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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

#91

Post by spinlock »

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…

I think there are "bad" guys. I've pointed out to a doctor that their agreement said that I would agree to pay any charge they decided to bill me for. I pointed out that I was in their office because they were in network for my insurance and that I couldn't agree to pay literally anything they decided to bill. So, I asked them to tell me what the maximum they might bill would be. And, they kicked me out of the office.

So, yes, if you refuse to be transparent in your billing and you extort money from your patients by refusing them treatment unless they agree to pay literally anything for service, you are a "bad" person.

Re: The Company Behind Many Surprise Emergency Room Bills

#92

Post by theandrewbailey »

jackmott wrote: post #65
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…

vote for candidates who will support single payer.

It seems like we already have single payer healthcare: the patient. The patient pays up the ass. All the way.

Re: The Company Behind Many Surprise Emergency Room Bills

#93

Post by ydt »

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…

I have no evidence other than a person that works in claims for an insurance company looked at my claim, drafted a letter citing relevant statutes and the bill went away.

I agree that an attorney only makes sense if you're facing a significant bill. On a smaller bill I would go to the hospital billing department and negotiate.

Re: The Company Behind Many Surprise Emergency Room Bills

#94

Post by chimeracoder »

maxxxxx wrote: post #87
chimeracoder wrote: post #64

Earlier quoted context omitted.

> 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.

> 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.

The bills themselves aren't capped. The amount they are obligated to pay is. Insurers make up some of the difference, and the rest is forgotten about. (It's not written down in the accounting sense, because the hospital doesn't necessarily actually treat the entire billed amount as receivable.)

I explained in a top-level comment how this works and why it works this way.

Re: The Company Behind Many Surprise Emergency Room Bills

#95

Post by justin66 »

chimeracoder wrote: post #71
jaymzcampbell wrote: post #31

Earlier quoted context omitted.

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…

On the other hand, patient satisfaction correlates with increased rates of hospitalization, higher expenses, and increased mortality. You'd want to dig a little deeper than patient satisfaction before drawing any conclusions regarding medicare vs. medicare advantage, I would think.

Re: The Company Behind Many Surprise Emergency Room Bills

#97

Post by dungle6 »

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…

If you have excellent credit you can simply not pay and make them do the work. I had a $1500 dispute. I was getting tired of wasting time. When it went to collections I drafted the standard leave me alone. The funny thing is now the collection company has screwed up twice on some things. It is their prerogative to sue. I doubt they will. If they do it, it will be annoying but I can respond in kind with a countersuit. Oh and the credit score? Dropped about 40 points into the upper 700s. Annoying, but not worth just rolling over and paying.

You can of course negotiate as well.

Re: The Company Behind Many Surprise Emergency Room Bills

#98

Post by AngeloAnolin »

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…

> Every technology that I know of has been tried to address these issues, such as data mining, machine learning, rule-based expert systems, etc. and none of them has addressed the root cause, which is the basic system is fundamentally flawed.

There's no technology cure for the insatiable greed of a few. Sad reality.

Re: The Company Behind Many Surprise Emergency Room Bills

#99

Post by spinlock »

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)?

Because people don't get sick every day. Most people don't run into these bad situations and, in general, americans lack empathy for others who do wind up in bad situations. We have a media that tells us -- and religion before -- that you get what you deserve. So, if you're rich, you deserve it. If you're sick, you deserve it.

The idea that life is unfair and random is not accepted by america.

Re: The Company Behind Many Surprise Emergency Room Bills

#100

Post by sjg007 »

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…

ER + hospitalization visit should be covered no matter what.
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