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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

#311

Post by kbos87 »

I have a relative sick with cancer right now and I’m seeing this first hand. Hearing stories like this you hope it’s a one off, but it’s absolutely the norm of how insurance companies operate.

My aunt is still employed, fully insured, and every day is a fight between her and her insurance company. They randomly deny claims for chemo treatments, and put her through invasive procedures to verify the disease after doctors formally diagnosed her.

The list of landmines they strategically place that could cause her to lose her insurance seems to only grow. This payment isn’t made on this date? Insurance gets cancelled. This form isnt filed on this day three months from now? Insurance gets cancelled. Forget the fact that she is too sick to work; her insurer is already busy trying to figure out how to not pay.

Unless you are wealthy enough to pay for everything yourself, everyone in the US should expect to be left behind by the health insurance they’ve paid their entire life for as soon as the insurer can figure out how to do it.

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

#312

Post by dragonwriter »

mnm1 wrote: post #294
dragonwriter wrote: post #99

Earlier quoted context omitted.

> 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 o…

Your first point is simply not true. There is no plan that covers every ER and every hospital. Even on the top plans, there are in-network and out of network providers. So once again, we're back to making decisions while incapacitated or unconscious. No matter how carefully you chose your plan and how much you pay, you're still fucked. Not to mention that almost everyone is stuck with the plans their employers choose…

> Your first point is simply not true.

My first point is what the insurance company is saying. It's absolutely true that they are saying that. (It's also a true claim; your argument that all provider networks are limited such that the risk of similar problems exists at some level in all insurance plans is perhaps pedantically true, but not necessarily relevant—e.g., it may be that the only reason the care from the profile provider in this particular case was out of network was that the district's individually negotiated narrow network plan excluded providers that would have been included in standard plans this insurer offered in the area.)

> Not to mention that almost everyone is stuck with the plans their employers choose.

That's factually false; only 49% of Americans are covered by insurance provided by an employer (either their own or as a dependent) health insurance, and not all of them have no other practical option than that plan, so, no “almost everyone” is not stuck with their employer's plan choices.

But, in any case, the employer's plan choice is exactly what the insurance company is highlighting as the issue in this case.

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

#313

Post by Sohcahtoa82 »

defen wrote: post #200
achoped wrote: post #85

Earlier quoted context omitted.

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 let it go to collections. You'll get harassed for a little over a year. Debt older than a year is almost never pursued by collections agencies. I don't understand. Is there no penalty to not paying other than a hit on your credit score? Can't you end up with wage garnishments or liens or something like that?

Nope. Wage garnishments and liens only happen with debts to the government such as unpaid taxes, child support, or fines.

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

#314

Post by ThrustVectoring »

megamindbrian2 wrote: post #307
ThrustVectoring wrote: post #186

Earlier quoted context omitted.

Creditors can do more than ruin your credit score. It's state dependent, but they can also sue you to seize bank accounts, garnish your wages, etc. Fortunately, it's Texas, so wage garnishment is out, as is seizing your primary residence. So is seizure of retirement accounts. Really the practical amount of debt is what the creditor can force you to pay, which is capped at your liquid assets.

True. Good points, so withdraw and store in mattress. Garnishment is still an issue.

Not in Texas it isn't. Wage garnishment in Texas generally isn't a thing that creditors can do. Skip out on child support? Don't pay your taxes? Yeah, you can get your wages garnished. But a random creditor who convinces the court that you have a valid debt that you're obligated to pay? They can mess up your credit and seize bank or investment accounts, and that's about it.

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

#315

Post by Sohcahtoa82 »

jfk13 wrote: post #220
jhayward wrote: post #155

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…

> 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 correspondin…

Yup. The ACA failed to address the core problem that the hospitals are charging exorbitant prices.

Trying to make health insurance affordable is a fool's errand as long as hospitals can charge whatever the hell they want.

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

#316

Post by woobar »

nerdponx wrote: post #119
woobar wrote: post #47

Earlier quoted context omitted.

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…

The whole warped part of this is that the consumer has no way to anticipate cost in advance, and often the individual providers (doctors, nurses, etc.) don't either. Shouldn't the burden be on the insurance company to investigate and discourage excessive billing? Or are they too strict as it is, leading providers to play games with billing?

I think in this particular case insurance did investigate actual (or within a reason) costs and paid them. But there is no business relationship between the insurance company and an out-of-network provider. Should they go to the court on behalf of the patient? As a customer I'd like this. But it looks like combining health and legal insurances.

Another option is maybe to require that language on the "patient responsibility form" to include the blurb about fair prices. For instance:

In the event that my health plan determines a service to be “not payable”, I will be responsible for the complete charge and agree to pay the usual, customary, and reasonable costs of all services provided.

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

#317

Post by Sohcahtoa82 »

alphabettsy wrote: post #227
krupan wrote: post #219

Earlier quoted context omitted.

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).

HSA’s are available and most people don’t effectively use them, part of the problem is most people don’t/can’t save anyway. You’re not all wrong, but you’re talking about changing behavior which is much harder than just making the system work for how people actually behave.

I'd like to think HSA's are a good idea, but many HSA's have a "use it or lose it" policy that any money contributed that doesn't get used by the end of the year just disappears into the pockets of the HSA provider. It's almost a scam. It might be nice for someone that has some sort of ailment that needs frequent care, such as diabetes or cancer, but it's worthless for someone that wants to have money kept aside in case of an emergency.

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

#318

Post by Terr_ »

krupan wrote: post #249
Terr_ wrote: post #235

Earlier quoted context omitted.

Not sure if you're joking, but that's a pretty lazy fallacy of composition there. Ex: Human memory sucks, but you can generally trust the immutability of books, despite them being written and copied and bound and distributed and sold by humans. It's all about using strengths in the right direction and order to sidestep weaknesses.

Fallacy of composition says I look at a few stupid humans and decide that all humans are stupid. That's what the person who I was replying to was doing in reply to my original post. I was trying to point out that if their supposition is true then we are all screwed no matter what. Fortunately their supposition is false. Humans are not generally shortsighted and stupid, if you give them a chance.

> Fallacy of composition says I look at a few stupid humans and decide that all humans are stupid.

No, a fallacy of composition would be "the organization is stupid because its employees are stupid", or "metal boats are impossible because metal sinks in water." It involves something which is composed of the smaller pieces.

What you're describing is more like a hasty generalization, where individual-qualities within a sample lead to a conclusion about individual-qualities shared by the entire population.

> I was trying to point out that if their supposition is true then we are all screwed no matter what.

And -- even if their supposition is true -- I disagree!

Metal boats can float on water, even though individual metal pieces sink. Institutions can solve problems, even ones that individuals humans suck at.

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

#319

Post by gowld »

lacker wrote: post #36
jhayward wrote: post #11

Earlier 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.

I was going to respond saying that most hospitals are nonprofits and aren't actually making a great profit margin off this sort of overcharging. But then I looked it up and St. David's, despite having a religious nonprofit-sounding name, is actually owned by HCA Healthcare, which is a for-profit that has almost 4x'd its stock price over the past five years while acquiring more hospitals to grow. So, yeah, this one is…

HCA is a massive criminal enterprise. https://en.m.wikipedia.org/wiki/Hospital_Corporation_of_Amer...

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

#320

Post by gowld »

noelsusman wrote: post #303
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 generally operate on Also, people like you who force hospitals to chase you down to pay a bill are part of the reason why it's so expensive in the first place.

The hospital in OP article is part of HCA, that has perpetuated $billions in fraud profits. https://en.m.wikipedia.org/wiki/Hospital_Corporation_of_Amer...
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