We had a call with someone who works on the pricelist/chargemaster for a major metro hospital recently, they set their prices by taking the Medicare reimbursement rate, and multiplying by 8.
That $600 is just monopoly money to the majority of constituents, because they have insurance of some kind or they're on Medicare/Medicaid. So those people are usually, not always, but usually fine.
And that of course is part of the problem. Medical billing is like playing numberwang or who's line is it anyway. No two numbers on a bill seem to be correlated in any way to another except as upper or lower bounds.
When someone without coverage comes in then, they have to play that stupid game with all the numbers, and of course they either ignore it and go into debt, pay the cash price if they're able, or they manage to negotiate it down by orders of magnitude - proving the price didn't matter anyway.
That’s what i don’t get. A lot of the billing is clearly fraudulent. They routinely bill for treatments that never happened or for drugs that were never given.
That’s a common but false talking point. Hospitals with above average Medicare patients generally get paid more than the general population. It’s also a question of what percentage of a nominal bill gets paid vs sent to collections.
From 2015 to 2017 Medicare lowered it’s uncompensated care payments. However, that program covers uncompensated care underpayment. Medicare explicitly does not pay for everything at hospitals: https://www.medicare.gov/coverage/inpatient-hospital-care
That was tried during the Clinton administration. Result: many doctors dropped all their Medicare patients, making it impractical for Medicare patients to find a doctor to treat certain conditions.
This is pretty common. Uninsured patients are such a small percentage of revenue (and many aren't going to pay anyway) that hospitals don't put much effort into setting prices. Negotiating with insurers and navigating billing them is a big operation as it is.
Yeah, and there’s the Lesser Of clause in their insurance contracts - they’ll be reimbursed at the lesser of their retail rate and their negotiated rate. So they make their retail rate ridiculously high to make sure it’s never the limiter for insurance payments.
i wonder if a hospital would still charge you if you refused
thier price gouge materials and used your own purchased at a proper price, as in "thanks for setting the bone, i dont need your sling i have my own and it will do fine, here is my lawyers contact card."
IIRC prior to being treated you agree to be financially liable for the costs. Prior to even knowing that that will be or even the costs involved. Or even if you know what is involved are you going to understand what a reasonable cost is? EG: Sling is easy but what about a x-ray study? Is that 200$ or $150?
Just like a proper capitalist system! You know, like when you agreed to pay whatever for your iPhone prior to even know it'll work.
> You know, like when you agreed to pay whatever for your iPhone prior to even know it'll work.
I can contact Apple for help with any issues I have with my iPhone. I can contact my carrier for any issues I have with my iPhone. I can return my iPhone within a grace period if I don't like it.
For fun I do this: I ask them how much it'll cost upfront. (they can rarely even give bounds). Ask about refund policy (?!?!?!). Tho must be done nicely as the person handling the questions is no way responsible for the absurdity.
I know these won't actually succeed in adding a bit of capitalism but it does succeed in highlighting the absurdity.
I'm not sure what your argument is. Is it that it is fine that our healthcare is like shopping at an Apple store? Or that medical costs cannot be predicted? Or that we should be happy with the system we have?
Other than pedantry, what are you trying to get across?
We asked for an itemized price list when my wife gave birth. They claimed she received lactation consultation even though she rejected it, as this was our 2nd baby. Despite having documentation saying so it went back and forth and we just paid it because it was too time consuming.
Anyways. In the itemized bill they charge about $40 per ibuprofen. If we knew the price, we should have brought our own and just rejected theirs.
Someone might come along and reply with that $40 covers nurse salary, tracking the medicine etc. Yeah... Bull$hit.
I believe it was $200. For our first daughter ours was helpful. We took a class (paid by ourselves) before hand but it definitely helps to have someone walk through it with your actual baby. However for each delivery the nurses knew enough to be helpful too.
Also, since my wife has had surgery to remove a benign tumor in her breast, lactation consultation was covered the first time. No idea WTF happened the second time. This is the US medical system for you.
I'd also like to add we received a random bill for our first daughter 2 years later. No idea what it was, but the insurance covered all of it so I didn't care.
The hospital definitely didn't carefully consider the $40 price to cover the actual cost of delivering the medicine to you. They just multiply their cost by some number and call it a day.
The fact is that hospitals aren't built for itemized bills because very few patients pay the posted prices out of pocket. Medical debt is extremely hard to recover in the US, so why bother expending the resources to figure out a sensible pricing structure for a small minority of your customers who mostly aren't going to pay that price anyway?
I have Kaiser health insurance in the bay area. Whenever we needed a hand or foot brace or walking boot, they seemed to just give out the basic stuff at no extra charge beyond the visit copay. Per the insurance plan there is a copay but they just give it out. Other times they will just recommend something you can buy locally or online. They would give a printout with suggested brand/SKU to consider. They don't mind if you price shop.
I just got an itemized bill today for a minor fall I took a couple months back..
On top of the nearly $6k in other charges from the hospital, they charged $531 for one dab of superglue or "liquid stitches" on my forehead for something that would have healed by itself.
One of my friends died two years ago from pneumonia. He didn't go to the hospital when symptoms first started because he was afraid of the bills that would come from it.
They don't ask you if you want to spend $500 for a dab of glue on your forehead, they just do it and you're essentially writing them a blank check in the process. I hate our medical system.
The thing I don't understand about tips like these is, what obligation does the other party have to cooperate at all? Like you "ask for a supervisor" (and then a director!) what incentive do they have to not just say no? Or if you ask for an itemized bill, what if they just refuse? How are you supposed to get past a blunt refusal, which to me seems like the easiest response for them?
Once upon a time, I had a surprise bill for about $4,000 that health insurance decided should have been $700 for that procedure. I fought it and won. But it took forever, almost a year of calling them and going back and forth - and this was actually decent corporate health insurance.
It took a lot of reading through the 600+ page plan document and finding loopholes. For example, I asked them that if they thought it should be done for $700, who would actually do it for $700? They couldn't list one provider that would accept the payment rate they thought they should pay. And since this was a reimbursement, and they had already pre-approved the procedure (knowing the price), I think I caught them already saying they would do it, but them not following through. There was a lot of going back and forth about in-network vs out of network, but again, no one in-network would perform the procedure. In the fine print of the plan document, it said if there are no in-network providers, the plan must provide you were in-network rates and deductibles for using an out-of-network provider.
So I told them if they can't find anyone who will accept what they are willing to pay, their figure is obviously wrong. It helped that with my health insurance, everything was supposed to be covered, 100% with no copay. So the fact that they tried to charge me for the $3300 overage was very out of line for them.
They never just said "no, we're not going to cooperate" it was more just endless stalling on their part. It was never really a blunt refusal, or if they tried that, I just proved how ridiculous their arguments were. I kept a lot of documentation.
I think in the end, they just relented because they were spending more dealing with me than actually just paying me my money. But it was certainly an uphill battle the whole way, and not one I would recommend to someone who isn't well versed in legalese.
These stories are horrifying to me. I live in a less developed country than the US, other businesses may be crooked and all but at least the medical field is manageable.
If they give in to the few people who have the initiative to complain, they likely placate the few people who'd have the initiative to demand change.
See also, the TSA precheck systems. By allowing people like frequent flying businessmen and politicians to avoid the standard TSA experience, they reduce the likelihood that such people might use their influence to advocate against the TSA, for the betterment of all passengers.
Sometimes the first price quoted is just a formality. One time my significant other went to an optometrist for a contacts prescription, without optical insurance (long story), and the bill was for $1000. She emailed asking why, and they just replied "here's your updated bill: $250"
It's sort of like "add to cart to see the real price" but they can't say that. And sometimes hospitals are in a different mode where they fight for it. It's not logical, it's screwed up, but anyway the first bill is usually just fake.
Generally, these excessive bills are, to put it mildly, of questionable legality. If you complain, they assume you're the type with enough savvy to maybe sue them, so they'll give in to placate you. And yet they do this anyway, knowing that some people will not properly contest the bill.
See also the US unemployment benefits situation, where many employers will contest an unemployment insurance claim by default even when the worker is actually eligible, in the hopes that some workers will not navigate the bureaucracy well enough to fight back. Because of the weakness of their case, however, they will then back down as soon as their denial is challenged.
I've thought about this aspect, but the thing is, how would you ever even show you were refused without a recording? (Say if you're in a 2-party-consent state? Which they would obviously not consent to?)
Civil cases are based on preponderance of evidence, and your testimony is evidence. If they refute it and they're lying, that's a felony, and I don't think these professionals are being paid enough to commit felonies for their employer.
This reminds me of another question I've had -- does anyone ever get prosecuted for false testimony? I feel like I don't really hear of this happening, which has always baffled me.
I had a deep split over my eye (metal ring tossed while I was still down range) and knew going to the ER for stitches would end up costing thousands for a five minute stitch job, so I pinched it together and put on superglue. Healed better than stitches and cost me nothing. I hate our medical system too.
When you say superglue, do you mean an off the shelf superglue that you would pick up at a hardware or craft supplies store? Did it just dissolve on its own after X number of days?
I've used off-the-shelf superglue on cut fingertips where I couldn't get bandages to stay. I believe it's also commonly used in place of stitches where you don't want the scarring that stitching would cause (e.g., parts of the face.)
Yes I used some old super glue lying around the house. I was worried at first because even though I pinched it together, a large amount of glue went into the gash and so I was left with a hard shell over the wound and a clump of glue in the gash. But after 4-5 day the shell peeled off and the clump of glue fell out and even though the cut was completely through the skin, it healed perfectly. It was like the skin bitter together under the lump of glue until the clump was pushed out. I’m no doctor and only know about the glue because my mechanic brother in law uses it for every cut and gash he’s ever had.
I'm not sure open pricing would help seeing as how the average person doesn't have much knowledge to defend themselves against gouging. And when I've got a gash on my head, I'm not going to call around for prices and special discounts.
Another commenter said they asked the hospital and they just bill 8x the Medicare rate. Price transparency should help equalize the market. Right now it’s very much a smoke and mirrors pricing scheme.
I just got an emergency room bill. I had a severe sore throat and fever for 2 weeks, step tests came back negative. Then at night my back side started hurting so I went to the ER.
I paid $850 at the ER and today I received another bill for $850.
The only thing on the Bill just says
> "Charges": $11,680
> "Adjustmnets: $9,980
I just got off the phone with them and they say that it will take 10 business days to receive an itemized bill. However, that means the itemized bill will be delivered after the current bill is due.
How are they going to charge somebody $1700 without an itemization?
Furthermore, I am expecting another bill from the ER doctor that saw me because they bill separately and are not covered by insurance. The ER legally cant tell you if the doctor or the hospital accepts your insurance. Thats so crazy.
My wife was absolutely mortified. In brazil I never carried insurance but going to the ER I just had to pay R$400 flat fee for a private hospital. Anything else for tests they would give me the prices up front.
My wife about started screaming when the woman brought in the credit card machine while I was still in pain in the ER hospital bed. It was so embarrassing.
All this is with the top insurance my company (a ~$500 million startup) offers and to make it worse it happened when I was on a company mandated trip.
I am not a lawyer or financial advisor. But I’ve heard that you can’t be sent to collections if you make a good faith attempt to pay your (medical) bill. Which in practice might mean you just pay $5 while you wait for the itemization
From what I understand it, it doesn’t mean you acknowledge that the entire bill is for the correct amount. Also if you know you’re going to have to pay at least $5 out of pocket anyway you’re not really losing money. But again IANAL I’m just parroting advice I read on Reddit one time
Insurance companies negotiate a lot of this stuff away. The poster needs to call them first, see if they can arrange a $5 payment without addition interest while the itemized bill comes in (honestly, there is legal ground here for not even being willing to honor any of the bill with itemization).
Get on the phone, try to keep cool, but realize you're probably going to yell at some poor customer service rep at some point. Apologize, keep going and get the full bill before you agree to pay anything. Then you gotta do the same thing with the full bill on ever bullshit charge, over and over again.
Honestly, how the fuck can they admit you and treat you and then bill you without telling you what the prices are up front? That's fucking madness right there. Imagine having to agree to having car or bicycle service without an estimate? Imagine the total cost being $2000 over the estimate? Would people pay? Of course not; it's worth it at that point to call a lawyer.
The trouble is that in an emergency or urgent situation, you can’t really shop around for service. “I’m having a heart attack, but can we try the hospital in the next town over? Their cardiologist is cheaper.” Bike service is a leisurely afternoon; emergency medical care is not.
It shouldn’t cost that much in the first place. You shouldn’t need to shop around for health care, and you shouldn’t be bankrupted by an emergency. Why people aren’t marching through the streets right now is beyond me.
Our first born came with a $42k bill. Hospital and doctor said we were covered by our insurance pre-auth, but come bill time apparently pre-auth was null and void b/c it was requisite on a negotiation that fell through. Each side had a different story and their representatives acted absolutely helpless.
We were broke at the time we found out about the pregnancy and memories of the first two years of my boy's life are largely dominated by this kafka-esque nightmare that took time and security away from our family life. I refused to pay a cent until what we were told was honored, my thinking being any sort of payment may legitimize it.
Eventually I didn't hear back from the hospital about our latest contestation for two months after confirming their receipt of the documentation (about a four hour process each submission, always new fax numbers, life-wasting hold times to confirm receipt of said documentation, transfers to other agents and departments, then a promise of giving a decision in a few weeks, often just reprinting the last non-descript document they used in the previous round without any real detail). Decided to just do nothing and ignore it as long as I didn't get contacted again and got everything ready to go to court if someone ever decided to pursue it against us again. The documentation I've been holding from the ordeal is 60 pounds of paper.
I still have no idea what the true status is, but it hasn't shown up on credit checks and our boy is now 5 years old.
I could not find anyone in various governmental institutions to even look into the matter and the lawyers I talked to said the outlook of winning was grim and would have cost a lot of money on top of that to even pursue it.
Our insurance company [Anthem] posted a $17 billion profit that year. The hospital had the highest gross profit of any hospital in our city and the surrounding area at $80.4 million declared. Both entities make so much money they give away individual debts amounting in the tens of thousands of dollars for pennies (maybe ours included?).
It's an absolutely depraved system and my point is maybe be careful showing good faith to an entity trying to screw you lest it be taken as consent.
