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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

#81

Post by alonmower »

godot wrote: post #29
istorical wrote: post #10

Earlier quoted context omitted.

Because those in the middle and upper class have employer-paid health insurance which protects from the worst of bills. You only go bankrupt if you're uninsured and usually only those in the lower-middle or lower class are uninsured. And those in the lower echelon of society economically are those least able to have the time or money to march or lobby for change.

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.

Very similar story, in the US as well. Went in, had a couple of tests that ruled out anything serious and was on my way in ~1.5 hours including all of the various wait times. Saw one doctor for maybe 1 minute and had a couple of nurses spend about 10 minutes with me total during the various tests.

Insurance was billed ~10k, with coinsurance I had to pay $1,400. This is after the hospital billing in multiple rounds and forgetting to bill insurance on one of them and also forgetting to send the bill to me (which if I hadn't been proactive about following up with would have led to it getting sent over to collections).

I'm assuming I have better health insurance than a decent percentage of the population and I can afford the bill but how the hell can most people? What a terrible, terrible choice for someone to have to make between getting care when they're at their most desperate and avoiding financial ruin

Re: The Company Behind Many Surprise Emergency Room Bills

#82

Post by [deleted] »

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…

[deleted]

Re: The Company Behind Many Surprise Emergency Room Bills

#83

Post by sixdimensional »

snuxoll wrote: post #72
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…

It's possible you're right. Without knowing the details of the relationship, you never know.

The reason I say that is the article points out another glaring issue - the shortage of ER docs that we are currently facing. I know this first-hand, as I have a family member who is one and is working harder than ever.

Some of these arrangements are to make up for the shortage, and the hospital systems and physician groups are often working in partnership... so it could be there was benefit for both since the hospital system needed coverage for their ER (due to physician shortages), and Emcare is providing the physicians. Without the physicians doing the services in the hospital, there would be no facility claim either...

Re: The Company Behind Many Surprise Emergency Room Bills

#84

Post by adolph »

zippergz wrote: post #41

I feel like there must be something I'm missing here. Isn't providing health care the core purpose of a hospital? Why are they outsourcing that? Outsourcing might make sense for ancillary stuff (e.g. running the cafeteria), but I'm confused why they'd look to outsource their core job. And if the outsourcing company can do it so much more efficiently, why don't they just open their own hospitals and take all of the pr…

Think of a doctor as being an specialist independent contractor affiliated with the primary business.

Imagine if you would, a small hospital. They probably don't see enough patients with diagnosis X to keep staff specialized for X busy year round. There is a doctor in town that specializes in X. This doctor needs a place to get their patients stabilized and where the doctor can see the patients periodically. When one of the patients needs hospitalization, the doctor can write an admission order telling the hospital to take care of a patient in a certain way. When somebody comes into the ER and the generalist/hospitalist discovers that person has condition X, then the hospital knows they can call on the doctor to consult with them on how to treat X.

A historical artifact of the hospital/physician relationship is that there are separate billing streams for each side. There is just enough information sharing so that the doctor's billing system knows who the patient is and it is up to the doctor to claim that certain actions were performed for a valid medical reason and documented.

The current state ranges from very arms length relationships to total economic integration, which is rare enough to have a term for it, Single Billing Office.

http://healthaffairs.org/blog/2016/05/09/the-tangled-hospita...

Re: The Company Behind Many Surprise Emergency Room Bills

#86

Post by mikeash »

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)?

Decades of propaganda has convinced half our electorate that the US's system is the best in the world, and that countries with socialized medicine are hellholes where you have to wait months to get a broken bone looked at.

Re: The Company Behind Many Surprise Emergency Room Bills

#87

Post by maxxxxx »

chimeracoder wrote: post #64
maxxxxx wrote: post #57

Earlier quoted context omitted.

You can easily add tens of thousands of out of network costs with some medical issues.

> You can easily add tens of thousands of out of network costs with some medical issues It doesn't matter, because that's still capped.

I know people who have run up medical bills in the hundreds of thousands due to a long term illness despite having insurance. I don't know how this could happen, but it did.

Re: The Company Behind Many Surprise Emergency Room Bills

#88

Post by tcbawo »

ballenf wrote: post #32
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…

Another approach would be that a hospital actually has to take responsibility for the doctors and all other care teams working inside. Legislation to this effect would work, but in some cities there is enough competition that a marketing campaign along the lines of "guaranteed no out of network bills!" would catch my attention. I'd happily drive an extra hour for that piece of mind. And the reality is that a large nu…

I learned about these independent groups during a jury stint on a medical malpractice trial. This was actually a four way fingerprinting exercise (plaintiff's family, hospital, nurse, physician's group). The incentives in the system are perverse and corrupting. I think the system will need to be reinvented from the ground up.

Re: The Company Behind Many Surprise Emergency Room Bills

#89

Post by manarth »

ajross wrote: post #9
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…

What if there was a group or coop or company somewhere, where people could get together and collectively fund their health care. Then this entity could make deals with providers like EmCare to ensure that the care provided was as efficient as possible. Sarcasm aside: this problem is solved, and it's called insurance. Private entities sell it. The government does it too. It works. We just need to make sure everyone ac…

The article shows that this issue affects people with insurance.

It's not that the patients don't have insurance, it's not even that they go to a hospital without an agreement in place with their insurer - it's that the ER has a number of people outside that insurance contract, you don't know who they are, you don't get to choose whether they treat you, you just get a bill at the end - despite being insured, and choosing a hospital recognised by your insurer.

Insurance is not the solution for this problem.

Re: The Company Behind Many Surprise Emergency Room Bills

#90

Post by patrickg_zill »

eatbitseveryday wrote: post #74
ydt wrote: post #70

Earlier quoted context omitted.

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 w…

A consultation with the lawyer will be free or low cost. Paying even 200 to save 600 seems like a good idea.
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