often) end up needing to educate clients on potential violation risks. Nowhere as good as a lawyer but I deal with it on a daily basis at least. So take this as the typical "I am not your lawyer or pretending to be a lawyer - go speak with an actual lawyer" disclaimer.
>Wasn't this a HIPAA violation?
100% yes that was a HIPAA violation and honestly anything shy of giving your information to people who actually need it (aka: any hospital/practitioner you visit who should be aware of your medical history) is a violation with very few exceptions (mostly legal ones). Gossiping about patients is probably one of the most common violations.
>If yes, what do you even do about it?
Depends how much you care and how long it has been since the event happened and you became aware of the violation. If it happened within the last 6 months you can report it online through the process xapata linked you. If it's been over 6 months it's too late to report. I'm not sure if "it happened but I didn't know it was a violation until recently" counts as a start date for the "aware of the occurrence" limitation. Would be a great question for an actual lawyer.
You also don't know what else could possibly have been said about you or your medical history - so I'd keep that in mind when deciding if this violation is a "big deal" to you personally or not.
Deliberately writing bills for services not performed is fraud. Of course there can be billing mistakes and corner cases where it is not clear what exactly has been performed. Excessive billing that goes beyond what insurance pay can motivate people to fight back...
There are so many things wrong in how the doctor behaved it is mind-boggling and a big red flag. Fighting angry and stupid people in court is best avoided but one does not always have a choice.
Re: Of course there can be billing mistakes and corner cases where it is not clear what exactly has been performed...
This is where good lawyers know how to play. They have experience. Unless the consumer's layers are equally skilled/powerful, usually the deeper pockets win, I hate to say. It's why the rich get richer while the rest get [bleeped].
It's one of the reasons Hillary was unlikely to be jailed for being sloppy with email; the laws are fuzzy enough to milk. But this applies to all plutocrats, not just Hillary, including the current occupants at Washington DC.
"Eschew flamebait. Don't introduce flamewar topics unless you have something genuinely new to say. Avoid unrelated controversies and generic tangents."
My question around reviews in medical is always around how a physician is supposed to be able to respond because of HIPAA? It almost seems unfair to be able to review them since there is very little they can do to refute anything without violating it.
It seems like there should be some special set of rules around medical reviews, in my opinion at least.
You can explain just that in the response and not much more.
Even if the patient reveals PHI you should avoid confirming or acknowledging it as the "covered entity" under HIPAA. A confirmation of a diagnosis is different than a person discussing symptoms. I would argue that you probably should avoid even acknowledging that the person is a patient or has been seen in the office. The approach will reinforce to others how seriously you take privacy and you can taut your customer service policies, etc.
I wouldn't call this unfair since all providers are in the same situation.
It's not unfair in the sense of "advantage over competitors", but it definitely seems unfair in the sense of "not being allowed to publicly refute public allegations against you".
Reviews are opinions. Some of them are lies. Some of them are fake. It is almost never a good idea for a business to try a detailed rebuttal to a negative review, no different for doctors.
If it's BS, call them on it with something along the lines of "We dispute the veracity of this claim. Further, the alleged conduct is a felony, so if the client genuinely believes their allegations, we encourage them to file a criminal complaint at their local police station." This conveys "client is a nut, we are professionals, and we can prove it" whereas arguing the details of a case with confidential info in a public forum is wildly unprofessional and sometimes illegal.
It cant be understated how a bad review on yelp can tear your practice down and put you on the street. Figure a physician sees 16 to 22 patients a day, and if one of them tanks you you can lose everything.
Review wars are real in all retail businesses, its pretty sad.
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I cannot imagine a lawyer would condone the HIPAA violation, I wonder if there are exceptions when the patient has made that information public before you (patient said she had x, and you say "We did not diagnose x") or smth.
I've been threatened with a lawsuit over a review before. Even though I know I'd be in the right, just the processes of going to court and defending yourself is a huge pain. Not sure why a company would risk trying to sue someone over a review when it would undoubtedly backfire and be really bad pr for them.
Definitely recommend checking out libel insurance. Shouldn't cost much to get and will help protect against companies trying to go after you.
You are assuming this is true. I have read through the case records and I am not confident that anything the defendant says is true. If it is false then the defendant will have just increased their loss - judges tend not to look to favourably on running a PR campaign outside of the court process.
In contrast to privately insured people (basically, public servants, company founders, rich and ultra rich) who get to see the bills of the medical provider, they can bill the "common" insurance providers (GKV, Gesetzliche Krankenversicherung) directly without the customer seeing anything of the bill. This is, of course, ripe for abuse as no one will look if a doctor really did a specific billed procedure on a patient, especially not something in the 20-50€ range...
Think of how many people this business has bullied into silence before someone with enough resources to make the news came along. For most people (unfortunately,) $20k of expenses is bankruptcy.
Patients are by far the worst kind of customer to deal with. So maybe if the costs were disclosed upfront ("I can perform an ultrasound if you have pelvic pain, but it will cost you/your insurance xxx") we wouldn't come to such he-said-she-said extremities. But I guess it's pure fantasy in the USA where I've heard medical costs can be negotiated... How could they announce full price / insurance coverage when you're about to get the exam done if it's not even settled yet ?
Why can't the costs be disclosed upfront? Whenever I go to the dentist and I need to have some work done, I get an estimate telling me how much it costs and how much they expect the insurance company to cover. This isn't rocket science, it can easily be calculated, and should be, as you said, for the benefit of everyone.
As I said, I don't live in the US but I've heard that there, bills are negociated by insurances afterwards. It's a shame that the patient has an unexpected bill to pay (and I think a good part of trouble/resentment stems from there). Here it seems like they were not warned about it (whereas we are where I live) and that's the only reasonable explanation I could think of. But maybe someone from there can shed light on why the exam the patient agreed upon came back as an unexpected bill, instead of incomprehensible downvotes ?
I too wonder why the MD side of healthcare doesn't work more like this in the US.
I was actually very taken aback recently when I needed to get dental work and was presented with costing info about 10 mins after my visit started.
It did feel a bit greasy, I must admit - but I get that the point is for everyone to be on the same page before the procedure.
edit: I now recall that I did use Urgent Care for awhile for healthcare while uninsured - in the US - these are basically "fixed menu" clinics. They have a menu of services / costs for cash.