Is there any way to get this sort of advice for ordinary people easily? I remember when I was an exchange student to the US from Hong Kong and I got a flu, I thought I'd get it checked out just in case. I went to a clinic and they told me to get into a medical robe for a checkup and I thought wtf. I also remembered about reading all these horror stories. Of course it might not have been that bad since I didn't go through with the checkup but it's very different from what we have in hk and China where the doctor just takes a look at you, blood test at most, and gives you some pills, usually for no more than 40usd max
"The conservative echo chamber yelled for 40 years that every mild reform to improve people’s lives is socialism, so socialism has started polling well. Couldn’t have done it without them. … @InternetHippo"
most are still stuck in the loyalty type mentality buffered by things like patriotism and national anthems and flags for any event with >5 people and a TV camera.
50 years ago people had the same loyalty towards their companies, and look where that got US manufacturing workers. nowadays you'd be nuts to expect to stick with a company for 10 years. get yours and get out: others be damned.
so it shall be with citizenship. as more and more citizens have more and more power to up and leave, or work outside the confines of the US without too much hassle, questions such as "what on earth are we still doing here?" will be asked, at first in whispers (as they are now), later in louder volumes.
Last time I went to the ER I got an itemized bill in a week for $300 or so.
All medical imaging I've had done has had pricing given up front showing what they where going to bill the insurance company and what the insurance company was going to pay and what I'd have to pay.
My non-emergency visits have a $40 copay up front.
Conjecture is silly when there's good data to be had.
The number one cause of bankruptcy in the United States:
> "medical expenses"[0]
The average amount charged for an ER visit in the United States:
> between 2008 and 2017, the average price of hospital ER visits rose 135 percent, from $393 to $924[1]
The cost of an ambulance ride in the United States:
> $164/mile[2]
And make sure to compound the monetary cost with the cost of people avoiding medical care out of fear and unknowns surrounding the actual monetary cost.
It needs to be fixed, but a $900 average that includes $200 charges for a $25 "medical boot" and charges for a $30 bandaid sounds like it may be not too hard to reduce costs across the entire board.
If the average ER visit was 5K of unknown miscellaneous charges than that would indicate nationwide maliciousness on the part of nearly all hospitals. If only a small # of hospitals are engaging in that level of unfair billing, then they can possibly be investigated one by one.
It is the same thing as "we have thousands servers that are crashing at random multiple times a day" versus "we have a bunch of servers that are low on RAM, and a couple servers that crash 5 times a day."
Neither scenario is good to be in, but it is possible to get a hand on the latter scenario, while in the first scenario a "burn it all down and rewrite" fix might be appropriate.
Emigration is hard, and emigrating somewhere remotely decent is even harder (because everyone wants to do the same thing as you). I’d also wager that the people who truly need to leave have the least means to do so. Getting into Canada or Western Europe requires at least a college degree, and probably being in a sought-after field. And by that point, you’re probably doing okay in America (for now). I mean, I live comfortably, although even good insurance and a high salary isn’t a guarantee that you’ll be okay. I’ve thought of moving, but the difficulty (logistically and psychology) and the fact that I really am comfortable make it unrealistic at the moment.
I agree, though, the masses are exploited (us included), and it’s troubling.
For one, probably because these stories are the exception? I know a bunch of people will probably tell me I'm wrong and I might be (haven't used the US health system in a 3 or 4 years since I moved out) but for most people their insurance just covers it (or medicade if they're old).
Otherwise most people don't want to leave their friends and family
Note: not defending the horrible system. Only suggesting that most people using their company provided insurance probably don't run into these issues.
Company provided insurance, only cost us $5k to have a healthy pregnancy followed by a healthy baby, with no special circumstances. This was the usual “negotiated” cost. Why not print $2mil for a yearly wellness check while you’re at it, and then give a generous 1.9mil discount? The whole system is absolutely positively bonkers. How much of my premium is going to professional negotiators for insurance, and how much of my hospital costs are going to professional negotiators for hospitals?
Not much. Your premium is going towards paying for the $1M NICU cases where it takes extreme interventions and the $1M/month hemophilia patients. Even a population of a small state like Iowa can have problems distributing costs like that.
I think distributing the costs is entirely reasonable; warranted, even. That is, after all, why insurance works at all. Distributing the cost by inflating receipts is, no matter how altruistic or “necessary” you may think it to be, a fraud.
I'm a lifelong patient. I currently have great coverage.
I don't know how it's possible, but our healthcare system has been getting worse every year. Even simple stuff like refilling scripts has become Kafka Meets Keystone Kops. The insurer has interjected itself into every single transaction, second guessing everything, adding ever more hoops to jump thru.
It's a wonder that we even bother with doctors any more, since the insurers apparently know better than my doctors.
Things are so bad, I wouldn't even know where to start if anyone wanted to fix things.
At least what we know is that currently the flow of migration is reversed with a lot of European countries. Many countries like all the northern countries, Netherlands, Switzerland, or even Spain have more Americans moving than their own citizen settling in the US.
Because most of these stories are extremes. All my friends' pregnancies and major surgeries came with some hefty "residual" bills, but all got negotiated down or tossed. If you stand up to them they'll back off. About 80-90% of America has insurance that is "ok" and will keep you from going bankrupt. It's not as bad overall (big picture) as the anecdotes portray. Don't forget there are 340 million people in the USA (1% is still 3.4 million people, plenty of room there for stories to arise). It still really sucks and we need price controls and public option for insurance though. Also fear of the unknown, leaving your family behind, other countries in general don't like Americans unless you bring a few million dollars with you, other countries seem to have a very high barrier to foreigners working there, etc get in the way.
You'll probably get a bill in a few years for 10% of the original amount from a bill collector the debt got sold to. Don't pay that either. They should have made sure your insurance covered it, so the onus is on them.
Federal law means your insurance has to pay for emergency room care. They do like to try to weasel out of it by saying you actually have a true emergency though. You can push back and get your state insurance regulator involved.
Isn't this why the costs are so outrageous? The guaranteed insurance coverage means hospitals know they can charge whatever they want. This is why I'm not psyched about single payer healthcare solutions: It's not solving the problem, and may just mean huge government waste.
It'd be far more effective to aggressively regulate hospital billing, wouldn't it?
Depends on whether hospitals execute efficiently on the capital they raise from bad billing practices. If they are, regulating billing either won't change the final costs, or degrade service.
ERs are mandated to provide emergency care to anyone regardless of insurance status. They get sweet tax deductions to do so and they get reimbursed by medicare as well. Also they have to take every insurance. There's a limit though, usually they will do enough to stabilize you out of immediate danger. So if you go to the ER with cancer and no insurance they may help you stabilize but they won't necessarily treat your cancer.
A couple things you should know. First, there is no such thing as late fees or interest on a hospital bill. Second, if you have called to question the bill, they cannot send it to collections until they have fulfilled your reasonable requests for more information.
If you really did just get the bill it will be several months (and several more copies of the bill sent to you) before a final bill would show up that would indicate the account is "PAST DUE" and heading for collections.
IANAL but you can safely wait for the itemized bill.
In the future to save on costs, you might try to find a 24-hour Urgent Care instead of full-fledged ER. Unfortunately the level of equipment that they have to keep in a full ER means just having someone in a bed costs them a lot of money, even if they are just swabbing your throat for a strep test.
First, there is no such thing as late fees or interest on a hospital bill.
Sure, just like you can't charge extra for using a credit card in California as payment in most scenarios (you can get a cash discount though). There may not be late fees, but the hospital will absolutely offer to settle for a hefty discount if you pay ASAP.
By the time you get something claiming "PAST DUE" the hospital may be less willing to negotiate.
That’s not necessarily true. They would rather get something than nothing.
Who said anything about getting nothing? If the hospital sells your debt to a collection agency they get something. If the hospital deals with it in house they can act like UVA[1] and sue you to garnish your wages or take out a lien on your property. Playing chicken with the hospital billing department is a bad way to deal with medical debt.
Re. the comment about ER equipment costs, I think people wouldn't be so mad if ER's didn't amortize the cost over every service they provide during a stay (like charging $40 for a tylenol equivalent) and instead billed simple services as reasonably as possible and put the bulk of the cost into the stay itself. Is there any reason why they don't do that? If they do that, then people can easily see that an ER costs money to operate due to the equipment and that the bulk of the payment they are making is towards that.
I went to the ER with chest pains seeming like a heart attack. They did an EKG, determined it wasn't a heart attack, then a blood test, which determined it was low potassium, and did a chest x-ray just in case. I received a saline IV and potassium pills as treatment, and went home after a couple of hours. The bill was about $18,000 for this. The insurance negotiated rate was about $1,500, of which I had to pay about $600, then over the next weeks, I received about 20 bills, each of which was for a large amount, bit the resultant patient "responsibility" was about $20 - all from shell organizations like "CA ER Physicians", or "Hospital Diagnosticians", etc. It's such a mess!
Another example was the birth of my child. We prepared for this by setting up an FSA, and having really good PPO coverage that year, supposedly, with a 10% copay. After all the billing shenanigans, my copay was about 30% and well above the out of pocket maximum. How does that happen? You can go to an in-network hospital, and be treated by a mix of providers, all of whom bill separately. Some will be in-network, others will be out of network, so you are in effect deducting against two out of pocket limits.
Medical billing is fraudulent. Medical insurance is fraudulent. These people are all acting in violation of tons of existing laws - I don't understand why this isn't prosecuted.
The lobby for insurance companies, pharmaceutical companies, and hospital chains spend ungodly amounts of money to influence our political process. Once all the politicians are bought and paid for everything becomes kosher.
For some reason, Americans keep complaining about the same problems with their government over and over again - particularly lobbying, and yet every election they nearly universally reject all their concerns in favor of tribalism and vote for the same two parties that are responsible for everything they don't want, or nobody at all, which has the same effect.
Wouldn't it be fun if whenever somebody criticizes their government, they also state who they voted for to force them to open their eyes to the fact that it's their own fault.
People rationalize it by saying that voting for a 3rd party is "wasting" their vote, but in that sense, voting for anybody is wasting their vote because it never comes down to one individual's vote deciding things. Really they just have two driving forces - allegiance to whatever tribe they randomly found themselves feeling like a part of (and mysteriously agree with all the inconsistent aims of), and wanting to be on the winning team. Healthcare be damned.
> People rationalize it by saying that voting for a 3rd party is "wasting" their vote
In reality, voting for someone who didn't win the election is a "wasted" vote. But people will say that a particular candidate has no chance of winning the election, so voting for them is "wasting" your vote. Unfortunately, because most people follow this line of reasoning, it becomes a self fulfilling prophecy.
“People rationalize it by saying that voting for a 3rd party is "wasting" their vote,”
I guess I am stubborn but I will never vote for one of the two big parties. However it would be great if smaller parties got some kind of representation in Congress. It seems ridiculous that in the 90s Ross Perot got 20% of the vote but that resulted in zero representation.
There's an ideal world we want (that might never happen) and there's the real world. We live in the latter. Voting for the 3rd party is effectively voting one of the big 2.
Also, I find it curious that while our community has generally settled on "incremental improvement" approach, we expect different from our governments and want the "big bang" changes. Then we are surprised when things get worse.
I don't know, I'm just questioning the quality and magnitude of the signal sent by voting for a third party.
The public memory is so short and so malleable, people forget things week over week let alone the entirety of an election cycle.
The issue with third party voting is a classic case of the problem of coordinated collective action.
Would-be voters don't participate out of perceived futility or participate in the dual party system for similar reasons.
I don't know how to solve it but there does seem to be growing agitation in the electorate with the current system as it stands, with the Electoral College under public scrutiny and with media support. To me that is a signal that times are changing.
> People rationalize it by saying that voting for a 3rd party is "wasting" their vote
It's actually worse than what people say. First past the post voting systems have a lot of problems, one of which is called the spoiler effect. By not voting for the major party you prefer you are actually voting against said major party.
Take this simple example: Major party A has 51% of the votes, while major party B hast 49%. Party A wins the election. Next election party C makes a big campaign at party A voters and convinces 3% to vote for them. Now we have A 48%, B 49% and C 3%. Party B wins the election. And if we look at the paper trails it probably doesn't surprise who funded party C's campaign.
Assigning this well studied behaviour of rational voters to simple tribalism is trivialising the core issue in the US: Elected officials are not representing the people. The way to fix this issue is to fix their voting system.
I'm just saying we need to figure out how to change the lobbying process to not allow these big players (e.g. conglomerates) to influence the political process so much. However, I do agree with you that our country has descended into tribalism not seen before, which undoubtedly helps the folks who want to undermine our democratic process.
Simply examine the way the issue was presented by frontrunners in the supposedly liberal party of the United States on the debate stage yesterday.
Two candidates call for true universal coverage, a few call for a public option but brand it as universal coverage to confuse viewers, and several (with moderator and broadcast sponsor support) outright mislead by stating that universal coverage that eliminates private insurance will threaten access to health care.
Elizabeth Warren’s plans are very vague, and only a few weeks old at this point. We still know very little about what she actually proposes. Bernie Sanders’ plans are about 5 years old at this point, and have been modified, but are rather solid.
Three candidates actually. (Bernie, Warren, and Yang.)
...
Loss aversion is a powerful emotion with destructive effects on our politics.
Once enough people have something to lose from a change, change becomes extremely hard, even if the overall net effect would be positive.
Not only does this preserve bad policies, it turns some into a one-way ratchet--where it's easy to make things worse and very hard to make them better.
Examples
- Medical middlemen (insurance, insurance brokers, billing companies...) are pure waste. But they employ so many people and generate so much revenue that they are very hard to attack. The US has slowly climbed to ~2x the per-person medical spending of our peers... so now, any effort to reduce that to 1.9x will be met with fierce resistance.
- Prison guard unions are powerful nationally and in many states, including California. They fight any and all attempts to reduce incarceration. That was true in 1980 with ~100 prisoners per 100k population... and it's true now with ~650, by far the highest in the world.
- Realtors and car dealers essentially tax the two biggest purchases most people in America make, house and car. They have powerful lobbies in all 50 states.
There is no particular amount that will placate these rent-seekers. They just never want their income stream reduced.
They could be strung up as combined they do not have enough marketing power as a strong populist political party. Unfortunately, as we've seen, the closest USA has for this is Trump, who is playing the Republican playbook.
Both parties are economically right wing. Third party is easily squished by tribalism and system being unbalanced.
I strongly support the Warren/Sanders universal healthcare plan, but in terms of optics, I don't actually see what the point is to making “duplicate coverage” private insurance illegal. It invites FUD and provides a convenient bogeyman while being entirely irrelevant in practical terms. If the government is providing comprehensive free healthcare to all, why would anyone need duplicate private health insurance? There's no reason to make it illegal, because there's no reason anyone would continue to pay for it. It will shrivel up and die on its own.
