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Medical equipment pricing is completely broken when a sling costs $200

latimes.com

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Re: Medical equipment pricing is completely broken when a sling costs $200

#51

Post by cbanek »

mehrdadn wrote: post #42
throwaway1777 wrote: post #7

Earlier quoted context omitted.

Pretty sure if you go through the effort to challenge such charges you can get them changed. https://www.vox.com/2019/3/22/18261698/how-to-fight-expensiv...

The thing I don't understand about tips like these is, what obligation does the other party have to cooperate at all? Like you "ask for a supervisor" (and then a director!) what incentive do they have to not just say no? Or if you ask for an itemized bill, what if they just refuse? How are you supposed to get past a blunt refusal, which to me seems like the easiest response for them?

Once upon a time, I had a surprise bill for about $4,000 that health insurance decided should have been $700 for that procedure. I fought it and won. But it took forever, almost a year of calling them and going back and forth - and this was actually decent corporate health insurance.

It took a lot of reading through the 600+ page plan document and finding loopholes. For example, I asked them that if they thought it should be done for $700, who would actually do it for $700? They couldn't list one provider that would accept the payment rate they thought they should pay. And since this was a reimbursement, and they had already pre-approved the procedure (knowing the price), I think I caught them already saying they would do it, but them not following through. There was a lot of going back and forth about in-network vs out of network, but again, no one in-network would perform the procedure. In the fine print of the plan document, it said if there are no in-network providers, the plan must provide you were in-network rates and deductibles for using an out-of-network provider.

So I told them if they can't find anyone who will accept what they are willing to pay, their figure is obviously wrong. It helped that with my health insurance, everything was supposed to be covered, 100% with no copay. So the fact that they tried to charge me for the $3300 overage was very out of line for them.

They never just said "no, we're not going to cooperate" it was more just endless stalling on their part. It was never really a blunt refusal, or if they tried that, I just proved how ridiculous their arguments were. I kept a lot of documentation.

I think in the end, they just relented because they were spending more dealing with me than actually just paying me my money. But it was certainly an uphill battle the whole way, and not one I would recommend to someone who isn't well versed in legalese.

Re: Medical equipment pricing is completely broken when a sling costs $200

#52

Post by partialrecall »

mehrdadn wrote: post #42
throwaway1777 wrote: post #7

Earlier quoted context omitted.

Pretty sure if you go through the effort to challenge such charges you can get them changed. https://www.vox.com/2019/3/22/18261698/how-to-fight-expensiv...

The thing I don't understand about tips like these is, what obligation does the other party have to cooperate at all? Like you "ask for a supervisor" (and then a director!) what incentive do they have to not just say no? Or if you ask for an itemized bill, what if they just refuse? How are you supposed to get past a blunt refusal, which to me seems like the easiest response for them?

If they give in to the few people who have the initiative to complain, they likely placate the few people who'd have the initiative to demand change.

See also, the TSA precheck systems. By allowing people like frequent flying businessmen and politicians to avoid the standard TSA experience, they reduce the likelihood that such people might use their influence to advocate against the TSA, for the betterment of all passengers.

Re: Medical equipment pricing is completely broken when a sling costs $200

#53

Post by rwcemergency »

brink wrote: post #4

I just got an itemized bill today for a minor fall I took a couple months back.. On top of the nearly $6k in other charges from the hospital, they charged $531 for one dab of superglue or "liquid stitches" on my forehead for something that would have healed by itself. One of my friends died two years ago from pneumonia. He didn't go to the hospital when symptoms first started because he was afraid of the bills that w…

I just got an emergency room bill. I had a severe sore throat and fever for 2 weeks, step tests came back negative. Then at night my back side started hurting so I went to the ER.

I paid $850 at the ER and today I received another bill for $850.

The only thing on the Bill just says

> "Charges": $11,680 > "Adjustmnets: $9,980

I just got off the phone with them and they say that it will take 10 business days to receive an itemized bill. However, that means the itemized bill will be delivered after the current bill is due.

How are they going to charge somebody $1700 without an itemization?

Furthermore, I am expecting another bill from the ER doctor that saw me because they bill separately and are not covered by insurance. The ER legally cant tell you if the doctor or the hospital accepts your insurance. Thats so crazy.

My wife was absolutely mortified. In brazil I never carried insurance but going to the ER I just had to pay R$400 flat fee for a private hospital. Anything else for tests they would give me the prices up front.

My wife about started screaming when the woman brought in the credit card machine while I was still in pain in the ER hospital bed. It was so embarrassing.

All this is with the top insurance my company (a ~$500 million startup) offers and to make it worse it happened when I was on a company mandated trip.

Re: Medical equipment pricing is completely broken when a sling costs $200

#54

Post by [deleted] »

mehrdadn wrote: post #42
throwaway1777 wrote: post #7

Earlier quoted context omitted.

Pretty sure if you go through the effort to challenge such charges you can get them changed. https://www.vox.com/2019/3/22/18261698/how-to-fight-expensiv...

