121–130 of 377 posts
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Hahahahahaha. No. The American legal system is so stacked in favor of insurance companies it's ridiculous.
This isn’t true at all. Insurance is heavily regulated. If you can’t resolve an issue with your insurance, most states have arbitration committee that will smack down insurance companies pretty quickly.
"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.
> 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.
Not always. My mom had a quadruple bypass about 6 years ago during a gap year where she stopped working but didn't have Medicare yet. Unlucky. I think she was billed for around $180k. She told them "I'm on Social Security for $1000/mo, I'll pay you $50/mo". It was basically that or sending it to collections and never getting a dime from a retiree. So they accepted and told her a "non-profit" paid for the doctor's por…
Just another data point, a large property management company I used to work for specifically exempted bankruptcies due to medical debt when calculating applicant credit scores.
There are midterms coming up. Vote for change and don’t vote for anyone who took one cent from the insurers.
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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…
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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.
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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 b…
People in the US are used to their employers purchasing group health plans from insurance companies. In that model, a premium (often part paid by the employer, part by the employee) is paid to an insurance company in return for coverage. When there's a claim, the insurance company pays, out of its own money, and the insurance company's profit comes from taking in more money in premiums than it pays out in claims.
In a self-funded plan, the employer and employees still pay premiums, and all that money goes into a pool which is used to pay the claims. Typically a company is hired to administer the plan, but that company is not an insurer, and that company does not pay claims; the money to pay off claims comes directly out of that pool of premiums.
What this means is that the administrator just pays whatever it's told to pay by the company that hired them to run the plan. It's not the administrator's money being spent, and their profit is in the fees they charge to run the plan, not in denying or underpaying claims.
My very first real job out of school, years and years ago, was a place that did administration for self-funded plans. About once a month we'd get a call from one of our client companies saying "yeah, we know our plan's rules say not to pay that claim, but we want to pay that claim". And we'd say "OK, it's your plan and your money, you make the rules".
The downside is that if the company gets into financial trouble, its contributions to the pool of money that pays claims are often one of the first things to stop happening. I remember pretty clearly one client company that went bankrupt and just stopped paying into its plan, and once the money in the plan's pool ran out there were no more claims paid.
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Supply of doctors is definitely an important issue. But prices are high not because they can't find doctors. It is high because they have no real competition. When someone is suffering from a heart attack what options do they have than to go to the nearest hospital? Even in non-emergency situations people chose to go to the healthcare provider nearest to them. Also even if we assume people magically able to chose any…
If this were true, then nations with deregulated health care would also have high prices. Instead they have low prices and better outcomes. Patients shop on reputation. In a country with less regulation, like India, you see competing hospitals across the spectrum of price and performance. Everyone knows which ones are good and which ones are expensive. People know which hospitals they're going to attend before they f…
For the majority of lower-middle and poor class, medical care is hard to obtain because they cannot afford the private care, and the government-run hospitals that offer low-cost care suffer from bad service, and inadequate facilities/medicine.
India is well on its way to emulating the American medical system:
(1) medical costs have been rising at a rate of 15-25% a year (where inflation has been 5-10%). This is okay for now, but in about 2 decades will price out even the affluent classes.
(2) Health insurance is being touted by the Indian government as a solution to this -- which is the first step to going down towards the American model of healthcare. India also has poor safeguards against crony capitalism so I expect large insurance companies to capture the regulatory framework to frame rules in their benefit.
> 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 tra…
At these rate differences it starts seeming prudent to medical airlift to the right hospital...
How is a regular person who has other things to do than to read and understated all the details and traps of his health insurance supposed to navigate this insane system? From what I read going to a hospital is pretty much a gamble that has a certain probability to bankrupt you and there is pretty much nothing you can do about it. There should be bipartisan agreement that these practices are just not acceptable and t…
If I think you are trying to extort me, I am just going to go to another hospital.