Bay Area couple shocked by $200K hospital bill for rabies shots • Hacker News Board

Re: Bay Area couple shocked by $200K hospital bill for rabies shots

#101

Post by xiphias2 » Wed, Apr 12, 2023, 2:06 AM UTC

1letterunixname wrote: post #41

dmarchuk wrote: post #11

> Tens of thousands of people each year receive a series of shots to prevent rabies after a possible exposure. It normally costs between $1,200 and $6,800. Not in this case. Even that "normal" cost is absolutely crazy.

Most Americans don't realize how bad they have it. They've grown accustomed to being punched and slapped around and so won't rebel. They'll keep giving all of what little and shrinking of what they have to legitimized criminals.

How? They don't have internet?

Even in Zurich, Switzerland, one of the most expensive places and healthcares in the world, it's 85 CHF / shot:

https://reisemedizin.uzh.ch/en/pre-travel_advice/rabies

Emergency room is 50 CHF extra in non-emergency cases:

https://www.thelocal.ch/20210617/emergency-room-visits-to-no....

Re: Bay Area couple shocked by $200K hospital bill for rabies shots

#102

Post by xiphias2 » Wed, Apr 12, 2023, 2:11 AM UTC

lastofthemojito wrote: post #50

Absolutely insane that they would have been better off heading to SFO, walking up to the Air Canada or Aeroméxico counters, and leaving the country for care.

Or just get a private flight...it's much cheaper than $200k

Re: Bay Area couple shocked by $200K hospital bill for rabies shots

#103

Post by maxerickson » Wed, Apr 12, 2023, 2:12 AM UTC

etrautmann wrote: post #100

maxerickson wrote: post #96

Earlier quoted context omitted.

Doctors could, to some approximation anyway, go on strike. They endorse the system we have by working in it (and have not been silent participants in building either).

It seems uncommon for one group to strike on behalf of another group. Pragmatically that seems very unlikely to happen even if theoretically possible. Policy level changes seem more likely to me.

Okay, but the point is sort of that doctors are not in fact blameless for the system that they helped build and continue to participate in.

Like sure, they aren't solely to blame, and it would probably be hard for individual doctors to successfully push for systematic changes, but the flip side to that is that they don't get to say "Oopsie doopsie, it sure isn't great".

Re: Bay Area couple shocked by $200K hospital bill for rabies shots

#104

Post by seanmcdirmid » Wed, Apr 12, 2023, 2:44 AM UTC

myth2018 wrote: post #81

1letterunixname wrote: post #68

Earlier quoted context omitted.

Oh my word. 2018, I was on Medi-Cal (Medic-aid) and had a stress ECG, right heart catheterization, and 12-lead EKG when admitted to their cardiac unit for 3 days. Cost $0. Like a third-world country: in America, you're better off being either totally penniless or a billionaire. If you don't have a balance sheet of $5 megabucks, your life will be miserable. The advantage most European and other countries have under so…

> Like a third-world country: in America, you're better off being either totally penniless or a billionaire. If you don't have a balance sheet of $5 megabucks, your life will be miserable. I live in a "third-world" country. My family and I have insurance and only use private hospitals -- the capitalist portion of the system. Never had as bad an incident as the ones you guys are reporting here. Just some minor annoyan…

When I was living in China working for Microsoft, our company provided insurance had a cap on claims paid ($100k), so while everything was cheap enough via the private system, I wondered if I was screwed if I ever got cancer or something really bad.

Re: Bay Area couple shocked by $200K hospital bill for rabies shots

#105

Post by mindslight » Wed, Apr 12, 2023, 4:15 AM UTC

1letterunixname wrote: post #72

I once dropped in to a hospital near Vacaville, maybe the same one. There was a security guard at the front with a grey keypad. The would not speak to you unless you entered your Social Security Number. I made the mistake of entering it but thought nothing would happen because I didn't see any live human. Guess what? $800 bill for the pleasure of seeing exactly no service provider. This is how they work.

Did you pay it? If so, why?

So many anecdotes end with "they sent me a bill", without saying what happened next. Just because someone sends you a bill does not mean you have to pay, especially when that bill seemingly isn't based on a contract or other form of legal liability. Did you tell them to go screw, they took you to court, and they actually managed to substantiate the debt? Or if you were worried and strapped for time and just gave in to the extortion, please let us know that.

Re: Bay Area couple shocked by $200K hospital bill for rabies shots

#106

Post by mindslight » Wed, Apr 12, 2023, 4:21 AM UTC

nradov wrote: post #52

olliej wrote: post #13

This is another of those cases which seem to be very clearly price gouging, which is illegal, unless you're a hospital. The hospital should be subpoena'd to get the actual cost of treatment - both the vaccination, the amount paid to the ER staff during the time the patients were there, etc. Also this BS where they can just say "out of respect for patient privacy we don't discuss billing matters", when the patient has…

I won't attempt to defend the hospital but even outside of healthcare, price gouging is almost always legal. There are only a few limited circumstances where it is banned in a subset of US states.

"Price gouging" is only legal when a contract is formed. A contract requires well defined consideration, as well as a meeting of the minds - neither is present when a person is not told an up front price (especially after asking), and is under medical duress.

