Insured, but Still Owing $109K for a Heart Attack • Hacker News Board

Re: Insured, but Still Owing $109K for a Heart Attack

#171

Post by HamSession » Tue, Aug 28, 2018, 7:00 PM UTC

donclark wrote: post #29

I curious to know the details of his health. He just did an IRONMAN 5 months before. Why was he unaware of the status of his clogged “widow-maker” artery? Why was his artery clogged? high cholesterol? What does his diet consist of? Use of ultrasound imaging to measure the thickness of the inner walls of the carotid arteries that supply blood to the brain. Increasing carotid artery intima-media thickness, or CIMT, ind…

There are a lot of factors that can go into heart disease. Some of these factors are:

1. Under/over working out, especially for white men over working out can lead to increased shear stress on the arteries

2. Genetic familia hypercholesterolemia aka high cholesterol. This is caught by a blood test and fixed with statins.

3. High Blood Pressure again exams and medication

4. Size of ldl particles, this one is new

5. Genetic markers especially 9p21.3, sadly about a third of people have this marker. How it works we don't entirely know, but the best guess I've come up with is it has to do with interlukin

6 signaling which signals inflammation. Solution to this might be taking curcumin, lower weight, Mediterranean diet.

7. Low HDL again mostly genetic, niacin may help some as may exercise

From my research into the matter it seems that the initial damage is done via HBP, shear stress, or cell repair failure. Then inflammatory markers attach to site causing white blood cells and ldl to infiltrate between the inner and outer walls. Eventually the plaque grows and the inner wall continues to thin until one of two scenarios occur 1) hard cap forms (calcification) and the plaque grows until it restricts enough blood that it causes heart attack or 2) The much more dangerous scenario of the inner wall thinning and breaking causing a clot and instant heart attack. The bad part about 2) is that its undetectable except for angiograph or nuclear stress (treadmill can if the heart rate goes high enough and the doctor skilled at interpretation). Some hope for 2) is that statins seem to encourage calcification of those thin walls thus preventing the heart attacks.

This is just what causes the heart attack and the actual fix (stenting and balloon angioplasty) has its own issues. Where the only surefire fix after a heart attack is a bypass, but if more than 2 plaques are found you need to harvest veins which don't last as long. What the entrepreneur world needs to focus on in my opinion is easier at home detection of coronary plaques (sound, radar, electrical, magnetic, etc.). If the government got involved nanorobotics and bio compatible hearts could be explored along with angiogensis via external stimulation, but each of those would be a moonshot program.

Re: Insured, but Still Owing $109K for a Heart Attack

#172

Post by dalore » Tue, Aug 28, 2018, 7:01 PM UTC

donclark wrote: post #29

I curious to know the details of his health. He just did an IRONMAN 5 months before. Why was he unaware of the status of his clogged “widow-maker” artery? Why was his artery clogged? high cholesterol? What does his diet consist of? Use of ultrasound imaging to measure the thickness of the inner walls of the carotid arteries that supply blood to the brain. Increasing carotid artery intima-media thickness, or CIMT, ind…

Cholesterol is a very low if not irrelevant marker for heart disease now. It's been a myth for 40+ years that food high in cholesterol will clog your arteries. Dietary cholesterol has very little impact on total blood LDL cholesterol levels.

https://www.biznews.com/health/2015/02/16/science-says-tim-n...

There is NO evidence that:

- too much saturated fat raises cholesterol

- saturated fat causes heart disease

- high cholesterol causes heart disease

- lowering cholesterol reduces heart disease

- there is a correlation between obesity rates and the amount of fat consumption

- there is a correlation between obesity rates and the amount of protein consumption

And there IS evidence that:

- there is a correlation between obesity rates and the amount of carbohydrate consumption

- the obesity and diabetes epidemics are a direct result of the misleading cholesterol campaign.

Studies also show that the advice of replacing fats with carbs increases your risk of heart disease.

Re: Insured, but Still Owing $109K for a Heart Attack

#173

Post by Rapzid » Tue, Aug 28, 2018, 7:01 PM UTC

mjcl wrote: post #123

achoped wrote: post #85

Earlier quoted context omitted.

Not always. My mom had a quadruple bypass about 6 years ago during a gap year where she stopped working but didn't have Medicare yet. Unlucky. I think she was billed for around $180k. She told them "I'm on Social Security for $1000/mo, I'll pay you $50/mo". It was basically that or sending it to collections and never getting a dime from a retiree. So they accepted and told her a "non-profit" paid for the doctor's por…

> Medical debt is the least concerning type of debt for most lenders. Just another data point, a large property management company I used to work for specifically exempted bankruptcies due to medical debt when calculating applicant credit scores.

I used to worked at Wells Fargo and my friend in sales said the mortgage underwriters typically didn't blink at medical debt.

I wonder what would happen if it was widespread knowledge that the smart money was in never paying it.

Re: Insured, but Still Owing $109K for a Heart Attack

#174

Post by robin_reala » Tue, Aug 28, 2018, 7:05 PM UTC

ThrustVectoring wrote: post #149

This is why I plan on moving to Texas: creditor protection. At any point in time I could require medical services and have medical service providers simply decide that I owe them a truly massive amount of money. The only route I have to mitigate that risk is through creditor protection laws. In Texas, wage garnishment is limited to child support, unpaid taxes, and some other limited categories that medical billing do…

You might be better moving to a country with a nationalised health system and avoiding this mess entirely.

