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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

#141

Post by silentsea90 »

2Gkashmiri wrote: post #43

In India you have these government run hospitals. Entry is essentially free and so is the emergency / opd treatment. For procedures they charge peanuts compared to private sector. The only thing, there is a waiting list and hygeine is not always a priority. There is an AIIMS hospital in Delhi and I had the misfortune of taking a relative there for treating surgical infection. It was brutal. We got in line around 9 am…

Public services in India, especially ones interacting with people en masse are terrible. No recourse but to go to private hospitals.

Re: Congress is set to ban most surprise medical bills

#142

Post by rayiner »

WrtCdEvrydy wrote: post #81
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 biggest fuck you is that Medicare can't negotiate.. it's actually written into the law.

That's not true. Medicare can and does negotiate the cost of procedures and doctor's services. What the law says is that Medicare can't negotiate prescription drug prices. That's because Medicare doesn't directly pay for drugs, except what's used incidentally in the course of covered hospital stays.

Medicare didn't provide coverage for prescription drugs until the adoption of Part D. That is structured differently than other parts of Medicare. Instead of the government serving as the insurer directly, the government subsidizes premiums for a private Part D insurer. The private insurer can and does negotiate drug prices.

The fact that Medicare can't negotiate prescript drug prices is often invoked as a talking point, but Medicare prescription drug spending accounts for a relatively small proportion of. overall Medicare spending: https://www.heritage.org/medicare/commentary/good-and-bad-id... ("Consumer choice and competition have made Part D the rarest of government programs: one in which spending hasn’t spiraled out of control. In fact, government actuaries report that federal general revenue spending on the program was $67.8 billion in 2018—that’s less than what it spent in 2015 ($68.4 billion).").

Re: Congress is set to ban most surprise medical bills

#143

Post by dr_orpheus »

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 out of network care at an in-network hospital, is the absolute worst. In a similar vein, my wife's insurance was supposed to cover "out-of-network" ER visits. So one night that we had to go the ER we went to an out-of-network hospital ER because there wasn't an in-network one close by. Turns out that the coverage of the out-of-network ER visit basically just covers the cost of the bed in the ER, every treatment that you get (IV, vitals check, medication) is considered out-of-network treatment. This resulted in an absolutely insane bill with charges like $250 for administering oxygen monitor (you know the things you can buy at Wallgreens for $30) or $300 for ibuprofen.

Re: Congress is set to ban most surprise medical bills

#144

Post by Karunamon »

zbrozek wrote: post #134
annexrichmond wrote: post #118

Earlier quoted context omitted.

> 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 rat…

We still need up-front transparency on what codes will be billed to whom, from whom, and for how much. I want a comprehensible restaurant-like menu. And we need to break up regional monopolies so that there's actually a choice of provider. Further, agreements to pay whatever, whenever, before any diagnosis need to be banned as contracts under duress. If we want the free market approach to work, we need to make it pos…

I want a comprehensible restaurant-like menu.

Likely not going to happen purely out of complexity if nothing else. Look at the list of ICD procedure codes[1] and imagine all of these with a price attached. Comprehensive, sure, but comprehensible? Ehhh.. pushing it.

[1]: https://www.icd10data.com/ICD10PCS/Codes

Re: Congress is set to ban most surprise medical bills

#145

Post by Phenomenit »

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.

>If this doesn't describe evil, I don't know what else could.

Private prisons seem awfully close to slavery/indentured workers.

Re: Congress is set to ban most surprise medical bills

#146

Post by oblio »

marcusverus wrote: post #72
jsperson wrote: post #48

Earlier quoted context omitted.

> The existing health insurance industry is far from free market. Try getting a price for a procedure or visit beforehand. Oh, I know. I've tried getting prices in the past. Traditional providers can't do it. One thing that has opened my eyes is using a Direct Primary Care (DPC) provider. I pay $75 a month for direct access to my doctor (email, text message, cell phone etc.). The access is great, but an unexpected si…

> We do not have a free market. Other countries seem to have solid solutions for "socializing" medicine. I can't think of any highly functional system that is a free market. I don't even think that one is possible without people dying in the streets. The government is perfectly capable of ensuring access to a market without regulating it to death. The SNAP program (Food Stamps) is a great example of how this works in…

I don't understand this.

