Emergency room patients can face steep bills even when treatment is declined • Hacker News Board

Re: Emergency room patients can face steep bills even when treatment is declined

#31

Post by c0nfused » Wed, May 02, 2018, 1:33 PM UTC

awicz wrote: post #11

“While we cannot comment on rates for emergency room services..." Why not?

Typically, the rates negotiated with the various insurance companies are basically secret. No one wants to share the data and there is great incentive not to.

If you are in the insurer side, you think you have a competitive advantage compared to company Y. Sharing what you are paying per procedure is bad business

If you are on the Hospital side, you want to make sure the insurers keep paying more, and publishing means a quick race to the bottom.

This means that in most cases in america, you cant know what something is going to cost until after you get billed. Its great for literally everyone except the consumer.

Re: Emergency room patients can face steep bills even when treatment is declined

#32

Post by a-saleh » Wed, May 02, 2018, 1:33 PM UTC

ishansharma wrote: post #3

Carlton87 wrote: post #2

There is an easy way to avoid this, don't go to the Emergency Room unless you have an Emergency.

I guess the point of the article is exhorbitant fees. An ice pack and a bandage in ER don’t have to cost $5k plus.

As far as I know, point of the exorbitant fees is the weird process of collective bargaining between the care-providers and insurers.

I.e. you, as the hospital, inflate your price, by X00% margin over what you actually plan to charge the insurance. Then you let the insurance negotiators negotiate, and you negotiate down to the reasonable price.

This looks really good on the paper. Unfortunately, you as a patient, if you don't have good coverage, you end up paying the inflated price, that you didn't really have the chance of negotiating (and wouldn't really have the chance even if you hadn't been unconcious ;)

Like, if I compare it to Czech Republic, where I live (or even Germany), the prices seem much more reasonable (i.e. you would be able to get a complication-free birth in hospital for ~400$, more complicated, i.e. cesarean section ~1500$, including hospital stay, in US it seem to be 5-10x as much)

Re: Emergency room patients can face steep bills even when treatment is declined

#33

Post by nickjj » Wed, May 02, 2018, 1:33 PM UTC

toomanybeersies wrote: post #9

How can people read and hear about stories like this, and even possibly think it's OK or even normal? How do lawmakers in the USA convince people that this is acceptable? I have never directly paid a single cent for healthcare, and neither has anyone I know. When I had to get 6 stitches in my forehead at 2 AM on a Sunday morning, it cost me nothing. When my friend needed to get the tip of his finger reattached, it co…

It's because most people in the US are brainwashed (note: I live in the US) into thinking paying ~$450 / month per adult for basic health insurance with high deductibles is a bargain because it "saves" them from $100,000+ hospital bills in an emergency scenario. Meanwhile they are still losing ~40% of their income to taxes if they own a small business with no insurance applied.

The messed up thing is, the US also offers "catastrophic" insurance for about $150 / month but they only allow people under the age of 30 to apply for it. But at the same time I'm pretty sure hospitals are forced by law to perform emergency surgery on you regardless of whether or not you have insurance (don't quote me on this).

In 2017 I had to spend thousands of dollars in tax penalties for not having insurance. Welcome to the US!

Re: Emergency room patients can face steep bills even when treatment is declined

#34

Post by merb » Wed, May 02, 2018, 1:33 PM UTC

Arnt wrote: post #13

ishansharma wrote: post #3

Earlier quoted context omitted.

I guess the point of the article is exhorbitant fees. An ice pack and a bandage in ER don’t have to cost $5k plus.

What is it that does cost $5k? Keeping a mostly-unused tomography machine and crew ready in case someone at the ER needs it? Insurance premiums charged per patient who walks in the door? We get these complaints in Germany too (where I currently live) BTW. "A five-minute drive with an ambulance shouldn't cost €500!" someone complained to the newspaper here recently. It doesn't, what costs €500 is keeping enough ambula…

eh in germany driving the ambulance is free - if you really need one. of course there are people who call the ambulance without too much reasons and even than as long as the amublance doctor will allow you to take the drive to the hospital you would still be on the safe side.

Re: Emergency room patients can face steep bills even when treatment is declined

#35

Post by ClassAndBurn » Wed, May 02, 2018, 1:34 PM UTC

No other industry entirely hides the end price you'll pay, or even an estimate, until after you have gone through the service. It's a sad state of affairs but not something we have to be stuck with; most of the time we could get these numbers ahead of time.

ER visits are difficult in their own ways; you can be brought in unconscious and go through treatment you can't agree to, you can be close to death and the time it takes to check costs could impact if you live or not. This means you'd want to do something like fixed costs for these services but with good medical coverage for everyone those fixed costs could be what people do in place of insurance.