The reason is so that there aren't "boutique" private practices. Keeping the rich people in the same boat as the poor people is actually quite important for the long-term health and welfare of the system. Members of the Canadian parliament have the same healthcare system as anyone else. Thus they aren't terribly tempted to cut it.
If private insurance was allowed (in Canada), the elite would have expensive plans that had physicians only caring for a few people each, and so on. This worsens the care in the general system but more importantly, it splits the interests of the elite from the general public.
So how do you justify to your family that you are voting for someone who will reduce availability of very specialized treatment for them (those boutique doctors), so some random people you've never heard of can have better care "on average"?
Specialized care is not synonymous with boutique care. We have a robust research and development economy in the US that will continue to exist without the perverse incentives of private insurance.
And people all over the world go to South Korea for plastic surgery. We don’t stop being the best because we now pay for the care for every American at the point of need.
Specialized illnesses don’t discriminate by class. Those without means don’t receive the care they need. We are fighting so that the system centers that care instead of revolving around a third party private payer that has every incentive to deny that care.
From a selfish perspective, because you run into those random people. When your servers and your retail employees can go to the doctor instead of "waiting it out" because of medical expenses, that's less likely to make you and your family ill.
From a less selfish perspective, there but for the grace of God go you.
Having boutique practices is what reduces the availability of very specialized treatment, not the reverse. You're stuck because your understanding is completely backwards.
Just FYI, Warren is backpedaling heavily on Medicare for All. She released her “healthcare plan” the other day and it its full of obvious outs and hedges away from M4A. Sanders is the only candidate still really fighting this fight.
M4A just won't work when half the country is completely against it. A public option as a stepping stone is much more feasible. We also need to stop limiting the number of doctors and nurses artificially.
Medical cartel needs to be investigated by FTC. HHS and Medical Boards are infiltrated with physicians with conflict of interest, so their supervision is not enough.
They’re not shell organizations, hospitals just outsource tons of stuff, frequently including physicians. (In fact, in California, hospitals may not legally employ physicians to practice medicine)
Yeah, but when you pay for services you don't expect to have to write checks for every subcontractor your service provider users. They do that. You pay them. Everywhere but our messed up Medical System is like that.
Imagine if every time you went grocery shopping you had to pay for the people stocking the shelves, putting the carts back if you used one, the cashier, and each wholesale distributor. It's crazy and senseless. Just the way they like it so they can get away with so much more.
> Yeah, but when you pay for services you don't expect to have to write checks for every subcontractor your service provider users.
Well, yeah, that's true by the definition of “subcontractor”, which doctors in hospitals often are not.
OTOH, healthcare isn't the only place where you might pay a fee to a facility for use of the facility and a fee to a service providers associated with the facility for services they provide in the facility. It's perhaps an inconvenient arrangement, but by no means unique.
> OTOH, healthcare isn't the only place where you might pay a fee to a facility for use of the facility and a fee to a service providers associated with the facility for services they provide in the facility.
That's a really obscure example. I have a lot of family around me and we have many weddings. Most of the time the venue is the caterer since that is what they charge for the venue.(500-900 people weddings, over 10 a year). Not always though.
BUT STILL, weddings are a really bad example here.
The people getting married get to chose from whom they want the table and chair covers, flowers, singer/band, catering, belly dancers/entertainment, lights people, AV people.
Those are choices you got to make and the bills will obviously come separate since there is clear distinction of entities. Heck, the venue and the singers might not even of said a word to each other, let alone have a billing agreement.
Event facilities (for weddings, etc.) often have established partners for various event services that you pay directly rather than through the facility, which you also rent.
Dance studios where the dance instructor is affiliated but not an employee of the studio (especially where the affiliation is non-exclusive) will sometimes (especially for private lessons rather than group classes) charge a floor fee which you will pay to the studio, while the instructor is paid directly.
Fairs, etc., often charge you a gate fee, while you pay for goods and services inside to vendors directly (which vendors are also paying the fair for the privilege of being there, too.)
Arguably, residential real estate leases without included utilities is a closer analogy than any of those: there are a number of non-optional service providers you pay separately, on top of paying the landlord to occupy the premises.
How does this work with institutions like Kaiser? Are their hospitals not technically hospitals? Or are the physicians all technically contractors there?
"For those who are not familiar with the Kaiser system, here is a very abbreviated explanation. Kaiser Permanente is an HMO, and consists of the Kaiser Foundation Health Plan (the Kaiser insurance) and the Permanente Medical Groups (the Kaiser doctors). The patients buy the Kaiser insurance and they are only allowed to see Kaiser doctors. The Kaiser doctors are salaried from the pool of insurance premiums and provide service only to the Kaiser patients. In the Kaiser model, services are prepaid, so there is no financial incentive or penalty to providing or receiving medical care."
There are there different entities that all work together: Kaiser Foundation Health Plan provides medical insurance. The Kaiser Foundation of Hospitals owns all the hospitals. The Permanente Medical Group, Inc. employs all the doctors. The latter is a Professional Corporation, so its allowed to employ physicians to practice medicine, but it doesn't operate hospitals.
California really makes it hard to have everything on one bill because no hospital can hire a doctor.
But businesses and some consumers do want things to be under one roof - no surprises on in vs out of network, they don't like separate bills from each doctor that sees them, easy referrals, etc.
Kaiser is sort of a funny workaround.
The Kaiser Foundation Health Plan, the Kaiser Foundation of Hospitals and The Permanente Medical Group = Kaiser Permanente
The win for the patient is everything in-network and under one roof. If you are in a Kaiser facility EVERYONE is basically in network (with the exception of some state mandated providers that have to go through their own state flows - yes, that's why sometimes you need to repeat info on forms even at Kaiser)
The win for doctors is you really don't have denied claims or the billing pain you might in private practice.
CMA I think has really fought these setups before, but now oddly (in part because of medical malpractice and EHR overheads etc) working for Kaiser isn't considered a dump job anymore.
Bad news, obamacare put demand through the roof at Kaiser (even though they are not the cheapest plan) so they are shortstaffed I think.
If you do or know anything about medical billing - medical providers probably hate it as much as you do. A patient with primary coverage through Kaiser and secondary through Medi-cal - just to bill Medi-cal for $40 - you could spend hours on that as you hoop jump.
The sort answer is California Business and Professions Code 2417.5, but thats probably not exactly what you meant.
Most (all?) states forbid whats called the "Corporate Practice of Medicine." The idea is that profit motive of a corporation can lead the corporation to manage physicians contrary to the interests of their patients. To mitigate this, states only allow certain business models for physicians:
* Sole Proprietorships - they can work for them selves
* Professional Corporations - a restricted sort of corporation that requires all shareholders and executives to hold a license for the profession the corporation practices (ie, they all must be physicians)
* Some states have exceptions for research universities, public hospitals, non-profits, and other sorts of organizations.
The exact restrictions of course vary from state to state. Here's a state-by-state rundown: [1]
Its my understanding that analogous restrictions are common for other licensed professions such as law and accounting, but I know much less there.
I ended up in the ER a few months ago. The paramedics wanted around $2,500, the hospital (Dignity Health) wanted maybe $3,500, and the doctor had another few hundred in fees. Sadly that all felt pretty cheap.
Dignity Health deserves a special mention though. They obfuscate their billing as much as possible. The initial bill indicated they'd give me a cash discount and wanted something like $2500. Then they sent me another bill for $1800 if I paid promptly, with lots of weasel words to make it seem like I really owed more than $1800. So, of course I paid but I had no real idea if $1800 would be sufficient (in fact their online payment portal hinted it wouldn't be). The best part was getting a survey about the quality of their billing statements right after.
> These people are all acting in violation of tons of existing laws - I don't understand why this isn't prosecuted.
$$$$$$.
The Medical system is being used to transfer wealth from the working and middle classes to the capital class under the guise of "free market". That money is being used to shape legislation, buy politicians, influence elections and kill threats to the system, allowing for even greater wealth transfer.
The rigged markets of socialist Europe are far more transparent, fairer and free, whereas our "free market" is opaque, completely unfair, totally impossible to understand and offers very little in terms of real free market choice. Yet we are brainwashed to think that our system is superior, due to the propaganda the industry pumps out.
A lot of systems will work when the people involved are acting in good faith. And that is what's missing from the US system. US corporations and government have been captured by looters.
I would start by making all drugs legal without a prescription except in the rare case of a systemic risk. Antibiotics and super-bugs are one example of systemic risk. Grandma's heart medication, or Suzie's asthma inhaler are not. And of course you should be able to purchase those drugs from countries we generally would trust to create safe products: Canada, UK, France, Spain, Germany, etc.
Second, I would require that all medical products and services must have their prices acknowledged by the consumer before service is rendered. Obviously there would have to be some exceptions for extreme medical emergencies, but emergency care only makes up about 1% of healthcare costs, so that can slide.
I would disband medical unions such as the AMA, which spent decades artificially limiting supply of medical workers to keep wages sky high.
I would ban employer provided health insurance, decoupling healthcare from employment.
I would attempt to reshape the health insurance industry to actually work like insurance instead of total coverage. If you get the sniffles, just pay the market rate to visit the NP at the CVS minute clinic, get your antibiotic or whatever, and be on your way. Insurance should not be involved in that, and should be reserved for major medical emergencies or serious conditions like cancer.
I would have serious patent reform, moving pharmaceuticals to generics at a faster rate, and expedite FDA certification for generics. I would work to create a system of partner countries for healthcare certification. If your drug is approved in France, you get a greatly expedited process in the US and vice versa.
If those things didn't dramatically bring down the price of healthcare to a reasonable rate, then I'd consider some socialization of risk.
I'd like to understand why healthcare doesn't bill using time & materials plus markup. All current pricing seems little more than make believe.
I also don't understand why different people are billed different prices. I get that different providers will likely (hopefully) have different billing rates. But isn't billing different prices for the exact same thing illegal?
I don’t think you could find even one person who thinks our healthcare system is a free market system. If only we could make it a free market system I think most of the problems would solve themselves. Unfortunately, I don’t think it’s feasible to untangle the decades of junk laws. Instead, it honestly might just be a better idea to implement single-payer. At least the incentives mostly line up unlike 3rd party payer.
How can you have a free market system where the most expensive items are heart attacks, organ replacements, brain operations and other situations where you often don't have a chance to "shop around"? Unless we have price controls and socialized medicine like other more modern nations, our system will remain a failure.
>then over the next weeks, I received about 20 bills
I'm going through this now! It is completely baffling! I went to the ER, and then I received a steady stream of bills over a period of months. They were so numerous and so devoid of useful context that I began to worry that they were illegitimate. The billing process is absolutely insane.
For full years after we had a baby we’d get 1-2 $20 bills a month. And they could always be traced back to a specific appointment or procedure, so we didn’t argue. But yeah, it’s loco.
And yet, Canadians and others come into these discussions talking about how sane and reasonable our system is, and invariably someone immediately jumps in with "yeah but at least we have CHOICE here instead of having to appear before DEATH TRIBUNALS and then going on INFINITY WAIT LISTS."
America kills more people willingly than most other western countries. I work for a startup with a decent health insurance plan. But even then out of pocket is nuts.
For many procedures, we’ve just been avoiding going to the doctors. Doctors have been a hit and miss too. Most really don’t know what they’re talking about.
I’m kinda hopeful that someone will really commoditize common procedures and checks and will make them dirt cheap. May be amazon. Can’t say.
But shit like LapCorp and a whole swath of vulture physicians and insurance companies need to die.
Stories like this are scary. My employer based health insurance has an $18,000 deductible before it starts to cover 70% of approved, in-network bills. One visit to ER could easily cost me $20,000. A simple doctor visit can range from $150 to $1000. The effect is that any doctor visit is viewed as a last resort option.
Your employer is screwing the employees via a terrible grandfathered plan. Any new insurance plan after ACA would have a maximum deductible equal to out of pocket maximum, which for 2019 was $15.8k for non HSA and $13.5k with HSA.
But I’ve never heard of a deductible actually being set equal to out of pocket maximum or even anything close to it. Even the bronze family plans on healthcare.gov had deductibles of a few thousand.
I once went to the ER and the FIRST bill I received was from a law firm/collection agency. They actually employed a law firm to do first-line billing (which they of course double-billed, sending the bill to the insurance company and the threat to me at the same time!).
Because if they were truly investigated, our dire need for universal health care would become kite apparent and the party in power just can't have that can they?
I just linked the Schedule of Benefits from OHIP in another comment I made, but your comment made me curious to look it up.
Z176 - Repair of lacerations - up to 5 cm = $20.00
Note: Wound closure via tissue adhesives (such as cyanoacrylate) is payable at 50% of the appropriate fee.
Meaning, in Ontario, your procedure would have cost us $10. I'd have to look through to see what other costs would be incurred for the ER visit, but suffice it to say, it's probably well under $6,000.
Oh, and that's $10 CAD, which is like 2 Freedom Bucks. ($7.52 USD)
It’s worth writing a long article about. In the US there’s no cost conscious party that does price shopping or similar to bring the costs down. There’s only cost pushing parties. Hospitals pushes it to insurance, insurance to employers and employers to the govt as a tax write off. The person getting the treatment only looks at where the “best” care is. That is usually a code word for finding the most expensive hospital my insurance will cover. Insurances don’t have the power - and also they mostly don’t care - to negotiate with hospitals. Employers have to provide coverage by law. So they do the least they can to satisfy it. Who in this system keeps the costs in check?
The insurers would be able to keep the costs in check, IF the employers were taken out of the equation. With employers, especially white collar ones, siphoning the healthy lives into their own separate insurance pools, the remaining pool of lives is costly to insure and thus only a very small number of insurers can afford to exist. If the pool of healthy lives was bigger to offset the cost of the sick lives, then multiple insurance companies can exist and compete on healthcare.gov to offer lower premiums which they can offer because they negotiated lower prices with providers.
I was once charged $1,500 for a doctor to talk to me (without ever touching my physical body) to “prescribe” me over the counter motrin....
I then questioned them on this and they said “well it was a prescription” : i said you never even physically touched me. “So im going to tell you what this was worth to me: $50”
They then said “okay we will charge you $297 for the visit”
I said “you made me wait over 45 minites before even seeingg me, at 9:00 pm when i was the only person in the waiting room. NO; im am going to charge YOU $50 for my time wasted”
The dropped the entire bill completely.
Good samaritan hospital in los gatos ca.
(Where my grandmother worked for decades, and after el camino hospital bout them and i was the technology designer for their upgrade)
You can negotiate codes with hospitals.
