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Insured, but Still Owing $109K for a Heart Attack

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Re: Insured, but Still Owing $109K for a Heart Attack

#11

Post by jhayward »

jtokoph wrote: post #7

> UPDATE: Monday, shortly after publication and broadcast of this story by Kaiser Health News and NPR, St. David’s said it was now willing to accept $782.29 to resolve the $108,951 balance because Drew Calver qualifies for its “financial assistance discount.” Sounds all fine and dandy until you realize that these charges will just be made up for by people that aren't able to get NPR to publish a story about them.

> Sounds all fine and dandy until you realize that these charges will just be made up for by people that aren't able to get NPR to publish a story about them.

No, St. David's has already fully recouped their costs and then some. They were simply trying to extract as much money as the stone could bleed.

Re: Insured, but Still Owing $109K for a Heart Attack

#12

Post by throwawayjava »

cmurf wrote: post #2

FTA St. David’s is out-of-network on his school district health plan So apparently the "max out of pocket" on the cover sheet of your plan is b.s. and only applies in-network. I guess good luck having in-network coverage if you're on a vacation and have an emergency.

The article goes on to clarify the problem: the school district has a self-funded insurance plan.

Actionable advice: check if your employer-provided healthcare is a self-funded insurance plan or a fully insured plan. And then look up the relevant consumer protections in your state for that type of plan.

Also, in case you're wondering what the hell all those hospital administrators are dong, the answer is "shaking down your employer and screwing you over":

> In a statement, St. David’s HealthCare defended its handling of Calver’s bill and sought to blame the school district and Aetna for offering such a narrow network.

>“While we did everything right in this particular situation, the structure of the patient’s insurance plan as a narrow network product placed a large portion of the financial responsibility directly on the patient because our hospital was not in-network,” the hospital said.

> WellRithms reviewed Calver’s bill in detail at the request of Kaiser Health News and determined that a reasonable reimbursement would have been $26,985. That’s less than half what Aetna paid.

Re: Insured, but Still Owing $109K for a Heart Attack

#13

Post by FactolSarin »

jtokoph wrote: post #7

> UPDATE: Monday, shortly after publication and broadcast of this story by Kaiser Health News and NPR, St. David’s said it was now willing to accept $782.29 to resolve the $108,951 balance because Drew Calver qualifies for its “financial assistance discount.” Sounds all fine and dandy until you realize that these charges will just be made up for by people that aren't able to get NPR to publish a story about them.

Yeah, more like he qualifies for the "got some sympathetic media coverage" discount. That's not something most people can count on.

Re: Insured, but Still Owing $109K for a Heart Attack

#15

Post by FactolSarin »

quickben wrote: post #3

All this is a bit surreal (Canadian here), but it prompts the question: why won't people sue in a class action to refund money they gave to the insurance in the first place? I realize it's a complex subject, but at the end of the day, the insurance companies advertise and sell: insurance.

Hahahahahaha. No. The American legal system is so stacked in favor of insurance companies it's ridiculous.

Re: Insured, but Still Owing $109K for a Heart Attack

#18

Post by maxxxxx »

scarejunba wrote: post #6

Well, it doesn't have to cost that much to take care of a heart attack. Remove the AMA from the equation and it'll clear up. The real problem is that we restrict the supply of doctors. Without that, competing hospitals can arise that will compete on price.

Why don't they compete now or why can't you even get a price upfront from them?

EDIT: I am responding to a comment that the AMA is the problem. Maybe the AMA is a problem but it has nothing to do with hospitals not competing over prices.

Re: Insured, but Still Owing $109K for a Heart Attack

#19

Post by refurb »

FactolSarin wrote: post #15
quickben wrote: post #3

All this is a bit surreal (Canadian here), but it prompts the question: why won't people sue in a class action to refund money they gave to the insurance in the first place? I realize it's a complex subject, but at the end of the day, the insurance companies advertise and sell: insurance.

Hahahahahaha. No. The American legal system is so stacked in favor of insurance companies it's ridiculous.

This isn’t true at all. Insurance is heavily regulated. If you can’t resolve an issue with your insurance, most states have arbitration committee that will smack down insurance companies pretty quickly.

Re: Insured, but Still Owing $109K for a Heart Attack

#20

Post by donretag »

"Calver asked whether his health insurance would cover all of this... The hospital told him not to worry and that they would accept his insurance."

From my experience, it is completely legal for any medical practitioner to say they accept an insurance even though they really do not.

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