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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

#231

Post by sol8 »

The entire pricing scheme is an elaborate sham if you ask me. My wife had to have surgery. A outpatient laparoscopic procedure that required cutting a tendon. The time she spent at the facility (from the when they took her back and discharged her) was about 3 hours. A month later we got a statement showing they tried to charge $67k and were denied… followed by a separate bill for $7.5k We ignored the bill and contacted Anthem who said the hospital didn’t code it correctly. Anthem said they would resolve it. A month later… another attempt to charge $67k another separate bill for $7.5k. Again we repeated the same process. This time it appears it went through. Final total when they “coded it correctly” was $74k.

I have a friend who had to have an emergency appendectomy this year. She paid $1500 for it after insurance. My father had knee surgery he says they tried to charge the insurance company $64k for it.

At this point I think the pricing is all arbitrary. It’s about them trying to charge what they think they can get away with and sticking you for the rest. Kind of like raising the price so you can offer a deep discount later on. I think the real price of the surgery (without insurance) was probably the $7.5k.

I can think of no other business where you agree to have work done without an agreed upon price. The insurance company will tell you it’s covered but the hospital you go to may decide to play games with you. At the very least I suppose they are just hopping you pay so they can collect interest on your money on it before sending it back.

Re: The Company Behind Many Surprise Emergency Room Bills

#232

Post by throwrow »

chimeracoder wrote: post #54

If you want to understand how medical billing works and why these ridiculously high bills get created, there's a lot of important context that this article unfortunately leaves out. Large hospital systems accept patients who have a range of payers (Original Medicare, Medicare Advantage, various Medicaid plans, private insurance, and uninsured patients). On the aggregate, they want to make sure that their entire syste…

For surgery centers, the Affordable Care Act has limited a lot of plans to daily center maxes (on the facility side) so in theory the doctors are being paid market rates for their services. But the differences in prices between Medicare rates and out of network are significant.

Re: The Company Behind Many Surprise Emergency Room Bills

#233

Post by mistermann »

sloppycee wrote: post #164
mistermann wrote: post #115

Earlier quoted context omitted.

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.…

Sigh. Do you think I was suggesting that emergency rooms in Canada should adopt a FIFO approach?

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

This is a decent example of the typical Canadian attitude I was referring to, blind refusal to even acknowledge any issues, such as the well documented long waiting times for non-emergency procedures, as well as the outright refusal to treat ailments deemed "not important enough" by your doctor.

Re: The Company Behind Many Surprise Emergency Room Bills

#234

Post by throwrow »

Some out of network providers send bills to patients but don't collect. Some even tell the patients not to worry about it, although I believe this may be illegal.

In theory, the high reimbursements are so out of network doctors can get paid market rates. There's also a fair amount of propaganda from insurance companies on this issue which makes the reality hard to discern. Yet they pay 10-20% on average of the bills they receive, so it's just another way to punish the patient while both the insurance company and doctor are taken care of.

Re: The Company Behind Many Surprise Emergency Room Bills

#235

Post by mistermann »

Devthrowaway80 wrote: post #122
mistermann wrote: post #111

Earlier quoted context omitted.

Changing things so all taxpayers are getting robbed rather than just the individual being treated seems like a sub-optimal solution.

Yeah, it won't work. It works in every other developed nation in the world, and they all pay less money for better healthcare outcomes, but hey, the US is Totally Special.

> It works in every other developed nation in the world

The cost side works in every other developed nation? Surely you're aware of how much more expensive health care costs are in the US, so what might you be referring to?

Re: The Company Behind Many Surprise Emergency Room Bills

#236

Post by maxerickson »

vkou wrote: post #124
madengr wrote: post #14

Earlier quoted context omitted.

Yep. Took my wife to the ER last week for suspect appendicitis or diverticulitis. Last time this happened a CT scan alone was $3k ($11k prior to insurance reduction). My HDP is $4,500 OOP max per family member; $8,500 for family. What really pisses me off is that the HSA max contribution has not kept up with family OOP max. I contribute the max every year and can't end up with $8,500 saved. I had a decent insurance p…

Wouldn't the mandate against dropping coverage for people with pre-existing conditions result in price increases across the board? (Because now insurers can't take your money, and then tell you to fuck off once you get sick.) You're probably now paying the 'true' cost of healthcare. (Of course, inflated by the peculiarities of the American system.)

Large employer group plans already operated along those lines prior to the ACA.

Re: The Company Behind Many Surprise Emergency Room Bills

#237

Post by 21 »

sol8 wrote: post #231

The entire pricing scheme is an elaborate sham if you ask me. My wife had to have surgery. A outpatient laparoscopic procedure that required cutting a tendon. The time she spent at the facility (from the when they took her back and discharged her) was about 3 hours. A month later we got a statement showing they tried to charge $67k and were denied… followed by a separate bill for $7.5k We ignored the bill and contact…

> I can think of no other business where you agree to have work done without an agreed upon price.

You can't really compare this with other businesses. Unless you want the doctors to stop the moment they hit your negotiated price (like lets say a building constructor would).

However you should be able to get a rough quote for the procedure (assuming no unexpected complications).

And I agree with you in general, US health care is a total scam (very high-quality to be fair).

Re: The Company Behind Many Surprise Emergency Room Bills

#238

Post by mistermann »

heartbreak wrote: post #114
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,…

Well the progressives including President Obama pushed for single payer (or a public option) which would eliminate abuse on the billing side, at least to the insured.

> which would eliminate abuse on the billing side, at least to the insured

How does single payer fix that? If the hospital gives you a bill and won't negotiate down, how does the government "fix" this? Which is kind of what my question is: were specifics given in the ACA on how that problem will be fixed?

Re: The Company Behind Many Surprise Emergency Room Bills

#239

Post by damontal »

empath75 wrote: post #27
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 just spent over a year and countless phone calls arguing with the hospital over bills for the birth of my son. We had two employer paid insurance companies and HRA, and they still managed to send us to collections until we threatened to take them to court. They eventually sent us a refund of $600.

Similar experience w/ twins in the NICU. when you have 2 employer paid insurance plans, the two insurers fight over who pays and the hospital doesn't get paid, which leads to them coming after you.

Re: The Company Behind Many Surprise Emergency Room Bills

#240

Post by mistermann »

hockley wrote: post #190
maxsilver wrote: post #128

Earlier quoted context omitted.

> 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. If anything, the billing abuse is a much, much larger problem than lack of insurance. At least, that has generally been true since the ACA/"Obamacare" changes passed.

It was a problem before ACA; it's a problem now. The law didn't really change that aspect of the system.

This is my uninformed impression of the matter as well, and if true (please, anyone with a rebuttal please weigh in), to me it is further proof that the true motive of the ACA is to line the pockets of health care provider donors, by spreading the costs over the entire population and get rid of the politically damaging stories of overcharges causing individual bankruptcy.

Socializing this theft turns it into Just Another Crisis among the hundreds of others the US has.

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