US doctor forgives $650k in medical bills for cancer patients • Hacker News Board

Re: US doctor forgives $650k in medical bills for cancer patients

#301

Post by alistairSH » Wed, Jan 06, 2021, 5:55 PM UTC

lotsofpulp wrote: post #294

alistairSH wrote: post #260

Earlier quoted context omitted.

Sure, I won't go as far as calling it outright fraud. But, it certainly is part of the business. And as the consumer, at the time of service, I really don't care why it happens, only that it does and that it costs me time and money and delays treatment. As far as I can tell, it's a byproduct of an adversarial relationship between the 3 parties (consumer, doctor, insurer). Insurance doesn't trust the MD to do his job,…

>the insurance company's own MDs are only there to provide legitimacy to the initial denial. I have first hand knowledge that this is false. Especially if the insurer is just acting as an administrator for a state Medicaid or federal Medicare or other payer, since there are big penalties for denying coverage just to save money. The insurers even have MDs and PharmDs to audit their own MDs and PharmDs to see if they a…

I guess, but if so, that's a massive amount of cost to the insurer (and eventually falls back on the consumer) around paperwork/review/approval for something they're going to approve eventually. I really don't understand it. Certainly in my experience, the insurer could get rid of their internal review process and people, just rubber-stamp whatever our MDs are prescribing, and save us all a lot of money and headache.

Re: US doctor forgives $650k in medical bills for cancer patients

#302

Post by lotsofpulp » Wed, Jan 06, 2021, 5:56 PM UTC

salawat wrote: post #255

lotsofpulp wrote: post #179

Earlier quoted context omitted.

> Where is your data to backup this claim? I’m claiming that insurers do not erroneously deny claims in the hopes that people give up. I don’t have data for it, but I’ve also never seen data that shows insurers deny coverage just to dissuade people (post ACA). > experience the problem with our health care system is not just denial of claims, but about the cost of medical services and medicine. Yes, I agree here about…

I have some exposure to the claim adjudication space, and I can say that there are undeniably people who see it as a fiduciary duty to make people jump through hoops before paying out a claim. This is a large part of why so many prior authorization proccesses suck royally. However, w.r.t. long term medications getting denied, keep in mind that every claim starts denied until a path through to an approval can be trave…

I agree. I think if the US is going to stick with this insurance as an agent for the patient system, then the federal government should standardize the prior authorization process, as well as EMRs and do whatever it takes to make the communications quicker and easier for the patient. I would also recommend dropping the state boundaries when it comes to healthcare, it makes everything literally 50x more complicated for no reason.

There's no reason why all these billing codes and coverage conditions should be shrouded in mystery.

Re: US doctor forgives $650k in medical bills for cancer patients

#303

Post by arcticbull » Wed, Jan 06, 2021, 5:56 PM UTC

refurb wrote: post #141

arcticbull wrote: post #123

Earlier quoted context omitted.

That's one people out of 36 million, making national news. You'll trip over a stack of them on your way to the news stand in the US. "I'm looking at having to sell my house for coverage of my medication" is practically America's national anthem. Failures happen from time to time but they are the exception and not the norm. Numbers available here: [1] for the most part Canadians getting medical care in the US are "sno…

I'm just calling out that health care coverage in Canada isn't all peaches and cream. I've experienced both systems so I know what the pros/cons of each are. Here is another examples: https://www.cbc.ca/news/canada/british-columbia/patients-liv... People in pain (who can't work or even walk) waiting 2 or 3 years for hip replacement. A friend of my mom's in BC is 85, needs a new hip and the gov't said no. Not "no, may…

> I'm just calling out that health care coverage in Canada isn't all peaches and cream. I've experienced both systems so I know what the pros/cons of each are.

As have I.

The US system is also generally ranked below the Canadian system on every measure I've seen. That doesn't necessarily mean much, as being better than the worst isn't much to write home about.

One great example of this is the US is the only developed country in the world where mother's mortality rate is rising. It's 4X higher than any in Canada. There's real serious on-the-ground issues with US healthcare. [1]

[1] https://en.wikipedia.org/wiki/Maternal_mortality_in_the_Unit...