All of what I said was with a US dentist. They're out of network but I honestly don't even care with the level of service they've given me. Every visit I feel at ease, and they always walk me through everything using photos and showing me on the x-rays. They never bullshit me and have always made sure I understood why they were doing what they were doing and what they are looking for and are concerned about.
Because the dentist will diagnose you first. When someone says they have a headache, you dont know if he needs an MRI that costs thousands of dollars, or aspirin which is cents.
And also, each insurance pays differently for the same service.
You can always go as a patient to an all cash-clinic, which will have fixed pricing, but then you throw away the benefit of your insurance.
> And also, each insurance pays differently for the same service.
Yes, and the provider knows more or less upfront how much each insurance provider will cover. My dentist can handle this just fine for every single procedure and I'm out of network. They've never been wrong. The coverages are fairly standard as are in/out of network fees.
I work in healthcare, I assure you you dont know. Because it depends on the service you are going to provide, the time you have, the procedures you are going to do, and that is done during the visit, no before service.
When a doctor has to file a claim with an insurance,he has to pick between 10s of thousands of codes and then out of different procedures, that have different values based on how much documentation is gathered, that changes per insurance, and then the insurance will renegotiate.
I am in the business, I can tell you its impossible to know what the insurance company is going to pay.
Please, tell that to my dental office that's been doing just that for over a year for me personally, and I'm sure many more years for everyone else going there. Plus, I'm not even in their network and they can somehow figure it out.
The codes are standardized for different procedures. If you know that you're doing procedure X, Y and Z and are billing against provider A who you've already billed before, then you know more or less how much they're going to pay for those three procedures based on experience and the standard in-network cost for those procedures. It's not like an insurance provider is suddenly going to reimburse half the cost for shits and giggles. Everything is fairly standardized and theres only so many variables you have to deal with.
Re: Patients are by far the worst kind of customer to deal with.
Sorry, but if your org has no patience for patients (pun intended), then you are in the wrong biz. It comes across as, "Our business would be smooth if not for pesky humans."
You are obviously overinterpretating what I've written. For many very comprehensible reasons, the patient/caregiver relationship is difficult. Why wouldn't they ease it with reasonable "contract" (prices, procedure you'll go under) both parties agree upon, and why everything in this story seems unexpected is beyond me. Agreeing to an exam and discovering you're due money for it afterwards is annoying. This should be clear from the get-go, otherwise you're exposing yourself to trouble considering you're already working in a tensed environment.
The author claimed that the provider in this case committed billing fraud, by charging the insurance for procedures that were not performed. She should write the NY attorney general; an investigation by the State would make the civil case a lot easier to deal with.
It is good to hear the other side of the story. I find it impossible for a lawyer company to post medical records of someone else publicly since they are supposed to know what they are doing. I am all for give power to the people but I have seen this being abused a lot nowadays.
> They posted my entire medical record, including notes about my mental health, my bills, my insurance info, my driver’s license, birth date and home address
If this is indeed true I'm not really interested to hear the other party story. Remember that the other party started the lawsuit and online reviews are something to get over with (unless the woman is backed by some entity that is going after that business)
This, I hope, is the list of documents filed in the case. No. 36 records a motion sealing some for containing her confidential information. I can't cut and paste here, but it says that in one of her affidavits, she included private information and in a response the plaintiff also included private information. There are charitable interpretations on either side.
> I find it impossible for a lawyer company to post medical records of someone else publicly
Where do people here think the medical records were posted? On yelp? On the lawyers website? It is so weird people are just thinking that this stuff is posted publicly.
Yes, yes they did/do. It's a move straight out of the mobster playbook. It's the modern day equivalent of paying for "protection".
Yelp has also been sued by investor's for allegedly misleading them into believing that Yelp was filtering out everything that wasn't reliable, first-hand reviews from people who actually went to those businesses and paid for services.
On a similar note, I believe business owners have alleged numerous times that when they refuse to pay the extortion fees to have bad reviews removed, they suddenly get a bunch of bad reviews all at once. Also, Yelp has seemingly had a habit of allowing competitor's post bullshit reviews on businesses who haven't paid them for that "service".
I don't what currently goes on, though. Maybe they have cleaned it up? But I doubt it.
One thing that sticks to me when I read such articles (I am not from US) is how ridiculously pricey medical services are. Common, 1k$ for a regular exam that costs like 20euros in my country in private clinics?! And I read about this ridiculous prices US so often that I am dumbstruck that people are cool with it.
Another thing that struck me is that if you don`t have money, evil people can just silence you by suing you (look at those court costs, 20k and counting?!)
Huge numbers, perhaps a majority, are not cool with it. We've had national elections fueled by the discontent. But at least so far the political configuration of that discontent, not the magnitude of it, has prevented progress on lowering the cost of health care.
But at least so far the political configuration of that discontent, not the magnitude of it, has prevented progress on lowering the cost of health care.
Health insurance in this country suffers from kind of a legacy situation. It is sort of like how the qwerty keyboard is terribly inefficient, but most people continue to use it.
From what I have read, at some point health insurance was offered as a means to beef up compensation in a way that was tax friendly for employees, thus helping to entice better employees to come work for your company. This became kind of the standard default and typically covered the family, not just the employee.
This was considered a perk in a situation where most people whipped out their check book to pay for medical care because it was relatively reasonably priced. Then health insurance became kind of the default and it adds overhead and complexity. Obomacare was passed as the only politically viable solution and it's a terrible solution.
Health insurance coverage for basic services doesn't really make sense. Insurance only makes sense as a bet to defray unexpected expenses. When you use it cover annual exams and other basics that you know are guaranteed to happen, it essentially creates an unnecessary middleman, pushing prices higher without providing any real benefit for the cost involved.
This is where we are now and most people don't know how to get out of this mess. It doesn't help that Obamacare puts a gun to your head and insists that most people participate in this charade or be fined at tax time, in essence. Ugh.
One can argue over the implementation method, but fundamentally a society must decide whether they believe health care - both routine/simple and unexpected/severe - is a right of all or a privilege for just some. If you say it's a right, everyone has to participate and those of means have to help pay for those who have none. The individual mandate was an admittedly roundabout way to achieve that.
The old system of paying a doctor outright with a check or cash was not a universal healthcare solution - a lot of people couldn't afford it even back then.
