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

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

#211

Post by loeg » Tue, Aug 28, 2018, 7:50 PM UTC

antisthenes wrote: post #165

FireBeyond wrote: post #96

Earlier quoted context omitted.

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.

Hospitals should be legally mandated to accept replacement of materials in lieu of payment. If I can source the same stents for cheaper than the hospital bills me, they should be required to erase them from the bill and accept them as material replacement. It's not as if medical supplies are unavailable to the end consumer. https://www.esutures.com/product/0-in-date/41-boston-scienti... Here are the stents available…

> Hospitals should be legally mandated to accept replacement of materials in lieu of payment.

> If I can source the same stents for cheaper than the hospital bills me, they should be required to erase them from the bill and accept them as material replacement.

Meh. The only reason they inflate supply costs is because that's where insurance negotiations let them. Mandating supplies must be available at-cost to consumers is just a stupid cost-shifting game. Consumers shouldn't care in particular about the cost of supplies — overall cost is what matters.

Price-fixing in general does not really work. The difference is made up somewhere. Things that would actually reduce pricing stupidity and surprise bills are obvious things like: increased pricing transparency, consumer stake in reducing costs (HDHPs are a stab in this direction), and single payer.

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

#212

Post by burkaman » Tue, Aug 28, 2018, 7:51 PM UTC

krupan wrote: post #205

0x7f800000 wrote: post #130

Earlier quoted context omitted.

Yes, I demand full and final information about what the heart attack I am currently suffering is going to cost me to be treated at this hospital. If I think you are trying to extort me, I am just going to go to another hospital.

I'm actually not sure if you are being serious. If the information on costs for emergency services were clear and available up front people could shop around ahead of time and basically write up a living will saying, if I have a heart attack, take me here. Insurance companies are the reason the costs are not clear and up front.

Are you serious? You think every American should be required to write a living will for them and their children listing every conceivable illness and injury by individually researching all the medical options in their area? And what, update it weekly as they follow the markets? Should they keep up with the latest medical research so they know what the newest drugs and treatments will cost? What about vacation, do you need to do a week of research to prepare for a weekend trip to NYC?

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

#213

Post by hellofunk » Tue, Aug 28, 2018, 7:57 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.

I think this is pretty common. If you get a hospital bill and the insurance already paid a lot, call up the hospital and complain, and it will often be lowered. This happened to me once, a $15k bill was reduced to $3k. The insurance had already paid $50k or so. Hospitals don't really seem to care about the extra portion the patient is supposed to pay. The try to get it, but don't make much fuss when you challenge it, since they already got what they really wanted, the insurance company's money.

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

#214

Post by DennisP » Tue, Aug 28, 2018, 7:57 PM UTC

krupan wrote: post #209

Here's the deal. Insurance is a simple concept. Take house fires. They are fairly rare, but they do happen. We could all just save up enough money to cover a house fire ourselves, or, since we know that house fires are rare, we can pool our money together as friends and neighbors and when one of us in that pool gets unlucky and has their house burn down, it can be covered by insurance. A lot of us pay a little money…

One reason they do it that way is that if you don't pay for screenings and small problems, people tend to skip going to the doctor for them, and you end up paying for more big, expensive problems.

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

#215

Post by antisthenes » Tue, Aug 28, 2018, 7:59 PM UTC

loeg wrote: post #211

antisthenes wrote: post #165

Earlier quoted context omitted.

Hospitals should be legally mandated to accept replacement of materials in lieu of payment. If I can source the same stents for cheaper than the hospital bills me, they should be required to erase them from the bill and accept them as material replacement. It's not as if medical supplies are unavailable to the end consumer. https://www.esutures.com/product/0-in-date/41-boston-scienti... Here are the stents available…

> Hospitals should be legally mandated to accept replacement of materials in lieu of payment. > If I can source the same stents for cheaper than the hospital bills me, they should be required to erase them from the bill and accept them as material replacement. Meh. The only reason they inflate supply costs is because that's where insurance negotiations let them. Mandating supplies must be available at-cost to consume…

Trivially disproven by UK's health care system, which consistently ranks #1 in the world by outcomes and employs price caps for health care suppliers.

https://www.commonwealthfund.org/press-release/2017/new-11-c...

> Mandating supplies must be available at-cost to consumers is just a stupid cost-shifting game.

That's not what I suggested in my post at all.

Also, if it reduces costs for the end consumer, what's the harm? Why should consumers subsidize hospitals with cutthroat billing departments who make up numbers out of thin air?

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

#216

Post by krupan » Tue, Aug 28, 2018, 7:59 PM UTC

burkaman wrote: post #212

krupan wrote: post #205

Earlier quoted context omitted.