Source: i have built more than ten hospitals; el camino, good sam, ucsf, nome, sequoia , zucks sf gen, etc...
Dont let their coding depts fuck with you - take a stand.
Codes are negotiated costs between insurance providers and hospitals, individually. So a cost for the same procedure at one hospital or another can be different.
Frankly you should challenge every single hospital charge you ever receive, they will always go lower.
As an example, just two weeks ago I made an appointment to go see a doctor. They called me back (kaiser) and said “ just come into the ER”
I said why, they said I don’t know, that’s what they told me to tell you.
So I called and verified my copay $30 and coverage etc.
When I got there they took my blood pressure asked a few questions, and then gave me the prescription I was asking for.
When I went to pay they tried to charge me $250
I said fuck you, I called and made an appointment, my co pay is $30 so that’s all I’m paying you period.
For whatever reason, the cost issue is completely missing from the dem primary debates on healthcare. Everything so far has been focused on health insurance coverage, and the candidates are really just debating what is the best way to cover more people.
A world where 100% of Americans are covered under the existing healthcare system is still a disaster because everything still costs so much between premiums, deductibles, copays and coinsurance. And on top of that, patient responsibility is still largely unknown until post treatment.
If you look at the cheapest Bronze plans on the Obamacare market, you're probably looking at $400/month for the premium with a $7500+ deducible for a single person. If someone is coerced into buying insurance and they can barely afford the premium, how is that something worth celebrating?
Thank you so much for bringing this up! This is one point that has really irked me in the current discussions. It should be about common sense access and lowered, transparent costs.
In the UK, I could walk into a Boots (pharmacy), speak to someone there and get prescription eyedrops for cheap for an infection vs the crap you have to wade through in the US. Same for other doctor/healthcare visits I've had around the rest of the world.
Only if they sell the debt to a creditor (hospitals and doctors can’t garnish wages) sue you, win, and pursue the judgement. And then they can only take from your disposable income (after rent, food, other bills, etc.)
And you can wipe out all of it by filing bankruptcy.
Similar to your situation, I went to a dermatologist concerned about a bump. Turned out to be a skin tag which she cheerily said "We can take care of this right now" and snipped. That snip cost $250 (wasn't on the genitals but was close enough for them to bump up the cost). I called their billing company and spoke to their office manager. She said that "the doctor just wants to make sure customers are happy and doesn't really concern herself with the billing part" when I brought up that if something is going to cost something they should say so upfront if it's something not necessary.
Thanks for the heads up about the glue. They really do take advantage even when you're a bad situation.
Young and middle-aged people need to vote. I've been in and out of hospitals for the last few years, months, days, hours with relatives, and guess what they don't ever worry about: medical bills. Like never.
And guess what they won't ever vote for: Those of us younger than 65 ever having the same luxury. We may be visiting them in the hospital every day, but they don't really see us.
And it's hard, because our generation loves them and wants the best for them, but most of us know we won't ever get the same quality of care for ourselves unless something changes...and as a human, well, you know, you get kinda bitter counting up "Wow, this is awesome, but what would it cost if I had this happen to me?"
Vote, people, because if our elderly are getting state-of-the-art amazing life-saving care, why shouldn't our young people, upon which our economy depends, be getting the same great service?
Are you referring to Medicare part A and B coverage? They paid out the whole $50k bill for triple coronary artery bypass. Apparently they cover 60 days of inpatient hospital stay for any health issue. I hope I have this coverage when we hit 65....
It is amazing...then, if you ever get alllll the way down to their private insurance policies, you find that they are nothing like our generation's insurance policies...they actually pay for stuff and have low deductibles!
I try not to get too bitter about it, though, because their great coverage means we don't go bankrupt trying to help them: we're very lucky for that (although eldercare is a whole other ball of wax)...
It just kills me to see all of these young people begging on GoFundMe just to afford insulin -- and dying! Over insulin! -- while it's stockpiling pretty nicely in Medicare-recipients' closets thanks to overzealous pharmacies that know Medicare will pay for whatever they keep shipping, and seeing young people cobbling together their own makeshift slings for broken bones while so many nonagenarians are technically part-robot thanks to Medicare's great coverage.
> Hillary Schuler-Jones, a Breg spokeswoman, declined to answer questions about the price of the Deluxe Shoulder Immobilizer. “It is important to note,” she said, “that Breg’s customer is not the patient, but the healthcare provider.” In most cases, “we don’t sell our products directly to patients, and we therefore don’t have a patient price list.”
This is pretty infuriating given that the article previously said that Breg directly billed the patient in a "surprise billing".
A company with seemingly no connection to the hospital directly bills the patient $200 for a $12 item and then when asked about this by a journalist says "We don't sell direct to patients" and refuses all further comment.
If they don't ever sell direct to patients then the bill must be fraudulent, sent by an imposter.
Curiously enough last year I received one of these sorts of fraudulent scam bills. A traffic camera ticket. It had my name but no street identified, no license plate or car description, no drivers license number, and no photo of the alleged infraction. The mailing address was to a location far away from the city, neither location which I had driven in recently, and the company I was supposed to write the check to didn't have a lot of information about who they were online. I was not allowed to contest it unless I signed an agreement to accept private arbitration results. I went to the city it allegedly came from and asked at their courthouse about it and the clerk told me "You are required to pay this" but said she was not able to verify anything about the ticket, give me a license plate number, or the name of an intersection or photograph, referring me instead to the arbitration and saying that "privacy laws" prevented her from saying anything else. So I didn't pay it, ignored it and never heard about it again. As far as I'm concerned it was a scam. If it really came from the city it was unconstitutional because there was no due process. It also wasn't served, it was mailed bulk rate and not even registered, which such mailing is not a valid server process in this jurisdiction.
Given that this company Breg says they don't sell to patients, the patient has a legal basis for refusing to pay this bill claiming to be sent from them, because the company itself has claimed in an official statement to a journalist that the bill is fraudulent.
Movie theater does not give you the popcorn and tell you the price a week after. Also, you can say no to the popcorn in a movie theater; you cannot control the fine details of your treatment.
This is why I've considered and End-Server License Agreement. In providing service to me as a User, yada-yada-yada yada.
If I actually went through the trouble of formally writing one up, and spreading it far and wide on the winds, and could actually get a significant portion of the population serving it in instances of predatory policy/pricing, and refusing the product such that a meaningful impact was made on service provider's bottom line, I've often wondered whether or not an equilibrium could finally be established where businesses stopped looking at customers who don't complain as people not yet sufficiently fleeced.
>My wife has Stage IV breast cancer. She has been a public school teacher for 20 years and we have pretty good health insurance. She continues to work. She will teach as long as she can because she wants to...and financially she will need to.
>Even with good health coverage, we have STILL spent thousands of dollars the past couple years out of pocket. If/when she takes medical retirement, it will get much worse. It will cost her 75% of her retirement income just to purchase health insurance. The rest will go to copays, gas for hospital trips, etc. Oh by the way, we still pay thousands in federal taxes each year, while corporations and the rich avoid most taxes and pay very little. It's fucking criminal. Fuck everyone who developed this system and fights to maintain it.
I have seen this with people who had cancer. Even with insurance they slowly got sucked dry. They spend hours and hours on the phone with insurance and doctors and if you don’t have a lawyer on retainer or really good nerves all the billing mistakes slowly bankrupt you. It’s a horrible system where the patient is just a football to be kicked around between hospitals, doctors and insurance.
This is why I like Kaiser so much. If you make it to a Kaiser emergency room, and you have Kaiser health insurance, you are not going to get an out-of-network surprise bill. Everyone at Kaiser works for Kaiser and is paid a salary by Kaiser and the Kaiser hospital is the only one that bills you.
Kaiser covers ER trips to other hospitals (I think they are probably required to by law). Any other Dr visit needs to be at a Kaiser though and it is def to your benefit to try to make it to a Kaiser even for the ER if you can.
"""
Under state law, the practice of “balance billing” — sending a bill to a patient if his or her insurance company doesn’t pay the full requested amount — is illegal for people insured through a health maintenance organization. Kaiser is an example of an HMO, a network of doctors that supplies services to its members.
"""
My wife had an emergency, which ended up with removing one of her ovaries. Kaiser was pretty insistent about transferring her from the closest ER to one of their facilities (which was stressful), but after that the treatment was awesome. After a some major surgery and a few days recovering the bill was completely covered. Kaiser isn't perfect, but they're the closest thing to a reasonable health-care system I've seen in the US. Agree that there are worse models for how to do healthcare, within some of the constraints of the US system.
Kaiser is great for critical care and general practitioner stuff. But they do most of their cost-cutting in specialty care; the stuff that is rare or tends to not be easily diagnosed while having a major impact on patients' quality of life. Just lookup lawsuits and Kaiser mental health.
There is an art to navigating specialist care at Kaiser for sure. Personally I don't think you are likely to have a significantly worse experience at Kaiser than you would with the average Dr, but you will also never have the _best_ experience. You do have to know when to be pushy and when to demand a different specialist.
That said, a lot of the reason the specialists costs are lower at Kaiser than other offices is because they don't all have their own little office and staff. Many specialists in the US are expensive because they have to have a secretary and an accountant, etc. At Kaiser they are just part of the system, so the costs look a lot lower.
Same experience here: routine care is ok, emergency care is great, hospital also pretty good, but trying to get them to refer you to proper specialist and figure out what's wrong when you yourself don't know it (e.g. not a cold or broken leg when it's obvious but kinds of conditions where you may need to ask several specialists to figure it out) is a long uphill battle and they are very reluctant to cooperate. It's a bureaucracy which likes doing what they know and hates complex cases and exceptions.
I get the general feeling that KP tends to under-prescribe care, but other doctors definitely over-prescribe care. That's what the financial incentives are for each anyways.
You know, I've recently seen here on HN complaints about "product substitution" at Amazon - getting, not what you ordered, but something that Amazon thinks is equivalent. I'm not sure medical supplies is where you want that to happen. I'm therefore not sure that the comparison of price to Amazon is fair.
Note well: Yes, hospitals also gouge you. I am not claiming otherwise.
So I work in manufacturing. On one of our systems, we recently upgraded the fleet to a $10k computer with a 22nm processor running RHEL 7 supplied by the system vendor. We had all of the install files and could have bought a $2k computer and gone through an extended install and qualification process, and closing the door to some support from our vendor, but we didn’t. We paid the extra $8k for a guarantee that it would just work and that we could get the exact same computer for years to come.
I see these high prices for what appear to be commodity items in a similar light. You are paying for a certain amount of comfort that the sling will just work. Amazon is not going to care if the sling, which might be a cheap knock-off, rips apart while you’re walking and unseats your unhealed bone.
Here's where that analogy falls apart: If your 10K computer fails, your vendor will fix it under the support contract for free. If the hospital-provided sling falls apart and you go back to the hospital, they'll charge you again. In most cases, the product is the same one you can get yourself elsewhere, and it still doesn't come with a guarantee.
While that is absolutely true, there is a level of confidence in knowing that the one from a hospital was sourced from a legitimate supplier and that it likely meets some level of quality control standards, legal standards, and supply chain controls.
But this is more of a criticism of Amazon than anything, as those things would be true for a drugstore as much as it would be for a hospital.
I think you missed the point that we need an open pricing system. Sure you are willing to pay $200 for that sling but others might decide differently if they see the price beforehand!
I worked in a newspaper plant. We did everything you just described for all of the same reasons. The system delivered was worse in every way than the one we ended up building for ourselves in the end, didn't work right anyway, and was "supported" by incompetent temps that damaged expensive equipment as they ham-handedly learned their jobs on our dime.
Sometimes its all just a paper facade over simple stuff we can easily do for ourselves with the smallest amount of courage and effort.
There are things like that in the hospital, sure. For example some surgical tools are glorified versions of construction tools (hammers, chisels, drills) but you are paying a premium for materials (have to be autoclave-able) and QA.
However for a lot of other things though are literally the same product, so it really isn't equivalent. If you are paying more for an individual (regular) Tylenol than you would have regularly paid for a box of them, it's hard to argue "value".
I live in Canada. I have visited the ER probably 5 times in the last year with different kid ailments. I pay MSP about 30$ a month CAD and that covers me and my kids. I do pay out of pocket for medications but any visits to the doctor or hospital are completely covered. Work benefits covers 80% of the meds I have to pay out of pocket. I don't have to second guess when to go in I just go in when things get bad, no questioning will this visit leave me financially unable to feed my family and take care of my health in other ways. I just go in. I hope you guys get something better working for you.
Some states have price gouging laws to keep people from being taken advantage of when they are in a vulnerable state, you can't charge $30 for a gallon of gas after a hurricane, I don't understand why hospitals are any different.
Just to pile on about how ridiculous medical costs are:
After giving birth my wife was offered Ibuprofen. On the bill we were charged $80 for the 2 pills she took. This was before Obamacare.
After Obamacare I twisted my ankle and the doctors insisted I wear a cheap fabric boot with stiff plastic plates while it healed over the next couple weeks. I asked how much it cost and they said $280. I took it off and refused it while they gave me dirty looks.
A medical facility is basically a monopoly. The switching costs are high and there are no prices on anything.
Unfortunately getting everyone insurance was only the tip of the iceberg of the actual problem. We still have a long, long way to go before we have real, competitive medical pricing with high quality care.
The ACA was a blatant failure in most states. It's still not affordable and large groups of people were never insured. ACA approved plans proved to be bogus. I wrote about this once before:
ACA plans on healthcare.gov are only too costly because employers were allowed to keep their grandfathered plans silo-ing healthy lives in low cost plans to benefit big white collar businesses. This had to be done to appease the Republicans who need to “cross the aisle” and vote for it (and Lieberman who was basically a Republican too).
If everyone was forced onto healthcare.gov, there would be enough healthy lives to offset costs from sick lives to create an effective market.
It isn't just about getting everyone insurance. It's about fixing the whole process. My Dr ordered some not too expensive tests for me. My insurance refused. I was like, wait, what? You're overriding my Dr? It's insane.
The health insurance company also has doctors working for them. Similar to how auto insurance companies will have mechanics working for them to ensure they aren’t getting ripped off on repair costs.
No kidding. In my experience even the most aboveboard DME vendors very aggressively push replacement of consumable components/supplies on the absolute minimum schedule allowed by insurance. They make a performance of confirming that you're ordering things that actually need to be replaced, but it's blatantly obvious (even to me, a person who largely sucks at reading social cues and verbal subtext) that the rep is just reading it off of a script to cover the company's ass.
