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Congress is set to ban most surprise medical bills

nytimes.com

161–170 of 440 posts

Re: Congress is set to ban most surprise medical bills

#161

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.

While so much of the cost is the care that the organizations provide and what they choose to charge there is some truth to what you are saying.

Had to get an MRI and the lab corporation that performed the MRIs said that it would be ~$850 if billed through insurance. This included the total cost minus what was covered by insurance so the initial cost of the procedure was in the ~$1200 range. BUT, then they said if we just paid them directly and they didn't have to bill through insurance it would only be $650. So our insurance didn't even cover the absolutely ridiculous amount of overhead that was added just to deal with our insurance provider.

Re: Congress is set to ban most surprise medical bills

#162
post #100

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.…

> Private Equity has been funneled in healthcare for two decades intentionally distorting the market behaviors for increased profitability

But that is precisely a market effect of PE being able to do this due to lack of effective regulation, isnt it?

Re: Congress is set to ban most surprise medical bills

#163

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…

> 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.

FYI, they weren't checking for your ADHD medication. They were likely checking for marijuana.

* Marijuana can introduce side effects that basically make it look like you have ADHD

* Most ADHD medications are stimulants, they have counter indications when taken with marijuana

* Stimulant prescriptions are under scrutiny right now, so places have been doing more diligence

> 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 shouldn’t receive an actual bill”. Uh, that’s not the point? The point is why was it necessary to send my urine for 14k in testing in the first place?

The underlying problem is how a bunch of stuff gets billed. Basically your pysch and insurance company have a pre-negotiated rate for re-imbursement on this - it has little to no bearing on what you actually pay as a patient. It's pretty much all BS because there's a secondary system for resolving those bills.

Re: Congress is set to ban most surprise medical bills

#164

The change does not apply to ambulances (except for air ambulances), ensuring the United States remains one of the few places in the world where a seriously ill person needs to debate if they're willing to risk their health and life to avoid a financially crippling trip to the hospital.

"‘As I was being eaten, I was thinking about my insurance’: Woman who lost face in bear attack on why she’s voting for Bernie Sanders" https://www.independent.co.uk/news/world/americas/us-electio...

How any of you snakes on here can downvote this is beyond me.

I mean, I know who you are. People who have a great job and don't really have to worry about insurance. Or maybe at a university where insurance is probably covered well. So f everyone else, right?

I am self employed so I have to worry about paying all this shit myself; 11k family deductible with 40% co-insurance for $1200.

Every time my young kids have had something that was not like a massive emergency, you know what the thought is? Oh god is this worth going to the hospital for and spending 1k? Or when I had my own person health issues, my first thoughts are always how much is this going to fucking cost?

So yeah, if you think OPs link is exaggeration.. it sure as hell is not.

Re: Congress is set to ban most surprise medical bills

#165
post #100

Earlier quoted context omitted.

> 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 rat…

This doesn't even begin to address the real problem: emergency care.

Sure I can shop around and do a bunch of research for something that I know is coming up, but when the out of network specialist drops into my wife's hospital room as she's having an asthma attack and can't breathe I don't have the temporal luxury of vetting how much that particular specialist is going to cost out of pocket and can I please have one that's in network.

And we didn't even take an ambulance to that ER. When I had my motorcycle accident I was definitely not given a choice of which ER I was being hauled to - they stuck me on a back board and away we went.

The issue isn't just transparency it's also coverage. We can get the menu of prices from the hospital but the specialists do their own billing so won't be covered on that - you're back to an "MP" on the menu.

Re: Congress is set to ban most surprise medical bills

#166

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…

Kickbacks from test labs, scan / x-ray centers are normal in India.

Re: Congress is set to ban most surprise medical bills

#167

Earlier quoted context omitted.

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 in…

Huh. My wife is actually having the same procedure done for the second time after Christmas. Naturally the doctor is in-network, but his surgical facility (on the same floor, immediately adjacent to the doctor's offices) isn't. So it's fork out $1500 and fight insurance to reimburse us after the fact.

In her case, the epidural really does give her life back by completely killing the pressure and migraines that otherwise plague her daily. Insurance can kiss my butt. Single payer would be fabulous in this case.

Re: Congress is set to ban most surprise medical bills

#168
post #100

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.…

I've that this before, but I like my markets free as in GPL, not free as in BSD. That is, I want the markets themselves to be free, even if that means that participants in the market have limitations put on them to keep them from capturing the market, forming monopolies, etc.

Re: Congress is set to ban most surprise medical bills

#169

> Surprise bills happen when an out-of-network provider is unexpectedly involved in a patient’s care. Patients go to a hospital that accepts their insurance, for example, but get treated there by an emergency room physician who doesn’t. Such doctors often bill those patients for large fees, far higher than what health plans typically pay. How do courts uphold this? You go to a restaurant, they say you can buy the tas…

> you are kinda expected to know that there's taxes and tipping to pay

Also not reasonable, so at least in Spain the menu has to include VAT.

Re: Congress is set to ban most surprise medical bills

#170

Earlier quoted context omitted.

Price transparency would help, but it wouldn’t solve the duress problem. After a car crash we all want to go to the nearest hospital rather than the most price efficient one.

That's probably true but a lot of medical cost is scheduled like follow up or specialist visits, surgery and things of the less urgent nature.

How is that solving the car crash situation?
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