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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

#321

Post by fiblye »

dsfyu404ed wrote: post #154
Devthrowaway80 wrote: post #122

Earlier quoted context omitted.

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.

Except that's not how it works everywhere else. Everywhere else the government shoves a telephone pole up the ass of taxpayers and then takes a few splinters to pay for healthcare.

I pay lower taxes than I did in America, and I get better, faster treatment for less money.

America isn't special.

Re: The Company Behind Many Surprise Emergency Room Bills

#322

Post by ams6110 »

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)?

Yes, it is not as crazy as it sounds for most users.

Media outlets like to publish horror stories because it attracts eyeballs.

Yes they can happen and there are bad actors in the system. But most ER patients either don't pay a dime because they don't have a dime, or their insurance picks up the tab subject to deductible. "In Network" rules specifically don't apply in true emergencies under most plans. Of course if you go to the ER for a runny nose, there may be some pushback.

Re: The Company Behind Many Surprise Emergency Room Bills

#323

Post by tptacek »

zanny wrote: post #313
mistermann wrote: post #286

Earlier quoted context omitted.

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?

On one hand, the Democrats did not have control of congress to pass whatever they wanted when the ACA was passed. On the other hand, the Democratic party of the US has never fought with any fervor against Republicans on pretty much anything. The closest I have seen in my lifetime to democratic resistance was to the most blatantly and obviously stupid and racist decisions Trump has made like travel bans and appointing…

Even if we just stay on the subject we're talking about here it's easy to rebut this notion that the Democrats don't fight the Republicans.

A lot of people forget that the GOP does not, as a political party, believe in universal coverage. Moving the country closer to universal coverage is not a GOP political objective. What is a GOP objective is minimizing federal interference and involvement with business. Health care is something like 15-20% of the entire economy, so the GOP's stated objectives run directly counter to universal coverage.

And yet, repeated efforts to eliminate the ACA have all retained policies built around universal coverage, including a massive federal expenditure in Medicaid (block granted or otherwise) and an extremely intrusive regulatory requirement for guaranteed issue insurance, something that only Ted Cruz has tried to push back on.

If that's not a win for the Democrats it's hard to imagine what plausible outcome would be. Nothing that involves 15-20% of the American economy will be simple, or will happen in one legislative session.

Re: The Company Behind Many Surprise Emergency Room Bills

#324

Post by Mz »

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…

This is ludicrous! I have insurance, & still this will completely drain me financially. I'm at the point where I almost think it would be easier to declare bankruptcy and start over!

I worked in insurance for over five years. Not this kind of insurance, but it was a kind of health insurance.

a) Get a letter of "medical necessity" drafted by your primary care physician.

b) Call the insurance company and ask about the policies concerning emergency treatment. Don't accuse them of anything. They get cussed out all the time and it will not help you. Be nice and start from the assumption that there must be some mistake.

c) If you make no progress with that, have a lawyer send the insurance company a letter requesting a copy of your records. This sometimes makes them look very carefully at the bill and sometimes is enough to get you whatever benefits you are legally due. Which may not be your wildest dreams of avarice, but may stave off your desire to declare bankruptcy.

If you do have a lawyer request your medical records, expect the insurance company to come back with a form letter stating they need a third party auth. Yes, a lawyer will need a third party authorization to get your medical records, but I wouldn't bother supplying them with one at the start. Just make the request without it and supply it if you really need to. If you get your bill paid because a lawyer wrote them, your lawyer doesn't really need your records. The initial inquiry sometimes gets the claim looked over more thoroughly. I am basically recommending this as a scare tactic.

There are actually a lot of errors made in paying complex medical bills at insurance companies for the simple reason that the claims processor may not see an 8 day hospital stay all that often and may have about 10 minutes in which to look your bill over and decide what is payable before moving on. I had to process 60 claims a day to keep my job. This meant I had minutes to decide what the benefits were and people who were very fast were actively rewarded for it. I often cleaned up their messes and, no, this did not get me promoted or anything, even though it sometimes kept the company out of court because the people were threatening to lawyer up.

Best.

Re: The Company Behind Many Surprise Emergency Room Bills

#325

Post by neuronexmachina »

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.

If you're curious, the non-partisan KFF has pretty comprehensive data on how average premiums for single and family coveraged have changed from 1999-2016. The increase is pretty darn linear: http://www.kff.org/report-section/ehbs-2016-section-one-cost...

Re: The Company Behind Many Surprise Emergency Room Bills

#326

Post by tptacek »

dankohn1 wrote: post #316
0xbear wrote: post #300

Earlier quoted context omitted.

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.

Because premium growth actually has slowed since Obamacare was passed: http://www.factcheck.org/2015/02/slower-premium-growth-under...

... and this underplays the effect, because the plans being sold under the ACA have a higher cost basis for insurers than pre-ACA plans do. You can easily observe this for yourself if you're in a major insurance market by calling up an insurer and asking for prices on non-ACA-compliant plans, which are still sold.

Re: The Company Behind Many Surprise Emergency Room Bills

#327

Post by sitharus »

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…

Wow, in New Zealand on a similar public system it's quite different. Having had chronic pain myself I've been through this.

- Book a GP appointment. Generally get in the same day (costs $20-$80 depending on your GP. I have private insurance that pays up to $38) - GP orders blood tests, these are free. Clinic is on-demand, just show up. Wait times are around 30 minutes. Also prescribes ibuprofen ($5 for 100 tablets) and paracetamol (non-subsidised. $10 for 100 tablets). - GP will assess you and refer to a public or private specialist depending on your preference. In my case a public rheumatologist would have taken around a month to see, so I chose private. This cost $180 for the consultation and $120 for follow-up (insurance paid 80%). - Specialist refers more tests. For me this was an MRI. Public wait times were around 3 months because the machine needed replacement and they'd only pay for serious cases to go to the private clinic. I went private, this cost $1400 (insurance paid 80%). - Specialist orders more blood tests, still free.

And they still didn't find anything conclusive.

Personally I'd like GP visits to be free. They can be for people under a certain income level with the right GP. The public system also needs more funding, but in NZ we spend less per capita on socialised healthcare than the US, and the US has to add private insurance on top of that.

Re: The Company Behind Many Surprise Emergency Room Bills

#328

Post by rpenm »

mistermann wrote: post #238
heartbreak wrote: post #114

Earlier quoted context omitted.

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?

A single buyer negotiating with multiple sellers can force prices down to cost. Whether it actually does so is a public choice problem.

Re: The Company Behind Many Surprise Emergency Room Bills

#329

Post by novia »

advisedwang wrote: post #8
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…

Price transparency is pretty meaningless for ER care. Anything that is serious enough for an ER visit probably distracts you from making good economic choices, plus it's likely impractical to change ER (plus you'll pay for that ambulance ride!) Further, it shouldn't be necessary for people to be making financial decisions in the middle of medical emergencies, even if it was easy.

If the pricing was transparent you could factor in the potential costs when deciding where to live.
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