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The Company Behind Many Surprise Emergency Room Bills

nytimes.com

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Re: The Company Behind Many Surprise Emergency Room Bills

#71

Post by chimeracoder »

jaymzcampbell wrote: post #31
rwmj wrote: post #4

Over here (in Europe) we get the impression that US has such a crazy healthcare system. Why aren't people marching in the streets? Is it not as crazy as it sounds for most users? If you're taken to ER how are you supposed to know if the doctors are all part of "your network" (whatever that even means)?

Fellow European (UK) here. From what I understand one argument often given, is that there's a mistrust of the government for anything like this and people prefer to "shop" for it themselves. By making their own choice (even if all that actually means is picking from 1 or 2 options given to them by their employer) - they feel empowered and in control of it. There is a general feeling of "if you want it, pay for it". T…

> From what I understand one argument often given, is that there's a mistrust of the government for anything like this and people prefer to "shop" for it themselves

As a data point: the patient satisfaction scores for Original Medicare (government-run) are drastically lower than every single major provider of Medicare Advantage (privately-run).

As much as people dislike insurance companies, people in the US are even less happy with the government-run programs, compared to their private counterparts.

Re: The Company Behind Many Surprise Emergency Room Bills

#72

Post by snuxoll »

sixdimensional wrote: post #39

In a past life, I worked in health insurance fraud detection. Everybody should know, the health insurance system in the US is fundamentally broken and has been almost since its inception in the early 20th century. The lack of adequate consumer protection, transparency, health systems and appropriate government regulation, in addition to organizational oversight, has lead to a situation where we have poor systems that…

> Props go to the hospital system for taking back their coding after they realized what the third party was doing, but the reality is, it was probably financially benefiting the hospital system too.

I doubt the hospital system got anything from it, physician groups usually keep all their revenue from professional services claims - the hospital gets paid whatever they do for their facility claim regardless of what the professional claim pays.

Re: The Company Behind Many Surprise Emergency Room Bills

#73

Post by godot »

Frondo wrote: post #19
pascalxus wrote: post #3

So, basically, if you visit any emergency room then your handing them a blank Check and they can write whatever number on there they want. That's egregious beyond belief. I'm never one to call for legislation and price controls, but in the face of such adversity, I think it may be our last hope. I think they should either provide a quote before they offer the services or there should be a law limiting the amount that…

The thing is, if you're in an emergency room, for the most part, you're there because of a medical emergency. (I know this isn't universally true, etc.) If you're bleeding, and someone hands you a price quote, what are you going to do? Or if you're unconscious, they can't even hand you a price quote. (I guess they could shove it in your pocket.) I know the one time I needed to go to the ER, for emergency surgery, I'd…

Your text is grey and you may be getting downvoted and I'm not sure why. You are absolutely right and anyone who has ever been to ER will agree. I was in ER a couple of months ago, and it wasn't even a life-threatening issue, but I felt terrible. I went to the closest hospital with ER department (thankfully, it was in-network), and I was going to get their treatment no matter what price quote they hand me (not that I asked). When you're deeply, physically unwell, nothing else matters to your mind.

I think you may be getting downvoted for your last sentence, but the points you're making are very real.

Re: The Company Behind Many Surprise Emergency Room Bills

#74

Post by eatbitseveryday »

ydt wrote: post #70
coreyp_1 wrote: post #22

I am having problems with my insurer at this very moment. I went to an in-network hospital for an ER visit, which turned into an 8-day stay (yes, it was serious). Evidently, none of the doctors at the hospital are in-network, however, (claims from various technicians are still "in processing", so I don't know how they will turn out) despite the fact that the hospital itself is definitely in-network. I had no choice a…

I had this same thing happen. My daughter was admitted via ER and it turned into a 6 day stay. At the end we received a bill for 40k for being out of network. Luckily I have friends in the industry and it turns out if they fail to inform you within 48 hours that you're not in network you don't have to pay the out of network cost. We ended up paying just our deductible after a letter was drafted. Do not take what the…

> Luckily I have friends in the industry and it turns out if they fail to inform you within 48 hours that you're not in network you don't have to pay the out of network cost.

Curious, can you perhaps provide evidence of this? Seems like a good thing to know.

> Call an attorney.

This is itself a cost, and maybe only makes sense if you owe ≥ $10k but for procedures billed as $1k when they should be $400 I don't think warrants the cost and time of an attorney; what other recourse is there except to pay?

Re: The Company Behind Many Surprise Emergency Room Bills

#75

Post by astockwell »

sbov wrote: post #60
coreyp_1 wrote: post #22

I am having problems with my insurer at this very moment. I went to an in-network hospital for an ER visit, which turned into an 8-day stay (yes, it was serious). Evidently, none of the doctors at the hospital are in-network, however, (claims from various technicians are still "in processing", so I don't know how they will turn out) despite the fact that the hospital itself is definitely in-network. I had no choice a…

We had a similar experience about 8 months ago, but only one night in the hospital. Raise hell with everyone. The out of network doctors were resolved the fastest for us, and the longest was the hospital stay itself, which our insurance didn't agree to pay until 8 months after the stay. It was a seriously draining experience, and luckily my wife doesn't work so I didn't have to take time off for all the phone calls a…

> luckily my wife doesn't work so I didn't have to take time off for all the phone calls and following up that was required

This.

This is so horrifically true, it takes call after call after call (and emails, and faxes, and snail-mail claims forms that take "30 days" to "process") to get anything changed, and by then you have collections companies harassing you and your credit goes down the drain. Meanwhile you must keep working and taking care of family and dealing with the actual illness/issue that led to the medical visit in the first place. It is insane.

