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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

#241

Post by maxerickson »

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…

A bit more than 1/4 of hospitals (with emergency departments) are designated as critical access hospitals. They are in most states:

http://www.flexmonitoring.org/wp-content/uploads/2013/06/CAH...

(in high population areas it doesn't make sense to comply with the limits imposed by the program, for instance, only having 25 beds, that's why there aren't any in Connecticut and such)

(Just adding a bit of info, I think CAHs are pretty high jargon)

Re: The Company Behind Many Surprise Emergency Room Bills

#242

Post by Declanomous »

et-al wrote: post #202
narrator wrote: post #127

Earlier quoted context omitted.

When I had back surgery, there were all these therapists coming in the moment I got out of surgery trying to get their 1 minute in. It was throughly ridiculous. One of them was attempting to do physical therapy and pulled on my leg a little and put me into so much pain I went into shock. She probably got her $600 bucks. I am with Kaiser now and it is the most BS free medical experience I have ever had. To fix healthc…

Everyone in the Bay Area loves talking down on Kaiser, but financially they've been the most worry-free experience. Had ringing in my ear for a week, went to the doctor, and she referred me to both an audiologist and MRI. Paid $20 for both of those other visits. If I had been on Blue Cross Blue Shield, I probably would've sucked it up given my super high deductible and navigating the in-network maze.

BCBS IL is super straightforward. Every doctor is $20, unless it's a specialist, then it is $40. I've never actually been billed $40, despite seeing many specialists, so I'm not sure what actually qualifies. I've been hospitalized and paid My biggest complaint about the medical industry is the cost of prescription drugs. It's ridiculous how much we pay for drugs in this country.

Re: The Company Behind Many Surprise Emergency Room Bills

#243

Post by spydum »

maxxxxx wrote: post #106
chimeracoder wrote: post #94

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. 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.

Indeed it doesn't take much imagination: chronic illness + prescriptions + high deductibles. Worse if multiple family members are sick (so many problems are inheritable and so on).

Also worth mentioning, it's been broken for a while (e.g.: ACA is not even broken in yet).

Re: The Company Behind Many Surprise Emergency Room Bills

#244

Post by enraged_camel »

albinofrenchy wrote: post #205
jazzyk wrote: post #193

Earlier quoted context omitted.

Strictly speaking, it was politically possible - the Democrats had majority in both the Congress and the Senate. Public option is a great solution, because it does not prevent the people who prefer (and can afford) to pay for private services from doing so.

Not really, they only had a filibuster proof majority for a very short period of time -- http://www.outsidethebeltway.com/did-the-democrats-ever-real... . And that is counting Lieberman as a D; a person who backed McCain for president and who later personally killed the public option. I do think we will get to the public option at some point. It just makes too much sense not to and would strengthen the healthcare as…

Public option is unlikely to happen in the near future. Too many people start frothing at the mouth and yelling "socialism!" every time it is proposed.

Re: The Company Behind Many Surprise Emergency Room Bills

#245

Post by xenadu02 »

madengr wrote: post #14
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…

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…

If you work for a company with 10,000 employees or more and don't have a gold-plated health plan then it is by deliberate effort on the part of the company to save money.

At that level a company that wants a good plan can demand no exclusions for pre-existing conditions (an issue prior to ACA), same-day partner additions, better drug tiers, lower copays, etc. Often they pay less per person than a 1,000 person company does for a much worse plan.

I know because I looked. Two employers ago we got acquired by a very large company (over 80k employees). They paid ~$800/mo for my family. When I moved to a startup, they were paying ~$1200/mo and the benefits were worse. I'm back at a large company again and it's back to ~900/mo for a better plan.

You are getting screwed because the company has decided to do so.

Re: The Company Behind Many Surprise Emergency Room Bills

#246

Post by refurb »

canhe wrote: post #169

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…

System works here. Sure people can cite edge cases, but they are relatively rare.

Not sure these are just "edge cases"...

http://www.cbc.ca/news/canada/british-columbia/patients-live...

Re: The Company Behind Many Surprise Emergency Room Bills

#247

Post by joe_the_user »

albinofrenchy wrote: post #210
joe_the_user wrote: post #207

Earlier quoted context omitted.

I would just note that "...it was politically impossible" and "the Democrats were never serious in saying they wanted it" are two ways to frame the same reality. Both are true. Take your pick.

I'm not saying any democrats at the time were willing to go all in on it, but the two statements would only be two ways to frame the same reality if democrats had the ability to make unilateral decisions in the senate. They never did.

The nuclear option - changing the rules to allow majority votes to override a filibuster - has existed in potentia for a long time. The republicans have used it lately for things they consider crucial to their agenda. If the democrats wanted single payer and considered it crucial to their agenda, they could have done that. Of course neither of those "ifs" are true and we can use the lack of action to judge this.

Re: The Company Behind Many Surprise Emergency Room Bills

#248

Post by Declanomous »

mistermann wrote: post #233
sloppycee wrote: post #164

Earlier quoted context omitted.

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 out…

My understanding, as an American, is that people in single-payer countries tend to see doctors much sooner than Americans do.

Say I'm sitting around and I finally decide to get pain in my wrist looked at that I've had since I broke it ten years ago. I could see a specialist in less than a week. However, I probably would have had it looked at 7 or 8 years ago if I was in a single-payer system. Maybe I would have had to wait 6 months to see a doctor, but that still puts me about 7.5 years ahead of where I am now.

I know a lot of people who have bones that never healed right because an emergency room visit is going to cost you a fortune whether or not you are insured, so they don't go to the ER because it doesn't hurt 'that bad'. I imagine that is somewhat less prevalent in places with socialized healthcare.

Re: The Company Behind Many Surprise Emergency Room Bills

#249

Post by tptacek »

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,…

The fact that the problems addressed by the Democratic health care bill are orthogonal to some other problem you care deeply about is not, logically, evidence that the Republicans and Democrats are "indistinguishable" when it comes to health care. The status quo ante of the ACA was a system in which millions of people were locked out of insurance by fiat due to pre-existing condition bans. For those people, all providers were "out-of-network".

Re: The Company Behind Many Surprise Emergency Room Bills

#250

Post by Danihan »

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)?

What would marching in the streets accomplish, exactly?
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