Most developed countries deal with the cost problems of health care through strong price regulation, even the relatively laissez-faire systems like Singapore [1] or Switzerland.
Obamacare did a lot to improve access [2] (subsidies, pre-existing conditions, adult children on parents plans) - it's a lot like the Swiss system, - but unlike that system, it did very little to address costs.
I agree with you. So I'm not sure what the argument is here. I was only describing how we got to the current morass and why it is so hard to extricate ourselves and do something not crazy.
Sorry, I'm not arguing with you. What I'm addressing is that the particular mechanisms only matter once the objective - affordable health care as right or a privilege - is broadly established and agreed upon. Until then, debating the mechanisms, whether taxes or mandates, or nothing at all if one believes health care is a privilege, doesn't address the root problem.
Ah. I generally find it helps to understand the problem space. With a sufficient understanding, sometimes one can come up with elegant solutions that can cut past the BS.
That approach of mine is frequently misunderstood and perceived to be things like making excuses or justifying the current status quo, etc.
The "prices" are moves in a game played between hospitals and insurance providers, and don't correspond to anything real or to the amount that gets paid. If a hospital discovers that the patient doesn't have insurance they'll be charged the real (more reasonable) prices instead.
Millions of americans pay those sticker prices. Just because millions more don't or get discounts doesn't change the fact that those are very real prices.
> and don't correspond to anything real or to the amount that gets paid.
Aren't designed to correspond to real payments. But like a sumo wrestling match in a kindergarten, sometimes the little guy gets squashed by accident. And you wind up with people getting $20k bills that don't necessarily know how to get out from under them.
That used to be the case, but in the last two years I have gotten $1k+ bills after insurance that are very real. For relatively common visits to in-network providers.
That's not true at all. I currently have a ~$450 bill for a test where I breathed in a tube for 10 seconds at a constant rate. That's after my insurance paid 4k for it already.
That used to be the case, but what I've experienced lately is the doctors will submit overpriced bill to insurance, insurance says, "oh you haven't hit your annual deductible yet," and passes the massively overpriced bill directly to me, no negotiation, no nothing.
I've gotten so I just ask what the out of pocket cost is to pay cheaper (usually 1/2 price), and they still manage to hose me with extra services.
I keep it around $2000 to $3000, so it's not high for me. We go to the doctor about once or twice a year for random stuff, so it doesn't make financial sense to have a zero to low deductible.
I want to protect from the hospital bills from something major though, like a car wreck. I'm not sure that those $50 copay per doctor visit right from the start are even available anymore. That's the insurance I had when I was a youngster.
if you have the legally-defined type of HDHP that could explain your bills because in HDHP-world you pay everything up-front until you reach your out-of-pocket yearly deductible (hopefully offset by using the HSA's tax savings; my job offers matching on HSA contributions that offset the premium cost entirely)
I pay (a lot) extra for a traditional PPO and get the old-fashioned $20/$50/$75 deductible.
If purchasing insurance through the Exchanges my experience was that this is not really clear unless you're paying attention to the exact phrasing in 1-2 places.
It's not "if the hospital discovers", it's if the patient is uninsured and makes it clear to the billing department that they're hopelessly broke, then the hospital gets flexible with the charges or even writes them off. Many billing departments have flexibility and expect to write off a fair number of bills rather than send them to collections, but they're hardly pushing discounted bills or automatically giving discounts.
If you get lucky you get that. Hospital around where I was (Indiana) rarely did such things. My uncle owed over 250k for emergency heart surgery. That was the discounted price, "as low as they could go".
Dude only made around 30k per year... doing flooring, which could now kill him. Even if he could go back to his work, he had been off work for a couple months. The hospital's "reasonable payments" exceeded his income with work, and was impossible out. More common was a collection agency and eventual court date.
What may work (if he has credit and can cover the lowered amount) is "I can borrow enough to cover the Medicare rate for this and pay it now if that will cover it in full. If that won't cover it then I'm not going to borrow from friends and family when I'll still be paying you and never be able to pay them back."
In his case, that wasn't as likely. Construction work, including flooring, often has slumps and that makes loans more difficult to get. Not to mention the fact that he could buy 2-3 houses for the price of the medical bill (Indiana is cheap) .... and his credit wasn't great even though he didn't carry much debt.
Not really. That would imply people value every aspect of a politician/party platform the same, and will give up on various beliefs to fight for other rights and benefits.
The problem is that you've got a two party system where groups that don't share much in common are lumped together and people are voting for the 'least worst' option. There's no reason the social and economic positions of the Democrats/Republicans have to be linked together like they are.
Half or almost half of the population here would let you die of curable sickness or disease just to save a couple bucks (for what purpose, I'm not sure, probably to kill more Arabs or line rich people's pockets). When you understand the underlying hate in America, all the things you list above become obvious as to why they exist. But look on the bright side: if you're lucky enough you can be here profiting off of all these sick people's misery instead of being one of them. You just need to be born in the right family at the right time. That's what most Americans hope for: that they were born to the right family at the right time instead of the one they were born into. Because they sure aren't about to change social class after being born...
How can you claim to understand them when you're posting their oppositions propaganda instead of their own arguments? That's like starting a conversation by referring to a pro-choicer as a pro-death... even if you have great arguments against the choice of abortion it's not going to lead to a productive conversation.
As a sibling poster to you said, the ridiculous pricing is part of a game between insurers and care providers. Throwing more money at insurers might not be the ideal answer.
Obviously throwing money at insurers isn't the solution. We've been doing that for decades. Other countries have already figured out how to provide healthcare for their citizens. America can too if people stop opposing it. Instead, we have movement in the other direction because a lot of people hate others so much they do not want them to have healthcare. That viewpoint is inexcusable in my opinion. Also, your first paragraph in unintelligible to me.
Do you realize that Obamacare is based on throwing more money at insurers - and furthermore wanted to legally require that every American throw a share of money at a for-profit insurer?
Is everyone against that really a "person that hates others so much"?
No, I'm talking about healthcare in general not Obamacare and yes, people that oppose healthcare for others do indeed seem to hate others so much that they'd rather them die than have healthcare. I do think that hate comes because of a love for profits and making money off of others who are considered less human. That's basically been the entirety of American history--profiting off the misery, suffering, and oppression of others. You can defend such actions however you want, but it won't ever make them morally defensible.