The thing I don't understand about tips like these is, what obligation does the other party have to cooperate at all? Like you "ask for a supervisor" (and then a director!) what incentive do they have to not just say no? Or if you ask for an itemized bill, what if they just refuse? How are you supposed to get past a blunt refusal, which to me seems like the easiest response for them?

[deleted]

Re: Medical equipment pricing is completely broken when a sling costs $200

#55

Post by henryfjordan »

rwcemergency wrote: post #53
brink wrote: post #4

I just got an itemized bill today for a minor fall I took a couple months back.. On top of the nearly $6k in other charges from the hospital, they charged $531 for one dab of superglue or "liquid stitches" on my forehead for something that would have healed by itself. One of my friends died two years ago from pneumonia. He didn't go to the hospital when symptoms first started because he was afraid of the bills that w…

I just got an emergency room bill. I had a severe sore throat and fever for 2 weeks, step tests came back negative. Then at night my back side started hurting so I went to the ER. I paid $850 at the ER and today I received another bill for $850. The only thing on the Bill just says > "Charges": $11,680 > "Adjustmnets: $9,980 I just got off the phone with them and they say that it will take 10 business days to receive…

Talk to a lawyer.

Re: Medical equipment pricing is completely broken when a sling costs $200

#56

Post by danans »

cosmodisk wrote: post #46

Reading this in Europe.I'm sure if I'd go with article alone to my American colleague on Monday, he'd defent the system even if he'd have to die for it. Knowing he's a healthy 20something man with affluent parents that could potentially bankroll even a year's stay in a private hospital- I could understand it to certain degree, however I fail to understand why nobody really is up for changing this system,where million…

> however I fail to understand why nobody really is up for changing this system,where millions upon millions left woth no choice but to struggle anything but basic medical care.

Plenty of people are up for changing it. It is quite literally the center of a huge debate at the moment in the Democratic primary, and there is a broad spectrum of changes being proposed, from Medicare for all with price controls to a slightly modified Obamacare. Only one candidate among those more or less supports the status-quo.

And the Republican party is currently avoiding discussing the way they'd like to change the health system (repealing Obamacare, fee for service care) because it isn't particularly popular at the moment.

Meanwhile, stories like the ones you see piling up in this thread happen every day.

Re: Medical equipment pricing is completely broken when a sling costs $200

#57

Post by cbanek »

henryfjordan wrote: post #55
rwcemergency wrote: post #53

Earlier quoted context omitted.

I just got an emergency room bill. I had a severe sore throat and fever for 2 weeks, step tests came back negative. Then at night my back side started hurting so I went to the ER. I paid $850 at the ER and today I received another bill for $850. The only thing on the Bill just says > "Charges": $11,680 > "Adjustmnets: $9,980 I just got off the phone with them and they say that it will take 10 business days to receive…

Talk to a lawyer.

Also, talk to your company. If it's a company trip, they may be on the hook this.

Re: Medical equipment pricing is completely broken when a sling costs $200

#58

Post by henryfjordan »

mdorazio wrote: post #29
narrator wrote: post #21

This is why I like Kaiser so much. If you make it to a Kaiser emergency room, and you have Kaiser health insurance, you are not going to get an out-of-network surprise bill. Everyone at Kaiser works for Kaiser and is paid a salary by Kaiser and the Kaiser hospital is the only one that bills you.

... what if you don't make it to a Kaiser emergency room? The Kaiser system would be great if every major hospital nationwide was under it. Kind of like a national healthcare system...

Kaiser covers ER trips to other hospitals (I think they are probably required to by law). Any other Dr visit needs to be at a Kaiser though and it is def to your benefit to try to make it to a Kaiser even for the ER if you can.

Re: Medical equipment pricing is completely broken when a sling costs $200

#59

Post by laurencerowe »

mdorazio wrote: post #29
narrator wrote: post #21

This is why I like Kaiser so much. If you make it to a Kaiser emergency room, and you have Kaiser health insurance, you are not going to get an out-of-network surprise bill. Everyone at Kaiser works for Kaiser and is paid a salary by Kaiser and the Kaiser hospital is the only one that bills you.

... what if you don't make it to a Kaiser emergency room? The Kaiser system would be great if every major hospital nationwide was under it. Kind of like a national healthcare system...

My experience has been fine with Kaiser for an out of network ER visit, I just got charged the standard copay. CA law seems to specifically protect those of us on HMO plans: https://www.sfchronicle.com/bayarea/heatherknight/article/SF...

""" Under state law, the practice of “balance billing” — sending a bill to a patient if his or her insurance company doesn’t pay the full requested amount — is illegal for people insured through a health maintenance organization. Kaiser is an example of an HMO, a network of doctors that supplies services to its members. """

Re: Medical equipment pricing is completely broken when a sling costs $200

#60

Post by [deleted] »

Gibbon1 wrote: post #40
ericd wrote: post #2

We had a call with someone who works on the pricelist/chargemaster for a major metro hospital recently, they set their prices by taking the Medicare reimbursement rate, and multiplying by 8.

If any other business tried billing people like hospitals and doctors do, people would go to prison.

[deleted]
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