Insured, but Still Owing $109K for a Heart Attack • Hacker News Board

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

#41

Post by lacker » Tue, Aug 28, 2018, 5:21 PM UTC

donretag wrote: post #20

"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.

From my experience, no human at the hospital has any idea whether they will accept your insurance or not. The doctors certainly don't. They just report things into the bill-processing system which occasionally delivers patients a crazy $100,000 bill.

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

#42

Post by [deleted] » Tue, Aug 28, 2018, 5:22 PM UTC

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.

[deleted]

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

#43

Post by aaroninsf » Tue, Aug 28, 2018, 5:22 PM UTC

Here is a reminder that in the US, we pay much more and receive far worse outcomes than any other first world nation, by any metric you care about: life expectancy; infant mortality; incidence of chronic disease; obesity; incidence of addiction; etc.

Then consider we are the only first-world nation in which medical bankruptcy is not just a thing, but a profound source of anxiety and genuine risk.

What do we get in exchange for worse care, worse lives, and risk of financial ruin...?

A "free market" like the one functioning in OP's case. Oh, and in the time since the ACA passed? Record private industry profits.

It's not just Trumpism sh-tcanning this country.

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

#44

Post by lacker » Tue, Aug 28, 2018, 5:22 PM UTC

kimsk112 wrote: post #23

> Industry analysts and consumer advocates say St. David’s has a reputation for exorbitant billing and for trying to collect big payouts as an out-of-network provider. Sounds just like St. David’s Medical Center in Austin, TX is run by crooks. I like the take-home message that "Faced with a surprise bill or a balance-billing situation, don’t rush to pay any medical bills you receive."

More specifically, it is run by HCA Healthcare, a for-profit company listed on the NYSE.

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

#45

Post by pc86 » Tue, Aug 28, 2018, 5:23 PM UTC

agumonkey wrote: post #40

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.

The power of companies. They write words and numbers on a stamped letter and now it's god spell. I once played dumb to an importer abusing fees, after monthes of bouncing mails to different people babbling the same thing over and over, then dealing with a 'lawyer firm' who behaved the same (basically nobody knew precisely what they were talking about). They suddenly accepted to give me a rebate of NN%. So I received…

I don't think anyone is treating the company's word as law. Just about everything is open to negotiation just about all of the time.

I'm assuming you mean "gospel" and not the 1971 Broadway musical.

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

#46

Post by stan_rogers » Tue, Aug 28, 2018, 5:24 PM UTC

donclark wrote: post #29

I curious to know the details of his health. He just did an IRONMAN 5 months before. Why was he unaware of the status of his clogged “widow-maker” artery? Why was his artery clogged? high cholesterol? What does his diet consist of? Use of ultrasound imaging to measure the thickness of the inner walls of the carotid arteries that supply blood to the brain. Increasing carotid artery intima-media thickness, or CIMT, ind…

There's not always a lot in the way of warning signs, and people tend not to get casual arteriograms just for kicks. The apparently-healthy suddenly dropping dead isn't exactly a rare phenomenon, and "being in shape" can be misleading. Jim Fixx[1] was kind of the poster child for this sort of thing; his death pretty much kicked off the over-40 checkup routine.

[1]https://en.wikipedia.org/wiki/Jim_Fixx

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

#47

Post by woobar » Tue, Aug 28, 2018, 5:24 PM UTC

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.

Yeah, out-of-network coverage (if provided) is often limited by terms like "the usual, customary, and reasonable amount". When a provider charges unreasonable amount the insurance will not have any contracts that enforce the cost of services. And the patient left holding the bag. ;(

My guess is in a situation like this I'd get the reasonable amounts for services provided from my insurer and use them as a basis to refuse any unreasonable charges.

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

#48

Post by PeekPoke » Tue, Aug 28, 2018, 5:25 PM UTC

aaroninsf wrote: post #43

Here is a reminder that in the US, we pay much more and receive far worse outcomes than any other first world nation, by any metric you care about: life expectancy; infant mortality; incidence of chronic disease; obesity; incidence of addiction; etc. Then consider we are the only first-world nation in which medical bankruptcy is not just a thing, but a profound source of anxiety and genuine risk. What do we get in ex…

This is why it's good to be English - our national health service fixes you up and sends you on your way without providing you with a bill.

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

#49

Post by jjeaff » Tue, Aug 28, 2018, 5:25 PM UTC

maxxxxx wrote: post #18

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.

You can get a price upfront in my experience. Especially for standard procedures. And definitely for outpatient stuff.

But it isn't reasonable to expect upfront pricing in things as complicated as heart surgery. Or where you are going in for unknown problems. There is no way to know what complications may arise or additional procedures, x-rays or scans may be required.

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

#50

Post by maxxxxx » Tue, Aug 28, 2018, 5:26 PM UTC

donclark wrote: post #29

I curious to know the details of his health. He just did an IRONMAN 5 months before. Why was he unaware of the status of his clogged “widow-maker” artery? Why was his artery clogged? high cholesterol? What does his diet consist of? Use of ultrasound imaging to measure the thickness of the inner walls of the carotid arteries that supply blood to the brain. Increasing carotid artery intima-media thickness, or CIMT, ind…

"I curious to know the details of his health. He just did an IRONMAN 5 months before. Why was he unaware of the status of his clogged “widow-maker” artery? Why was his artery clogged? high cholesterol? What does his diet consist of?"

That just happens. There are people who are in great health and drop dead one day. Whatever you do lifestyle-wise just improves your chances of being healthy but there are no guarantees. You can smoke a pack of cigarettes daily and live up to 100 and others will get lung cancer without ever touching a cigarette.