> Obviously throwing money at insurers isn't the solution
> we have movement in the other direction because a lot of people hate others so much they do not want them to have healthcare
Last I checked nobody was opposing healthcare discussion and debate, so the "opposing" you're talking about appears to be in reference to Obamacare. Obamacare allowing healthcare providers and insurance companies to game the system more than ever before, by providing the backing of government coffers.
One either throws money at something that "obviously won't solve the problem"[0] or one "hates people to the degree that one does not want people to have healthcare"[0].
> That viewpoint is inexcusable in my opinion
What was that you were saying about inexcusable viewpoints?
I've yet to see a "proper healthcare system" that doesn't require private insurance. Take Australia for instance, where the healthcare system seems to work pretty well, but only because private insurance options are available. Without private insurance, the public system that is already slow would basically come to a stop, and those that can comfortably afford regular payments for private insurance (most people) that all of a sudden get sick and have to pony up 100k, couldn't do so. Those who don't get sick would be living the dream.
I drew the Obamacare conclusion from the reason in my above response. Nobody is adverse to discussing healthcare solutions, so what are you talking about when you say there is a movement of hate to the degree such that people are actively rejecting the idea of others having access to healthcare?
Every single healthcare bill proposed in Congress last year that was voted on was a bill to remove healthcare options from people. There wasn't a single bill proposing a government controlled healthcare system that would end the insane mess of profiting off other people's misery and death. There was even disagreement on extending healthcare funding for children through CHIP. Even the measly Medicaid expansion was fought against a few years back. I can only conclude that the people who elect these politicians are so hateful, they'd rather children and others die than spend money on their healthcare. That's some incredible fucking hate.
You might try a little empathy. You have it for those with poor health and bad or nor insurance; you might try having some for those who disagree with you.
You might try to see how some of them might (reasonably) feel that the individual mandate was removing choice from them, rather than adding it. You might try to see how some of them felt that the cost of the mandated insurance was breaking them financially. Then you might not be so quick to ascribe their motives to nothing but hate.
You could have that level of empathy and still disagree with them.
It takes self-awareness to not get too carried away, and courage to say what you think is right. I know you didn't explicitly agree with me (or anybody for that matter), but the mindset that you conveyed is what we need more of on both sides of the spectrum -- all over the world. Just because somebody has an opinion on something that one disagrees with, does not mean that the opinion comes from a position of hate, bigotry, or intolerance. Kudos to you, sir.
How do you justify opposing Medicaid expansion or the children's health program (CHIP)? Cuts to Medicare? It seems to me that people who vote and sue against such things think that children, the elderly, and the poor don't deserve healthcare because not only do they vote against these programs and sue to stop them, they have no alternate proposals. Just let people suffer and die is their only proposal. You want me to empathise with people whose decisions will lead to the unnecessary suffering and death of millions? When they bring something, anything, to the table that doesn't increase suffering and death so more money can go to the rich, then we can talk. If they don't like the individual mandate, they should propose a different system that's does more than just leave people uninsured to suffer and die. Maybe then they might deserve some empathy but as long as they are actively fighting to prevent others from receiving healthcare, they deserve none.
If I came from a family that had generated a significant amount of wealth (my family was low-middle class), and I had never used the public health, education, transportation, or welfare systems, I would be pissed if the government started robbing me at gunpoint, to provide a service that, in all likelyhood, neither my family nor descendants would ever use.
You need to remember that healthcare and education taxes are literal robbery on the rich, who never have, and never will use those services.
I'm going to say something that is controversial, and I myself haven't decided is fact, so please don't interpret it that way. Most people who work hard and are smart, can get themselves out of the lower class, regardless of their start in life (assuming they are in a first world Western country).
For reference, I live in Australia and I pay a Medicare levy (public healthcare tax). I do not have private insurance and regularly use public healthcare services. Additionally, I have been on welfare in the past. I do not believe that public health care is a Bad Thing (c), but I believe that robbing from those that have never used the services is deeply immoral.
I am not arguing for or against public healthcare. This is a difficult problem to solve. Im just trying to tell you that the decisions and opinions are not necessarily hate fuelled. If you went outside and spoke to those who disagree with you, and listened, you would see that there are reasons besides hate, that people vote the way they do. If you can see my perspective and agree with what I've written in this comment (it's a hard problem, and I'm not arguing whether healthcare is bad or not), perhaps you would consider mailing your state rep about considering a healthcare plan that is only available to the lowest earning in society, and is funded by those who required the services in the past and have "made it". Perhaps something similar to an education loan in Australia (government pays for your education, you owe them the fee plus 30% (fixed, not annual interest), paid out of a fixed % of your salary whenever you earn more than a certain amount).
While this went through my head, I just thought about the idea of bank loans for medical expenses. Why is this not a thing? The person gets their healthcare (human life value) and then they pay the bank back over time, and don't have to rob other people (anti-theft value). I am absolutely sure that I'm not the first to come up with this idea, what down-sides does this have, such that it hasn't been considered as a viable solution?
Rich people don't use roads? What do they teleport nowadays? Rich people can't get sick? Serially? So when a rich person comes into the emergency room and the treatment costs ten million dollars but they only have coverage for five is it ok to let them die? By your reasoning it seems to be a dilemma. Rich people don't go to schools either? A ton of public school enrollment records beg to disagree. Anyway, rich people are generally not the majority that's voting against healthcare. People who are literally one job loss, accident, or injury away from homelessness outnumber them greatly (aka pretty much everyone in the lower and middle classes in America). The perspective of the rich is clear: profit off of and exploit everyone else. The perspective of the non rich who are anti healthcare is not.
I specifically avoided the example of roads, because, yes, everybody uses roads, and so everybody should be taxed to pay for them. My point was that people shouldn't have to pay for a service that they have never, and will never use. It is immoral to force somebody to buy a product or service against their will. Be it health insurance, education services, or whatever else.
By the way, I never said anybody should die. If you had actually read my comment, you would see at least one potential solution to the problem. If somebody with 5m gets sick and the medical bills cost 10m, then they could theoretically get a medical loan which they pay back over time. They might be paying it back for the rest of their life, but at least they're not dead.
I don't have statistics that indicate one way or another about the majority of people voting against public healthcare being those that need it the most. It doesn't really make sense to me, but I'm not arguing that point so I won't debate that.
