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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

#461

Post by 0xbear »

isostatic wrote: post #337
0xbear wrote: post #317

Earlier quoted context omitted.

You can measure whatever you like, but my costs have gone up nearly threefold and my plan is worse now than it used to be. I'm not interested in solving world peace here. I just want to understand why insuring a relatively healthy family of three under a very high deductible plan costs $1700/mo, and why is it now illegal to not go along with this ridiculous rip off.

$1700 a month would be £5,440 a year per person. The NHS costs about £3,500 a year per person.

The costs don't end there, though. Other than preventative care, you're also covering the first $6k or so in costs, though the insurance company will negotiate them down for you from the initial insane levels to something merely causing headaches and indigestion. I've yet to pay more than $6k per year, so essentially I'm paying the remaining 20k for the benefit of others. Not even when I broke my ankle a few years ago did the (negotiated) bills total up to more than $10k or so.

Re: The Company Behind Many Surprise Emergency Room Bills

#462

Post by pcwalton »

KekDemaga wrote: post #346
tptacek wrote: post #342

Earlier quoted context omitted.

No, I need a source for "the rate of cost increase is steeper under the ACA than it was prior to the ACA".

"enrollment-weighted premiums in the individual health insurance market increased by 24.4 percent beyond what they would have had they simply followed trends" https://www.brookings.edu/wp-content/uploads/2016/07/Fall201...

The very next two sentences: "The observed premium increase reflects unsubsidized premiums. Insurers receive the full premiums each month, regardless of whether they are paid by the individual or the federal government (IRS 2014). Thus, although the data reflect premiums received by insurers, individuals likely faced smaller changes in premiums after taking the subsidy into account."

It's remarkable that premiums didn't rise more under the ACA, despite how many new previously-uninsurable people were covered.

Re: The Company Behind Many Surprise Emergency Room Bills

#463

Post by parmta »

arcbyte wrote: post #445
parmta wrote: post #370

Earlier quoted context omitted.

I work in investment banking and cover hospital facilities (i.e. the "hospital chains"). You are right that the Kaiser model, or what the industry calls fully integrated systems, can often produce more efficient healthcare. For people that aren't as familiar with the healthcare system, I thought it might be helpful to provide a brief overview of why that is the case. Since the ACA, there has been an emphasis on shift…

I appreciate the time it took you to explain all that. You did a good job. I am in the opposite camp and don't have the time to write out my position to the extent you did. However, I'd just like to take a moment to point out the ludicrousness of calling something that isn't Fee For Service "Value Based", as if there's anything in the world more "value based" than paying someone for the value rendered in a specific s…

Thanks. I would be interested to hear your perspective.

I agree that "value based care" is probably not the best name for a fully capitated system. (Population health might be closer, but still not perfect.) By definition the "value" of something is whatever someone is willing to pay for it. A doctor's reimbursement rate is negotiated with the insurer, so there is an explicit agreement to pay that rate for that service. And by being a member of that health plan, the patient explicitly agrees to pay whatever deductible or copay is required by the plan, based on the rate the insurer negotiated with the doctor. So in a FFS system everyone has actually agreed to pay the price that is charged.

The problem is that as a patient, it is hard to tell how much a medical service will cost before receiving it. In a grocery store, you can look at the price of milk and decide whether it is worth buying. But there are all sorts of reasons why price consciousness is harder with healthcare (for example: emergency care, lack of price transparency, agency issues). And so the idea of value is harder to measure from the patient's perspective, which is why value and price paid may not exactly match.

Re: The Company Behind Many Surprise Emergency Room Bills

#464

Post by slededit »

ssambros wrote: post #451
BurningFrog wrote: post #415

Earlier quoted context omitted.

Sure, but if you're the single possible payer, you can push that number down quite low.

Which would require providers to cut as much corners as they possibly can to stay in business.

At the end of the day their revenue is dependent on throughput of people for their facility. If they gain a poor reputation relative to other providers they will lose. Quality of care would be the only thing they could compete on.

Re: The Company Behind Many Surprise Emergency Room Bills

#465

Post by groby_b »

chrishynes wrote: post #446
groby_b wrote: post #381

Earlier quoted context omitted.

> Argue the whys all you want, these sky high rates have to change. If you don't argue the whys, you're mostly providing a lot of noise that is convenient cover for the next attempt to bilk insured people. Yes, premiums are way too high. They are not high "because ACA", though. In fact, they'll rise at a much faster rate if we get rid of ACA. (The latest bill had an annual rise of $11.4K for a single male adult >62 y…

Certainly, and I am in full agreement with you on pretty much everything you said. I'm ranting against those who continually tell me "it's not that bad", "suck it up", "you're lucky you have insurance" or some variation of the above. The first step in fixing the problem is to recognize the problem, and there's many I've talked with that reflexively reject the premise that there is a problem in the first place because…

> with public healthcare for all and private healthcare available for the rich. That tends to rub Americans the wrong way because fairness,

I lol'ed. Because... we already have private healthcare for the rich, we just don't have public healthcare for all. Because fairness ;)

And I'm very much enamored with the German system as well, but then, I'm biased. I'm from there. (And currently pondering going back there, because as much as I love what the US could be, I hate what it currently is)

Re: The Company Behind Many Surprise Emergency Room Bills

#466

Post by erroneousfunk »

Mz wrote: post #324
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…

Insurance companies and hospitals "accidentally" bill you for the wrong thing all the time, even for the little stuff.

I went to the ER for a broken hand a couple years ago, got a $450 bill in the mail when I should have just had a co-pay. Called the hospital, they said I had to pay. Called my insurance, insurance company said I didn't have to pay. Got in a three way call with the insurance company and the hospital... The billing specialist at the hospital literally said "Sorry, that's a known billing error!"

I'm generally not a conspiracy theorist, but I've never heard of a medical billing error that was in favor of the patient... If you see something alarmingly high or out of whack (especially if you've done your due diligence, read and understood your policy, and researched covered hospitals) you'd be silly not to fight it.

Re: The Company Behind Many Surprise Emergency Room Bills

#467

Post by Declanomous »

et-al wrote: post #432
Declanomous wrote: post #242

Earlier quoted context omitted.

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.

Is your BCBS IL plan an HMO? That could explain the simplicity. I used to be on an HMO, but now it's a PPO with BCBS. The flexibility of choosing my provider hasn't been needed for my case.

Naw, I have a PPO. It's definitely one of the better plans I've seen offered anywhere though. My out of pocket cost is $1000 a year too, so that's pretty sweet.

It's not terribly expensive either. I just started COBRA and it is $750 a month or so.

I'm glad I don't have an HMO, as I'm not organized, and tracking down referrals and such would be a nightmare for me. I've never found a doctor that isn't in my network, so I just figure out which doctor is closest to me and isn't a hack and schedule an appointment. I live a couple of miles from Northwestern University Medical, and Rush University Medical Center, and they've got almost any type of doctor you could possibly need to see.

I don't think my PPO is complicated, but I've never found technical documents that hard to understand. Most of the complications seem to be for emergency and urgent care, but office visits are as uncomplicated as I've made them seem. Some types of lab work might cost more, but I've never been charged for any diagnostic tests outside of cat scans and MRIs.

Re: The Company Behind Many Surprise Emergency Room Bills

#468

Post by raphaelnunez »

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Re: The Company Behind Many Surprise Emergency Room Bills

#469

Post by raphaelnunez »

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Re: The Company Behind Many Surprise Emergency Room Bills

#470

Post by Ricky789 »

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