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

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

#181

Earlier quoted context omitted.

This is why it's good to be English - our national health service fixes you up and sends you on your way without providing you with a bill.

Unless the NHS has no approved treatment, in which case you die instead of being able to go abroad for care.

If the NHS has no approved treatment you can go abroad or you can pay privately in the UK.

What conditions are you thinking of that don't have "approved" treatments?

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

#182

Earlier quoted context omitted.

When you realize that the hospital was charging $19,000 for a stent that cost $1,500, you realize that painting Calver as someone who is going to cost us all money is misdirected anger. And, to be clear, they charged $19,000 for the stent, not "stent plus theater time to place it plus surgeon, anesthesiology, OR nurses", of course not. Those are all absolutely billed separately.

Hospitals should be legally mandated to accept replacement of materials in lieu of payment. If I can source the same stents for cheaper than the hospital bills me, they should be required to erase them from the bill and accept them as material replacement. It's not as if medical supplies are unavailable to the end consumer. https://www.esutures.com/product/0-in-date/41-boston-scienti... Here are the stents available…

Honest question - does this really work? I have tried it once or twice without success. Are there particular 'magic phrases' you need to use, or is it jut a question of persistence? Does it impact your credit?

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

#183
post #36

Earlier quoted context omitted.

I was going to respond saying that most hospitals are nonprofits and aren't actually making a great profit margin off this sort of overcharging. But then I looked it up and St. David's, despite having a religious nonprofit-sounding name, is actually owned by HCA Healthcare, which is a for-profit that has almost 4x'd its stock price over the past five years while acquiring more hospitals to grow. So, yeah, this one is…

> squeezing money out of insurance companies because they can FTFY. But seriously, how can it possibly be the hospital's fault for doing exactly what the law and market incentives give them every reason to do? There's almost no downward pressure on prices: little competition, no transparent pricing, huge barriers to market entry, and third party payers.

"But seriously, how can it possibly be the hospital's fault for doing exactly what the law and market incentives give them every reason to do? "

Because they're the ones actually doing it? Because they're run by adults who are fully capable of taking responsibility for their actions?

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

#184
post #3

All this is a bit surreal (Canadian here), but it prompts the question: why won't people sue in a class action to refund money they gave to the insurance in the first place? I realize it's a complex subject, but at the end of the day, the insurance companies advertise and sell: insurance.

Any insurance policy will have clearly stated the difference between out of network and in network benefits.

But you can't always pick your providers. Example: You go to emergency room that is in-network. A month later you get the bill for the doctors that treated you - who aren't in-network.

"A new study that looked at more than 2 million emergency department visits found that more than 1 in 5 patients who went to ERs within their health-insurance networks ended up being treated by an "out-of-network" doctor — and thus exposed to additional charges not covered by their insurance plan." https://www.cnbc.com/2016/11/16/many-get-hit-with-surprise-o...

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

#186

Another easy solution, file for bankruptcy. No sane judge will kick a family out of their house over a medical bill. That would be counter productive to their recovery and cause undue hardship. If you don't see the utility in bankruptcy, just remember our President has used it several times over decades. Edit: it's also known as unsecured-debt, which means the worst thing anyone can try to do to you is ruin your cred…

Creditors can do more than ruin your credit score. It's state dependent, but they can also sue you to seize bank accounts, garnish your wages, etc.

Fortunately, it's Texas, so wage garnishment is out, as is seizing your primary residence. So is seizure of retirement accounts. Really the practical amount of debt is what the creditor can force you to pay, which is capped at your liquid assets.

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

#188

Earlier quoted context omitted.

When you realize that the hospital was charging $19,000 for a stent that cost $1,500, you realize that painting Calver as someone who is going to cost us all money is misdirected anger. And, to be clear, they charged $19,000 for the stent, not "stent plus theater time to place it plus surgeon, anesthesiology, OR nurses", of course not. Those are all absolutely billed separately.

Hospitals should be legally mandated to accept replacement of materials in lieu of payment. If I can source the same stents for cheaper than the hospital bills me, they should be required to erase them from the bill and accept them as material replacement. It's not as if medical supplies are unavailable to the end consumer. https://www.esutures.com/product/0-in-date/41-boston-scienti... Here are the stents available…

Is anyone working on an app that can do this? There were those parking ticket negotiating apps for a bit. I wonder if there is a way to systemize the negotiation process here. I bet you could charge people up to 10% of the money you save them.

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

#189
post #53
post #7

> UPDATE: Monday, shortly after publication and broadcast of this story by Kaiser Health News and NPR, St. David’s said it was now willing to accept $782.29 to resolve the $108,951 balance because Drew Calver qualifies for its “financial assistance discount.” Sounds all fine and dandy until you realize that these charges will just be made up for by people that aren't able to get NPR to publish a story about them.

There is a whole industry of "medical billing advocates" you can pay to find what is likely thousands if not tens of thousands of dollars of completely made up charges on any given US hospital bill and "negotiate" them away. You don't necessarily need press coverage though it obviously helps. Hell one time I got a $15k bill for something insurance should have covered. Called the hospital, turns out insurance had cove…

A key element here is do not pay immediately. Once you pay, they stop working on the problem entirely.

I'm not saying, "ignore it and it goes away." Just that the billing side of things has no interest in working when they already have your money.

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

#190

Earlier quoted context omitted.

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.

So... When you're in the ambulance dying of a heart attack, you're supposed to be negotiating over your saline drip or on the phone with another ambulance company looking for a better deal?
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