Someone I know sprained their ankle. They recommended that he should use a cane for a while and said they had one to give him. When the bill came weeks later it was $200 for the cane that looked really close to what you can get for $20 at Walmart.
The really messed up thing is I drove him to the doctor and I carried some of the paperwork out (wasn't the bill) so he could use both hands to move around safely. When I was outside I held the piece of paper up and a gust of wind bent the paper in such a way that I ended up with a really nasty paper cut. Like a 2 inch slice on the inside of my finger. One of the worst paper cuts I've ever gotten.
So I went back into the medical center and I asked them if I could get a band-aid. They asked why, so I explained. I got a few smirks from them (they borderline laughed in my face) and they told me that they weren't allowed to give away medical supplies and that I should go a few blocks away to a CVS (a local drug store). Meanwhile just to be insured costs $450 / month for the bare minimum (which I don't pay for but I've payed many thousands in fines for not having insurance).
Reading this in Europe.I'm sure if I'd go with article alone to my American colleague on Monday, he'd defent the system even if he'd have to die for it. Knowing he's a healthy 20something man with affluent parents that could potentially bankroll even a year's stay in a private hospital- I could understand it to certain degree, however I fail to understand why nobody really is up for changing this system,where millions upon millions left woth no choice but to struggle anything but basic medical care.
> however I fail to understand why nobody really is up for changing this system,where millions upon millions left woth no choice but to struggle anything but basic medical care.
Plenty of people are up for changing it. It is quite literally the center of a huge debate at the moment in the Democratic primary, and there is a broad spectrum of changes being proposed, from Medicare for all with price controls to a slightly modified Obamacare. Only one candidate among those more or less supports the status-quo.
And the Republican party is currently avoiding discussing the way they'd like to change the health system (repealing Obamacare, fee for service care) because it isn't particularly popular at the moment.
Meanwhile, stories like the ones you see piling up in this thread happen every day.
The centerpiece of their plan is removing the protections provided by Obamacare, like pre-existing conditions coverage, the state insurance exchanges, and getting rid of the Medicaid expansion. They don't want to talk about any of that right now, even though it was the central refrain of what they ran on 4 years ago.
But that's smart actually. They correctly realize that it is political suicide to run on taking health protections away from people at this time.
I couldn't believe when I first heard about this -- Trump doing something potentially beneficial. Sounds like it will have no actual impact, but I hope it does.
Essentially everyone wants to change the system. The problem is that half of the voters want to fix it by having the government provide universal coverage, and half want to fix it by getting government out of the picture as much as possible and letting the market solve everything.
Of course, when it comes to health care, 'letting the market solve everything' actually means 'letting poor people die'. Sometimes it even means 'letting poor people die because poor people deserve to die' (look up prosperity gospel).
It BS to say "nobody is really up for changing this system", the whole dem party is for it. I don't like blanket statements like you're making. Some of us have been fighting this for years. There are 340 million Americans, we aren't all the same.
I went to the ER last year. They ended up making me stay overnight.
I was hit with a bill for over $10K, with much of that falling on me.
I also used to work in corporate finance and I have a good intuition for how billing works.
Before I even got the bill I mentally prepared myself for it by telling myself that it's going to be a long drawn out process.
I waited and waited and received an initial bill a few months after my hospitalization. It was for the aforementioned amount.
I called and politely asked to have it itemized. Naturally,that took several more months.
The bill was reduced, but the itemization was incorrect, so I asked for a correct itemization.
I went through a few more iterations of this. Each time the bill got lower and lower.
Eventually, I had to pay something like $1.5K out of pocket, which would have been a lot less if I didn't have an HSA.
The whole process took almost a year.
If you ever have to go to the hospital, just assume that it will take forever and nitpick the bill (within reason) and continue to challenge it. They will often give up and reduce your bill. Whatever you do, never pay a bill that is not itemized. As a former finance professional I am shocked that hospitals can get away with this, this would never fly in the B2B world, professionals always push back against "mystery bills" that show just the bottom line number.
What do you mean when you say the itemization was incorrect? Do you mean that the prices that they list were incorrect, or that the items didn't make sense given the treatment you received?
In either case, what reference do you use to ascertain correctness? I feel like information asymmetry is a problem for a lot of patients. It's hard to tell if you actually need a treatment, or if you're being charged fairly for it.
Upcoding is extremely common and almost never comes with any consequences. It's routine for staff at the hospital to add line items for things that never actually happened. I've personally seen procedure codes for neuropsychological testing in the ER when the staff never completed those exams, as an example. The billing codes require very specific actions to have taken place in order for the insurance companies to reimburse. It's not often done out of malice, the codes added are likely what should have taken place but the hospital staff are overworked and end up cutting corners.
This is outright fraud.. I wish I could wear a bodycam into the hospital and have the footage confirm everything I'm billed for is actually administered and necessary for the diagnosis I'm provided by the physician.
Here in europe we don't get to see the bill at all. The hospital sends the bill directly to the insurance company. Think about it. The negotiation of the costs will take place between two companies (B2B). In this case the insurance company becomes the advocate of the people not their opponent.
Also reminds me of unplanned importation fees. Transporter started to send me letters after letters. I bounced emails as long as possible asking for some explanation. After a few months and a few lawyer agencies (mind you it was just a few SBC bought online) they accepted to make me pay for a much smaller amount, sending me the same bill but with an added line "deal rebate" and that was it.
The whole ecosystem has evolved to loot people when they are at their most vulnerable moment. There is no two ways about it. It goes unchecked because insurance companies cover a bulk of the cost and so most ordinary people don't see it. The poor and uninsured get the bad end of the stick but no one cares about them. Just a pathetic state of affairs.
I have very good insurance by US standards through my FAANG employer. My son recently got a full body reaction to poison oak exposure. No hospitalization, just a couple dermatologist visits, 30 minutes each.
After insurance paid its portion, I got a bill for $800 in out-of-pocket charges.
When my wife was 25 weeks pregnant she started feeling ill and we noticed her blood pressure kept going up. We went to the hospital. Turns out she was pretty sick she so they made her stay for 4 days.
A few weeks later we had our son’s ashes and a $148,000 bill.
This is the only country in the world where there are people who will divorce on their hospital death bed, because they are so fearful of the financial impact on their remaining family.
And a non-insignificant part of the population finds this acceptable because they see the alternative as "the government treading on me".
I’m sure going to get downvoted for this but.... I just don’t pay my medical bills I pay my dentist and eye doctor bills since those are different. But I just let my insurance pay their part and I walk away from the rest. I haven’t had anything catastrophic yet. But have and do have bills in the 1,000s.
My credit score is great in the 740+ range.
I know big stuff they could take me to court or put a lien on my property. They haven’t yet.
It’s my little protest against all of this crazy healthcare prices and system we have here in the US.
I tried to make payments to the hospital on a few thousand in bills, fell behind, and eventually got sued. I would not offer this as advice to anybody.
If somebody from the hospital had told me _before_ I got served that I could get 85% of my bill written off just by submitting some paystubs, I would have appreciated it. If you're in a similar spot, call and ask about patient financial assistance or similar programs.
You can be several thousands in arrears (and even in collections) to the hospital and still visit the ER, see your doctor, get a CT scan etc. I know because I've been doing it since 2017, but I have insurance and the people I see probably just assume the bills are getting paid if I keep coming back. Care providers and admitting people don't generally access your financial/billing information.
I pay my dentist and eye doctors. Those are treated differently. There really isn’t eye insurance and dentists usually have normalish prices compared to other doctors.
I mean I can ask my dentist how much it’s going to be and he can actually give me a price before my procedure.
But as I stated above the insurance pays their portion so it’s not like nothing is being paid. Just not the 900% markup.
I don’t recommend doing this. I’m sure it will bite me eventually but it’s been 10+ years. And yes I haven’t had any major or catastrophic medical event in my life. So the bills haven’t been in the +10k range. I’m pretty sure once it gets there they will put a lien or sue me.
I go the same facility every time. I haven’t been denied. My family hasn’t been denied.
If I did go to an ER for something serious I would give them my real name and info. I do have insurance and it will pay a portion. Depending on the size I might pay it. I might not. Just haven’t had anything really large.
I think one of the reasons why most dentists can give you a straight up price on the spot is because they own the practice which means they are the decision maker when it comes to prices. Plus with a dentist, there's a pretty decent chance you're not dealing with insurance companies. With a hospital you're dealing with a million layers of abstraction at both the hospital and insurance company level.
I'm definitely not defending hospitals and most doctor's offices but I think that plays some part in it. There's also a decent amount of dental competition when it comes to routine work such as cleanings, so prices wind up staying somewhat reasonable where as with a hospital there's no competition really due to how insurance works.
Develop a good-quality fake identity purely for skipping on medical bills.
Just to add an alternative that I've considered (now being a kind of programmer emeritus) is to go into a full-tilt asset hiding mode. There's just too many ways to lose your hoard of cash.
I do the same, but it's not a protest, it's because I literally can't pay. They have sued me though, and they won, but nothing happened after the lawsuit closed. This country is headed towards mad max territory.Yippee ki yay boys, I'll see you on the road.
This is identical to what had happened in my case, the patient was my son who had fractured his arm.
Had taken him to Stanford Emergency, he got a a cast and a really cheap sling.
Received a bill from a Texas based company, don't remember the name, for about $200-$300, for the sling. Looked online, there were bunch of BBB reviews about this, including about calling them where the issue was settled. Same sling on Alibaba.com was $1-$2.
I called them up. I was told we were out-of-network for the sling, even though Stanford hospital was in-network.
However, since we were in CA, we are kinda protected if we don't know this (in/out of network) in an emergency room.
I had the option of asking Stanford and insurance company to refile, or pay them $20 (from original invoice of $200-$300). I paid them $20 to settle the claim.
I was charged $50 for 2 tylenol when I had my appendix taken out. The CVS down the street would sell you a 24-pack for $5.
Of course, that was just a minor component of the final $50,000 bill ($4k for me after insurance), but it still sticks out in my mind many years later because it was an easily comparable baseline.
Health insurance companies get alot of the blame for the broken healthcare system in America but I place most of it on the providers - doctors, hospitals, and drug companies. They bill an order of magnitude too much. Sometimes more. Attacking doctors seems to be a much less politically palatable option than attacking big insurance corporations, even though those doctors are essentially gouging their loyal patients with no qualms about it.
I have no idea what you're complaining about here.
If they had taken the $12.99 price (an actual exact price, with 4 actual significant figures of precision), the $200 bill (also an actual price paid, with five significant figures of precision) is actually, really-not-false-precisely, 1440% more expensive than amazon.
They allowed in the article that the sling might be a bit nicer than the ones on amazon - it had some padding. So they rounded its value up to roughly $20, giving, as you suggest, 10 times more expensive, as an estimated factor. Let's assume that's only good to one sig fig. That's fine for an estimate, and consistent with the 'probably worth a bit more than the ones on Amazon, let's say somewhere between $16 and $25' methodology.
"900% more expensive" is a perfectly accurate restatement of "10 times as expensive" to a single significant figure. Would you rather they went with "1000% more expensive" to make it feel more Benford's-law-comliant in its imprecision? That would surely have helped your supposed sensationalist editor, right?
"900% more expensive" is literally just another way of writing "ten times as expensive".
So I really don't know what kind of editorial sensationalism conspiracy you are trying to posit here. Wouldn't a sensationalist have gone with the 1440%, and nefariously rounded it up to 1500% to punch up the headline?
This seems like a weak place to try to hang an argument about the innumeracy of the press....
Another thing that bugs me in the whole "medical cost" disaster that is the USA. Whenever you talk to Doctors or other medical practitioners about the situation they blame the hospitals, or the insurance companies or <fill in the blank here> but ultimately they are complicit in the mess, but they don't want to rock the boat, its just shameful.
The whole system of massive school debt and massive salaries for doctors resting on the AMA artificially limiting the supply and scope of doctors? Yea I'd say so.
You could increase the supply of doctors without impacting quality, by training more doctors. Medical schools are the main bottleneck, and their sizes are regulated by the AMA to constrain supply.
Schools are not the bottleneck, residency spots are the bottleneck. Residency spots are governed by the federal government (Congress) and someone, somewhere must be lobbying to keep the number of spots low.
Has anyone here ever worked in this industry? I'm curious what the justification for these prices is?
I can't imagine it is quite the scrooge mcduck caricature where the people reaping these profits are literally trying to defraud people. I would love to talk to a health insurance insider or something and ask them to justify this stuff.
My mom worked in medical records at a small hospital. The way she explained it to me was that insurance companies negotiate prices way down, and expect to. So in order to make enough money to cover costs, the hospital has to put astronomical sticker prices on everything so that insurance can "talk them down" to the actual price they expect to receive.
Mostly our healthcare system is completely fucked and we should all feel bad.
I've spent my whole career working for hospitals primarily dealing with cost data.
There's not much incentive to create a sensible pricing structure because very few patients actually pay the posted prices. Most revenue comes from the government or insurers, and neither of them give a fuck what you charge for a sling. Hospitals have limited resources, and dealing with insurers is a big enough operation as it is. Most chargemasters are created by multiplying acquisition cost or Medicare rates by some absurd number (typically 8-10) and calling it a day.
Frankly, I see this whole thing as a red herring. I get why people get upset about it, but if you ended this practice then the money would just shift somewhere else. Hospitals are mostly non-profits with small margins, so the money has to come from somewhere. Instead of charging 10 times cost for everything they would just dump it all into a generic fee. This kind of stuff isn't actually relevant to the core problem of why healthcare is so expensive in the US.
It's definitely not a scrooge mcduck caricature situation. Like I said, most hospitals are non-profits who post their financial statements online. You can probably go look at your local hospital's statements to see what kind of margins they're working with. There are exceptions, but I'd bet they're pretty low.
Non-profit just means they don't pass money on to shareholders, right? That doesn't mean there isn't management taking a large cut. Recently a hospital near my family was bought up by CHI[1], making them the only game in town. Is there any reason to believe prices wont go up?
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[ 2.7 ms ] story [ 215 ms ] threadGas goes up a quarter and elected officials are thrown out of office. $600 for a drop of super glue? Okay then.
And that of course is part of the problem. Medical billing is like playing numberwang or who's line is it anyway. No two numbers on a bill seem to be correlated in any way to another except as upper or lower bounds.
When someone without coverage comes in then, they have to play that stupid game with all the numbers, and of course they either ignore it and go into debt, pay the cash price if they're able, or they manage to negotiate it down by orders of magnitude - proving the price didn't matter anyway.
https://www.medicaid.gov/medicaid/finance/dsh/index.html
It’s just another case where the government splits spending across multiple programs.
