What I learned from reading a thousand emergency room bills • Hacker News Board

Re: What I learned from reading a thousand emergency room bills

#251

Post by sly010 » Wed, Dec 19, 2018, 10:49 PM UTC

This is outrageous because the regulation wouldn't even have to be complicated. In the EU there is a directive that you have the rights to know the retail prices of things before you make a purchase and in some countries, retailers have to honor the lowest posted price and we are talking about baguettes!

I don't see why that same thing couldn't apply for healthcare. 1. ERs should publish prices in a public database. If a price is not published for an item/procedure, the customer can pay the lowest price she/he can find for the same procedure from an other provider. 2. The same price must be charged from everyone (regardless of insurance).

Even if only a small fraction of people shop around it might push down the prices. Even if the above is too naive, I am sure someone smarter can come up with a less naive version of it.

Re: What I learned from reading a thousand emergency room bills

#252

Post by stdplaceholder » Wed, Dec 19, 2018, 10:49 PM UTC

bluGill wrote: post #171

drak0n1c wrote: post #63

Earlier quoted context omitted.

Legislation requiring up-front presented costs to be honored and any additional procedures/costs to be cleared with patient consent as they happen (or a consent waiver obtained from the patient with a promised limit or incentive such as overall discount) might be an improvement. Or it may increase costs for the worse. Who knows.

Careful there though. If a surgeon is operating on cancer and discovers that the tumor is much larger than expected the operation will take longer - be more expensive - or the surgeon does the operation as planned and then charges even more for the second surgery to remove the rest. Or maybe all operations are estimated as the worst case and so you end up with no more clue about what you will pay than today - in some…

That’s not really the problem we face, though. Our problem is you ask how much it costs to give birth at a hospital and then everything goes according to plan and later you get endless bills for much more than they said, often from providers who weren’t even in attendance, for materials that weren’t even used, and so forth.

Re: What I learned from reading a thousand emergency room bills

#253

Post by diogenescynic » Wed, Dec 19, 2018, 10:49 PM UTC

>3) You can be charged just for sitting in a waiting room

I once fainted during a comedy show because the comedian was talking about his wife almost dying in surgery in graphic detail and I got nauseous and fainted. I woke up outside the comedy club up against a wall with an ambulance there. They basically took my blood pressure and gave me a bottle of water then asked if I wanted to go to the hospital. I declined. I still received a $3000 emergency services bill later... Apparently they checked my ID/insurance when I passed out and somehow I ended up with a bill even though I declined service.

In contrast, I once hit my head on a train in France and had a huge gash that needed stitches. I took a taxi to an ER, got seen within 20 minutes, left the ER within 90 minutes, then had a $50 Euro bill.

The contrast between "socialized" healthcare in Europe vs privatized healthcare in the US is shocking. We receive far, far, far worse quality and fewer services despite paying a lot more. We're in the worst of all situations.

Re: What I learned from reading a thousand emergency room bills

#254

Post by dsfyu404ed » Wed, Dec 19, 2018, 10:49 PM UTC

nojvek wrote: post #115

duxup wrote: post #39

Earlier quoted context omitted.

Anecdotal illustration time: Both my kids were born early. The medical bills for both totaled (with hospital stays for babies and mom) north of 100k each, the second WAY north. Both involved situations that were "emergency" type situations. We couldn't shop around, we couldn't even sign anything. We trusted the hospitals and doctors and went from there. Fortunately I had good insurance, if for some reason I had to pa…

Well that’s how they get you. Well it’s your dear ones life. Surely money isn’t an issue right ? Here take this bill that will bankrupt for the rest of your life. The big problem is that every other modern country has this shit sorted out. They don’t bring crippling debt because you got a minor surgery. In US, we are literally murdering people because they are too afraid of what it will cost.

>...literally murdering...

Literally one of those words is not being used correctly.

Re: What I learned from reading a thousand emergency room bills

#255

Post by krupan » Wed, Dec 19, 2018, 10:50 PM UTC

commandlinefan wrote: post #146

ams6110 wrote: post #5

I'm not an advocate of government paid health care, but hospitals and medical providers should see that this train is coming and if they don't become more transparent it's going to be forced upon them. I don't have a problem with ER care being more expensive -- that isn't necessarily unreasonable when you are getting care in an expensive facility open 24x7, fitted out with equipment to handle any possible medical eme…

> if they don't become more transparent it's going to be forced upon them. Semi-tinfoil-hat conspiracy incoming: I think doctors and hospitals actually want government funded medical care, and are doing some of this to speed that up. Think about it. No more dealing with 100 different insurance companies or sometimes trying to bill uninsured patients: just develop expertise in handling one single government agency, an…

"just develop expertise in handling one single government agency, and rake in essentially as much money as you care to have"

I hadn't thought of it this way before, but that's exactly what Raytheon, Northrup Gruman, and Lockheed Martin do. Hmm.

Re: What I learned from reading a thousand emergency room bills

#256

Post by vec » Wed, Dec 19, 2018, 10:51 PM UTC

CWuestefeld wrote: post #212

vec wrote: post #116

Earlier quoted context omitted.

