Banks and hospitals are cashing in when patients can't pay for health care • Hacker News Board

Re: Banks and hospitals are cashing in when patients can't pay for health care

#101

Post by ars » Fri, Nov 18, 2022, 2:57 AM UTC

JamesBarney wrote: post #98

ars wrote: post #91

Earlier quoted context omitted.

Deductibles were not so high before the ACA.

But coverage was not as extensive there were lifetime limits, and many people couldn't buy coverage at any price.

That is true. But I'm not sure the fix was worth it. Those uninsurable people were often able to get government assistance, and there were charities that helped them.

No one is helping the ordinary personal with a high deductible - and don't forget the huge deterrent it is to seeking medical care.

Re: Banks and hospitals are cashing in when patients can't pay for health care

#102

Post by HCDevid » Fri, Nov 18, 2022, 9:11 AM UTC

zdragnar wrote: post #100

tpmoney wrote: post #97

Earlier quoted context omitted.

>Fast forward a few weeks, and they got the bill. They ended up charging his insurance $2,200, and the insurance company valued the trip at $3,500 (presumably to bump up his co-pay? not sure). This makes no sense. Insurance companies NEVER pay more than they are asked to pay. It's half the reason why medical billing is such a royal pain. A doctor or pharmacy knows they've left money on the table if they get exactly w…

This was a point of contention for a minute on the radio show- the host was flummoxed as well that the insurance company "valued" the trip higher than what the hospital billed for. It's possible that the (clearly upset) father on the phone had the story mixed up, but I'm not sure that NY law would allow an estimate for a medical bill to end up being billed at more than double the original estimate. Hell, in my state…

On US healthcare bills there is:

Billed Amount - what the provider/health system tags as the “billed amount” Allowed Amount - what the insurer sets as the actual total $ allowed to change hands for the visit Patient Responsibility - the portion the patient is responsible for.

The Billed Amount is supposed to exceed the Allowed Amount by 2.5-5x typically so that the Allowed Amount the insurer/provider has negotiated “saves” money thanks to Insurance ostensibly in how the bill is displayed.

Put differently, your provider/health system is supposed to per the billing contract put in an inflated value well in excess of expected payment so your insurance company can reduce it so you can “save money” superficially on your bill. It is as smoke and mirrors as it sounds. Sounds like your provider / HS forgot healthcare billing 101 in this case.

The Billed - Allowed Amount value is also usually called Contractual Adjustment

Re: Banks and hospitals are cashing in when patients can't pay for health care

#103

Post by mistrial9 » Fri, Nov 18, 2022, 5:43 PM UTC

mistrial9 wrote: post #54

stevebmark wrote: post #44

Great article. It’s important to understand that hospitals are the enemy in American healthcare. (All of its layers are the enemy, but hospitals are often overlooked). Many hospitals are viscous for-profit machines that fraudulently maintain a non-profit status. They employ CFOs and business analysts to maximize profits unrelated to care quality. They hire “medical coders” whose entire job is to find the highest pric…

> that hospitals are the enemy in American healthcare no, not every hospital is run this way. Many are, of course.. how can constructive engagement get past these shrill and urgent criticisms, and make positive change?

I called for progress, as a negotiated and necessary step. constructive insights, anyone? Misaligned incentives seems to only scratch the surface of the problem space, given the quality and depth of the responses here.

Re: Banks and hospitals are cashing in when patients can't pay for health care

#104

Post by mgkimsal » Fri, Nov 18, 2022, 8:58 PM UTC

theGnuMe wrote: post #88

mgkimsal wrote: post #68

Earlier quoted context omitted.

Assuming that 10 or 100k of services is 'in network'. The only plan I can remotely afford now offers no functionality in any 'out of network' facility. The columns are all just 'n/a'.

Sure but that's ok. If you cannot get equivalent care nearby "in network" then you can go out of network and get covered. They won't like it and it can take negotiation but you have that option. All emergency care for example operates this way. This is why the ACA stuff uses your zip code to offer plans. Remember most of these are State and Federal partnerships with private companies. The companies are just offering…

"then you can go out of network and get covered"

I can get the care, but nothing in what you're describing sounds like what my paperwork details say. It indicates that any non-emergency services undertaken outside of their network will not be dealt with at all. I'm not sure how this is 'better' than what it used to be, with 'used to be' being last year's plan that would, at least, deal with services delivered out of network, with some % split up to a deductible.