If you owe a 6-figure amount of money because of a health issue, you don't actually have health insurance.
You do, it just doesn't cover you at all medical providers in all 50 states.
Insured, but Still Owing $109K for a Heart Attack
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Re: Insured, but Still Owing $109K for a Heart Attack
#102There 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…
> That probably rules out every state and federal politician.
That sounds absolutely dystopian. A politician running on a platform to reform healthcare can’t possibly be bribed by the companies that would die in the process.
Re: Insured, but Still Owing $109K for a Heart Attack
#103Earlier 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.
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?
Well, you'll notice on this bill in the article they've taken to charging "near retail" pricing for aspirin, and generic pricing for common drugs many of us will know the price of (still relatively outrageous, but $1/pill for aspirin, $10/pill for metoprolol).
Why? Not out of the kindness of their hearts. They know that their name showing up with a bill for $500 for ASA is bad PR, so better to make those common things realistic, and pad their numbers elsewhere (like charging $19,500 for a $1,500 stent)...
Re: Insured, but Still Owing $109K for a Heart Attack
#104The 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…
Do you expect one organization to have a pricing agreement with every single medical provider in the USA?
Re: Insured, but Still Owing $109K for a Heart Attack
#105The 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 possib…
Based on voting demographics, the poorest are the ones who are voting for politicians who hate the government and are opposed to any kind of subsidized healthcare.
Re: Insured, but Still Owing $109K for a Heart Attack
#106The 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...isn't there a law against this.. ?
Because the laws are made by people bought and paid for by the people perpetrating this fraud?
Re: Insured, but Still Owing $109K for a Heart Attack
#107My 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.
> 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.
Untrue, because health insurers profits are limited by law, sure, but to a specified fraction of the costs they pay; if their payouts are too small, they have to refund the excess profits to the people paying premiums.
Re: Insured, but Still Owing $109K for a Heart Attack
#108There are midterms coming up. Vote for change and don’t vote for anyone who took one cent from the insurers.
I feel like the issue here is caused more by greedy Health Care company like HCA than the insurance industry.
Re: Insured, but Still Owing $109K for a Heart Attack
#109> 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. So while dying of a heart attack he should have been negotiating with the ambulance driver, the paramedics, the nurses, each intern and doctor to make sure they are "in-network". > St. David’s said it was now willing to accept $782.29 to resolve the $108,951 balance bec…
> So while dying of a heart attack he should have been negotiating with the ambulance driver, the paramedics, the nurses, each intern and doctor to make sure they are "in-network".
Absolutely! I work in EMS. Thankfully, our Medic One system is funded entirely by property taxes and we simply do not bill (at all) for any treatment or transport.
However, a few years ago United got a lot of grief over denying airlift transport claims from things like MVAs, or traumas in remote locations, stating that the "transport had not been pre-approved through the insurer".
Apparently in their mind, us paramedics (or maybe the chopper pilot) should have been calling in between stabilizing our patient...
"This is John, I'm a paramedic working on one of your patients who was hit by a truck. We would like to fly him to the hospital due to his extensive multisystem trauma but we need your approval. His name? Hang on, let me find his wallet. No, that's Smythe, S-M-Y-T-H-E, sorry, it's a bit loud with the jaws of life in the background... Yes, I can hold for a nurse consult..."
Re: Insured, but Still Owing $109K for a Heart Attack
#110My 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.
That’s why three party systems, such as this, is a headache. Everyone involved has vastly different goals, and incentives.
Insurance companies are mandated to strict profit margins, yes. But they aren’t mandated to align with what the other parties say a patient needs. This creates a situation where insurance companies can discriminantly choose which services, and level of care to agree to pay for.
I see it happening right now: Long story short, to put it into everyday terminology, our family and the mechanic is urging for a new engine. Insurance is saying “all you need is air in your tires. That’s all we’ll approve.”