The Company Behind Many Surprise Emergency Room Bills • Hacker News Board

Re: The Company Behind Many Surprise Emergency Room Bills

#161

Post by dv_dt » Mon, Jul 24, 2017, 6:19 PM UTC

cookiecaper wrote: post #141

mistermann wrote: post #105

Earlier quoted context omitted.

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,…

The insurance model is at the heart of the medical system's issues; it distorts the market by disconnecting prices from providers and consumers and severely disaligns their interests. The provider must set a high sticker price so that they can give the insurer the expected 60-80% discount to get in-network (and still tolerate underpayment and other shenanigans). The consumer is either intentionally misled or confused…

Not only the insurance model, but the encouragement of health insurance as an employer benefit. It adds one more aspect of indirection to an already complex health system.

Re: The Company Behind Many Surprise Emergency Room Bills

#162

Post by jseliger » Mon, Jul 24, 2017, 6:19 PM UTC

cortesoft wrote: post #15

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…

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.

This statement is close to the fallacy "Something must be done. This is something. Therefore it must be done."

Consider counterexamples: http://marginalrevolution.com/marginalrevolution/2013/08/a-f...

Re: The Company Behind Many Surprise Emergency Room Bills

#163

Post by ugh123 » Mon, Jul 24, 2017, 6:20 PM UTC

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)?

Your impression is reality. And its more f'cked up then you think.

Re: The Company Behind Many Surprise Emergency Room Bills

#164

Post by sloppycee » Mon, Jul 24, 2017, 6:20 PM UTC

mistermann wrote: post #115

mikeash wrote: post #86

Earlier quoted context omitted.

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.

Similarly, decades of propaganda in Canada has convinced far beyond half our electorate that the Canadian system is the best in the world even though you actually do have to wait several months for treatment if your issue is not "urgent", the definition of urgent being unknown.

I take it you have never experienced a true urgent health crisis?

Once you have you'll quickly realise that the 'long wait times' narrative is complete propaganda FUD.

Anecdote time: My sister is anaphylactic, when she goes to the ER she is admitted, hooked up, and given epi almost immediately. When my aunt couldn't move her arm one day, she got an MRI, diagnosed brain cancer, and had brain surgery in the same week.

I'm glad to have a system that when you are waiting it's because there are people with more urgent needs, rather than because there are people who paid more.

Re: The Company Behind Many Surprise Emergency Room Bills

#165

Post by J_Sherz » Mon, Jul 24, 2017, 6:21 PM UTC

com2kid wrote: post #102

richthegeek wrote: post #76

Earlier quoted context omitted.

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…

Just to add another perspective also working in America for a good employer:

1. Schedule with GP, get appointment very quickly.

2. GP has no idea who is "in network" for you and doesn't seem to care very much. They also don't understand the different insurance plans so have no idea if you're covered for certain types of referral.

3. Schedule appointment with a specialist. Ask for up front cost estimate for consultation/procedure given your insurance plan. Unable to answer.

4. Go to appointment anyway as you don't have many other choices.

5. Receive astronomical bill for some obscure billing code that is not covered by your health plan.

6. Spend time calling doctors office and insurer to figure out the situation and try to avoid or reduce bill.

I've experienced the NHS too - for all its flaws, the peace of mind living in the UK from a health standpoint is worth every penny of the associated taxes IMO.

Re: The Company Behind Many Surprise Emergency Room Bills

#166

Post by maxerickson » Mon, Jul 24, 2017, 6:21 PM UTC

mistermann wrote: post #105

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…

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's well enough understood that the cost side is also a problem.

http://www.cnbc.com/2015/11/20/obamacare-architect-high-dedu...

The previous administration was working to move to different payment models to try to address it (it's not clear that the different models will have much long term impact):

http://www.reuters.com/article/us-usa-healthcare-reform-idUS...

Re: The Company Behind Many Surprise Emergency Room Bills

#167

Post by bdamm » Mon, Jul 24, 2017, 6:21 PM UTC

astockwell wrote: post #75

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…

> 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…

A friend of mine was in a sports accident almost two years ago. He had a good medical insurance plan for exactly this possibility.

He fractures his pelvis into 14 pieces, and broke another dozen major bones including both femurs.

The surgeries are still ongoing although he is mostly himself again. But even two years later, he is facing a daily barrage of calls, being put on hold, no callbacks, paper shuffling, records from hospital to hospital, faxing permission sheets, fighting with the insurance company (who has threatened to drop his insurance multiple times) and on top of it all, his landlord is trying to evict him.

It's been horrible to watch. It's like the insurance company is trying to kill him with stress.

Re: The Company Behind Many Surprise Emergency Room Bills

#168

Post by will_brown » Mon, Jul 24, 2017, 6:24 PM UTC

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…

Here is a nice article about that practice: https://fairhealthconsumer.org/reimbursementseries.php?terms...

Most importantly, most states have laws mandating insurers use in network rates for certain instances of using out of network providers, including in factual instances like you described (i.e. in network hostitals and out of network providers). Seperately, most states have statutes awarding attorneys fees to the insured when claims have been denied in bad faith, like refusing to adjust bills to in network rates when mandated by law.

Re: The Company Behind Many Surprise Emergency Room Bills

#169

Post by canhe » Mon, Jul 24, 2017, 6:26 PM UTC

Canadian here. Had a pain in my right side for about 3 weeks (thinking muscle pull). Called Doctor's office at 10am had appointment at 11am, had exam and referred electronically to local hospital for X-Ray, had X-Ray at 11:45am, out the door at 12pm. Doctor called me personally the next day to say it's probably a muscle pull and call back in a couple of weeks if still sore.

$0 out of pocket, just showed my government issued card everywhere.

Couple of years ago my father was in an ICU for two weeks with Parkinson's related complications. That one had a $0 out of pocket bill as well. The ICU was in a world class university teaching hospital.

System works here. Sure people can cite edge cases, but they are relatively rare. The single payer, $0 out of pocket system also encourages pro-active care as opposed to waiting until the problem is severe, which in turn keeps costs down.

Wouldn't trade our single payer, socialized medicine for anything. There's reason why Tommy Douglas, the father of Canadian socialized medicare, was voted the greatest Canadian of all time by the public in a recent CBC poll.

(Shameless plug: software industry is booming in Toronto and there's lots of jobs. Just sayin'...)

Re: The Company Behind Many Surprise Emergency Room Bills

#170

Post by rgbrenner » Mon, Jul 24, 2017, 6:26 PM UTC

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.

Completely agree.

There's no free market in healthcare. They are selling services without providing prices... it completely breaks any market that might exist.