> Hospitals with above average Medicare patients generally get paid more than the general population.
And the added payment isn’t that much.
Generally Medicaid pays below cost. Medicare is reasonable and leaves providers with a small profit (single digit percentage).
From 2015 to 2017 Medicare lowered it’s uncompensated care payments. However, that program covers uncompensated care underpayment. Medicare explicitly does not pay for everything at hospitals: https://www.medicare.gov/coverage/inpatient-hospital-care
Or, more likely, simple way to force hospitals to make drastic cuts to services.
lol. Seriously? Well it's a simple system.
I wonder what happens when it's Medicare-for-all. Do they make 1/8 as much all of a sudden?
That’s probably what they would do. We know that they don’t base prices in any kind of rationally economic way.
Just like a proper capitalist system! You know, like when you agreed to pay whatever for your iPhone prior to even know it'll work.
I can contact Apple for help with any issues I have with my iPhone. I can contact my carrier for any issues I have with my iPhone. I can return my iPhone within a grace period if I don't like it.
Try doing any of that for medical costs.
I know these won't actually succeed in adding a bit of capitalism but it does succeed in highlighting the absurdity.
Other than pedantry, what are you trying to get across?
Anyways. In the itemized bill they charge about $40 per ibuprofen. If we knew the price, we should have brought our own and just rejected theirs.
Someone might come along and reply with that $40 covers nurse salary, tracking the medicine etc. Yeah... Bull$hit.
Here in the UK, my wife's breast feeding help consisted of an inexperienced midwife (possibly only a trainee), awkwardly being remarkably unhelpful.
Also, since my wife has had surgery to remove a benign tumor in her breast, lactation consultation was covered the first time. No idea WTF happened the second time. This is the US medical system for you.
I'd also like to add we received a random bill for our first daughter 2 years later. No idea what it was, but the insurance covered all of it so I didn't care.
The fact is that hospitals aren't built for itemized bills because very few patients pay the posted prices out of pocket. Medical debt is extremely hard to recover in the US, so why bother expending the resources to figure out a sensible pricing structure for a small minority of your customers who mostly aren't going to pay that price anyway?
On top of the nearly $6k in other charges from the hospital, they charged $531 for one dab of superglue or "liquid stitches" on my forehead for something that would have healed by itself.
One of my friends died two years ago from pneumonia. He didn't go to the hospital when symptoms first started because he was afraid of the bills that would come from it.
They don't ask you if you want to spend $500 for a dab of glue on your forehead, they just do it and you're essentially writing them a blank check in the process. I hate our medical system.
It took a lot of reading through the 600+ page plan document and finding loopholes. For example, I asked them that if they thought it should be done for $700, who would actually do it for $700? They couldn't list one provider that would accept the payment rate they thought they should pay. And since this was a reimbursement, and they had already pre-approved the procedure (knowing the price), I think I caught them already saying they would do it, but them not following through. There was a lot of going back and forth about in-network vs out of network, but again, no one in-network would perform the procedure. In the fine print of the plan document, it said if there are no in-network providers, the plan must provide you were in-network rates and deductibles for using an out-of-network provider.
So I told them if they can't find anyone who will accept what they are willing to pay, their figure is obviously wrong. It helped that with my health insurance, everything was supposed to be covered, 100% with no copay. So the fact that they tried to charge me for the $3300 overage was very out of line for them.
They never just said "no, we're not going to cooperate" it was more just endless stalling on their part. It was never really a blunt refusal, or if they tried that, I just proved how ridiculous their arguments were. I kept a lot of documentation.
I think in the end, they just relented because they were spending more dealing with me than actually just paying me my money. But it was certainly an uphill battle the whole way, and not one I would recommend to someone who isn't well versed in legalese.
See also, the TSA precheck systems. By allowing people like frequent flying businessmen and politicians to avoid the standard TSA experience, they reduce the likelihood that such people might use their influence to advocate against the TSA, for the betterment of all passengers.
I was reminded of this just yesterday by a similarly simple story: https://twitter.com/chrisalbon/status/1172161958759395333
It's sort of like "add to cart to see the real price" but they can't say that. And sometimes hospitals are in a different mode where they fight for it. It's not logical, it's screwed up, but anyway the first bill is usually just fake.
See also the US unemployment benefits situation, where many employers will contest an unemployment insurance claim by default even when the worker is actually eligible, in the hopes that some workers will not navigate the bureaucracy well enough to fight back. Because of the weakness of their case, however, they will then back down as soon as their denial is challenged.
https://en.wikipedia.org/wiki/Cyanoacrylate#Medical_and_vete...
I've used off-the-shelf superglue on cut fingertips where I couldn't get bandages to stay. I believe it's also commonly used in place of stitches where you don't want the scarring that stitching would cause (e.g., parts of the face.)
It wears off in 3-4 days.
This is one of the areas that open pricing should help.
I paid $850 at the ER and today I received another bill for $850.
The only thing on the Bill just says
> "Charges": $11,680 > "Adjustmnets: $9,980
I just got off the phone with them and they say that it will take 10 business days to receive an itemized bill. However, that means the itemized bill will be delivered after the current bill is due.
How are they going to charge somebody $1700 without an itemization?
Furthermore, I am expecting another bill from the ER doctor that saw me because they bill separately and are not covered by insurance. The ER legally cant tell you if the doctor or the hospital accepts your insurance. Thats so crazy.
My wife was absolutely mortified. In brazil I never carried insurance but going to the ER I just had to pay R$400 flat fee for a private hospital. Anything else for tests they would give me the prices up front.
My wife about started screaming when the woman brought in the credit card machine while I was still in pain in the ER hospital bed. It was so embarrassing.
All this is with the top insurance my company (a ~$500 million startup) offers and to make it worse it happened when I was on a company mandated trip.
Get on the phone, try to keep cool, but realize you're probably going to yell at some poor customer service rep at some point. Apologize, keep going and get the full bill before you agree to pay anything. Then you gotta do the same thing with the full bill on ever bullshit charge, over and over again.
Honestly, how the fuck can they admit you and treat you and then bill you without telling you what the prices are up front? That's fucking madness right there. Imagine having to agree to having car or bicycle service without an estimate? Imagine the total cost being $2000 over the estimate? Would people pay? Of course not; it's worth it at that point to call a lawyer.
It shouldn’t cost that much in the first place. You shouldn’t need to shop around for health care, and you shouldn’t be bankrupted by an emergency. Why people aren’t marching through the streets right now is beyond me.
You answered your own question. They’re too fat, lazy, and sick to get up and walk 5 feet, let alone march in the street.
https://www.washingtonpost.com/health/uva-has-ruined-us-heal...
We were broke at the time we found out about the pregnancy and memories of the first two years of my boy's life are largely dominated by this kafka-esque nightmare that took time and security away from our family life. I refused to pay a cent until what we were told was honored, my thinking being any sort of payment may legitimize it.
Eventually I didn't hear back from the hospital about our latest contestation for two months after confirming their receipt of the documentation (about a four hour process each submission, always new fax numbers, life-wasting hold times to confirm receipt of said documentation, transfers to other agents and departments, then a promise of giving a decision in a few weeks, often just reprinting the last non-descript document they used in the previous round without any real detail). Decided to just do nothing and ignore it as long as I didn't get contacted again and got everything ready to go to court if someone ever decided to pursue it against us again. The documentation I've been holding from the ordeal is 60 pounds of paper.
I still have no idea what the true status is, but it hasn't shown up on credit checks and our boy is now 5 years old.
I could not find anyone in various governmental institutions to even look into the matter and the lawyers I talked to said the outlook of winning was grim and would have cost a lot of money on top of that to even pursue it. Our insurance company [Anthem] posted a $17 billion profit that year. The hospital had the highest gross profit of any hospital in our city and the surrounding area at $80.4 million declared. Both entities make so much money they give away individual debts amounting in the tens of thousands of dollars for pennies (maybe ours included?).
It's an absolutely depraved system and my point is maybe be careful showing good faith to an entity trying to screw you lest it be taken as consent.
The $42k is a fantasy figure which they collect approximately 0% of the time. It's the easiest $42k you ever saved.
At this stage, it seems like the US is the “land of the free”, whereby “freedom” is defined as the ability to freely exploit everyone.
I am also a British citizen, so I'm at least waiting to see how this whole Brexit thing shakes out.
50 years ago people had the same loyalty towards their companies, and look where that got US manufacturing workers. nowadays you'd be nuts to expect to stick with a company for 10 years. get yours and get out: others be damned.
so it shall be with citizenship. as more and more citizens have more and more power to up and leave, or work outside the confines of the US without too much hassle, questions such as "what on earth are we still doing here?" will be asked, at first in whispers (as they are now), later in louder volumes.
where things go from there, anyone knows.
All medical imaging I've had done has had pricing given up front showing what they where going to bill the insurance company and what the insurance company was going to pay and what I'd have to pay.
My non-emergency visits have a $40 copay up front.
Only the nightmare cases get talked about.
Why would health care be any different?
The number one cause of bankruptcy in the United States:
> "medical expenses"[0]
The average amount charged for an ER visit in the United States:
> between 2008 and 2017, the average price of hospital ER visits rose 135 percent, from $393 to $924[1]
The cost of an ambulance ride in the United States:
> $164/mile[2]
And make sure to compound the monetary cost with the cost of people avoiding medical care out of fear and unknowns surrounding the actual monetary cost.
[0] take your pick of any study done by anyone
[1] https://www.beckershospitalreview.com/finance/average-cost-o...
[2] https://www.consumerreports.org/consumerist/164-per-mile-sur...
The OOP is still averaging under 300, again, not the horror stories in this thread.
Problems exist, but it seems that only a small % of providers are horribly abusing the system.
(of course a small % across over 300 million people is still a lot of harm!)
I don't live in the US and I'm not American so perhaps I'm missing some information.
If the average ER visit was 5K of unknown miscellaneous charges than that would indicate nationwide maliciousness on the part of nearly all hospitals. If only a small # of hospitals are engaging in that level of unfair billing, then they can possibly be investigated one by one.
It is the same thing as "we have thousands servers that are crashing at random multiple times a day" versus "we have a bunch of servers that are low on RAM, and a couple servers that crash 5 times a day."
Neither scenario is good to be in, but it is possible to get a hand on the latter scenario, while in the first scenario a "burn it all down and rewrite" fix might be appropriate.
I agree, though, the masses are exploited (us included), and it’s troubling.
Otherwise most people don't want to leave their friends and family
Note: not defending the horrible system. Only suggesting that most people using their company provided insurance probably don't run into these issues.
https://www.desmoinesregister.com/story/news/health/2017/05/...
I don't know how it's possible, but our healthcare system has been getting worse every year. Even simple stuff like refilling scripts has become Kafka Meets Keystone Kops. The insurer has interjected itself into every single transaction, second guessing everything, adding ever more hoops to jump thru.
It's a wonder that we even bother with doctors any more, since the insurers apparently know better than my doctors.
Things are so bad, I wouldn't even know where to start if anyone wanted to fix things.
Better to just start over.
It'd be far more effective to aggressively regulate hospital billing, wouldn't it?
You should look into the efficiency of medicare and medicaid if you're really worried about this. It might put some of your fears to rest.
This year I had sepsis and had a two week stay in hospital - o dread to think what that would have cost
If you really did just get the bill it will be several months (and several more copies of the bill sent to you) before a final bill would show up that would indicate the account is "PAST DUE" and heading for collections.
IANAL but you can safely wait for the itemized bill.
In the future to save on costs, you might try to find a 24-hour Urgent Care instead of full-fledged ER. Unfortunately the level of equipment that they have to keep in a full ER means just having someone in a bed costs them a lot of money, even if they are just swabbing your throat for a strep test.
Sure, just like you can't charge extra for using a credit card in California as payment in most scenarios (you can get a cash discount though). There may not be late fees, but the hospital will absolutely offer to settle for a hefty discount if you pay ASAP.
By the time you get something claiming "PAST DUE" the hospital may be less willing to negotiate.
Who said anything about getting nothing? If the hospital sells your debt to a collection agency they get something. If the hospital deals with it in house they can act like UVA[1] and sue you to garnish your wages or take out a lien on your property. Playing chicken with the hospital billing department is a bad way to deal with medical debt.
1: https://www.washingtonpost.com/health/uva-has-ruined-us-heal...
Another example was the birth of my child. We prepared for this by setting up an FSA, and having really good PPO coverage that year, supposedly, with a 10% copay. After all the billing shenanigans, my copay was about 30% and well above the out of pocket maximum. How does that happen? You can go to an in-network hospital, and be treated by a mix of providers, all of whom bill separately. Some will be in-network, others will be out of network, so you are in effect deducting against two out of pocket limits.
Medical billing is fraudulent. Medical insurance is fraudulent. These people are all acting in violation of tons of existing laws - I don't understand why this isn't prosecuted.
Wouldn't it be fun if whenever somebody criticizes their government, they also state who they voted for to force them to open their eyes to the fact that it's their own fault.
People rationalize it by saying that voting for a 3rd party is "wasting" their vote, but in that sense, voting for anybody is wasting their vote because it never comes down to one individual's vote deciding things. Really they just have two driving forces - allegiance to whatever tribe they randomly found themselves feeling like a part of (and mysteriously agree with all the inconsistent aims of), and wanting to be on the winning team. Healthcare be damned.
Without a switch to range voting, approval voting, or one of the condorcet variants, the party system will remain broken into two corrupt halves.
http://scorevoting.net/NESD
In reality, voting for someone who didn't win the election is a "wasted" vote. But people will say that a particular candidate has no chance of winning the election, so voting for them is "wasting" your vote. Unfortunately, because most people follow this line of reasoning, it becomes a self fulfilling prophecy.
I guess I am stubborn but I will never vote for one of the two big parties. However it would be great if smaller parties got some kind of representation in Congress. It seems ridiculous that in the 90s Ross Perot got 20% of the vote but that resulted in zero representation.
Also, I find it curious that while our community has generally settled on "incremental improvement" approach, we expect different from our governments and want the "big bang" changes. Then we are surprised when things get worse.
It’s not. It sends a signal that there is a desire for something else.
The public memory is so short and so malleable, people forget things week over week let alone the entirety of an election cycle.
The issue with third party voting is a classic case of the problem of coordinated collective action.
Would-be voters don't participate out of perceived futility or participate in the dual party system for similar reasons.
I don't know how to solve it but there does seem to be growing agitation in the electorate with the current system as it stands, with the Electoral College under public scrutiny and with media support. To me that is a signal that times are changing.
