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

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

#61

Post by Scarblac » Tue, Aug 28, 2018, 5:34 PM UTC

InclinedPlane wrote: post #51

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.

You think someone who is staring at bankruptcy is going to say to themselves "I know what I'll do, I'll spend thousands of dollars I don't have on a lawyer to solve this problem for other people in 5 years"?

You're right, that's unrealistic. In fact this sort of thing is why government was invented.

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

#62

Post by apetresc » Tue, Aug 28, 2018, 5:35 PM UTC

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.

Later in that correction paragraph, it says:

> In a statement, the hospital said this offer was contingent on Calver submitting his application for a discount based on his household finances. Calver disputed that he owes any additional money to St. David’s and said this situation should have been resolved long before now.

I might be misreading, but is this saying that Calver isn't going to accept even the $700 charge, just to make a statement? I obviously side with him but this seems like a crazy stand to take on principle alone.

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

#63

Post by mabbo » Tue, Aug 28, 2018, 5:35 PM UTC

If you owe a 6-figure amount of money because of a health issue, you don't actually have health insurance.

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

#64

Post by huevosabio » Tue, Aug 28, 2018, 5:36 PM UTC

opencl wrote: post #53

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.

There is a whole industry of "medical billing advocates" you can pay to find what is likely thousands if not tens of thousands of dollars of completely made up charges on any given US hospital bill and "negotiate" them away. You don't necessarily need press coverage though it obviously helps. Hell one time I got a $15k bill for something insurance should have covered. Called the hospital, turns out insurance had cove…

Billing "mistakes" seem to be standard practice.

I went through surgery at the Stanford Hospital, using Stanford's insurance. Prior to the surgery, they charged me $2000, the out of pocket maximum. Then, a couple of weeks post-surgery. I got another $250 bill. I had to spend the whole day on the phone first with the hospital, then the insurance, and then the hospital.

Turns out, that all I had to pay was $250, that the hospital had made a mistake in billing me $2000 at the door. I got my money back a month later.

I would normally attribute this to ineptitude. But the frequency and scale with which this happens, reeks of widespread scams.

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

#65

Post by exolymph » Tue, Aug 28, 2018, 5:36 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.

Mere acceptance of insurance doesn't mean there won't be an exorbitant copay, anyway.

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

#66

Post by jhayward » Tue, Aug 28, 2018, 5:37 PM UTC

lacker wrote: post #36

jhayward wrote: post #11

Earlier quoted context omitted.

> 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.

I was going to respond saying that most hospitals are nonprofits and aren't actually making a great profit margin off this sort of overcharging. But then I looked it up and St. David's, despite having a religious nonprofit-sounding name, is actually owned by HCA Healthcare, which is a for-profit that has almost 4x'd its stock price over the past five years while acquiring more hospitals to grow. So, yeah, this one is…

> despite having a religious nonprofit-sounding name

They came by the name honestly, but it is indeed a shame the way it has gone since the St. David's Foundation partnered with HCA.

The hospital(s) were originally founded and run by St. David's Episcopal and were one of the first and foremost hospitals in Austin, with very high quality care and good service to the community.

After operating them for nearly 75 years, and growing to an enormous enterprise, it became clear that a church congregation simply couldn't and shouldn't be operating them any further and they were spun out. Some of the profits are still sent back to the foundation for community health care grants.

This particular wealth extraction strategy would never have occurred under church leadership.

(disclaimer: I was a member of the church during this period and hold it in very high regard)

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

#67

Post by badcede » Tue, Aug 28, 2018, 5:37 PM UTC

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.

Sounds a bit like getting support from Google.

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

#68

Post by treyfitty » Tue, Aug 28, 2018, 5:37 PM UTC

My father had a heart attack 4 months ago, and he’s been in and out of the ICU for 3 of those months. Everyone likes to think “oh, I’m insured. I’ll be fine.” But let me tell you, you won’t be fine. 3 months of ICU at Robert Wood Johnson was billed for $4Mn. BCBS-NJ only paid out $750k. The headache begins there- from a personal financial standpoint, and Tri-party incentive standpoint. Ignoring the difference of $3.25Mn “owed” to the hospital (technically, this $4Mn is an exaggerated number by RWJ to recoup as much as they can), the insurance company is essentially denying basic/reasonable services. The doctors have been fighting with insurance to get him to an LTACH, but the most they’ll pay for is a nursing home.

Insurance is a business. They aren’t looking out for you, or your loved ones. I hate to sound cynical, but boy, these past 4 months have shown me the deepest, ugliest side of commerce that inevitably results from aligning incentives with profits.

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

#69

Post by jim-jim-jim » Tue, Aug 28, 2018, 5:39 PM UTC

Just cut the gordian knot and nationalize the system already. It's a political no-brainer. There are very few Americans, even conservative ones, who are in love with the intricacies of paying medical bills. The only people beholden to the status quo are those paid to defend it.

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

#70

Post by acomar » Tue, Aug 28, 2018, 5:39 PM UTC

opencl wrote: post #53

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.

There is a whole industry of "medical billing advocates" you can pay to find what is likely thousands if not tens of thousands of dollars of completely made up charges on any given US hospital bill and "negotiate" them away. You don't necessarily need press coverage though it obviously helps. Hell one time I got a $15k bill for something insurance should have covered. Called the hospital, turns out insurance had cove…

Yea, but to hire a medical billing advocate, you need: 1) knowledge/information that they exist and that hospital bills are BS, and 2) money to pay the advocate AND the reduced bill. If the final bill is $800 and the advocate gets a cut of the savings, how many people in dire straights are likely to be able to afford that? Keep in mind, most Americans don't have 1k in savings, living pay check to pay check because they have no choice. Facing a 100k bill, people are more likely to wait for the collector to show up and then declare bankruptcy, facing damage to their already poor credit, garnishment of already subsistence wages, etc..

I'm much less worried about the folks who pay it anyway than I am about the folks whose lives are destroyed by an industry predating on people in the worst of circumstances.