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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

#141

Post by trocadero »

woobar wrote: post #47
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.

Yeah, out-of-network coverage (if provided) is often limited by terms like "the usual, customary, and reasonable amount". When a provider charges unreasonable amount the insurance will not have any contracts that enforce the cost of services. And the patient left holding the bag. ;( My guess is in a situation like this I'd get the reasonable amounts for services provided from my insurer and use them as a basis to ref…

This is a rare case where the insurance company is entirely blameless. According to the article, they paid much more than what experts say is reasonable for the care provided.

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

#142

Post by mgkimsal »

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.

"we accept it" is nowhere near the same thing as "the insurance company will pay for it". Of course they'll "accept" it, it just may not make a difference as to what you owe. they'll put it in their system.

the words used here have vastly different meanings to each party.

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

#143

Post by DesiLurker »

swebs wrote: post #73
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...

whats amazing to me is how little money it takes to sway a politicians vote. yes there are big numbers in the list but most of them are 10s of thousands. its just amazing that they are willing to put their conscience aside and condemn people to bankruptcy or worse for that little. for the worshipers of free market they sure are selling themselves off cheap.

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

#144

Post by krupan »

kimsk112 wrote: post #108
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.

I feel like the issue here is caused more by greedy Health Care company like HCA than the insurance industry.

The insurance industry is the enabler. Is there any other industry where you the individual do not know the cost until some third party that has agreed to pay the cost, negotiates said cost, and then even after negotiation may just give up and say, nevermind, pay it yourself?

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

#145

Post by lotsofpulp »

krupan wrote: post #138
lotsofpulp wrote: post #120

Earlier quoted context omitted.

How does that make it untrue? Health insurance companies are supposed to compete with each other based on their premium prices, and the insurance companies with lower premiums (and hence lower costs) will win more customers.

Except the insurance market doesn't work like that. You get a job, that job determines your insurance. There's no shopping around for the best rates.

That's because the government allowed tax exempt employer funded health insurance to stick around. If everyone was forced onto healthcare.gov then it could be possible. Employers would have one less thing to deal with that has nothing to do with their product and taxpayers wouldn't have to worry about being tied to their employers, and can more accurately compare differences in pay and whatnot.

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

#146

Post by csomar »

Looking at the bill, here is some ridiculous: NaCl (basically salted water) costing around $300/liter.

That's outrageous. These guys are protected by your politicians and make use of mercenary tactics. Villains in doctors clothing.

I'm for free markets but we are kinda going over the limit here. Maybe have fixed rates for emergency where you can't get the approval of the patient. Maybe give the patient the possibility to pay for these ridiculously priced items after.

I mean if I get you 1l of NaCl we'd be cool. And fix the rates for emergency.

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

#147

Post by eric_the_read »

jjeaff wrote: post #49
maxxxxx wrote: post #18

Earlier quoted context omitted.

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.

You can get a price upfront in my experience. Especially for standard procedures. And definitely for outpatient stuff. But it isn't reasonable to expect upfront pricing in things as complicated as heart surgery. Or where you are going in for unknown problems. There is no way to know what complications may arise or additional procedures, x-rays or scans may be required.

I was having trouble sleeping for a while; at one point my doctor recommending I go on oxygen for a while until she could figure it out. I called the company that provided the oxygen, and asked how much it would cost. Nobody knew. I called back 3 times, and still nobody could tell me. I called my insurance company; they couldn't tell me either. I ended up electing not to use it (which turned out to be perfectly fine), but it does seem like this was a fairly standard procedure, for outpatient stuff, and nobody involved knew what the prices were.

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

#148

Post by jhayward »

csomar wrote: post #146

Looking at the bill, here is some ridiculous: NaCl (basically salted water) costing around $300/liter. That's outrageous. These guys are protected by your politicians and make use of mercenary tactics. Villains in doctors clothing. I'm for free markets but we are kinda going over the limit here. Maybe have fixed rates for emergency where you can't get the approval of the patient. Maybe give the patient the possibilit…

Retail cost for Lactated Ringer's solution, injectable (basic saline fluid for IV) was over $40/liter in qty 12 liters about 3 years ago. I can imagine it has gone up since then.

The use of the health care system to extract every single excess dollar from the middle class extends to many, many layers of the supply and service chain. It may be that the saline was "merely" marked up by a factor of 2x.

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

#149

Post by ThrustVectoring »

This is why I plan on moving to Texas: creditor protection.

At any point in time I could require medical services and have medical service providers simply decide that I owe them a truly massive amount of money. The only route I have to mitigate that risk is through creditor protection laws.

In Texas, wage garnishment is limited to child support, unpaid taxes, and some other limited categories that medical billing doesn't have access to. Creditors can sue you, but they can only seize bank accounts, brokerage accounts, and the like - your primary residence is completely exempt, as are employer-sponsored retirement plans and IRAs.

So my emergency medical debt plan is to liquidate all taxable investments and close out bank accounts, send the cash from that to pay down a mortgage, and tell them to pound sand. The only real consequence is having to head to Walmart each month to cash paychecks and mail out money orders to pay bills.

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

#150

Post by petelevinea »

paulcole wrote: post #34

Went to the ER on the advice of my doctor. Went to my insurance's website to find an ER that accepted my insurance. Got there and asked at admittance, "Do you take my insurance?" Was assured they did. Got a big bill a few months later and it turned out the doctor working in the covered ER was not covered by my insurance.

Exact same thing happened to me. I went last April and just now got it all "fixed". I ended up negotiating with the hospital, the contracting company for the hospital's ER department, and my insurance on the phone at the same time to reduce the cost to what the contracting company's ER doctor on staff would normally bill the insurance company and paid that out of pocket.

I guess you have to ask if the doctor who may or may not see you depending on what you're in for also takes your insurance? I don't even know.

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