Congress is set to ban most surprise medical bills • Hacker News Board

Re: Congress is set to ban most surprise medical bills

#251

Post by normaljoe » Mon, Dec 21, 2020, 7:18 PM UTC

aamar wrote: post #80

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?

See here[1] for a pretty good explanation. Importantly, your insurer treating the visit as in-network does not force the provider to treat it as in-network; surprise bills come from the provider, not the insurer. From that post: If the insurer pays less than the out-of-network emergency room bills, the emergency room can send you a balance bill for the difference, over and above the deductible and coinsurance amounts…

And this still happens in Texas where it is suppose to be illegal as well. I called provider multiple times and explained the rate from my insurer. They of course sent to collections, but they know they can't enforce it in court, but that doesn't matter. Most people are just going to pay.

What really got to me was it was ER visit and the Doc(extortionist) spent maybe 5 minutes with me before having the nurse fix me up. After insurance $250 to hospital, and $2000 bill for the Doc.

Re: Congress is set to ban most surprise medical bills

#252

Post by AdrianB1 » Mon, Dec 21, 2020, 7:20 PM UTC

mehrdadn wrote: post #24

cdjk wrote: post #19

Earlier quoted context omitted.

The existing health insurance industry is far from free market. Try getting a price for a procedure or visit beforehand. Compare that to dental insurance. I’m always shocked when I get a treatment plant after 5 minutes that outlines exactly what the dentist needs to do, how much insurance will pay, and how much I will need to pay. Of course the set of possible treatments for dental work is a lot smaller, but it seems…

> I’m always shocked when I get a treatment plant after 5 minutes that outlines exactly what the dentist needs to do, how much insurance will pay, and how much I will need to pay. What you don't know (unless you get 2nd/3rd/4th opinions from good dentists) is how necessary those truly are. Some dentists just work around things by recommending things you don't need. (Fill teeth, taking panorex, etc. unnecessarily)

Same as code refactoring, needing it is a very subjective matter even is similar circumstances.

Re: Congress is set to ban most surprise medical bills

#253

Post by lotsofpulp » Mon, Dec 21, 2020, 7:20 PM UTC

lostapathy wrote: post #228

cogman10 wrote: post #190

Earlier quoted context omitted.

To me, that sort of proves a point. Cancer and other disease are extremely expensive to treat and fairly common in the population. Yet, somehow, emergency care which is a minority of health costs, eats up 10% of the spending. Anyone that's been to an emergency room knows how excessive the price gouging going on there is. Pills that cost $0.10 OTC (or less!) routinely see 100x markup. That same pill can cost anywhere…

It also doesn't help how insurance handles ER visits. I was in the ER earlier this year. Had an ultrasound done and a BUNCH of labs. $500 copay for the whole visit and insurance eats the rest - regardless of where I am on my deductible. I'd had the exact same ultrasound done "routinely" 2 days prior, at the same hospital, and similar lab the week before.. I had to pay about $1,300 for the privilege because that all f…

That makes perfect sense, assuming your annual deductible was met after you paid your $500 copay. Deductible means you pay for the first $x in a year. After that, your insurer starts paying some portion (your portion is called copay). Then you hit your out of pocket maximum (for in network services), after which insurer pays 100%.

Re: Congress is set to ban most surprise medical bills

#254

Post by AnthonyMouse » Mon, Dec 21, 2020, 7:21 PM UTC

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…

> into a believer in single payer healthcare.

That isn't the part of the market which is broken though. The insurance companies want their vig, and they have no objection to cost increases because then they get the same percentage of a larger pot, but they're not actually where most of the money goes.

It's really going to drug companies and medical devices companies and doctors and hospitals. Which all still exist even with single payer, and not only that but then have even less price sensitive customers (more unnecessary tests/treatments/procedures) and have a greater opportunity to have their lobbyists turn open the money spigot, because now it's tax dollars -- or government debt -- instead of insurance premiums that customers would balk at and switch to a less expensive plan when the price exceeds a given threshold.

So you still need the very things they're lobbying against. You need something to make patients price sensitive enough to refuse over-treatment. You need some kind of price setting mechanism that works better than giving the most money to the company with the best lobbyists. Single payer doesn't get you that.

Re: Congress is set to ban most surprise medical bills

#255

Post by arcticbull » Mon, Dec 21, 2020, 7:21 PM UTC

whiddershins wrote: post #235

npmaile wrote: post #227

Earlier quoted context omitted.

I think the argument you are responding to is not the one the previous user presented. This issue isn't that people are trying to maximize profit leading to issues. The problem is that there is undue government interference in the market leading to all of the negatives that come from people selfishly trying to maximize profit in a cynical way with none of the benefits of people trying to maximize profits by providing…

The thing is, government intervention is probably the biggest way the wolves take over. They distort the market to their benefit using governmental force (aka. regulation)

This article may change your mind [1].

It's an NPR interview with Cigna's former head of corporate comms, an executive in charge of pushing lies about socialized medicine. He has since come to terms with what he'd done and is working to undo the harm he has caused to the American people.