Re: Insured, but Still Owing $109K for a Heart Attack

#175

Post by Rapzid » Tue, Aug 28, 2018, 7:05 PM UTC

rdtsc wrote: post #52

> St. David’s HealthCare defended its handling of Calver’s bill and sought to blame the school district and Aetna for offering such a narrow network. So while dying of a heart attack he should have been negotiating with the ambulance driver, the paramedics, the nurses, each intern and doctor to make sure they are "in-network". > St. David’s said it was now willing to accept $782.29 to resolve the $108,951 balance bec…

I wouldn't pay them a single cent more. The 782.29 is just as bogus as the initial charges. There is pretty solid pricing data suggesting the insurance company already over paid.

Re: Insured, but Still Owing $109K for a Heart Attack

#176

Post by freeone3000 » Tue, Aug 28, 2018, 7:05 PM UTC

h4b4n3r0 wrote: post #139

TomVDB wrote: post #115

Earlier quoted context omitted.

And in some systems, horror stories are way more common than others. The simple fact is that I don't know anybody from my European family or friends who would willingly switch their system to the US one. And as a very well insured employee in the US, if, hypothetically, I had the option to use my European health care in the US, I'd switch immediately a well.

>> I'd switch immediately a well I doubt it. Someone needs to pay for it, so this switch would have to imply a 20% tax increase. Unless you’re paid peanuts, it’s not worth the tradeoff.

Huh? Tax rates are not 20% higher in Canada than in the US, and we somehow muddle through.

Re: Insured, but Still Owing $109K for a Heart Attack

#177

Post by epitrochoidal » Tue, Aug 28, 2018, 7:05 PM UTC

lotsofpulp wrote: post #104

mnm1 wrote: post #80

The insurance company is basically saying, you should still choose the in-network provider even if you are unconscious or don't have a choice or we'll fuck you financially. I've had this happen to me, appealed, and after many months, actually won. In my case I was unconscious and the ambulance and hospital were out of network. I was lucky the hospital was willing to wait over a year and not send it to collections. It…

Do you expect one organization to have a pricing agreement with every single medical provider in the USA?

You mean, like Medicare? OK, it's not with every provider, just anyone who wants to be a provider.

Re: Insured, but Still Owing $109K for a Heart Attack

#178

Post by theseatoms » Tue, Aug 28, 2018, 7:09 PM UTC

merpnderp wrote: post #154

csomar wrote: post #146

Looking at the bill, here is some ridiculous: NaCl (basically salted water) costing around $300/liter. That's outrageous. These guys are protected by your politicians and make use of mercenary tactics. Villains in doctors clothing. I'm for free markets but we are kinda going over the limit here. Maybe have fixed rates for emergency where you can't get the approval of the patient. Maybe give the patient the possibilit…

What about this market seems free? The entry barriers for competition are so high, the only players are the well established, and much more importantly, well connected. And they can freely abuse the system with almost zero market or political repercussions. On a side note there is no industry more heavily regulated than the medical industry. Coincidence?

Exactly. Price has become divorced from end user value basically anywhere you look in the medical field.

Re: Insured, but Still Owing $109K for a Heart Attack

#179

Post by lotsofpulp » Tue, Aug 28, 2018, 7:11 PM UTC

epitrochoidal wrote: post #177

lotsofpulp wrote: post #104

Earlier quoted context omitted.

Do you expect one organization to have a pricing agreement with every single medical provider in the USA?

You mean, like Medicare? OK, it's not with every provider, just anyone who wants to be a provider.

I should have written one health insurance company instead of one organization. Obviously it doesn't make sense to compare a health insurance company that has to abide by 50 different state insurance regulators to the US government.

Re: Insured, but Still Owing $109K for a Heart Attack

#180

Post by dalore » Tue, Aug 28, 2018, 7:12 PM UTC

HamSession wrote: post #171

donclark wrote: post #29

I curious to know the details of his health. He just did an IRONMAN 5 months before. Why was he unaware of the status of his clogged “widow-maker” artery? Why was his artery clogged? high cholesterol? What does his diet consist of? Use of ultrasound imaging to measure the thickness of the inner walls of the carotid arteries that supply blood to the brain. Increasing carotid artery intima-media thickness, or CIMT, ind…

There are a lot of factors that can go into heart disease. Some of these factors are: 1. Under/over working out, especially for white men over working out can lead to increased shear stress on the arteries 2. Genetic familia hypercholesterolemia aka high cholesterol. This is caught by a blood test and fixed with statins. 3. High Blood Pressure again exams and medication 4. Size of ldl particles, this one is new 5. Ge…

There is a faulty assumption that higher cholesterol leads to higher risk of heart disease, but the fact the opposite is true.

http://www.zoeharcombe.com/2016/11/familial-hypercholesterol...

A few of the other facts/assumptions you make are outdated. Statins do very little to improve mortality. Inflammation can be reduced by cutting out carbs and sugar. Eating more saturated fats and omega 3 also reduces your risk of heart disease.

In fact the whole dietary advice given over the last 60 years is responsible for the epidemic we now have with obesity, diabetes and heart attacks. But they can't come out and say they are wrong, but they are slowly changing it a bit at a time.