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Congress is set to ban most surprise medical bills

nytimes.com

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Re: Congress is set to ban most surprise medical bills

#111

Post by iaw »

HeyImAlex wrote: post #70

I had to provide a urine sample to get my ADHD medication. It was sold to me under the auspices of drug testing, even though ADHD meds are out of your system in 48h. A month later I received an explanation of benefits from my insurance company that said they received a 14k bill and had paid 4k of it, so I was on the hook for the other 10k. Furious I went to my psych. They casually said “we’ve taken care of it, you sh…

> You cannot convince me they weren’t getting kickbacks from this program.

Given all the problems this caused for the opioid epidemic I'm disappointed (but not surprised) such behaviors are still be legal.

Re: Congress is set to ban most surprise medical bills

#112

Post by mauflows »

jsperson wrote: post #13

That it takes such effort to pass a bill like this - 80% public approval, banning a clearly predatory practice, has turned me from a pure free market thinking into a believer in single payer healthcare. The free market just doesn't work when there is very little elasticity in consumption. I've been on the receiving end of a $15K air ambulance bill (thankfully covered by insurance) as well as the out of network specia…

I've become more staunchly single payer after I had my first major medical hurdle of my adult life this year. I had switched insurance in January, but apparently my old insurance had a bug in their system. The effect was that they were accepting my claims, but then denying them. So I had to coordinate both insurances and get them on the same page. Then I had to call every one of my many providers, get them to understand, and then get them to reprocess the claim on their end. It was miserable and I had to deal with it while I was still dealing with a broken wrist and just hoping everything would work out.

I feel awful for anyone who has to deal with that and has less time than me. I had to take notes during every phone call and get the numbers of customer reps so they could vouch for what I was saying

Re: Congress is set to ban most surprise medical bills

#113

Post by jartelt »

leetcrew wrote: post #31
kayodelycaon wrote: post #9

> Some private-equity firms have turned this kind of billing into a robust business model, buying emergency room doctor groups and moving the providers out of network so they could bill larger fees. If this doesn’t describe evil, I don’t know what else would.

I wouldn't reject this out of hand, but I do find that the complexities around healthcare and the obvious political implications lead to a lot of exaggeration and outright falsehoods being propagated. it's my understanding that the affordable care act requires insurers to treat any emergency services (if covered at all) as in-network. can anyone explain either a.) how I am wrong, or b.) how this can be circumvented?

My wife went into anaphylaxis at an urgent care facility. The doctor there administered an epi and then called 911 to get an ambulance to the nearest hospital.

We ended up getting a >$2,000 bill for a 10 minute ambulance ride because the ambulance company was out-of-network. The ambulance company then had the audacity to send the bill to collections before the 30 day pay period even expired...

So yea, even if you have good insurance you can still get bit by these issues in emergencies! Unfortunately, this new bill does not even address the out of network ambulance issue.

Re: Congress is set to ban most surprise medical bills

#114

Post by cmiles74 »

mehrdadn wrote: post #18
jsperson wrote: post #13

That it takes such effort to pass a bill like this - 80% public approval, banning a clearly predatory practice, has turned me from a pure free market thinking into a believer in single payer healthcare. The free market just doesn't work when there is very little elasticity in consumption. I've been on the receiving end of a $15K air ambulance bill (thankfully covered by insurance) as well as the out of network specia…

> What are you supposed to do, interrogate every person that comes in the room? I'm curious too. Some people must have tried filing a lawsuit... what do judges think people should be doing?

In my case it was the anesthesiologist who was out of network. Looking at the bill, they looked like just another practice. When I found their phone number and address, however, it turned out that their practice was part of the hospital.

I called their number and ended up talking to someone in their office and they agreed to waive the fee. I wonder if this is part of their process: if there's pushback, waive the fee.

Re: Congress is set to ban most surprise medical bills

#115

Post by abootstrapper »

jsperson wrote: post #13

That it takes such effort to pass a bill like this - 80% public approval, banning a clearly predatory practice, has turned me from a pure free market thinking into a believer in single payer healthcare. The free market just doesn't work when there is very little elasticity in consumption. I've been on the receiving end of a $15K air ambulance bill (thankfully covered by insurance) as well as the out of network specia…

“The free market will solve everything” is a seductive idea because of its simplicity. “Just let the free market solve it. Oh, there’s a problem? It’s because the market is not ‘free’ enough.” The reality is more complicated. We need a balance of a healthy market forces and regulations to prevent the exploitation of people and the environment. But that’s a lot of work, and not as elegant sounding of a solution as, “let the market figure it out.”

Re: Congress is set to ban most surprise medical bills

#116

Post by bcrosby95 »

jrumbut wrote: post #94
leetcrew wrote: post #31

Earlier quoted context omitted.

