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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

#301

Post by tptacek »

mistermann wrote: post #286
tptacek wrote: post #249

Earlier quoted context omitted.

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 provi…

Right, which increases revenue for the medical establishment, while also helping some people (and harming others) in the process. For me to consider the Democrats as the true party of the people rather than a tool of corporations, I'd want to see the cost side of health care addressed as well. My question is: was it?

I don't think you're going to get anywhere productive with analyses that connect all commercial health care spending with top-to-bottom regulatory capture by the health care industry. Essentially what you'd be saying is that any system short of federally-run single-payer was a sign of corruption.

Also: this idea that the "Democrats are the party of the people" and the "Republicans are the party of corporations" is pretty silly.

The Republicans are a conservative political party. The Democrats are a coalition of blacks (~25%), latinos (~10%), women (+10% share), labor unions, and urban (but not suburban) college-educated whites. Liberals are an important component of the Democratic party (and have no home whatsoever in the GOP), but they don't run the table.

Re: The Company Behind Many Surprise Emergency Room Bills

#302

Post by notyourday »

protomyth wrote: post #213
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.

Billing abuse (care provider) and billing fraud (bad agents) are two aspects of the system that need some serious time devoted to them. My thought experiment for some of this. Suppose the US government had a rider on every insurance policy in the US that said the government would pick up the tab for any amount over say $100,000 (think catastrophe insurance). Now, you would make the assumption that looking at the actu…

> Billing abuse (care provider) and billing fraud (bad agents) are two aspects of the system that need some serious time devoted to them.

We have a solution. It is called "make it a personal criminal liability". Go after individuals. No matter how low they are on a totem pole and no matter how high they are on a totem pole. Committing such fraud should lead to bankruptcy ( all assets wiped out ) and jail time.

You would be amazed how quick those "accidents" and "mistakes" stop happening.

Unfortunately, as the society we do not want to throw Suzi the billing clerk into the slammer, which means that Mike, the Billing Manager, does not get a slap on the wrist, which in turn means that Jack, the VP of Billing Revenue Optimization, does not get Jackie his wife go bananas on him when their bank accounts, house and kids college fund is seized which means that Jack is represented by the public defender and ends up in a slammer together with Suzi, who actually pushed the buttons, Mike, who told Suzi to do it, and Jack, who came up with this wonderful idea.

Re: The Company Behind Many Surprise Emergency Room Bills

#303

Post by albinofrenchy »

joe_the_user wrote: post #247
albinofrenchy wrote: post #210

Earlier quoted context omitted.

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.

> If the democrats wanted single payer and considered it crucial to their agenda, they could have done that.

And then watched it get blown away by next congress as soon as the GOP gained 51 seats to do whatever they want. Blowing away the fillibuster is an awful, terrible, no good idea and there is almost no legislative agenda which would validate it.

And to be clear, the GOP senators were and still are slimey bastards for basically everything they did leading up to Gorsuch. It should have never been done. They will almost certainly regret it as soon as they lose the senate.

Re: The Company Behind Many Surprise Emergency Room Bills

#304

Post by dgfgfdagasdfgfa »

mistermann wrote: post #286
tptacek wrote: post #249

Earlier quoted context omitted.

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 provi…

Right, which increases revenue for the medical establishment, while also helping some people (and harming others) in the process. For me to consider the Democrats as the true party of the people rather than a tool of corporations, I'd want to see the cost side of health care addressed as well. My question is: was it?

> For me to consider the Democrats as the true party of the people rather than a tool of corporations

It hasn't been like this since LBJ. Both parties are completely driven by corporate lobbies. All that differ are the excuses why.

Re: The Company Behind Many Surprise Emergency Room Bills

#305

Post by ewams »

madengr wrote: post #228
guntars wrote: post #198

Earlier quoted context omitted.

To be fair, health insurance doesn't HAVE TO be provided through work. It's easier than ever to find a private plan. To the employer it's just another employee cost along with salary so if you didn't ask for a raise when that happened, that's on you then.

I did get a raise; had to threaten to quit, but did get one. It's the HSA contribution limit that pisses me off. I don't have an issue paying, but I'd at least like the benefit of pre-tax $. The HSA limit has not kept up with the ACA OOP limit. Other than inflation adjustments, it's up to congress to raise it.

Employers can also contribute to HSA. Ask them to top you off.

Re: The Company Behind Many Surprise Emergency Room Bills

#306

Post by tptacek »

0xbear wrote: post #300
ComradeTaco wrote: post #297

Earlier quoted context omitted.

Obamacare only reduced the growth of healthcare costs, it did not stop the growth. The approach that most democrats believe would reduce cost is single payer or Medicaid for all.

As far as I can tell by looking at my premiums, it actually significantly sped up the growth of costs. I don't know how anyone could argue otherwise with a straight face.

That's not the cost we're measuring! We're measuring cost on the macro scale, in terms of the percentage of the economy spent on health care and, in particular, the percentage of the federal budget spent on health care entitlements. That's the cost curve we're talking about bending, because the pre-ACA projections were literally prima facie untenable.

Any number of effective cost-saving measures could be passed that would have the effect of increasing your premiums.

Re: The Company Behind Many Surprise Emergency Room Bills

#307

Post by amalcon »

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…

Also, don't forget that you'll frequently need to deal with multiple bills, each potentially requiring separate work to resolve.

If you take an ambulance to the emergency department, see a doctor, they order a scan, the scan shows appendicitis, and your appendix is subsequently removed, this can easily lead to six different bills:

  - Ambulance
  - Facility
  - ED doctor
  - Radiologist
  - Surgeon
  - Anesthesiologist
And that's assuming that the ED and hospital are under the same company (not always), and that no off-site labs are used. You may not have ever heard of the radiologist or anesthesiologist. I once had bill collectors calling me re: a radiologist I'd never heard of, who managed to ruin my credit for a good six months until I figured out what the bill was actually for.

Re: The Company Behind Many Surprise Emergency Room Bills

#308

Post by notyourday »

moheeb wrote: post #132
eatbitseveryday wrote: post #74

Earlier quoted context omitted.

> 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 agree with dungle6, whose comment is now dead. I say screw them and don't pay. Ignore collections for a few years and don't be a wuss about your credit score. Problem solved.

This may cause a cascading effect on your credit score. Certain banks tend to trim credit lines or outright close it when collections are reported on credit reports, which in turn increases utilization of credit lines which in turn drops score, which in turn leads to new reviews.

Re: The Company Behind Many Surprise Emergency Room Bills

#309

Post by kirrent »

mistermann wrote: post #287
heartbreak wrote: post #273

Earlier quoted context omitted.

Well since single payer typically refers to the government being the single payer, the bill goes to the government because you the insured are not the payer of the bill.

The bill goes to the government, who gets its funding from the people. This in no way stops any systemic over-billing that may be occuring.

Well, in my country, the government would laugh, and then only pay a standard amount.

Re: The Company Behind Many Surprise Emergency Room Bills

#310

Post by vkou »

astockwell wrote: post #59
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…

You may have some recourse with the insurance company because for emergency care that leads to an admission, the hospital being in-network is supposed to be what counts. Individual doctors being out-of-network should only come into play if you have a procedure done at their practice's office. I sincerely hope it works out for you. It might not hurt to get a 1-hr consult with a lawyer and send the insurance company a…

That depends on the state. Most states have no laws against this.

Also, if you read your insurer's fine print, you'll find that they will only pay out-of-network providers to some limit that they and the provider agreed to. Even in an emergency situation, you will foot the bill for the delta.

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