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U.S. health care's widespread overbilling problem

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Re: U.S. health care's widespread overbilling problem

#181

Post by jacobr1 »

binarymax wrote: post #96
anigbrowl wrote: post #91

Earlier quoted context omitted.

If it's massively complicated and obscure, then it's not transparent. Transparent means the information is available up front or for the asking, not that it's possible to obtain it if you have expert knowledge. What you're sharing is great information and a fine foundation for people to build on. But pateients shouldn't have to go off and do a pile of research, they should be able to get a straight answer from their…

Yes, hence the "transparent" in quotes and the overt sarcasm (apparently harder to detect than I intended). Of course patients shouldn't need to download a dataset and figure it out on their own! But please see my other response to see why it is tricky. Regarding pets, they are not beholden to hospital/insurance provider duality, and it follows that since it is out of pocket, you would not be able to afford a $60k se…

This is why the Dutch system is interesting. They have a two-tier model of private and public coverage. For short-term, low-cost care, the private market operates (under regulation) and for long-term care they have a state supplied universal coverage system.

Re: U.S. health care's widespread overbilling problem

#182

Post by pancreas »

While I do feel compassion for you and your pain, I need to point out to you that you are unreasonable, bordering on psychopathological irrational fear.

The scenario in which "the entirety monetary value of my life's work could be destroyed in a moment by a medical issue" - is very uncommon, the stuff of scary stories, not reality. in reality, you are protected even if you don't have a good insurance.

Think about "medical issues" that could happen to you or anybody to leave your "family destitute".

1. You can break a leg skiing. Suppose it is a nasty break requiring surgery then rehabilitation. Your ED bill would be 3-5 K, the surgical bill 4-10 K, hospital room x 3 days about 15 K, rehab charges maybe 3K. So you owe roughly 33 K. At most. You can negotiate it down by 1/2 easily, with customer service, the hospital would rather get some money than none. They can design a payment plan an 0% over 10 years. You can also walk away - you won't be taken to court, the hospital will eat the bill and sell it to collectors - but you will turn your phone off. Medical contributions to bad credit are not as toxic as your unpaid Target bill, and you can still get loans by pointing out that you are in negotiation over the unfairly large hospital bill.

So... Unpleasant, but no tragedy.

2. Suppose a tragedy happens. You have a horrible illness that will require millions in maintenance. There is a social worker and a case worker assigned to you, and you will get Medicaid retrospectively, or Medicare - both have loopholes that allow certain disabled patients to be included before they even apply for disability.

So... You are in tough shape, but not financially. Your wealth is protected.

Re: U.S. health care's widespread overbilling problem

#183

Post by empath75 »

maxxxxx wrote: post #3

To me hospitals are basically scam operations. My girlfriend has had several surgeries in the last two years. In addition to already outrageous standard prices ($40000 surgical center cost for a surgery where we spent in total five hours at the center) pretty much every bill had mistakes. Then after a few months a collection agency will try to collect for something that never got billed and never has happened. I can…

My son was born last year. We had two insurance companies and accidentally filed with the wrong one as primary.

I used my hsa to pay the balance of about $800

9 months later, instead of refilling with the correct insurance company, they sent us a $20k bill.

After we called them and said, hey you know you should probably refill with the right company, they did. The insurance company declined because they took to long to refile.

The hospital never bothered to follow up and explain the situation until we called the insurance company ourselves and had them restart the process.

In the meantime our secondary insurance approved the part of the bill that was for my son, rather than my wife. The hospital sent me a new bill for $200 for their deductible.

From here, there was an extended game of back and forth where they'd send me a bill and I'd call and ask if they figured out the rest of the insurance and what happened to the HSA check we sent them. This went on for 13 months.

My son is now walking and this week they finally sent us to collections.

I called and threatened to take them to court, and finally talked to a supervisor who admitted that they owed us $600.

But what about collections?

Sir, that was a different bill.

Why can't you take the money that you owe me and pay the bill that you just sent me to collections for?

Well you didn't ask us to do that. I'll go ahead and do that now.

I resisted throwing my phone through a wall just barely.

Re: U.S. health care's widespread overbilling problem

#184

Post by ridgeguy »

I guess it won't hurt to offer my own anecdata point about idiot medical billing.

Stanford hospital billed us for an IVF procedure. However, we were in Paris at the time they claimed my wife was undergoing the procedure.

It took going down to the billing office with our ticket stubs and pitching a fit to get it zeroed out.

I agree there's lots of room for improvement in medical billing.

Re: U.S. health care's widespread overbilling problem

#185

Post by xenadu02 »

ams6110 wrote: post #170
tptacek wrote: post #163

Earlier quoted context omitted.

The United States will get single-payer before it gets government-set pricing for 15% of its economy. Both, by the way, are problematic solutions! There are options for transparency that don't involve a government takeover of health care. But the brinksmanship in the politics of health care --- almost entirely the fault of the GOP --- is keeping us from exploring solutions.

Don't Medicare and Medicaid pay fixed prices? And aren't they generally below cost for the provider? So they have to "make up the difference" by charging private insurers and cash payers more?

They are generally less than what providers bill to others but Medicare doesn't pay below cost.

Medicaid varies because states have way more control and many states (especially Republican-leaning ones) have slashed their rates as part of a concerted effort to kill the program. Not that it matters - in Texas you generally can't qualify for Medicaid if you're childless or have a job. The income requirements are insanely low.