I don't know what is considered middle class in America, but in Australia, 120k household income before tax is considered basically the bottom of the middle class. I could afford private health insurance in a single income family working as a cashier. So I would question the validity of the middle class being "People who are literally one job loss, accident, or injury away from homelessness".
Yes. Evil people can just silence you by suing you, and yes, you cannot afford to defend yourself.
Present company (much of the HN demographic) excepted: a fair number of HN posters are very atypical in terms of their resources for doing things like hiring lawyers.
For 400$, in my country, I paid (well not me, my job but that is not the point) for private health insurance for a WHOLE YEAR. It covers all the basic stuff, pregnancy costs, some surgery costs, etc..
Aside from that we are all covered by the state and are not billed for anything apart from some medications. Yeah, hospitals are not that great of a place and there is a lot to be improved, but at least you know that even if you are very poor, you will not be left to die (or with some ridiculous bills) if you are very ill.
And before someone asks, why to pay for private if you have state coverage.. It is a job perk, and in any case, you pay for your time. Service is much faster and more convenient for the basic stuff/illnesses.
Of course. But if I roughly compare medical and/or litigation costs between my region and US, taking into account average wage, US is still whey pricier. Our law also does not require you to have a lawyer if you don`t want it. Also if you are poor you can have free legal counseling (but not to be represented in the court).
To be fair... that 427 is more than I'll pay for normal doctor's services in an entire year. (Some things have a different category, but I'm still in less than $1k for the year). I'm in Norway, which isn't exactly known for being a low-cost nation.
Now, I understand I pay taxes to cover health care. This isn't really any worse than I was paying in the states in my monthly premiums. The thing is that it creates a wonderful sort of stability in life. I can plan on taxes, I can plan on the out-of-pocket costs for a year. I won't go bankrupt. I no longer feel I'm getting ripped off for something I might have little to no control over.
> Please note that we can’t publish claims about the accuracy of a practitioner’s treatment and diagnosis. Those are factual matters, and to verify them would require extensive medical studies.
Any negative review meant to be shown publicly is more hassle than it's worth. Airbnb, Yelp, etc. Don't give a review at all unless you must, and if you must, keep it breezy and positive. One nice thing about this is you don't need to think about it too hard. Some generic compliments, five stars on everything, and you're done!
If you wrote a restaurant review 30 years ago and it was seen by millions, likely the same number who saw your post on yelp, and attached your photo along with your text, you would have been impacted. Yelp is a saw you held the wrong way. Do we need instructional videos for saws?
One thing that annoys me about Yelp is that they pulled my information and put this info on their site. I have absolutely no intention of being there (working remotely, had to establish legal entity for 'freelance' work that is already 7 years with same company). And they refuse to take down my details (including my address) from their page…
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[ 2.0 ms ] story [ 263 ms ] threadThat said, if she can prove this bit:
> “They tried to drag my start-up wine-and-spirits technology business into it … They posted my entire medical record, including notes about my mental health, my bills, my insurance info, my driver’s license, birth date and home address,” she said.
... they're about to get smacked really hard.
I know Yelp has a shady underbelly, but pretending that it doesn't have anything to offer is just being intellectually dishonest.
Their coverage is not uniform across different countries (Germany is not bad but still occasionally spotty) but it's a great filter of the crap restaurants.
Actually, I used to read the Yelp complaints about the ice cream place near me, which had a famously cranky owner. Those often made me laugh; does that count as joy?
Yes, yes it does!
That screams HIPAA violation, to me. The practice could (and should) be shut down over it.
The story is in a tabloid, and that's such an insanely egregious breach of HIPAA that I'm a little skeptical that it played out exactly like that.
Because a common tabloid tactic is posting technically true statements in a misleading manner.
For example, the woman's statement could apply to having introduced her medical records into the court transcripts, which would be entirely normal practice. The wording in the article leaves us thinking they uploaded her records and driver's license in a Yelp reply or something, but I think that's unlikely.
> [The doctor's office] posted my entire medical record, including notes about my mental health, my bills, my insurance info, my driver’s license, birth date and home address.
That's exactly the sort of "true but out of context" thing a tabloid like this site would use.
People freak out the moment they hear privacy violation. They get angry and stop thinking. The comment above from AdmiralAsshat already says "the practice should be shut down". Some comments above say "it's an open and shut case" without even knowing the details of the proceedings.
Can you imagine if as a doctor, you kept your patient's info private, but a patients says you "posted her medical record" even though it was sealed for her court proceedings? Wow
At issue here is a disagreement over what services were performed, so it makes perfect sense that the court would require access to these documents.
The reporting is incredibly one-sided here considering that the case is still unresolved. No doubt it will be damaging to the doctor's reputation even if he is cleared of wrongdoing.
[0] if the provider has to issue such refunds all the time, there are other problems to address...
She accused him of committing felonious fraud; seeing the doctor respond by giving her her money back and saying "most people don't have a problem" would not cast that doctor in a good light at all, to me. I'm not really sure if there's any kind of response they could have left that would feel reassuring to me: recommending the client contact law enforcement like someone else suggested might help a little, but not that much. The presence of a review with accusations like that that the doctor shrugged off or dealt with casually would be infinitely more offputting to me than hearing the doctor had previously won a libel case against a former client.
> They posted my entire medical record, including notes about my mental health, my bills, my insurance info, my driver’s license, birth date and home address,” she said.
wow. That violates HIPAA law. The counter-sue is going to be huge.
Also, I had a related issue where a doctor threatened to sue based on my yelp review. I cut the review back to verifiable facts instead of opinion and asked if that compromise was ok, he said it wasn't and started claiming it was defamation. I cut off contact and that was that. I wondered if it was possible to be dragged into court by something like this, apparently I may have dodged a bullet. Scary stuff.
This reveals a predicament for businesses that have to protect customer privacy. If a restaurant owner thinks a customer is lying, they can call the person out on all kinds of media and say they're a liar. Alamo Drafthouse made a set of videos to play before movies making fun of a customer complaint call, telling her to eff off.
If a doctor believe a patient is lying or doing a detriment to their business, they can't call them back out on social media. Their only remediation, if they think the statements are false, is a lawsuit to have the force of law take lies down.