I wouldn't reject this out of hand, but I do find that the complexities around healthcare and the obvious political implications lead to a lot of exaggeration and outright falsehoods being propagated. it's my understanding that the affordable care act requires insurers to treat any emergency services (if covered at all) as in-network. can anyone explain either a.) how I am wrong, or b.) how this can be circumvented?

Regarding how it can be circumvented, insurance companies, in my experience, try to say that this or that service was not actually part of the emergency. For instance, they may want to begin some of the long term maintenance of your new condition while you're still in the hospital. Whether the insurance company is successful or not, they may at least try to say this isn't covered. Eventually, you and your loved one a…

For my wife's emergency surgery, they paid the surgeon. But the surgery room, recovery room, and anesthesiologist - that was all determined to not be medically necessary. And they fought those bills for about 8 months before paying.

Re: Congress is set to ban most surprise medical bills

#117

Post by jschwartzi »

cpuguy83 wrote: post #58
tehjoker wrote: post #47

Earlier quoted context omitted.

Price discovery doesn't help you. If you get knocked out, heart attack, your arm cut off, whatever (i.e. a lot of the expensive stuff) you just go to the nearest hospital, no consumer market finagling is even possible other than trying to live near a good hospital. Other times with chronic conditions where theoretically price discovery could help, the problem is that you need care badly so all the chronic care provid…

The sad thing is, as expensive as healthcare is they probably have to jack up those rates because they are getting screwed everywhere else. In the end, though, the consumer is always the one who ends up getting the ultimate screw... exactly why healthcare shouldn't be seen as a service to consume.

These organizations charge exorbitant amounts of money for the care they provide. This is care which very few people are able to refuse. And if you do refuse care you are likely to die. What hospitals do would be considered extortion if a private citizen did it.

I have no sympathy for them whatsoever.

Re: Congress is set to ban most surprise medical bills

#118

Post by annexrichmond »

iaw wrote: post #100
jsperson wrote: post #13

That it takes such effort to pass a bill like this - 80% public approval, banning a clearly predatory practice, has turned me from a pure free market thinking into a believer in single payer healthcare. The free market just doesn't work when there is very little elasticity in consumption. I've been on the receiving end of a $15K air ambulance bill (thankfully covered by insurance) as well as the out of network specia…

> has turned me from a pure free market thinking into a believer in single payer healthcare The current trend in 'free-market economics' is to call captured markets free and then argue for the relatively lax regulation. Most markets are not free markets and the healthcare definitely isn't. There's very little true choice, participants are typically under duress when seeking expensive services, and prices are hidden.…

> and prices are hidden

I believe the Trump administration is addressing this:

https://www.hhs.gov/about/news/2019/11/15/trump-administrati...

https://www.hhs.gov/about/news/2020/10/29/trump-administrati...

> The rule requires that most health plans and health insurers not only provide easy-to-understand personalized information on enrollee cost-sharing for healthcare services, but must also publicly disclose the rates they actually pay healthcare providers for specific services.

> Through a shopping tool available through their plan or insurance company, consumers will be able to see the negotiated rate between their doctor and their plan or insurer, as well as the most accurate out-of-pocket cost estimate possible based on their health plan for procedures, drugs, durable medical equipment, and any other item or service they may need.

> Consumers will also have access to accurate price and plan information that allows them to shop and compare costs between individual doctors before receiving care, so they can choose a healthcare provider that offers the most value and best suits their medical needs.

But it'll be another couple years before it's all implemented it seems

Re: Congress is set to ban most surprise medical bills

#119

Post by khuey »

ecf wrote: post #108
jsperson wrote: post #13

That it takes such effort to pass a bill like this - 80% public approval, banning a clearly predatory practice, has turned me from a pure free market thinking into a believer in single payer healthcare. The free market just doesn't work when there is very little elasticity in consumption. I've been on the receiving end of a $15K air ambulance bill (thankfully covered by insurance) as well as the out of network specia…

The only statistic you need to know to justify America being a shitty country with even shittier healthcare is that it is only one of two countries in the entire world that allow pharma companies to directly advertise to consumers.

New Zealand is the other country that allows it and they seem generally satisfied with their healthcare system.

Re: Congress is set to ban most surprise medical bills

#120

Post by cpuguy83 »

jschwartzi wrote: post #117
cpuguy83 wrote: post #58

Earlier quoted context omitted.

The sad thing is, as expensive as healthcare is they probably have to jack up those rates because they are getting screwed everywhere else. In the end, though, the consumer is always the one who ends up getting the ultimate screw... exactly why healthcare shouldn't be seen as a service to consume.

These organizations charge exorbitant amounts of money for the care they provide. This is care which very few people are able to refuse. And if you do refuse care you are likely to die. What hospitals do would be considered extortion if a private citizen did it. I have no sympathy for them whatsoever.

Sympathy has nothing to do with it.
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