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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

#71

Post by cmurf »

throwawayjava wrote: post #12
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 dow…

I wonder if the local county this school district is in, also provides only a "self-funded" plan to their employees. Are all the government employees getting screwed or just the teachers? It's a quaint ethical puzzle which is worse.

So the last line, "less than half what Aetna paid", does that ostensibly mean the hospital is definitely charging an unreasonable price, and by having been paid twice what is reasonable by Aetna that ostensibly this teacher shouldn't have to pay a dime? It's just a contractual reason he owes this money?

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

#72

Post by scarejunba »

xyzzyz wrote: post #28
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.

I'm not sure if our patient here was quite in a mood for price shopping, with the whole ongoing heart attack thing.

When there's enough competition, all hospitals will be cheap. He won't price shop at illness time. He'll know which hospitals close by he can afford. There'll be three or four equivalently accessible ones and he'll already know which one he's going to go to.

Surgery outcomes in Indian top cardiology hospitals are better than in America. And they're cheaper. And more available. And perform more surgeries per week. Competition is good.

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

#73

Post by swebs »

alkonaut wrote: post #37

There are midterms coming up. Vote for change and don’t vote for anyone who took one cent from the insurers.

And here's a handy list of all representatives and how much they took from healthcare lobbyists.

https://www.opensecrets.org/industries/summary.php?ind=H&cyc...

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

#74

Post by rabidrat »

apetresc wrote: post #62
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…

He shouldn't have to submit for a "discount" based on his "household finances" anyway! What if he doesn't qualify after all? Does he owe $100k if he makes more than $70k/year? Actually what level of income should be the low threshold for having to pay $100k after insurance for your life-critical health event?

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

#76

Post by benmowa »

acomar wrote: post #70
opencl wrote: post #53

Earlier quoted context omitted.

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 th…

sounds like an opportunity....

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

#77

Post by Wohlf »

alkonaut wrote: post #37

There are midterms coming up. Vote for change and don’t vote for anyone who took one cent from the insurers.

That probably rules out every state and federal politician. Either way, this was on the hospital. Insurance paid $50k for an operation that costs $25k, and still the hospital charged him $109k.

>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.”

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

#78

Post by AstralStorm »

stan_rogers wrote: post #46
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

Unfortunately you can't really get a heart arteriogram done as a checkup and anything else is actually guesswork.

Both MRA and CTA are really expensive.

Bloodwork can point to problems but there is still a plenty of differential diagnosis involved... You need a bunch of history (main factors are currently age and family history) to reasonably evaluate risk using e.g. European joint guidelines.

You can perhaps guess better based on local doppler USG of some big extremity artery or of carotid. Doppler of heart is not precise enough to show anything useful.

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

#79

Post by scarejunba »

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.

The doctors are the scarce factor. They determine the price.

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

#80

Post by mnm1 »

The insurance company is basically saying, you should still choose the in-network provider even if you are unconscious or don't have a choice or we'll fuck you financially. I've had this happen to me, appealed, and after many months, actually won. In my case I was unconscious and the ambulance and hospital were out of network. I was lucky the hospital was willing to wait over a year and not send it to collections. It was hell. Why the fuck isn't there a law against this kind of shit? Do we expect people who are unconscious or having a heart attack to say, "oh no, take me to an in-network provider so I don't go bankrupt?" Fucking absurd the healthcare in this country and the lack of proper regulation. How long are we going to allow these insurance companies to get rich while people die and go bankrupt?
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