I had a friend of mine who refused a request by a patient out of the country, while on-call one weekend. I'll leave out the details apart from it involved shipping a large quantity of a very expensive medication to another country - as the hospital did not have this medication available. He had already sent enough of this medication to cover for at least a week (at huge cost to the NHS, as the medication had to be couriered by plane) when a second request was received 2 days later. A huge internet hate-mob appeared on Facebook saying all sorts of things about this doctor by name, to which he had no ability to respond.
I'm for making healthcare more transparent, but I wonder if, as a doctor, we'd be pressurised into pleasing the patient more than treating the patients correctly, with the threat of negative yelp reviews, though that's obviously a risk with any sort of profession and review system.
Though I guess if a phone call had protected HIPAA information and you could tell who it was through their voice it might be a violation?
In this case the subject is in NY state which has an Anti-SLAPP law and she should apply it and HIPAA.
https://en.wikipedia.org/wiki/Strategic_lawsuit_against_publ...
I would suggest using a pseudonym and VPN for any review written on a potentially litigious business unless you have the funds to litigate. Problem is Yelp is much more likely to mark the review as spam.
We are hearing one side of the story here. HIPAA violations have teeth -- potentially 10 years imprisonment for intentional leaks for personal gain -- so a vindictive public action is highly unlikely, and certainly some lawyers would take the case on spec. Especially if personal information like driver's license info and home address were leaked.
What likely happened is this quip triggered the mess:
> “I suspect that this doctor gives unnecessary procedure [sic] to a lot of people and then charges the insurance sky high prices and no one knows the difference.
Levine is accusing Song of health care and medical insurance fraud. While there's some ambiguity regarding "unnecessary procedures", insurance fraud is a crime and arguably Levine is accusing Song of criminal behavior
>The most damning thing in there was that the Doctor tested for HHV-6 (something 100% of humans have) and then charged for it and claimed it was HHV-2 (genital herpes). Theres apparently a lab technician available to testify that the Doctor commonly tests for HHV-6. Guy seems sleazy.
[0] https://news.ycombinator.com/item?id=17182181
>HHV-6 primary infections account for up to 20% of infant emergency room visits for fever in the United States
The test can be used to assess viral load, which may indicate other issues, I'm told. (I'm not a doctor, though.) If you have a very high viral load of HHV6, it may indicate something else is going on. However, that doesn't mean it was necessary in this patient's case. But the test exists for legitimate reasons.
[1] https://en.wikipedia.org/wiki/Human_herpesvirus_6#Epidemiolo...
I was sued and I pro-se to defend myself. Although the plaintiffs know the lawsuit is frivolous but that doesn’t matter. He said if I don’t apologize and I win the case, he will just spend more money appeal the case and make my life miserable. I apologized and he dismissed the case.
It probably caused him some money, but it had caused me a lot of distress and time reading up the laws.
Basically an open and shut case too. Assuming they were smart enough to "correct" the mistake it may not be a Tier 4 ($50,000+) violation, but instead a Tier 3 violation ($10,000 - $50,000 per violation) of willful neglect. I'm not sure if each violation above would be considered a single large violation or multiple small violations ( 1 violation vs 7 violations is a major difference in penalty cost). There's also SLAPP.
If litigation has gone on long enough to cost her $20,000 in legal fees I can't help but feel there is a lot more to this story or my understanding of the legal system is completely out of touch...
Reminds me of that famous poem "First they came for the ..."
Isn't it worse than that -- more like 'we might not win, but you're probably boned either way'? I may be wrong but I have the impression that it's relatively rare to be awarded full costs, and anyway you'll have to pay your lawyers up front.
It's somewhat hard to square with "litigious culture" criticisms of some parts of the country. But the details matter. Filing & defending in small-claims court is pretty cheap without a lawyer (and even with one is "only" in the small thousands) and person-vs-person cases won't be too terrible compared to companies-vs-individuals...
And that assumes that the lawyer isn't handling the case on contingency.
Generally, the reason people overestimate the costs of trials is because standard contingency fees are 30%-40% of judgements.
If it's not posted under seal, then yes. Particularly if it's posted as part of the initial filing and not as a response.
The most damning thing in there was that the Doctor tested for HHV-6 (something 100% of humans have) and then charged for it and claimed it was HHV-2 (genital herpes). Theres apparently a lab technician available to testify that the Doctor commonly tests for HHV-6. Guy seems sleazy
I was really confused. Wasn't this a HIPAA violation? If yes, what do you even do about it? Feels like a cause for concern if your doctor is also trying to play cupid? What should I do/have done?
>Wasn't this a HIPAA violation?
100% yes that was a HIPAA violation and honestly anything shy of giving your information to people who actually need it (aka: any hospital/practitioner you visit who should be aware of your medical history) is a violation with very few exceptions (mostly legal ones). Gossiping about patients is probably one of the most common violations.
>If yes, what do you even do about it?
Depends how much you care and how long it has been since the event happened and you became aware of the violation. If it happened within the last 6 months you can report it online through the process xapata linked you. If it's been over 6 months it's too late to report. I'm not sure if "it happened but I didn't know it was a violation until recently" counts as a start date for the "aware of the occurrence" limitation. Would be a great question for an actual lawyer.
You also don't know what else could possibly have been said about you or your medical history - so I'd keep that in mind when deciding if this violation is a "big deal" to you personally or not.
There are so many things wrong in how the doctor behaved it is mind-boggling and a big red flag. Fighting angry and stupid people in court is best avoided but one does not always have a choice.
This is where good lawyers know how to play. They have experience. Unless the consumer's layers are equally skilled/powerful, usually the deeper pockets win, I hate to say. It's why the rich get richer while the rest get [bleeped].
It's one of the reasons Hillary was unlikely to be jailed for being sloppy with email; the laws are fuzzy enough to milk. But this applies to all plutocrats, not just Hillary, including the current occupants at Washington DC.
https://news.ycombinator.com/newsguidelines.html
It seems like there should be some special set of rules around medical reviews, in my opinion at least.
Even if the patient reveals PHI you should avoid confirming or acknowledging it as the "covered entity" under HIPAA. A confirmation of a diagnosis is different than a person discussing symptoms. I would argue that you probably should avoid even acknowledging that the person is a patient or has been seen in the office. The approach will reinforce to others how seriously you take privacy and you can taut your customer service policies, etc.
I wouldn't call this unfair since all providers are in the same situation.
(This isn't legal advice, obviously.)