Re: U.S. health care's widespread overbilling problem

#186

Post by bmelton »

ams6110 wrote: post #170
tptacek wrote: post #163

Earlier quoted context omitted.

The United States will get single-payer before it gets government-set pricing for 15% of its economy. Both, by the way, are problematic solutions! There are options for transparency that don't involve a government takeover of health care. But the brinksmanship in the politics of health care --- almost entirely the fault of the GOP --- is keeping us from exploring solutions.

Don't Medicare and Medicaid pay fixed prices? And aren't they generally below cost for the provider? So they have to "make up the difference" by charging private insurers and cash payers more?

Sure, but that's why participation rate varies pretty wildly from one practice to the next on whether or not they accept Medicare or Medicaid.

If a doctor doesn't like the rates Medic[are|aid] are paying, they're free to not accept Medic[are|aid] patients.

Re: U.S. health care's widespread overbilling problem

#187

Post by drdaeman »

rsync wrote: post #106
projectramo wrote: post #4

I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price. On the 10th call, I finally got someone to tell me what the out-of-poc…

"Let me add my big one: price transparency." Lack of price transparency bothers me as well and I wish we had it. However, I don't know if there will ever be enough pressure to manifest this. Price transparency really only matters to the person paying the bill. Our society is very rapidly evolving to consider any healthcare cost of any kind to be an insurmountable burden that no normal person could ever be expected to…

> I'm sure there are rare people here and there that care how much a mile of highway costs

No offense meant, but I find this attitude really odd. I'm not from US and only have an overall idea how things work there, but I wonder... Isn't that still your money, even if you pay $0 directly and the rest comes from the shared pool your insurance payments or taxes are also in?

I just tend to believe there ain't no such thing as a free lunch - someone has to pay for the medical services, highway pavement or sewer line installation. People can't be expected to work for free, right?

So I think anyone participating in a collective funding effort should have at least some rough ideas how the money they pay are used. If we don't care about how government or insurance company (or whatever entity we pay our share to) manages things - we would surely end up with insurmountable burdens called "things running out of control".

Re: U.S. health care's widespread overbilling problem

#188

Post by extra88 »

ams6110 wrote: post #170
tptacek wrote: post #163

Earlier quoted context omitted.

The United States will get single-payer before it gets government-set pricing for 15% of its economy. Both, by the way, are problematic solutions! There are options for transparency that don't involve a government takeover of health care. But the brinksmanship in the politics of health care --- almost entirely the fault of the GOP --- is keeping us from exploring solutions.

Don't Medicare and Medicaid pay fixed prices? And aren't they generally below cost for the provider? So they have to "make up the difference" by charging private insurers and cash payers more?

It's lower than what the provider charges other insurers, that doesn't mean it's below the provider's cost. It's also commonplace for providers to bill insurers one amount but the insurer only pays a lesser amount, it's a little game they play. Pricing of medical goods and services in the U.S. are very divorced from the actual costs of providing them.

Also, Medicare and Medicaid can't negotiate drug prices.

Re: U.S. health care's widespread overbilling problem

#189

Post by fencepost »

EvanAnderson wrote: post #11
projectramo wrote: post #4

I know this will attract a lot of people who have suggestions for healthcare. Let me add my big one: price transparency. I had a simple test the other day. I could not get a price. I could not get a price with my insurance, or without it. I called at least 9 times. I got 5 call backs from people who asked me to schedule the procedure but no price. On the 10th call, I finally got someone to tell me what the out-of-poc…

An an anecdote: I've been on a high-deductible plan for nearly 13 years. I have been regularly met with shock and incredulity that I could possibly want to know the cost of a procedure. My wife and I have spent, collectively, hours on the telephone trying to get answers. It's particularly galling when we get "guilt trip" treatment for asking about costs for procedures for our young daughter. We have been met with bot…

For some of these you may have to resort to the "ludicrous claim" approach, because people will provide information to correct you when they would never provide it just because you asked - go look at old Usenet discussions if you don't believe me.

When they won't provide price information, act as if they've just told you that it's going to cost more than $100,000 and repeat that to them. If they then say "It's not going to cost that much!" "Oh, you mean you do have some information on how much it costs?" Then work them to more detail from there "Well, is it more than 50,000?"

You may also be running into a situation where the person thinks you want an exact price and doesn't have it, so be sure you tell them you're looking for a ballpark number - or if they've irritated you and you wish to unleash the snark, "Ma'am, I'm trying to find out whether I'm going to be feeding my family on rice and beans for a week, a month, a year, or until we lose the house and my child's getting meals at the women and children homeless shelter while I'm out on my own."

Edit: It doesn't quite have to be as ludicrous as I started - a simple "Oh man, I really can't afford $5,000 for that test right now." can also get the conversation started and information flowing.

Re: U.S. health care's widespread overbilling problem

#190

Post by extra88 »

Spooky23 wrote: post #169
yellowstuff wrote: post #165

Earlier quoted context omitted.

My dental hygienist once told me to get 3 cleanings a year. I told her my insurance covered 2. She told me that it was like chemotherapy- you should do what's medically necessary whether or not your insurance covers it.

That's probably good advice. The extra $80 for a cleaning is cheaper than many of the dental procedures that many folks will need.

I find it hard to believe that a two month difference between cleanings (4 months vs. 6 months) is going to prevent any more serious dental procedure.
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