I'm actually not sure if you are being serious. If the information on costs for emergency services were clear and available up front people could shop around ahead of time and basically write up a living will saying, if I have a heart attack, take me here. Insurance companies are the reason the costs are not clear and up front.

Are you serious? You think every American should be required to write a living will for them and their children listing every conceivable illness and injury by individually researching all the medical options in their area? And what, update it weekly as they follow the markets? Should they keep up with the latest medical research so they know what the newest drugs and treatments will cost? What about vacation, do you…

"listing every conceivable illness and injury"

No. Just the ones that are true emergencies where you won't have time to do any shopping around ahead of time. Why is this such a hard concept? Think of all the times you've seen a doctor in your life. How many of those were super time critical? Big accidents and heart attacks are. Having a cold or flu isn't. Heck, even cancer isn't super time critical, you could take a few days to shop around treatment centers. Shopping around for most medical care shouldn't be that weird of a concept.

Another option would be to only have insurance for those critical time sensitive events, then you don't have to be super price sensitive for those, and the free market could drive down prices of all the other medical care we get.

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

#217

Post by TomVDB » Tue, Aug 28, 2018, 8:00 PM UTC

h4b4n3r0 wrote: post #139

TomVDB wrote: post #115

Earlier quoted context omitted.

And in some systems, horror stories are way more common than others. The simple fact is that I don't know anybody from my European family or friends who would willingly switch their system to the US one. And as a very well insured employee in the US, if, hypothetically, I had the option to use my European health care in the US, I'd switch immediately a well.

>> I'd switch immediately a well I doubt it. Someone needs to pay for it, so this switch would have to imply a 20% tax increase. Unless you’re paid peanuts, it’s not worth the tradeoff.

> Someone needs to pay for it

Or you could pay less for it.

There are many studies that show how the US system has incredibly high overhead that simply isn't needed.

Just an example: in the US, a primary care physician usually has a nurse and somebody who handles paperwork, insurance BS, and what not. Most European countries simply don't have this, mostly because there is no insurance BS to deal with.

There is insurance related overhead every step of the way.

And that's not including the free-for-all pricing of $500 saline bags.

Your 20% tax increase is ridiculous. It doesn't have to be nearly that high (and it isn't.) And even though I'm in the highest tax bracket, I'd gladly pay 5% more if it meant quality medical care for everyone without any risk of bankruptcy.

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

#218

Post by NTDF9 » Tue, Aug 28, 2018, 8:05 PM UTC

Has anyone in the US considered flying overseas to get treatment done? Many hospitals in third world countries are cheaper and more humane.

Sure, you lose out on the ability to sue them if things go awry but where is the tradeoff between six figure debt at an old age vs paying $10000 to get the whole thing done?

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

#219

Post by krupan » Tue, Aug 28, 2018, 8:05 PM UTC

DennisP wrote: post #214

krupan wrote: post #209

Here's the deal. Insurance is a simple concept. Take house fires. They are fairly rare, but they do happen. We could all just save up enough money to cover a house fire ourselves, or, since we know that house fires are rare, we can pool our money together as friends and neighbors and when one of us in that pool gets unlucky and has their house burn down, it can be covered by insurance. A lot of us pay a little money…

One reason they do it that way is that if you don't pay for screenings and small problems, people tend to skip going to the doctor for them, and you end up paying for more big, expensive problems.

Yes, and is that line of reasoning working? Are we as a society saving money doing it that way?

It seems what people really need is just a savings account and some incentive to actually save money for future expenses (because knowing that someday you are going to get an illness that 100% of people get apparently isn't enough motivation).

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

#220

Post by jfk13 » Tue, Aug 28, 2018, 8:05 PM UTC

jhayward wrote: post #155

acomar wrote: post #131

Earlier quoted context omitted.

I've suddenly started seeing this take all over the place and I have no idea where it comes from because it doesn't make sense. That the insurance companies profit margins are restricted means rather little because executive pay isn't capped: if they earn too much money, they can simply pay bonuses to raise their expenses. Or cut shareholders a check. Or. Or. Or. Tangentially, this is why "non-profit" doesn't mean wh…

> I've suddenly started seeing this take all over the place and I have no idea where it comes from because it doesn't make sense. That the insurance companies profit margins are restricted means rather little because executive pay isn't capped: if they earn too much money, they can simply pay bonuses to raise their expenses. Or cut shareholders a check. Or. Or. Or. Tangentially, this is why "non-profit" doesn't mean…

> This is not correct, as I understand it. Under the ACA (Obamacare), health plan providers had to ensure that at least 80% of premiums were paid out for patient services. That leaves 20% for overheard, including profit and compensation.

Doesn't this imply that it's in the interest of health plan providers for patient services in general to be as expensive as possible? That means premiums will have to be correspondingly high, and the 20% available for profit and compensation will be larger.