Re: US doctor forgives $650k in medical bills for cancer patients

#304

Post by s1artibartfast » Wed, Jan 06, 2021, 6:10 PM UTC

programmertote wrote: post #268

trynewideas wrote: post #162

Some context: the clinic (technically named the Arkansas Cancer Institute, not the Arkansas Cancer Clinic as in the story) faced lawsuits in 2018-19 after more than 50 patients tested positive for an undisclosed bacterial infection linked to saline flushes on infusion ports.[1][2] The results of the lawsuit weren't reported, but the clinic closed in February 2020, about a year after the firm behind the suit pursued c…

Glad to see someone pointing out the context. Certainly this doctor and his family did a great thing by forgoing the debt owed by his patients. BUT, my wife worked and volunteered at a few private clinics around NY metro areas and I would wager that this doctor's clinic already makes a lot of money (2-3x that 650K) every year if not more. As an example, one of the primary care physician's clinic that my wife (who is…

> In summary, some of these private clinics (not to mention the hospitals and we have read about their b.s. billing practices many times) are billing patients bogus stuff on almost every patient encounter.

Do you think public clinics are any different?

Re: US doctor forgives $650k in medical bills for cancer patients

#305

Post by lotsofpulp » Wed, Jan 06, 2021, 6:12 PM UTC

valenterry wrote: post #256

lotsofpulp wrote: post #224

Earlier quoted context omitted.

I didn't feel like writing 99.9999% chance at the time, so I rounded up to 100%. It's not insurable in the sense that at some point, the losses are so large and so frequent, that the insurer needs to collect premiums from almost everyone in order to cover the costs. At that point, the premiums start to resemble a tax. I actually do consider the premiums a tax for the following reasons: 1) there is a mandate to purcha…

> It's not insurable in the sense that at some point, the losses are so large and so frequent, that the insurer needs to collect premiums from almost everyone in order to cover the costs. I actually do consider the premiums a tax for the following reasons Could it be that you limit your perspective onto only the US at the current point in time? Otherwise what you say just doesn't make any sense and your points can't…

>Could it be that you limit your perspective onto only the US at the current point in time? Otherwise what you say just doesn't make any sense and your points can't be generalized. And even in the US, health insurance is not mandatory (as you say yourself), hence I would still not call it a tax.

What I mean by insurable and uninsurable is that an entity can come in and sell insurance which can benefit the buyer alone, and is not an explicit subsidy to the other insureds in the risk pool. However, for health, it's a no brainer to opt out of health insurance between ages 20 and 40 (maybe not if you're a woman that's going to have kids). This makes the risk pool completely full of people experiencing losses and that point, it's just a cost sharing arrangement.

I.e. Auto insurance premiums reflect the loss the insurance company will experience from your driving. Home insurance premiums reflect the loss the insurance company will experience from damage to your home. Life insurance will reflect the loss the insurance company will experience from your death. But health insurance (as implemented in the US) premiums explicitly reflect the loss the insurance companies experience from older, sicker people due to the various stipulations I listed in my posts above.

>And to be honest, I think it's not good that the taxpayers are paying here. The nice thing about insurance is that it gives incentives, such as "don't live somewhere if you can't afford the dangers at this place".

I agree, and that's why I don't like using the word insurance when it's not really insurance in the conventional sense. It's a tax, which I'm not opposed to, but I think there is value in recognizing that health insurance premiums are explicitly going to pay for healthcare for other people.

This manifests itself every time someone complains about ACA causing health insurance premiums to increase, as if the law or insurers caused the premiums to go up.

What really happened is the law allowed more healthcare to be provided to more people, and the way it funded it was by increasing health insurance premiums and having everyone pay (i.e. the mandate to purchase health insurance), and I think we'd be better off if we referred to this as a tax and recognize that the increase in insurance premiums is going towards benefiting others by giving them access to previously inaccessible healthcare.

Re: US doctor forgives $650k in medical bills for cancer patients

#306

Post by lotsofpulp » Wed, Jan 06, 2021, 6:16 PM UTC

alistairSH wrote: post #301

lotsofpulp wrote: post #294

Earlier quoted context omitted.

>the insurance company's own MDs are only there to provide legitimacy to the initial denial. I have first hand knowledge that this is false. Especially if the insurer is just acting as an administrator for a state Medicaid or federal Medicare or other payer, since there are big penalties for denying coverage just to save money. The insurers even have MDs and PharmDs to audit their own MDs and PharmDs to see if they a…

I guess, but if so, that's a massive amount of cost to the insurer (and eventually falls back on the consumer) around paperwork/review/approval for something they're going to approve eventually. I really don't understand it. Certainly in my experience, the insurer could get rid of their internal review process and people, just rubber-stamp whatever our MDs are prescribing, and save us all a lot of money and headache.