I don't have an answer other than universal healthcare. There are reasons that this can't happen at the moment and it's still difficult to implement in a way that works across the board. This is a hard problem and will take a lot of effort to get right

Re: Emergency room patients can face steep bills even when treatment is declined

#36

Post by merb » Wed, May 02, 2018, 1:34 PM UTC

pyvpx wrote: post #30

Arnt wrote: post #13

Earlier quoted context omitted.

What is it that does cost $5k? Keeping a mostly-unused tomography machine and crew ready in case someone at the ER needs it? Insurance premiums charged per patient who walks in the door? We get these complaints in Germany too (where I currently live) BTW. "A five-minute drive with an ambulance shouldn't cost €500!" someone complained to the newspaper here recently. It doesn't, what costs €500 is keeping enough ambula…

what German health insurance plan does not cover an ambulance ride in full?

it does, if you take the ride and are allowed (if you are healthy you probably need to pay) to take the ride.

Re: Emergency room patients can face steep bills even when treatment is declined

#37

Post by maxerickson » Wed, May 02, 2018, 1:35 PM UTC

avs733 wrote: post #15

"Hoboken University Medical Center, where Pell was seen, declined to comment on the bill. The hospital did, according to Pell, reverse the entire balance after Vox began inquiring about the fees." I'll bet the hospital sees that as 'fixing the situation' and all I am left wondering is how many other people don't have Vox reporters sending emails for the same type of treatment. I'm hoping the CMS plan [0] to require p…

I doubt it, hospitals were already required to make those prices available, the change is that they have to make them available on the internet.

While hospitals are already required under guidelines developed by CMS to either make publicly available a list of their standard charges, or their policies for allowing the public to view a list of those charges upon request, CMS is updating its guidelines to specifically require that hospitals post this information. The agency is also seeking comment on what price transparency information stakeholders would find most useful and how best to help hospitals create patient-friendly interfaces to make it easier for consumers to access relevant health care data so they can more readily compare providers.

One reason to doubt it is that an awful lot of people live within reasonable distance of 1 hospital, and almost everyone else lives near busy hospitals.

Re: Emergency room patients can face steep bills even when treatment is declined

#38

Post by sjg007 » Wed, May 02, 2018, 1:35 PM UTC

spsrich wrote: post #22

Any parent has similar stories. Consumer law does not seem to apply to doctors and hospitals. Imagine if you took your car into the shop - there is no price list, they won't give you an estimate, and for weeks after they send you random bills without indicating what it's for? This affects everybody in the US, and I don't understand why it's allowed to continue, except the medical industry has bought off all the polit…

It’s predicated on the HMO model where you pay a copay and your insurance company negotiates the rates. Under the guise of consumer choice insurance companies have expanded copays and coinsurance to shift the burden to the insured. Out of network Hospitals and doctors balance billing needs to be outlawed. They should only be able to balance bill up to the Medicaid rate.

Re: Emergency room patients can face steep bills even when treatment is declined

#39

Post by Talyen42 » Wed, May 02, 2018, 1:35 PM UTC

Hospital corporations and insurance corporations are not your friend.

You shouldn't have to do this in a first world country, but:

* Go to the ER without ID

* (optional) Ask how much it will cost

* (optional) They do not give prices, as a matter of policy

* They must treat you by law

* Afterwards, offer a cash payment you deem reasonable

* They will accept or decline it

Transaction complete.

For non-emergency care and prescriptions, get cash quotes up front, pay in cash, and order discount online prescriptions from canada, a first world country.

For chronic medical conditions, leave the US and immigrate to a first world country.

Re: Emergency room patients can face steep bills even when treatment is declined

#40

Post by chapium » Wed, May 02, 2018, 1:35 PM UTC

nickjj wrote: post #33

toomanybeersies wrote: post #9

How can people read and hear about stories like this, and even possibly think it's OK or even normal? How do lawmakers in the USA convince people that this is acceptable? I have never directly paid a single cent for healthcare, and neither has anyone I know. When I had to get 6 stitches in my forehead at 2 AM on a Sunday morning, it cost me nothing. When my friend needed to get the tip of his finger reattached, it co…

It's because most people in the US are brainwashed (note: I live in the US) into thinking paying ~$450 / month per adult for basic health insurance with high deductibles is a bargain because it "saves" them from $100,000+ hospital bills in an emergency scenario. Meanwhile they are still losing ~40% of their income to taxes if they own a small business with no insurance applied. The messed up thing is, the US also off…

“Brainwashed” is a bit harsh. We put up with this because it’s necessary to work within the constraints of the system.