Re: Bay Area couple shocked by $200K hospital bill for rabies shots

#107

Post by mindslight » Wed, Apr 12, 2023, 4:31 AM UTC

etrautmann wrote: post #89

1letterunixname wrote: post #15

That's a shitty bill. It's also insane that US doctors and hospitals aren't required to post prices, keep prices reasonably within an allowed range, and are allowed to price gouge customers for however much they want without limit. In Redding CA, I ran across a woman with a nasal infusion pump tube taped to her face in a coffee shop. She was hurriedly collecting paperwork for a hearing across the street. It turns out…

Doctors are NOT to blame here. It's almost as inscrutable and impossible for them to understand the process as the patients. Doctors often times have to battle insurance companies on behalf of the patients to get them the drugs they need with coverage. My wife is a cancer physician and spends hours on the phone convincing insurance companies that patients actually need the treatments she's proscribed. It's an infuria…

Providers are a full half of the problem! We live in a market economy, and it is doctors' responsibility to be able to answer straightforward questions about how much various treatments will cost, just as every other profession gives quotes and estimates. Pretending that money doesn't exist is doing a grave disservice to patients, for whom money most certainly is a concern.

In the short term, I know it's a tall ask for a provider to be able to tell a patient how much care from other providers might cost. But providers could certainly start by knowing the prices of services that they themselves perform. And if that's too hard because their billing departments have made it opaque with a whole slew of prices depending on who might be paying, then providers need to work on reforming their own houses before pointing fingers at the other half of the problem.

Re: Bay Area couple shocked by $200K hospital bill for rabies shots

#108

Post by teeray » Wed, Apr 12, 2023, 5:47 AM UTC

p1esk wrote: post #74

1letterunixname wrote: post #59

Earlier quoted context omitted.

That doesn't work in the real world. Their army of lawyers can and will outspend you at every turn. They will force you into bankruptcy when you should've declared bankruptcy to begin with.

But do they want to outspend you? Especially if the case is not a sure win for them.

So the real disruption would be to DoS their lawyers by patients disputing absolutely everything questionable. Create an app to upload all the EOBs and make it dead simple to create grief for the hospital.

Re: Bay Area couple shocked by $200K hospital bill for rabies shots

#109

Post by dheera » Wed, Apr 12, 2023, 5:55 AM UTC

theGnuMe wrote: post #95

dheera wrote: post #38

Earlier quoted context omitted.

I got charged $5000 for a 30-minute preventative echocardiogram (basically an ultrasound) that insurance was supposed to pay 100%. 20 emails later it's now at debt collectors, and I've contested the debt twice. I'm ready to appear in court if I have to. I'm ready to pay $8K in lawyer fees to get rid of this $5K bill because it's wrong. I just don't want this to impact my credit score because it's not my debt. I hate…

Why didn't the insurer pay? Was it not covered? And what setting was it in, outpatient or ER? If ER then you should be able to dispute with your insurer to get it covered. If outpatient you might be able to negotiate with the Financial Services folks that they (the doctor) did not submit for pre-authorization appropriately per industry standards. That's where you build your argument that they acted inappropriately an…

> Why didn't the insurer pay? Was it not covered? And what setting was it in, outpatient or ER?

Outpatient. Routine preventative care, I have a heart condition so echocardiograms are done every 2-3 years as a preventative measure. Insurance plan claims 100% coverage of preventative care with no deductible or coinsurance. I tried to dispute with insurance but they insist that it wasn't preventative (it's my body, my health, I know better than them that it was preventative) and they consistently would put me on hold for VERY long times on the phone until 5pm and then say "whoops, we're closed"

> The next question is are you on a State plan or a corporate EIRSA plan?

Self-purchased out of marketplace plan (HealthNet). I was self-employed at the time.

> Or you can talk to the news. They love to report on these things.

I would absolutely love if someone can put me in touch with a contact.

Re: Bay Area couple shocked by $200K hospital bill for rabies shots

#110

Post by wdr1 » Wed, Apr 12, 2023, 5:56 AM UTC

1letterunixname wrote: post #15

That's a shitty bill. It's also insane that US doctors and hospitals aren't required to post prices, keep prices reasonably within an allowed range, and are allowed to price gouge customers for however much they want without limit. In Redding CA, I ran across a woman with a nasal infusion pump tube taped to her face in a coffee shop. She was hurriedly collecting paperwork for a hearing across the street. It turns out…

> It's also insane that US doctors and hospitals aren't required to post prices,

This doesn't get a lot of attention because, well, what media outlet could write a positive article about Trump & get away with it, but healthcare price transparency was a big issue of his and during his administration the Hospital Price Transparency Final Rule was established.

The rule was issued by the Centers for Medicare & Medicaid Services (CMS) in November 2019 and requires hospitals to post prices.

The Trump administration argued that the rule would help to empower patients by providing them with more information about the costs of healthcare services, and that it would promote competition among hospitals and other providers, leading to lower prices and improved quality of care.

The rule was initially challenged in court by a group of hospital organizations, but in June 2020, a federal judge upheld the rule, clearing the way for it to take effect on January 1, 2021.