>the insurer could get rid of their internal review process and people, just rubber-stamp whatever our MDs are prescribing, and save us all a lot of money and headache.

If that was true, there would be an insurer doing that and offering lower premiums on healthcare.gov

But it's not true, and the review processes do control costs (even if wrongly at times). I think the government farms this task out to insurers specifically so the insurer can take the heat for the denials, when it's actually the government's rules and standards for the requested therapies that is resulting in denial of coverage.

I've personally seen this with Medicaid or CMS penalizing for erroneously approving payment for treatments and also erroneously denying payment for treatments. And it gets very fun when the rules are not clear and there is a lot of gray area.

Re: US doctor forgives $650k in medical bills for cancer patients

#307

Post by simple_phrases » Wed, Jan 06, 2021, 6:19 PM UTC

Maksadbek wrote: post #194

It is very good that hospitals give debts for patients. I live in Uzbekistan and my father has pancreas cancer. There are no good oncologists in my country. I've contacted many hospitals worldwide and most of them asking about 10K USD and we must pay 80% of the bills before they start curing my father and of course I can't afford this amount of money and I have no any option to get it. I am ready to be in debt for an…

This is the same case in the US. Nobody is getting cancer treatment without insurance or the ability to pay. Hospitals in the US only need to stabilize an uninsured patient, and that doesn't include treating cancer or chronic conditions.

Re: US doctor forgives $650k in medical bills for cancer patients

#308

Post by s1artibartfast » Wed, Jan 06, 2021, 6:20 PM UTC

stickyricky wrote: post #258

dfxm12 wrote: post #250

Earlier quoted context omitted.

My understanding is that most voters don't support universal healthcare. Most Americans think it is the government's responsibility to ensure all Americans have healthcare coverage [0]. Also, it seems like you're talking about Obamacare as if it is universal healthcare. It's not. why there is no pressure to fix it? There is pressure. We're not even weeks removed from the "Force the Vote" campaign for Medicare for all…

> Overall, this is just another way where most politicians (in this case, Republicans and moderate Democrats) are representing their lobbyists more than their constituents. I would be careful with this interpretation. Universal healthcare has broad support but when phrased in the context of specifics or in the context of what has to be given up to achieve it the percentage of people supporting it declines.

Agreed. Of course, if ask Americans “wouldn’t it be nice if everybody had access to healthcare" everyone says yes. If you touch on how, who pays, or if you have to give up existing care, approval tanks

Re: US doctor forgives $650k in medical bills for cancer patients

#309

Post by allendoerfer » Wed, Jan 06, 2021, 6:24 PM UTC

allendoerfer wrote: post #185

undecisive wrote: post #161

Earlier quoted context omitted.

I think all systems have their downsides. In the UK for example, we've started doing citizenship checks for anyone who looks remotely like a foreigner, which to my mind is perverse and unnecessary, and part of a governmental preoccupation with trying to become as racist as possible via the back-door. (essentially, if we can blame the foreigners, we can absolve the government) However, I think we can still say "Americ…

The rest of the developed world, especially Switzerland, also has to thank the US for single-handedly ensuring the profits for its pharmaceutical industry.

Downvoters might read up on which country those pharma profits overwhelmingly come from and why companies like Novartis or Roche are worth what they are worth. As a European the US healthcare system gives me a failed-state vibe, but there are people close to me profiting directly from the absurd prices it pays for drugs.

Re: US doctor forgives $650k in medical bills for cancer patients

#310

Post by pnutjam » Wed, Jan 06, 2021, 6:44 PM UTC

lotsofpulp wrote: post #166

gambiting wrote: post #164

Earlier quoted context omitted.

Not OP, but when my dad had cancer in Poland, the national health fund covered his entire treatment over 8 years. Few operations, monthly dose of Glivec(google the cost of Glivec treatment in the US to see how insane that is), hospital stays, and like OP said - he would get reimbursed for travelling to the hospital and back. And this treatment was never tied to his employment, he never had to prove to anyone that he…

The Gleevec was probably an order of magnitude cheaper or more for the Polish government than in the US: https://www.statista.com/statistics/312011/prices-of-gleevec... And doctors in Poland are probably not earning a few hundred thousand USD per year, and similar for nurses wages and all the other people in the healthcare chain. Quick googling shows wages might be an order of magnitude cheaper also. I assume healthc…

Right on schedule, here comes someone to parrot all the debunked reasons the US can't do stuff everyone else in the world can do.