Almost every other developed country has a system that works for healthcare. It's almost always single payer or something where you definitely don't go shopping around for hospitals.

Doesn't it start to feel a bit like indoctrination when arguing for a "free market" when no other developed country has a free market for healthcare?

Is everyone else stupid? What aren't they seeing? Especially in the age of the internet?

I just can't follow this logic.

I would love to get someone who argues from the "free market" point of view do some introspection and explain the logic in a way that doesn't feel like repeating the same 2-3-4 ideas which as far as I can see, are common talking points in the US.

So, repeating the question, what is every other developed country missing?

Why aren't they all doing this, if it's obviously superior?

Re: Congress is set to ban most surprise medical bills

#147

Post by kevinofe »

mcshicks wrote: post #29

California has such a law already. I went to an ER at the beginning of the year for a minor fracture and had a "contract physician". I was pleasantly surprised when the bill was exactly my er visit copay. I had an equally unpleasant experience several years ago that cost me thousands of dollars. https://dmhc.ca.gov/Portals/0/HealthCareInCalifornia/FactShe...

The CA law is kind of BS. My partner went to see doc, they ran a few tests, told her it would probably be covered by insurance and then we got a bill for $1700. They said it wasn't "surprise" bill because it wasn't out of network. I told them "it is a surprise to us!"

From then on, we always ask the cost of every single test/procedure. (In fairness to the hospital, they did give us a $50/month, interest free payment plan.)

Re: Congress is set to ban most surprise medical bills

#148

Post by Dirlewanger »

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.

Nah, being evil implies there being a higher moral cause to one's actions. This is worse than evil, it's only pure uncaring avarice.

Re: Congress is set to ban most surprise medical bills

#149

Post by mrlala »

zaroth wrote: post #68
OminousWeapons wrote: post #54

I was working on a health insurance related startup for awhile so I would say I know more than the average person about the space, and even I get surprised on a regular basis by the absurdity in this field. For example, I was finishing up an advanced degree program between September and January and my University decided to terminate my health insurance in September. Without telling me. In the middle of a pandemic. Wh…

The intent here is to prevent people from gaming the system by buying insurance only right after a serious diagnosis. There are several qualifying events to be able to enroll outside the eligibility window if you’ve had a job change for example.

>The intent here is to prevent people from gaming the system by buying insurance only right after a serious diagnosis.

Of course.. but, that's basically why health insurance should be "required" for everyone, because then it's not an issue.

Because if you are not gaming the system, and make a simple mistake by OP, it can be fucking life altering.

I was in a similar situation a few years ago. For whatever reason our auto payment stopped on the health insurance on a year-to-year rollover. I didn't notice, everything is on autopay. Sure it was my 'fault', but you know what the result was? I was uninsured for 9 months (except for a garbage plan I could find that I'm sure would have done almost nothing).. if something serious had happened I would have been FUCKED.

So yeah we can sit here and say all this bullshit about eligibility windows. But the truth of the matter is every one of these things just points to why the entire country should be covered.

It's honestly SICK how some people think healthcare should work. And honestly the amount of resources put into all the billing jobs and compliance and all the bullshit is STAGGERING. How much energy is wasted on the bullshit billing systems and rules which are just made to fuck people over who have health problems.

/rant off

Re: Congress is set to ban most surprise medical bills

#150

Post by dr_orpheus »

cmiles74 wrote: post #114
mehrdadn wrote: post #18

Earlier quoted context omitted.

> 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.

> I wonder if this is part of their process: if there's pushback, waive the fee.

This is 100% how a lot of medical offices and/or insurance operates. For some practices that perform complicated procedures bills will get sent with a "catch-all" sort of approach of all possible scenarios that could have happened and you have to go back and tell them what treatment you actually got.

Insurance companies will also just initially deny claims in the hopes that people won't spend the time to debate it. My wife had to get back injections for a bulged disk and insurance initially denied the claim on the basis that "it was not inhibiting her daily function". The original request from the doctor included the wording of "this is medically necessary because the pain is inhibiting her daily function" because he knew that was their criteria. Insurance still just rejected it because it is easier for them to do that and only accept the claims people fight for. Luckily in this case the doctors office was on our side and called the insurance company to get it approved. The doctor said that this kind of shit happened all the time.

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