Review wars are real in all retail businesses, its pretty sad.
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I cannot imagine a lawyer would condone the HIPAA violation, I wonder if there are exceptions when the patient has made that information public before you (patient said she had x, and you say "We did not diagnose x") or smth.
Definitely recommend checking out libel insurance. Shouldn't cost much to get and will help protect against companies trying to go after you.
And to be scrupulously neutral, 3 stars if that's an option.
Opinion is allowed, verifiable facts are allowed. False statements of facts are not.
[0] https://en.m.wikipedia.org/wiki/Streisand_effect
"I'm a food critic with Yelp.com... umkay."
http://southpark.cc.com/full-episodes/s19e04-youre-not-yelpi...
In contrast to privately insured people (basically, public servants, company founders, rich and ultra rich) who get to see the bills of the medical provider, they can bill the "common" insurance providers (GKV, Gesetzliche Krankenversicherung) directly without the customer seeing anything of the bill. This is, of course, ripe for abuse as no one will look if a doctor really did a specific billed procedure on a patient, especially not something in the 20-50€ range...
And many self-employed people and also some middle class people. Private insurance isn't that rare here.
PS: Interesting to see LN linked ;)
I was actually very taken aback recently when I needed to get dental work and was presented with costing info about 10 mins after my visit started.
It did feel a bit greasy, I must admit - but I get that the point is for everyone to be on the same page before the procedure.
edit: I now recall that I did use Urgent Care for awhile for healthcare while uninsured - in the US - these are basically "fixed menu" clinics. They have a menu of services / costs for cash.
And also, each insurance pays differently for the same service.
You can always go as a patient to an all cash-clinic, which will have fixed pricing, but then you throw away the benefit of your insurance.
Yes, and the provider knows more or less upfront how much each insurance provider will cover. My dentist can handle this just fine for every single procedure and I'm out of network. They've never been wrong. The coverages are fairly standard as are in/out of network fees.
When a doctor has to file a claim with an insurance,he has to pick between 10s of thousands of codes and then out of different procedures, that have different values based on how much documentation is gathered, that changes per insurance, and then the insurance will renegotiate.
I am in the business, I can tell you its impossible to know what the insurance company is going to pay.
The codes are standardized for different procedures. If you know that you're doing procedure X, Y and Z and are billing against provider A who you've already billed before, then you know more or less how much they're going to pay for those three procedures based on experience and the standard in-network cost for those procedures. It's not like an insurance provider is suddenly going to reimburse half the cost for shits and giggles. Everything is fairly standardized and theres only so many variables you have to deal with.
Sorry, but if your org has no patience for patients (pun intended), then you are in the wrong biz. It comes across as, "Our business would be smooth if not for pesky humans."
[0] https://iapps.courts.state.ny.us/webcivil/FCASSearch?param=P
https://iapps.courts.state.ny.us/webcivil/FCASCaseInfo?parm=...
And file a suit against Yelp.
If this is indeed true I'm not really interested to hear the other party story. Remember that the other party started the lawsuit and online reviews are something to get over with (unless the woman is backed by some entity that is going after that business)
https://iapps.courts.state.ny.us/webcivil/FCASeFiledDocsDeta...
Where do people here think the medical records were posted? On yelp? On the lawyers website? It is so weird people are just thinking that this stuff is posted publicly.
Yelp doesn't do nearly as much as they should to protect their users.
Yelp has also been sued by investor's for allegedly misleading them into believing that Yelp was filtering out everything that wasn't reliable, first-hand reviews from people who actually went to those businesses and paid for services.
On a similar note, I believe business owners have alleged numerous times that when they refuse to pay the extortion fees to have bad reviews removed, they suddenly get a bunch of bad reviews all at once. Also, Yelp has seemingly had a habit of allowing competitor's post bullshit reviews on businesses who haven't paid them for that "service".
I don't what currently goes on, though. Maybe they have cleaned it up? But I doubt it.
Another thing that struck me is that if you don`t have money, evil people can just silence you by suing you (look at those court costs, 20k and counting?!)
Huge numbers, perhaps a majority, are not cool with it. We've had national elections fueled by the discontent. But at least so far the political configuration of that discontent, not the magnitude of it, has prevented progress on lowering the cost of health care.
Health insurance in this country suffers from kind of a legacy situation. It is sort of like how the qwerty keyboard is terribly inefficient, but most people continue to use it.
From what I have read, at some point health insurance was offered as a means to beef up compensation in a way that was tax friendly for employees, thus helping to entice better employees to come work for your company. This became kind of the standard default and typically covered the family, not just the employee.
This was considered a perk in a situation where most people whipped out their check book to pay for medical care because it was relatively reasonably priced. Then health insurance became kind of the default and it adds overhead and complexity. Obomacare was passed as the only politically viable solution and it's a terrible solution.
Health insurance coverage for basic services doesn't really make sense. Insurance only makes sense as a bet to defray unexpected expenses. When you use it cover annual exams and other basics that you know are guaranteed to happen, it essentially creates an unnecessary middleman, pushing prices higher without providing any real benefit for the cost involved.
This is where we are now and most people don't know how to get out of this mess. It doesn't help that Obamacare puts a gun to your head and insists that most people participate in this charade or be fined at tax time, in essence. Ugh.
The old system of paying a doctor outright with a check or cash was not a universal healthcare solution - a lot of people couldn't afford it even back then.
Most developed countries deal with the cost problems of health care through strong price regulation, even the relatively laissez-faire systems like Singapore [1] or Switzerland.
Obamacare did a lot to improve access [2] (subsidies, pre-existing conditions, adult children on parents plans) - it's a lot like the Swiss system, - but unlike that system, it did very little to address costs.
1. https://mobile.nytimes.com/2017/10/02/upshot/what-makes-sing...
2. https://www.kff.org/uninsured/fact-sheet/key-facts-about-the...
That approach of mine is frequently misunderstood and perceived to be things like making excuses or justifying the current status quo, etc.
The discount is not guaranteed.
Aren't designed to correspond to real payments. But like a sumo wrestling match in a kindergarten, sometimes the little guy gets squashed by accident. And you wind up with people getting $20k bills that don't necessarily know how to get out from under them.
It's
I've gotten so I just ask what the out of pocket cost is to pay cheaper (usually 1/2 price), and they still manage to hose me with extra services.