"Canada has done a better job [re: COVID], I think, because of having the kind of health care system you have in making sure that everyone who needs to be treated is treated. And so that was what prompted that. And I felt that to provide some context, I needed to describe what I used to do for a living to try to scare people away from the Canadian health care system because insurance companies fear that. They know that if the U.S. moves to a system like that, it would certainly put a real crimp in their profits."

"Our industry PR and lobbying group, AHIP, supplied my colleagues and me with cherry-picked data and anecdotes to make people think Canadians wait endlessly for their care. It's a lie. And I'll always regret the disservice I did to folks on both sides of the border."

[1] https://www.npr.org/2020/06/27/884307565/after-pushing-lies-...

Re: Congress is set to ban most surprise medical bills

#256

Post by throwaway201103 » Mon, Dec 21, 2020, 7:22 PM UTC

ajtaylor wrote: post #167

dr_orpheus wrote: post #150

Earlier quoted context omitted.

> 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 otherw…

There's this idea that "single payer" will pay for "anything I want" and it seems to me that evidence for this is sorely lacking.

Re: Congress is set to ban most surprise medical bills

#257

Post by tehjoker » Mon, Dec 21, 2020, 7:22 PM UTC

rayiner wrote: post #183

tehjoker wrote: post #178

Earlier quoted context omitted.

That's 1/10th of the military budget for drugs that can be often be manufactured for pennies (drugs with biological elements requiring glass column filtration and such are a different story but are far more rarely used). A point in case is the Hep C vaccine: https://www.medicalnewstoday.com/articles/323767#drug-types-...

And the Moderna vaccine was designed in two days: https://www.businessinsider.com/moderna-designed-coronavirus... . Is that all there is to it?

There was 10+ years of research prior, but much of that research was academic. Phased studies must be conducted regardless of whether manufacture is public or private. There does not appear to be any need for private profit, we are sufficiently motivated to research this stuff out of a desire for self-preservation.

I'll admit that profit seeking would work better* in a society that doesn't have a strong state or other coordinating body, but given that one exists to counterpose our existing system is not reasonable.

EDIT: * In the sense that products might be produced at all. Without a strong regulatory body, the market would be flooded with snake oil medicine and the average consumer would not be able to make heads or tails of things. This is because it's much cheaper to make a fake medicine than a real one, which is what profit optimizes for: the cheapest solution with the highest payoff for the seller regardless of costs not borne by the seller (such as death and destruction writ large).

Re: Congress is set to ban most surprise medical bills

#258

Post by throwaway201103 » Mon, Dec 21, 2020, 7:23 PM UTC

billpg wrote: post #65

baryphonic wrote: post #44

Earlier quoted context omitted.

> The free market just doesn't work when there is very little elasticity in consumption. Should we have single-payer markets for auto repairs, then? Or how about toilet paper, especially in a pandemic? Both of those are very inelastic, yet socialism has a particularly poor record of producing either reliably. > I've been on the receiving end of a $15K air ambulance bill (thankfully covered by insurance) as well as th…

Toilet paper shortages this year occurred in capitalist economies.

Only because retailers were not allowed to raise prices to meet demand.

Re: Congress is set to ban most surprise medical bills

#259

Post by lostapathy » Mon, Dec 21, 2020, 7:23 PM UTC

lotsofpulp wrote: post #253

lostapathy wrote: post #228

Earlier quoted context omitted.

It also doesn't help how insurance handles ER visits. I was in the ER earlier this year. Had an ultrasound done and a BUNCH of labs. $500 copay for the whole visit and insurance eats the rest - regardless of where I am on my deductible. I'd had the exact same ultrasound done "routinely" 2 days prior, at the same hospital, and similar lab the week before.. I had to pay about $1,300 for the privilege because that all f…

That makes perfect sense, assuming your annual deductible was met after you paid your $500 copay. Deductible means you pay for the first $x in a year. After that, your insurer starts paying some portion (your portion is called copay). Then you hit your out of pocket maximum (for in network services), after which insurer pays 100%.

No - I hadn't hit my out of pocket max, by a long shot, even after the second encounter. They could have happened in either order - and the emergency visit would have been MUCH cheaper out of pocket for me.

Re: Congress is set to ban most surprise medical bills

#260

Post by sebastien_b » Mon, Dec 21, 2020, 7:23 PM UTC

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 been on the receiving end of a $15K air ambulance bill (thankfully covered by insurance) as well as the out of network specialist at an in-network hospital. The latter is particularly galling. What are you supposed to do, interrogate every person that comes in the room

That could present a rather interesting legal challenge...

Say you state "I can only allow care from in-network physicians/personnel" - will they take that as you outright refusing care if they're not in-network?

And if they decide they're not going to care for you because of this, and you end up dying, what would be the recourse? Did the personnel (esp. doctors) still have a duty to care for you? Or else on what exact basis would they conclude you refused care and let you die?