Because it's not everyone paying for everyone's health care, it's one entity paying for everyone's health care (using funds they get from everyone). That one entity can unilaterally refuse to do business with abusive vendors. They can negotiate for lower prices. They can notice and investigate discrepancies in pricing between similar cases. They are in a position to judge which types of care are and are not cost effe…

They are in a position to judge which types of care are and are not cost effective and can refuse to cover the latter. That doesn't always work out as well as you might think. A number of years back Medicare told hospitals they'd no longer pay for UTI treatment, unless the provider could prove that the patient had the UTI when they were admitted. This made sense, because hospital-acquired UTI is a big thing. The thin…

It doesn't always have to work out, it just has to work out in the aggregate. The bar that the existing private insurance regime has set for discouraging wasteful medical tests isn't exactly high, though.

It's also worth pointing that what you're describing is an illusion of efficiency arising from Medicare implicitly pushing costs off onto non-Medicare patients. That wouldn't be able to happen if there weren't any non-Medicare patients.

Re: What I learned from reading a thousand emergency room bills

#257

Post by shoguning » Wed, Dec 19, 2018, 10:51 PM UTC

UnpossibleJim wrote: post #26

vec wrote: post #14

Exhibit A for why "free market healthcare" is an oxymoron. I have yet to hear a coherent explanation for how anyone can reasonably expect for price discovery to even pretend to function in a market where the consumers can't even guess the prices until after they've already purchased and frequently couldn't reasonably be expected to refuse service even if they did believe it was overpriced.

Exactly. It's the same reason we don't have free market police and fire services. You simply don't get to "shop around" for emergency services, which includes privatized ambulance services (which are outrageously expensive, on the order of $12,000 for the ride I took when I had to take one, and it was a relatively benign one... thank god I had insurance). EMS is covered, but that's the Fire Department. After that, it…

There is so much good that price transparency would do. Most treatments are not emergency and you can absolutely shop around even if it's not cosmetic. Ever hear of medical tourism? It's not a perfectly 'free market', but it could benefit so much from better information.

Re: What I learned from reading a thousand emergency room bills

#258

Post by krupan » Wed, Dec 19, 2018, 10:53 PM UTC

vec wrote: post #207

krupan wrote: post #190

Let's be careful to not look at one type of health care, emergency care, and generalize to all types of health care. Right now we all (Americans at least) don't really have insurance. We are part of pre-paid health clubs and we try to use the health club membership to pay for everything. For true time-sensitive emergencies we should all have traditional insurance, and yes, the services should probably be supplied, li…

This works reasonably well for things like vision care because they're entirely opt-in. Patients who aren't satisfied with the prices they're being quoted can realistically choose to keep wearing glasses instead. No one in their right mind is going to decide that the going rate for chemotherapy is a little steep right now so they're going to sit with the cancer for a year or two and see if the prices come down.

So think of it in terms of food then. We don't have "food insurance," yet food is a short-term need and it works pretty darn well as a free market.

Re: What I learned from reading a thousand emergency room bills

#259

Post by y-c-o-m-b » Wed, Dec 19, 2018, 10:53 PM UTC

wycy wrote: post #46

y-c-o-m-b wrote: post #28

I was a victim of the surprise out of network bill in the Portland, OR area. I did all my research before hand: hospital in network, surgeon in network, etc. but ONE person in that operating room was not in network and SURPRISE i'm out thousands of dollars. The worst part about this is my state passed a bill to stop this prior to my surgery, but the bill's effective date was roughly 3 months later. Talk about bad tim…

From what I understand (which is honestly not much), I think in cases like this you can contact the hospital and just insist on paying the same amount your insurance would have paid, and they'll often take it. That's just what I hear, though.

Not in all cases - it varies significantly for everyone. In my case the hospital, surgeon, anesthesiologist, and some of the assistants were all billed under different systems and as separate entities. The hospital has nothing to negotiate because they're in-network so I had no balance due (meet my out of pocket maximum).

The surgeon's assistant was the out of network provider and he was also part of a different practice, so it was his practice billing department that would not budge because they deemed their costs as reasonable and "already discounted".

Re: What I learned from reading a thousand emergency room bills

#260

Post by manfredo » Wed, Dec 19, 2018, 10:54 PM UTC

maxxxxx wrote: post #96

manfredo wrote: post #83

Earlier quoted context omitted.

Realistically, no hospital is going to give out a price. They don't know what unexpected complication may arise that requires additional services.

They have nice pricing tables for insurances,. Just not for patients. Even unexpected complications will have a billing code but the prices are kept secret.

Insurance companies are very different types of customers than uninsured patients. They're effectively averaging their price over a large number of patients. Most are probably slightly more expensive than necessary, but that difference helps subsidize those that experience complications. Furthermore, individual patients fail to pay at a much higher rate so that is reflected in the cost as well. A hospital can't just give the "insurance price" to uninsured patients as this may put them underwater.