It's actually worse than what people say. First past the post voting systems have a lot of problems, one of which is called the spoiler effect. By not voting for the major party you prefer you are actually voting against said major party.
Take this simple example: Major party A has 51% of the votes, while major party B hast 49%. Party A wins the election. Next election party C makes a big campaign at party A voters and convinces 3% to vote for them. Now we have A 48%, B 49% and C 3%. Party B wins the election. And if we look at the paper trails it probably doesn't surprise who funded party C's campaign.
Assigning this well studied behaviour of rational voters to simple tribalism is trivialising the core issue in the US: Elected officials are not representing the people. The way to fix this issue is to fix their voting system.
Simply examine the way the issue was presented by frontrunners in the supposedly liberal party of the United States on the debate stage yesterday.
Two candidates call for true universal coverage, a few call for a public option but brand it as universal coverage to confuse viewers, and several (with moderator and broadcast sponsor support) outright mislead by stating that universal coverage that eliminates private insurance will threaten access to health care.
We have a long way to go.
...
Loss aversion is a powerful emotion with destructive effects on our politics.
Once enough people have something to lose from a change, change becomes extremely hard, even if the overall net effect would be positive.
Not only does this preserve bad policies, it turns some into a one-way ratchet--where it's easy to make things worse and very hard to make them better.
Examples
- Medical middlemen (insurance, insurance brokers, billing companies...) are pure waste. But they employ so many people and generate so much revenue that they are very hard to attack. The US has slowly climbed to ~2x the per-person medical spending of our peers... so now, any effort to reduce that to 1.9x will be met with fierce resistance.
- Prison guard unions are powerful nationally and in many states, including California. They fight any and all attempts to reduce incarceration. That was true in 1980 with ~100 prisoners per 100k population... and it's true now with ~650, by far the highest in the world.
- Realtors and car dealers essentially tax the two biggest purchases most people in America make, house and car. They have powerful lobbies in all 50 states.
There is no particular amount that will placate these rent-seekers. They just never want their income stream reduced.
Both parties are economically right wing. Third party is easily squished by tribalism and system being unbalanced.
If private insurance was allowed (in Canada), the elite would have expensive plans that had physicians only caring for a few people each, and so on. This worsens the care in the general system but more importantly, it splits the interests of the elite from the general public.
Becuase that's where I get stuck.
Specialized illnesses don’t discriminate by class. Those without means don’t receive the care they need. We are fighting so that the system centers that care instead of revolving around a third party private payer that has every incentive to deny that care.
From a less selfish perspective, there but for the grace of God go you.
Hoy por ti, mañana por mi.
But they would never be able to outcompete it.
Imagine if every time you went grocery shopping you had to pay for the people stocking the shelves, putting the carts back if you used one, the cashier, and each wholesale distributor. It's crazy and senseless. Just the way they like it so they can get away with so much more.
Well, yeah, that's true by the definition of “subcontractor”, which doctors in hospitals often are not.
OTOH, healthcare isn't the only place where you might pay a fee to a facility for use of the facility and a fee to a service providers associated with the facility for services they provide in the facility. It's perhaps an inconvenient arrangement, but by no means unique.
Where else does this occur?
BUT STILL, weddings are a really bad example here.
The people getting married get to chose from whom they want the table and chair covers, flowers, singer/band, catering, belly dancers/entertainment, lights people, AV people.
Those are choices you got to make and the bills will obviously come separate since there is clear distinction of entities. Heck, the venue and the singers might not even of said a word to each other, let alone have a billing agreement.
Event facilities (for weddings, etc.) often have established partners for various event services that you pay directly rather than through the facility, which you also rent.
Dance studios where the dance instructor is affiliated but not an employee of the studio (especially where the affiliation is non-exclusive) will sometimes (especially for private lessons rather than group classes) charge a floor fee which you will pay to the studio, while the instructor is paid directly.
Fairs, etc., often charge you a gate fee, while you pay for goods and services inside to vendors directly (which vendors are also paying the fair for the privilege of being there, too.)
Arguably, residential real estate leases without included utilities is a closer analogy than any of those: there are a number of non-optional service providers you pay separately, on top of paying the landlord to occupy the premises.
"For those who are not familiar with the Kaiser system, here is a very abbreviated explanation. Kaiser Permanente is an HMO, and consists of the Kaiser Foundation Health Plan (the Kaiser insurance) and the Permanente Medical Groups (the Kaiser doctors). The patients buy the Kaiser insurance and they are only allowed to see Kaiser doctors. The Kaiser doctors are salaried from the pool of insurance premiums and provide service only to the Kaiser patients. In the Kaiser model, services are prepaid, so there is no financial incentive or penalty to providing or receiving medical care."
But businesses and some consumers do want things to be under one roof - no surprises on in vs out of network, they don't like separate bills from each doctor that sees them, easy referrals, etc.
Kaiser is sort of a funny workaround.
The Kaiser Foundation Health Plan, the Kaiser Foundation of Hospitals and The Permanente Medical Group = Kaiser Permanente
The win for the patient is everything in-network and under one roof. If you are in a Kaiser facility EVERYONE is basically in network (with the exception of some state mandated providers that have to go through their own state flows - yes, that's why sometimes you need to repeat info on forms even at Kaiser)
The win for doctors is you really don't have denied claims or the billing pain you might in private practice.
CMA I think has really fought these setups before, but now oddly (in part because of medical malpractice and EHR overheads etc) working for Kaiser isn't considered a dump job anymore.
Bad news, obamacare put demand through the roof at Kaiser (even though they are not the cheapest plan) so they are shortstaffed I think.
If you do or know anything about medical billing - medical providers probably hate it as much as you do. A patient with primary coverage through Kaiser and secondary through Medi-cal - just to bill Medi-cal for $40 - you could spend hours on that as you hoop jump.
...why?
Most (all?) states forbid whats called the "Corporate Practice of Medicine." The idea is that profit motive of a corporation can lead the corporation to manage physicians contrary to the interests of their patients. To mitigate this, states only allow certain business models for physicians:
* Sole Proprietorships - they can work for them selves
* Professional Corporations - a restricted sort of corporation that requires all shareholders and executives to hold a license for the profession the corporation practices (ie, they all must be physicians)
* Some states have exceptions for research universities, public hospitals, non-profits, and other sorts of organizations.
The exact restrictions of course vary from state to state. Here's a state-by-state rundown: [1]
Its my understanding that analogous restrictions are common for other licensed professions such as law and accounting, but I know much less there.
[1]: http://archive.healthlawyers.org/google/health_law_archive/p...
Dignity Health deserves a special mention though. They obfuscate their billing as much as possible. The initial bill indicated they'd give me a cash discount and wanted something like $2500. Then they sent me another bill for $1800 if I paid promptly, with lots of weasel words to make it seem like I really owed more than $1800. So, of course I paid but I had no real idea if $1800 would be sufficient (in fact their online payment portal hinted it wouldn't be). The best part was getting a survey about the quality of their billing statements right after.
$$$$$$.
The Medical system is being used to transfer wealth from the working and middle classes to the capital class under the guise of "free market". That money is being used to shape legislation, buy politicians, influence elections and kill threats to the system, allowing for even greater wealth transfer.
The rigged markets of socialist Europe are far more transparent, fairer and free, whereas our "free market" is opaque, completely unfair, totally impossible to understand and offers very little in terms of real free market choice. Yet we are brainwashed to think that our system is superior, due to the propaganda the industry pumps out.
Second, I would require that all medical products and services must have their prices acknowledged by the consumer before service is rendered. Obviously there would have to be some exceptions for extreme medical emergencies, but emergency care only makes up about 1% of healthcare costs, so that can slide.
I would disband medical unions such as the AMA, which spent decades artificially limiting supply of medical workers to keep wages sky high.
I would ban employer provided health insurance, decoupling healthcare from employment.
I would attempt to reshape the health insurance industry to actually work like insurance instead of total coverage. If you get the sniffles, just pay the market rate to visit the NP at the CVS minute clinic, get your antibiotic or whatever, and be on your way. Insurance should not be involved in that, and should be reserved for major medical emergencies or serious conditions like cancer.
I would have serious patent reform, moving pharmaceuticals to generics at a faster rate, and expedite FDA certification for generics. I would work to create a system of partner countries for healthcare certification. If your drug is approved in France, you get a greatly expedited process in the US and vice versa.
If those things didn't dramatically bring down the price of healthcare to a reasonable rate, then I'd consider some socialization of risk.
I'd like to understand why healthcare doesn't bill using time & materials plus markup. All current pricing seems little more than make believe.
I also don't understand why different people are billed different prices. I get that different providers will likely (hopefully) have different billing rates. But isn't billing different prices for the exact same thing illegal?
I'm going through this now! It is completely baffling! I went to the ER, and then I received a steady stream of bills over a period of months. They were so numerous and so devoid of useful context that I began to worry that they were illegitimate. The billing process is absolutely insane.
Oh, America, you will never change.
For many procedures, we’ve just been avoiding going to the doctors. Doctors have been a hit and miss too. Most really don’t know what they’re talking about.
I’m kinda hopeful that someone will really commoditize common procedures and checks and will make them dirt cheap. May be amazon. Can’t say.
But shit like LapCorp and a whole swath of vulture physicians and insurance companies need to die.
US healthcare is really fucked up.
https://www.uhc.com/employer/news/consultant/irs-sets-new-20...
https://www.cigna.com/assets/docs/about-cigna/informed-on-re...
But I’ve never heard of a deductible actually being set equal to out of pocket maximum or even anything close to it. Even the bronze family plans on healthcare.gov had deductibles of a few thousand.
Most people would be surprised how closely hospitals and other medical companies pay attention to their social media and Google alerts.
I'm less concerned if they're scamming the insurance (although I'm existentially and politically interested) than billing of individuals.
Z176 - Repair of lacerations - up to 5 cm = $20.00 Note: Wound closure via tissue adhesives (such as cyanoacrylate) is payable at 50% of the appropriate fee.
Meaning, in Ontario, your procedure would have cost us $10. I'd have to look through to see what other costs would be incurred for the ER visit, but suffice it to say, it's probably well under $6,000.
Oh, and that's $10 CAD, which is like 2 Freedom Bucks. ($7.52 USD)
I was once charged $1,500 for a doctor to talk to me (without ever touching my physical body) to “prescribe” me over the counter motrin....
I then questioned them on this and they said “well it was a prescription” : i said you never even physically touched me. “So im going to tell you what this was worth to me: $50”
They then said “okay we will charge you $297 for the visit”
I said “you made me wait over 45 minites before even seeingg me, at 9:00 pm when i was the only person in the waiting room. NO; im am going to charge YOU $50 for my time wasted”
The dropped the entire bill completely.
Good samaritan hospital in los gatos ca.
(Where my grandmother worked for decades, and after el camino hospital bout them and i was the technology designer for their upgrade)
You can negotiate codes with hospitals.
Source: i have built more than ten hospitals; el camino, good sam, ucsf, nome, sequoia , zucks sf gen, etc...
Dont let their coding depts fuck with you - take a stand.
Frankly you should challenge every single hospital charge you ever receive, they will always go lower.
As an example, just two weeks ago I made an appointment to go see a doctor. They called me back (kaiser) and said “ just come into the ER”
I said why, they said I don’t know, that’s what they told me to tell you.
So I called and verified my copay $30 and coverage etc.
When I got there they took my blood pressure asked a few questions, and then gave me the prescription I was asking for.
When I went to pay they tried to charge me $250
I said fuck you, I called and made an appointment, my co pay is $30 so that’s all I’m paying you period.
They conceded and accepted.
A world where 100% of Americans are covered under the existing healthcare system is still a disaster because everything still costs so much between premiums, deductibles, copays and coinsurance. And on top of that, patient responsibility is still largely unknown until post treatment.
If you look at the cheapest Bronze plans on the Obamacare market, you're probably looking at $400/month for the premium with a $7500+ deducible for a single person. If someone is coerced into buying insurance and they can barely afford the premium, how is that something worth celebrating?
In the UK, I could walk into a Boots (pharmacy), speak to someone there and get prescription eyedrops for cheap for an infection vs the crap you have to wade through in the US. Same for other doctor/healthcare visits I've had around the rest of the world.
Go to the hospital, let them bill you, and then throw the bills in the trash.
And you can wipe out all of it by filing bankruptcy.
Is it possible that they cannot garnish wages in your state? Where are you getting your information?
Similar to your situation, I went to a dermatologist concerned about a bump. Turned out to be a skin tag which she cheerily said "We can take care of this right now" and snipped. That snip cost $250 (wasn't on the genitals but was close enough for them to bump up the cost). I called their billing company and spoke to their office manager. She said that "the doctor just wants to make sure customers are happy and doesn't really concern herself with the billing part" when I brought up that if something is going to cost something they should say so upfront if it's something not necessary.
Thanks for the heads up about the glue. They really do take advantage even when you're a bad situation.
And guess what they won't ever vote for: Those of us younger than 65 ever having the same luxury. We may be visiting them in the hospital every day, but they don't really see us.
And it's hard, because our generation loves them and wants the best for them, but most of us know we won't ever get the same quality of care for ourselves unless something changes...and as a human, well, you know, you get kinda bitter counting up "Wow, this is awesome, but what would it cost if I had this happen to me?"
Vote, people, because if our elderly are getting state-of-the-art amazing life-saving care, why shouldn't our young people, upon which our economy depends, be getting the same great service?
I try not to get too bitter about it, though, because their great coverage means we don't go bankrupt trying to help them: we're very lucky for that (although eldercare is a whole other ball of wax)...
It just kills me to see all of these young people begging on GoFundMe just to afford insulin -- and dying! Over insulin! -- while it's stockpiling pretty nicely in Medicare-recipients' closets thanks to overzealous pharmacies that know Medicare will pay for whatever they keep shipping, and seeing young people cobbling together their own makeshift slings for broken bones while so many nonagenarians are technically part-robot thanks to Medicare's great coverage.
This is pretty infuriating given that the article previously said that Breg directly billed the patient in a "surprise billing".
A company with seemingly no connection to the hospital directly bills the patient $200 for a $12 item and then when asked about this by a journalist says "We don't sell direct to patients" and refuses all further comment.
If they don't ever sell direct to patients then the bill must be fraudulent, sent by an imposter.
