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

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

#91

Post by acomar » Tue, Aug 28, 2018, 5:51 PM UTC

mnm1 wrote: post #80

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…

> Why the fuck isn't there a law against this kind of shit?

There's a pretty clear answer to this question almost every single time it's asked... the people who benefit are wealthy and the people hurt are poor. The latter structurally lack the ability to fight it or lobby their congresspeople to change the law to help them. Until a mass movement steps forward to say "no, we will not tolerate this", nothing can possibly change. We have no recourse but each other and collective action.

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

#92

Post by acomar » Tue, Aug 28, 2018, 5:54 PM UTC

rabidrat wrote: post #82

thrillgore wrote: post #16

Earlier quoted context omitted.

What about when I need to get a heart valve replaced and my insurance covers 20% of it?

Early death == simpler life. Old age really complicates things.

You joke, and the OP is possibly joking as well, but this is a reality for a lot of people... Their poverty freezes them out of the credit system, they lack health insurance, etc.

Poverty in the US has gotten so bad in some places that it rivals the worst of Africa[0][1].

[0]: https://www.nytimes.com/2018/01/24/opinion/poverty-united-st... [1]: https://www.ohchr.org/EN/NewsEvents/Pages/DisplayNews.aspx?N...

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

#93

Post by jimmydddd » Tue, Aug 28, 2018, 5:55 PM UTC

jhayward wrote: post #11

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.

What's strange is that many hospitals seem to legitimately be in financial trouble. You often hear about smaller hospitals not being able to make it financially, and being gobbled up by larger health networks. How can I be paying them $600 for an asprin, and other fake charges, and they still can't make any money?

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

#94

Post by lotsofpulp » Tue, Aug 28, 2018, 5:57 PM UTC

treyfitty wrote: post #68

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 $3.2…

Health insurance companies' profit margins are restricted by law, whereas Robert Wood Johnson and its executives and doctors profit margins are not restricted. If anyone is on the patient's side from a cost perspective, it's insurance, and the ones benefiting from higher pricing and unnecessary procedures are the providers.

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

#95

Post by acomar » Tue, Aug 28, 2018, 5:57 PM UTC

benmowa wrote: post #76

acomar wrote: post #70

Earlier quoted context omitted.

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....

For what? Lay out a business plan in this area for me that doesn't take money from the worst off.

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

#96

Post by FireBeyond » Tue, Aug 28, 2018, 5:57 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.

When you realize that the hospital was charging $19,000 for a stent that cost $1,500, you realize that painting Calver as someone who is going to cost us all money is misdirected anger.

And, to be clear, they charged $19,000 for the stent, not "stent plus theater time to place it plus surgeon, anesthesiology, OR nurses", of course not. Those are all absolutely billed separately.

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

#97

Post by HarryHirsch » Tue, Aug 28, 2018, 5:58 PM UTC

lainga wrote: post #4

After a reporter made inquiries, St. David’s said collection efforts were put on hold, and a hospital representative called Calver, offering to help him apply for a discount based on his income. I refuse to believe that the US medical system is run by humans, and not trolls we pulled from under a nearby bridge.

No, it's run by people like George Shultz, who himself pays for an on-call boutique physician, while the plebs can get their medical testing for cheap from Theranos. When the grandson, who was a Theranos intern, becomes concerned because Theranos' numbers are not better than throwing darts on a board the grandfather becomes enraged, arguing that his investment and his reputation are being threatened.

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

#98

Post by dboreham » Tue, Aug 28, 2018, 5:58 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.

"accept an insurance" doesn't mean what you think it means.

It just means they will exchange paperwork with said insurance company. Whether or not your policy/company covers treatment is a completely different issue.

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

#99

Post by dragonwriter » Tue, Aug 28, 2018, 5:59 PM UTC

mnm1 wrote: post #80

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…

> 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.

Actually, they are saying if you choose to cut premium costs by selecting a narrow provider network, well, there's a reason why the premium costs are low.

> Why the fuck isn't there a law against this kind of shit?

Because Republicans actively oppose any attempt at health security, and Democrats keep ignoring the majority support for single-payer that polls have shown for close to 30 years in favor of Rube Goldberg solutions that keep private insurers and this type of network-based limitation as central features, despite the fact that hey have less public support and are thus more subject to being politically sabotaged before passage (Clinton) and after (Obama).

Though there's signs of potential for that to change on the Democratic side in the near future...

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

#100

Post by dboreham » Tue, Aug 28, 2018, 5:59 PM UTC

lacker wrote: post #41

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.

They have no idea if the insurance company will pay. I know this from personal experience where the hospital explicitly called insurance co to ask if a procedure would be covered, received confirmation that it would be, AND the hospital recorded the call. But coverage was subsequently denied.