Re: The Company Behind Many Surprise Emergency Room Bills

#76

Post by richthegeek »

jaymzcampbell wrote: post #31
rwmj wrote: post #4

Over here (in Europe) we get the impression that US has such a crazy healthcare system. Why aren't people marching in the streets? Is it not as crazy as it sounds for most users? If you're taken to ER how are you supposed to know if the doctors are all part of "your network" (whatever that even means)?

Fellow European (UK) here. From what I understand one argument often given, is that there's a mistrust of the government for anything like this and people prefer to "shop" for it themselves. By making their own choice (even if all that actually means is picking from 1 or 2 options given to them by their employer) - they feel empowered and in control of it. There is a general feeling of "if you want it, pay for it". T…

Unfortunately the NHS is, in many ways, pretty bad. They're pretty good at dealing with pregnancies, cancers, and emergencies but try getting seen for a chronic pain and you'll follow this rough timeline:

- Try see your GP. Wait 2 weeks until your appointment.

- GP will give a cursory examination and recommend a dietary change, taking ibuprofen/paracetamol, and to come back if problem persists.

- Problem persists. Book in with your GP and wait another 2 weeks.

- GP will actually examine you this time. They may then refer you to the local hospital, and so you should await a letter.

- about 2 weeks later, the a will arrive saying that you should phone up to make an appointment.

- within 8 weeks you should get another letter telling you when your appointment is, which will be within 4 weeks.

At this point you have spent 20 weeks just to get seen by a specialist. And that's assuming everything goes ok. Admin may not update your details, so the letters go to an old (or wrong) address. They may just entirely forget to make an appointment for you. Probably if you try phone them they just won't pick up the phone.

There's a fetishisation of the NHS in this country that protects it from a lot of criticism. Some will say "well you should put up with that because it's free" or some similar rubbish, ignoring that it costs £2200 per person.

None of these issues are restricted to the NHS. Any large organisation will have such issues. But it's utterly frustrating stuff like this that makes me consider going private - I shouldn't have to spend hours on the phone figuring out why I haven't been assigned an appointment despite being referred 3 months ago.

Re: The Company Behind Many Surprise Emergency Room Bills

#77

Post by chimeracoder »

SilasX wrote: post #33
godot wrote: post #29

Earlier quoted context omitted.

I went to ER a couple of months ago for a relatively minor issue and stayed for a few hours total. This was in-network hospital, doctors and so on. Purely by co-pays this ended up being a ~$800 bill after all the insurance kicked in. If I didn't have a comfy software engineer salary, and instead lived paycheck to paycheck, this would've been devastating, even with insurance.

Which is ridiculous. We're at the point where the insurance is just covering the cost of the overhead that necessitates having insurance in the first place. There's no way the real charge should be $800, let alone co-pay.

> Which is ridiculous. We're at the point where the insurance is just covering the cost of the overhead that necessitates having insurance in the first place. There's no way the real charge should be $800, let alone co-pay.

You're right. Of course the private insurance premiums have a negative expected value. Aside from insurance always having a negative expected cash value by definition, private insurance premiums are literally used to subsidize care of Medicare, Medicaid, and uninsured patients.

Re: The Company Behind Many Surprise Emergency Room Bills

#78

Post by JackFr »

rwmj wrote: post #4

Over here (in Europe) we get the impression that US has such a crazy healthcare system. Why aren't people marching in the streets? Is it not as crazy as it sounds for most users? If you're taken to ER how are you supposed to know if the doctors are all part of "your network" (whatever that even means)?

For an explanation of how the bizarre US system came to be I would recommend the following episode of EconTalk:

http://www.econtalk.org/archives/2017/06/christy_ford_ch.htm...

The guest is an economic historian who details the historical forces which led us to where we are right now. She also describes a few different, more effective and rational models (not just single payer) which could potentially have existed, but which sadly are, for all practical purposes, impossible to get to now.

Re: The Company Behind Many Surprise Emergency Room Bills

#79

Post by westbywest »

maxxxxx wrote: post #18
cortesoft wrote: post #15

Earlier quoted context omitted.

This is the fundamental problem of treating healthcare like any other market distributed good; you just don't have the ability to use consumer choice. People using an emergency room are not in a position to negotiate price or seek an alternative service. An unconcious accident victim can't say, "That price is crazy I am going to the hospital across town." Single payer is the only viable solution.

"Single payer is the only viable solution. " That's not true. Plenty of European systems are not single payer and work fine.

A physician relative pointed out the Dutch healthcare system as a compelling, hybrid public/private alternative to strict single-payer schemes. Gist of his recommendation was that single-payer systems may not be the silver bullet they're touted to be, and that alternative models are being tried out. I.e., viable solutions may turn out to be hybrid healthcare systems, where negative effects can really only be minimized rather than eliminated. https://en.wikipedia.org/wiki/Healthcare_in_the_Netherlands

Re: The Company Behind Many Surprise Emergency Room Bills

#80

Post by chimeracoder »

wccrawford wrote: post #68
ProAm wrote: post #23

Earlier quoted context omitted.

> You only go bankrupt if you're uninsured This is absolutely not true [1] [1] http://www.cnbc.com/id/100840148

>NerdWallet estimates nearly 10 million adults with year-round health-insurance coverage will still accumulate medical bills that they can't pay off this year. That's only saying that you'll have bills you can't pay, not that you'll go bankrupt from it. Most (if not all) insurance plans have a maximum out-of-pocket expense amount that's like $10k. Yes, that's more than some middle-class Americans can afford to pay in…

> Most (if not all) insurance plans have a maximum out-of-pocket expense amount that's like $10k

It's more like $6800 for 2016 and $7100 for 2017. That's the federally-mandated cap; many private plans set their cap even lower.

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