Curiously enough last year I received one of these sorts of fraudulent scam bills. A traffic camera ticket. It had my name but no street identified, no license plate or car description, no drivers license number, and no photo of the alleged infraction. The mailing address was to a location far away from the city, neither location which I had driven in recently, and the company I was supposed to write the check to didn't have a lot of information about who they were online. I was not allowed to contest it unless I signed an agreement to accept private arbitration results. I went to the city it allegedly came from and asked at their courthouse about it and the clerk told me "You are required to pay this" but said she was not able to verify anything about the ticket, give me a license plate number, or the name of an intersection or photograph, referring me instead to the arbitration and saying that "privacy laws" prevented her from saying anything else. So I didn't pay it, ignored it and never heard about it again. As far as I'm concerned it was a scam. If it really came from the city it was unconstitutional because there was no due process. It also wasn't served, it was mailed bulk rate and not even registered, which such mailing is not a valid server process in this jurisdiction.
Given that this company Breg says they don't sell to patients, the patient has a legal basis for refusing to pay this bill claiming to be sent from them, because the company itself has claimed in an official statement to a journalist that the bill is fraudulent.
Sounds like they were in on the scam. What would be the appropriate method to legally-resolve this and shut it down?
Contact the state's Attorney General?
And it doesn't help that the price is basically opaque and paid for by insurance, for a person who doesn't care about the price at that moment.
It's a ridiculous system.
And you're a captive audience; they don't allow you to bring in your own supply.
If I actually went through the trouble of formally writing one up, and spreading it far and wide on the winds, and could actually get a significant portion of the population serving it in instances of predatory policy/pricing, and refusing the product such that a meaningful impact was made on service provider's bottom line, I've often wondered whether or not an equilibrium could finally be established where businesses stopped looking at customers who don't complain as people not yet sufficiently fleeced.
>My wife has Stage IV breast cancer. She has been a public school teacher for 20 years and we have pretty good health insurance. She continues to work. She will teach as long as she can because she wants to...and financially she will need to.
>Even with good health coverage, we have STILL spent thousands of dollars the past couple years out of pocket. If/when she takes medical retirement, it will get much worse. It will cost her 75% of her retirement income just to purchase health insurance. The rest will go to copays, gas for hospital trips, etc. Oh by the way, we still pay thousands in federal taxes each year, while corporations and the rich avoid most taxes and pay very little. It's fucking criminal. Fuck everyone who developed this system and fights to maintain it.
From this thread on medical bankruptcy being a uniquely American phenomena: https://www.reddit.com/r/politics/comments/d10ab6/medical_ba...
The Kaiser system would be great if every major hospital nationwide was under it. Kind of like a national healthcare system...
""" Under state law, the practice of “balance billing” — sending a bill to a patient if his or her insurance company doesn’t pay the full requested amount — is illegal for people insured through a health maintenance organization. Kaiser is an example of an HMO, a network of doctors that supplies services to its members. """
That said, a lot of the reason the specialists costs are lower at Kaiser than other offices is because they don't all have their own little office and staff. Many specialists in the US are expensive because they have to have a secretary and an accountant, etc. At Kaiser they are just part of the system, so the costs look a lot lower.
Note well: Yes, hospitals also gouge you. I am not claiming otherwise.
The important part is being over-charged 900% over retail price, not the exact retailer you buy it from.
Also, it's a sling, not an anti-HIV drug. Hardly a "medical supply".
I see these high prices for what appear to be commodity items in a similar light. You are paying for a certain amount of comfort that the sling will just work. Amazon is not going to care if the sling, which might be a cheap knock-off, rips apart while you’re walking and unseats your unhealed bone.
But this is more of a criticism of Amazon than anything, as those things would be true for a drugstore as much as it would be for a hospital.
Sometimes its all just a paper facade over simple stuff we can easily do for ourselves with the smallest amount of courage and effort.
However for a lot of other things though are literally the same product, so it really isn't equivalent. If you are paying more for an individual (regular) Tylenol than you would have regularly paid for a box of them, it's hard to argue "value".
After giving birth my wife was offered Ibuprofen. On the bill we were charged $80 for the 2 pills she took. This was before Obamacare.
After Obamacare I twisted my ankle and the doctors insisted I wear a cheap fabric boot with stiff plastic plates while it healed over the next couple weeks. I asked how much it cost and they said $280. I took it off and refused it while they gave me dirty looks.
A medical facility is basically a monopoly. The switching costs are high and there are no prices on anything.
Unfortunately getting everyone insurance was only the tip of the iceberg of the actual problem. We still have a long, long way to go before we have real, competitive medical pricing with high quality care.
https://fightthefuture.org/article/returning-to-america-and-...
If everyone was forced onto healthcare.gov, there would be enough healthy lives to offset costs from sick lives to create an effective market.
Someone I know sprained their ankle. They recommended that he should use a cane for a while and said they had one to give him. When the bill came weeks later it was $200 for the cane that looked really close to what you can get for $20 at Walmart.
The really messed up thing is I drove him to the doctor and I carried some of the paperwork out (wasn't the bill) so he could use both hands to move around safely. When I was outside I held the piece of paper up and a gust of wind bent the paper in such a way that I ended up with a really nasty paper cut. Like a 2 inch slice on the inside of my finger. One of the worst paper cuts I've ever gotten.
So I went back into the medical center and I asked them if I could get a band-aid. They asked why, so I explained. I got a few smirks from them (they borderline laughed in my face) and they told me that they weren't allowed to give away medical supplies and that I should go a few blocks away to a CVS (a local drug store). Meanwhile just to be insured costs $450 / month for the bare minimum (which I don't pay for but I've payed many thousands in fines for not having insurance).
I'm shocked they could give you a price. Anytime I ask for a price it takes hours of talking to multiple people spread across several days.
Plenty of people are up for changing it. It is quite literally the center of a huge debate at the moment in the Democratic primary, and there is a broad spectrum of changes being proposed, from Medicare for all with price controls to a slightly modified Obamacare. Only one candidate among those more or less supports the status-quo.
And the Republican party is currently avoiding discussing the way they'd like to change the health system (repealing Obamacare, fee for service care) because it isn't particularly popular at the moment.
Meanwhile, stories like the ones you see piling up in this thread happen every day.
Are you so sure about that? A republican president recently signed an executive order for more transparent pricing:
https://www.npr.org/sections/health-shots/2019/06/24/7355785...
But that's smart actually. They correctly realize that it is political suicide to run on taking health protections away from people at this time.
As much as I despise Trump, this idea wasn't terrible. Obamacare/ACA was only a stepping stone. But the republicans had a 'talking' with him.
https://www.npr.org/2019/04/02/709175203/trump-backs-off-oba...
I was hit with a bill for over $10K, with much of that falling on me.
I also used to work in corporate finance and I have a good intuition for how billing works.
Before I even got the bill I mentally prepared myself for it by telling myself that it's going to be a long drawn out process.
I waited and waited and received an initial bill a few months after my hospitalization. It was for the aforementioned amount.
I called and politely asked to have it itemized. Naturally,that took several more months.
The bill was reduced, but the itemization was incorrect, so I asked for a correct itemization.
I went through a few more iterations of this. Each time the bill got lower and lower.
Eventually, I had to pay something like $1.5K out of pocket, which would have been a lot less if I didn't have an HSA.
The whole process took almost a year.
If you ever have to go to the hospital, just assume that it will take forever and nitpick the bill (within reason) and continue to challenge it. They will often give up and reduce your bill. Whatever you do, never pay a bill that is not itemized. As a former finance professional I am shocked that hospitals can get away with this, this would never fly in the B2B world, professionals always push back against "mystery bills" that show just the bottom line number.
In either case, what reference do you use to ascertain correctness? I feel like information asymmetry is a problem for a lot of patients. It's hard to tell if you actually need a treatment, or if you're being charged fairly for it.
Also reminds me of unplanned importation fees. Transporter started to send me letters after letters. I bounced emails as long as possible asking for some explanation. After a few months and a few lawyer agencies (mind you it was just a few SBC bought online) they accepted to make me pay for a much smaller amount, sending me the same bill but with an added line "deal rebate" and that was it.
I wonder how much money get lost this way...
After insurance paid its portion, I got a bill for $800 in out-of-pocket charges.
Generally really good insurance has a 10% co-insurance charge. But the first $X amount is entirely borne by you.
A few weeks later we had our son’s ashes and a $148,000 bill.
We lost our first, and er visit costed us much less. Few thousands... Didnt have the energy to fight that time...
We had insurance so we didn’t pay that crazy amount but it’s just absurd what these places charge.
I am willing to fight, even though my out of pocket is also very small.
This is the only country in the world where there are people who will divorce on their hospital death bed, because they are so fearful of the financial impact on their remaining family.
And a non-insignificant part of the population finds this acceptable because they see the alternative as "the government treading on me".
My credit score is great in the 740+ range.
I know big stuff they could take me to court or put a lien on my property. They haven’t yet.
It’s my little protest against all of this crazy healthcare prices and system we have here in the US.
If somebody from the hospital had told me _before_ I got served that I could get 85% of my bill written off just by submitting some paystubs, I would have appreciated it. If you're in a similar spot, call and ask about patient financial assistance or similar programs.
Also, if you had to go to an emergency room, would you give them fake personal info so they can't send you bills?
I mean I can ask my dentist how much it’s going to be and he can actually give me a price before my procedure.
But as I stated above the insurance pays their portion so it’s not like nothing is being paid. Just not the 900% markup.
I don’t recommend doing this. I’m sure it will bite me eventually but it’s been 10+ years. And yes I haven’t had any major or catastrophic medical event in my life. So the bills haven’t been in the +10k range. I’m pretty sure once it gets there they will put a lien or sue me.
I go the same facility every time. I haven’t been denied. My family hasn’t been denied.
If I did go to an ER for something serious I would give them my real name and info. I do have insurance and it will pay a portion. Depending on the size I might pay it. I might not. Just haven’t had anything really large.
I'm definitely not defending hospitals and most doctor's offices but I think that plays some part in it. There's also a decent amount of dental competition when it comes to routine work such as cleanings, so prices wind up staying somewhat reasonable where as with a hospital there's no competition really due to how insurance works.
Develop a good-quality fake identity purely for skipping on medical bills.
Just to add an alternative that I've considered (now being a kind of programmer emeritus) is to go into a full-tilt asset hiding mode. There's just too many ways to lose your hoard of cash.
Had taken him to Stanford Emergency, he got a a cast and a really cheap sling.
Received a bill from a Texas based company, don't remember the name, for about $200-$300, for the sling. Looked online, there were bunch of BBB reviews about this, including about calling them where the issue was settled. Same sling on Alibaba.com was $1-$2.
I called them up. I was told we were out-of-network for the sling, even though Stanford hospital was in-network. However, since we were in CA, we are kinda protected if we don't know this (in/out of network) in an emergency room.
I had the option of asking Stanford and insurance company to refile, or pay them $20 (from original invoice of $200-$300). I paid them $20 to settle the claim.
Of course, that was just a minor component of the final $50,000 bill ($4k for me after insurance), but it still sticks out in my mind many years later because it was an easily comparable baseline.
Health insurance companies get alot of the blame for the broken healthcare system in America but I place most of it on the providers - doctors, hospitals, and drug companies. They bill an order of magnitude too much. Sometimes more. Attacking doctors seems to be a much less politically palatable option than attacking big insurance corporations, even though those doctors are essentially gouging their loyal patients with no qualms about it.
Amazon sling is $12.99 to $16.99 according to the article.
So hospital sling is 12-15 times more expensive.
So I suspect that the original writer of the article correctly wrote that hospital sling is 10 times more expensive.
Then the editor came and decided that 10 times more expensive looks not as scandalous as 900% more expensive.
The result is false precision https://en.wikipedia.org/wiki/False_precision and bad journalism.
If they had taken the $12.99 price (an actual exact price, with 4 actual significant figures of precision), the $200 bill (also an actual price paid, with five significant figures of precision) is actually, really-not-false-precisely, 1440% more expensive than amazon.
They allowed in the article that the sling might be a bit nicer than the ones on amazon - it had some padding. So they rounded its value up to roughly $20, giving, as you suggest, 10 times more expensive, as an estimated factor. Let's assume that's only good to one sig fig. That's fine for an estimate, and consistent with the 'probably worth a bit more than the ones on Amazon, let's say somewhere between $16 and $25' methodology.
"900% more expensive" is a perfectly accurate restatement of "10 times as expensive" to a single significant figure. Would you rather they went with "1000% more expensive" to make it feel more Benford's-law-comliant in its imprecision? That would surely have helped your supposed sensationalist editor, right?
"900% more expensive" is literally just another way of writing "ten times as expensive".
So I really don't know what kind of editorial sensationalism conspiracy you are trying to posit here. Wouldn't a sensationalist have gone with the 1440%, and nefariously rounded it up to 1500% to punch up the headline?
This seems like a weak place to try to hang an argument about the innumeracy of the press....
No, it is not.
Same way as "ten times more expensive" is not the same as "10.000000 times more expensive".
Using percentages here implies high precision.
> Would you rather they went with "1000% more expensive"
"10 times more expensive" sound just right.
> I really don't know what kind of editorial sensationalism conspiracy you are trying to posit here.
Sorry, no sensation here. Just false precision which is a bad sign.
I see people say this, but what does this mean? Should we not certify our doctors? Should just about anyone be able to hang out their shingle?
https://www.huffpost.com/entry/who-pays-for-resident-sal_b_1...
Another thing would be to expand the scope of nurse practitioners where it makes sense.
I can't imagine it is quite the scrooge mcduck caricature where the people reaping these profits are literally trying to defraud people. I would love to talk to a health insurance insider or something and ask them to justify this stuff.
Mostly our healthcare system is completely fucked and we should all feel bad.
There's not much incentive to create a sensible pricing structure because very few patients actually pay the posted prices. Most revenue comes from the government or insurers, and neither of them give a fuck what you charge for a sling. Hospitals have limited resources, and dealing with insurers is a big enough operation as it is. Most chargemasters are created by multiplying acquisition cost or Medicare rates by some absurd number (typically 8-10) and calling it a day.
Frankly, I see this whole thing as a red herring. I get why people get upset about it, but if you ended this practice then the money would just shift somewhere else. Hospitals are mostly non-profits with small margins, so the money has to come from somewhere. Instead of charging 10 times cost for everything they would just dump it all into a generic fee. This kind of stuff isn't actually relevant to the core problem of why healthcare is so expensive in the US.
It's definitely not a scrooge mcduck caricature situation. Like I said, most hospitals are non-profits who post their financial statements online. You can probably go look at your local hospital's statements to see what kind of margins they're working with. There are exceptions, but I'd bet they're pretty low.
* https://en.wikipedia.org/wiki/Catholic_Health_Initiatives