It's a racket.
I want to protect from the hospital bills from something major though, like a car wreck. I'm not sure that those $50 copay per doctor visit right from the start are even available anymore. That's the insurance I had when I was a youngster.
I pay (a lot) extra for a traditional PPO and get the old-fashioned $20/$50/$75 deductible.
Dude only made around 30k per year... doing flooring, which could now kill him. Even if he could go back to his work, he had been off work for a couple months. The hospital's "reasonable payments" exceeded his income with work, and was impossible out. More common was a collection agency and eventual court date.
His way out was bankruptcy.
Totally not true. Often they'll send a collection agency.
The problem is that you've got a two party system where groups that don't share much in common are lumped together and people are voting for the 'least worst' option. There's no reason the social and economic positions of the Democrats/Republicans have to be linked together like they are.
If they weren't, people may vote differently.
As a sibling poster to you said, the ridiculous pricing is part of a game between insurers and care providers. Throwing more money at insurers might not be the ideal answer.
Is everyone against that really a "person that hates others so much"?
> we have movement in the other direction because a lot of people hate others so much they do not want them to have healthcare
Last I checked nobody was opposing healthcare discussion and debate, so the "opposing" you're talking about appears to be in reference to Obamacare. Obamacare allowing healthcare providers and insurance companies to game the system more than ever before, by providing the backing of government coffers.
One either throws money at something that "obviously won't solve the problem"[0] or one "hates people to the degree that one does not want people to have healthcare"[0].
> That viewpoint is inexcusable in my opinion
What was that you were saying about inexcusable viewpoints?
[0] Paraphrased, but sentiment remains the same.
I drew the Obamacare conclusion from the reason in my above response. Nobody is adverse to discussing healthcare solutions, so what are you talking about when you say there is a movement of hate to the degree such that people are actively rejecting the idea of others having access to healthcare?
You might try to see how some of them might (reasonably) feel that the individual mandate was removing choice from them, rather than adding it. You might try to see how some of them felt that the cost of the mandated insurance was breaking them financially. Then you might not be so quick to ascribe their motives to nothing but hate.
You could have that level of empathy and still disagree with them.
You need to remember that healthcare and education taxes are literal robbery on the rich, who never have, and never will use those services.
I'm going to say something that is controversial, and I myself haven't decided is fact, so please don't interpret it that way. Most people who work hard and are smart, can get themselves out of the lower class, regardless of their start in life (assuming they are in a first world Western country).
For reference, I live in Australia and I pay a Medicare levy (public healthcare tax). I do not have private insurance and regularly use public healthcare services. Additionally, I have been on welfare in the past. I do not believe that public health care is a Bad Thing (c), but I believe that robbing from those that have never used the services is deeply immoral.
I am not arguing for or against public healthcare. This is a difficult problem to solve. Im just trying to tell you that the decisions and opinions are not necessarily hate fuelled. If you went outside and spoke to those who disagree with you, and listened, you would see that there are reasons besides hate, that people vote the way they do. If you can see my perspective and agree with what I've written in this comment (it's a hard problem, and I'm not arguing whether healthcare is bad or not), perhaps you would consider mailing your state rep about considering a healthcare plan that is only available to the lowest earning in society, and is funded by those who required the services in the past and have "made it". Perhaps something similar to an education loan in Australia (government pays for your education, you owe them the fee plus 30% (fixed, not annual interest), paid out of a fixed % of your salary whenever you earn more than a certain amount).
While this went through my head, I just thought about the idea of bank loans for medical expenses. Why is this not a thing? The person gets their healthcare (human life value) and then they pay the bank back over time, and don't have to rob other people (anti-theft value). I am absolutely sure that I'm not the first to come up with this idea, what down-sides does this have, such that it hasn't been considered as a viable solution?
By the way, I never said anybody should die. If you had actually read my comment, you would see at least one potential solution to the problem. If somebody with 5m gets sick and the medical bills cost 10m, then they could theoretically get a medical loan which they pay back over time. They might be paying it back for the rest of their life, but at least they're not dead.
I don't have statistics that indicate one way or another about the majority of people voting against public healthcare being those that need it the most. It doesn't really make sense to me, but I'm not arguing that point so I won't debate that.
I don't know what is considered middle class in America, but in Australia, 120k household income before tax is considered basically the bottom of the middle class. I could afford private health insurance in a single income family working as a cashier. So I would question the validity of the middle class being "People who are literally one job loss, accident, or injury away from homelessness".
Present company (much of the HN demographic) excepted: a fair number of HN posters are very atypical in terms of their resources for doing things like hiring lawyers.
Aside from that we are all covered by the state and are not billed for anything apart from some medications. Yeah, hospitals are not that great of a place and there is a lot to be improved, but at least you know that even if you are very poor, you will not be left to die (or with some ridiculous bills) if you are very ill.
And before someone asks, why to pay for private if you have state coverage.. It is a job perk, and in any case, you pay for your time. Service is much faster and more convenient for the basic stuff/illnesses.
I'm sure lawyers charge much less there than ones in New York as well.
Now, I understand I pay taxes to cover health care. This isn't really any worse than I was paying in the states in my monthly premiums. The thing is that it creates a wonderful sort of stability in life. I can plan on taxes, I can plan on the out-of-pocket costs for a year. I won't go bankrupt. I no longer feel I'm getting ripped off for something I might have little to no control over.
I don't know where you get US$1k for a regular exam, but that is wrong.
My doctor, for example, charges a base (list/MSRP/whatever) rate of $120-$180 for a regular exam.
The "negotiated" rate with the insurance company is $80.
The amount I pay, as a patient, is $10.
If you don't have insurance (for a while I didn't), he charges $50.
$1k for a regular exam is fiction.
> The amount I pay, as a patient, is $10.
This is Shkreli math. "Oh, insurance companies pay larger amounts, most people will get this drug for a $10 copay!"
Oh yes, the insurance companies, those philanthropists magicking money out of ... somewhere other than your pocket, be it directly or indirectly.
https://www.zocdoc.com/about/blog/for-patients/the-zocdoc-do...
> Please note that we can’t publish claims about the accuracy of a practitioner’s treatment and diagnosis. Those are factual matters, and to verify them would require extensive medical studies.
https://nycdatascience.com/blog/student-works/web-scraping/a...
And so forth.