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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

#101

Post by ProAm »

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…

> That's only saying that you'll have bills you can't pay, not that you'll go bankrupt from it.

This is one of the things Obama-care addressed, because before that most bankruptcy's in America where caused by medical bills. I'll see if I can find the article. [1] But with Obama-care going away/being changed this might be a thing again.

[1] "A study done at Harvard University indicates that this is the biggest cause of bankruptcy, representing 62% of all personal bankruptcies. One of the interesting caveats of this study shows that 78% of filers had some form of health insurance, thus bucking the myth that medical bills affect only the uninsured.

Rare or serious diseases or injuries can easily result in hundreds of thousands of dollars in medical bills - bills that can quickly wipe out savings and retirement accounts, college education funds and home equity. Once these have been exhausted, bankruptcy may be the only shelter left, regardless of whether the patient or his or her family was able to apply health coverage to a portion of the bill or not. (Find out what you can do to avoid a financial meltdown when there's a medical emergency. " http://www.investopedia.com/slide-show/top-5-reasons-why-peo...

Re: The Company Behind Many Surprise Emergency Room Bills

#102

Post by com2kid »

richthegeek wrote: post #76
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…

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. Bo…

In contrast, to America working for a good employer:

1. Schedule with GP. Say I am in pain. Get in within 2 days.

2. Get a referral to Physical Therapy. Asked if I have any preference where to go. My doctor knows my network and gave me a number of choices that were within network (a number of which were within walking range of where I lived).

3. Call PT office. Schedule an appointment. They apologize that their next opening is a week away. Gladly accept.

Physical Therapy is interesting in that it is semi-free market and rather competitive, so it tends to work a bit better than some other scenarios.

Re: The Company Behind Many Surprise Emergency Room Bills

#103

Post by spinlock »

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…

It's not just the emergency room. When you go to any doctor they make you sign a blank check before they will see you.

Re: The Company Behind Many Surprise Emergency Room Bills

#104

Post by TheCoelacanth »

ballenf wrote: post #55
cortesoft wrote: post #21

Earlier quoted context omitted.

I am not familiar with these alternate systems; how do they work?

Germany is two-tier. Public health for the masses, private for those making over 80k or so and healthy. The public system premiums are a % of income. The private is a flat cost, so as you make more become much more attractive (even costing less in many cases). Doctors are sometimes private only or have separate private insurance waiting rooms. Hospitals have separate public and private rooms/beds, etc. It's a two-tie…

Aren't the public premiums only a % of income up to a certain cap? So it's not like super high income people would pay an outrageously huge amount to use the public system, they would just potentially pay somewhat more than they would if they got private insurance.

Re: The Company Behind Many Surprise Emergency Room Bills

#105

Post by mistermann »

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…

Can someone knowledgeable on the subject comment on whether the "Obamacare movement" has been up front in acknowledging this aspect of the problem with health care in the US?

My perception is that the problem is typically framed as a lack of insurance problem for financially challenged people, but the "abuse" on the billing side to me seems like at least as big of a problem. And if this is being conveniently ignored, it feeds my conspiracy thinking that the Democrats are actually largely indistinguishable from Republicans - they may wear a different mask, but their actions are only slightly different, in this case altering who is getting robbed.

Re: The Company Behind Many Surprise Emergency Room Bills

#106

Post by maxxxxx »

chimeracoder wrote: post #94
maxxxxx wrote: post #87

Earlier quoted context omitted.

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 actu…

I hear what you are saying but I know people who have 6 figure medical debt despite being insured. This happens.

Re: The Company Behind Many Surprise Emergency Room Bills

#107

Post by mistermann »

spinlock wrote: post #91
sbov wrote: post #60

Earlier quoted context omitted.

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, I asked them to tell me what the maximum they might bill would be. And, they kicked me out of the office.

Sounds like dental care in Canada.

Re: The Company Behind Many Surprise Emergency Room Bills

#108

Post by chimeracoder »

justin66 wrote: post #95
chimeracoder wrote: post #71

Earlier quoted context omitted.

> 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.

> 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.

I didn't in my previous comment, because we were talking about the overall public perception, which may or may not be connected to the tangible metrics that we actually want a healthcare system to focus on.

As it turns out, though, Medicare Advantage also consistently outperforms Original Medicare on medical outcomes, and it comes in under-budget for identical coverage. Medicaid options vary much more (and they're different in every state, because Medicaid is administered at the state level), but the equivalent private plans for Medicaid coverage also typically perform much better than the public ones.

Hacker News readers aren't generally in the demographic for Medicare[0], but for anyone who is: there's really no reason to use Original Medicare. Every jurisdiction should have Medicare Advantage plans that cost you the same amount as Original Medicare does, and your experience (and overall care) will be vastly improved.

[0] people over the age of 65, or people of any age who are on dialysis for more than two years, etc.

Re: The Company Behind Many Surprise Emergency Room Bills

#109

Post by openasocket »

toss1 wrote: post #63
cortesoft wrote: post #21

Earlier quoted context omitted.

I am not familiar with these alternate systems; how do they work?

E.g., Switzerland is private insurance, but having a policy is mandatory for everyone within 3 months of moving there or being born. https://en.wikipedia.org/wiki/Healthcare_in_Switzerland This ensures that the system works better than the US system, as the hospitals do not need to deal with having to treat uninsured patients who cannot pay. This is a major problem for the US healthcare system, and a critical threat…

The insurance mandate is a principal component of the ACA. In the US you have to have health insurance or you pay a fine, and there are subsidies to help people pay for insurance. To further lower the number of uninsured in the US would involve increasing the penalties for not having insurance, paired with further expansion of subsidies or Medicaid. Honestly sounds like that area of the Swiss healthcare system is pretty similar to what the ACA provides.

Re: The Company Behind Many Surprise Emergency Room Bills

#110

Post by spinlock »

occultist_throw wrote: post #2

Does anyone know if a lawsuit has been lodged questioning these practices? I've always thought that my informed consent should also apply to cost of procedure - I have a right to say "NO" to something in the medical establishment. And had I known the price and the success rate, I would have said "No". Now, I'm not asking "What is my exact rate?", although that would indeed be nice. But given minimal complications, I…

I tried to get a doctor to tell me how much they would bill me for an office visit (not ER) and they kicked me out of the office. It was literally, sign this document agreeing to pay any charge we decide to bill or we will not see you. This was a doctor that I went to only because they were recommended by my insurance company as being in network.

They also didn't understand why anyone would even ask the question. They kept saying, "for patients that can't afford to pay we usually work out a payment plan." They didn't understand that I could afford anything and that was the problem. I can write a seven figure check which is why I'm careful not to open myself up to that kind of liability.

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