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

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

#31

Post by nightcracker » Wed, Dec 19, 2018, 9:06 PM UTC

tivert wrote: post #25

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…

> But it is unfair to have no idea what costs you are facing and whether any of those costs are out of network on your insurance. It's practically impossible to make an informed economic decision about truly emergency medical care without heavy regulation. It's not uncommon to be literally unconscious while all the care decisions for you are being made by others. See this article for an example: some uninsured woman…

Considering she was unconscious she could not possibly have consented to those transactions. What laws exist that allow these companies to unilaterally create these transactions, and what limitations do they have?

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

#32

Post by repiret » Wed, Dec 19, 2018, 9:06 PM UTC

lolsal wrote: post #3

I know $60 Ibuprofen can seem like a lot, but is anyone arguing that you're literally paying for only the pill(s) with that $60? Aren't you paying for the instant availability, the insurance that it's not expired (do they even expire? I really don't know), and confidence that your healthcare provider has signed off that XXX mg of Ibuprofen is a.) OK to have with your current medications and conditions and b.) suffici…

The law doesn’t require you to serve your customers regardless of their abality to pay. You don’t have a set of customers who have figured that out and come to you for services outside your core competencies.

The market also doesn’t expect you to accept payment terms much worse than NET30.

And a hundred other ways that healthcare is a tricky business. If we want to fix price transparency, we need to fix all that too.

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

#33

Post by joewrong » Wed, Dec 19, 2018, 9:06 PM UTC

AngeloAnolin wrote: post #4

Reading this article and seeing all the startups sprouting in the field of health care and medicine tells me that there's still a lot more areas to innovate and disrupt in this industry. One big issue though are that lobbyists who wanted to keep prices high - to squeeze in as much profit as they can out of these. Drugs, Antibiotics, Procedures, Medical Professionals. I know it would be far-fetched to standardize and…

Elisabeth Rosenthal's "An American Sickness" is one of the best overviews of the many aspects and incentives for pricing in healthcare.

https://www.anamericansickness.com/

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

#34

Post by lolsal » Wed, Dec 19, 2018, 9:06 PM UTC

cableshaft wrote: post #22

lolsal wrote: post #3

I know $60 Ibuprofen can seem like a lot, but is anyone arguing that you're literally paying for only the pill(s) with that $60? Aren't you paying for the instant availability, the insurance that it's not expired (do they even expire? I really don't know), and confidence that your healthcare provider has signed off that XXX mg of Ibuprofen is a.) OK to have with your current medications and conditions and b.) suffici…

I don't think I have an issue with $60 Ibuprofen (or one thing being upcharged), it's everything being so upcharged, with the expectation that it's going to be negotiated down by an insurance company, and then if you don't have insurance, they try to get you to (or at least pretend) that they haven't overinflated everything and you owe them every penny, unless you just don't pay them, and only then will they consider…

> it's everything being so upcharged, with the expectation that it's going to be negotiated down by an insurance company

I agree with you 1000%. Highball the bill to the insurance company - fight with them - send the leftovers to the patient. That is totally unfair.

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

#35

Post by smileysteve » Wed, Dec 19, 2018, 9:07 PM UTC

SlowRobotAhead wrote: post #30

ttcbj wrote: post #24

Earlier quoted context omitted.

I was not an advocate for gov't health care, but I am now for the same reason you stated. I have a high deductible plan, and have tried to get quotes in advance, but never can. I have been ripped off multiple times, despite trying to do my research, etc. My wife is a doctor, and at this point, I think single-payer is the least bad option.

>have tried to get quotes in advance, but never can. >I have been ripped off multiple times, >I think single-payer is the least bad option. Can you help me understand why if everyone is paying for everyone's healthcare in a socialize system - how that reforms the transparency and stops the abuses?

Because, then the single payer, can say "your policies/prices don't work with our system", fix it, or we won't cover any patients, effectively shutting you down.

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

#36

Post by mikeash » Wed, Dec 19, 2018, 9:07 PM UTC

lolsal wrote: post #27

mikeash wrote: post #15

Earlier quoted context omitted.

I'm guessing you tell your clients, "I'm not really the right person to set up WordPress for you. I can do it, but it'll be incredibly expensive. You can probably do it yourself with a good online tutorial." Hospitals aren't telling their patients, "We're not really the right institution to give you ibuprofen. We can do it if you really want us to, but it'll be incredibly expensive. You can just go buy some at the st…

I think the difference just having a hospital triage you and tell you 'ibuprofen will handle the pain, it's nothing serious' is _already_ worth a boat load of money and peace of mind. I agree with you - it would be really interesting to see honest and transparent itemized bills, with separate items for overhead. I wonder if people would have the same problem with high bills in that case. Probably wouldn't like the to…

That’s definitely worth a lot. But the difference in price between “you just need ibuprofen, pick some up on your way home” and “you just need ibuprofen, so take this pill” should be minimal.

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

#37

Post by stdplaceholder » Wed, Dec 19, 2018, 9:08 PM UTC

nightcracker wrote: post #31

tivert wrote: post #25

Earlier quoted context omitted.

> But it is unfair to have no idea what costs you are facing and whether any of those costs are out of network on your insurance. It's practically impossible to make an informed economic decision about truly emergency medical care without heavy regulation. It's not uncommon to be literally unconscious while all the care decisions for you are being made by others. See this article for an example: some uninsured woman…

Considering she was unconscious she could not possibly have consented to those transactions. What laws exist that allow these companies to unilaterally create these transactions, and what limitations do they have?

They have literally no limitations. The reason that an advil at the hospital costs $200 is because they were afraid if they made it cost $20000 people would burn down the hospital.

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

#38

Post by stdplaceholder » Wed, Dec 19, 2018, 9:09 PM UTC

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.

Even if you ask for the price and even if you get it in writing up front you will still get a different bill later.

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

#39

Post by duxup » Wed, Dec 19, 2018, 9:09 PM UTC

tivert wrote: post #25

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…

> But it is unfair to have no idea what costs you are facing and whether any of those costs are out of network on your insurance. It's practically impossible to make an informed economic decision about truly emergency medical care without heavy regulation. It's not uncommon to be literally unconscious while all the care decisions for you are being made by others. See this article for an example: some uninsured woman…

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 pay it would have been a huge financal burden for years and years.

And let's say I did have time to think about it? What then? I'm not a doctor, this isn't shopping for a car... I don't feel like I could possibly know enough about emergency baby birthing, surgery, etc to know... "Gosh honey when the baby's heart rate starts to slow unexpectedly, I think we should save a few bucks".

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

#40

Post by SlowRobotAhead » Wed, Dec 19, 2018, 9:09 PM UTC

smileysteve wrote: post #35

SlowRobotAhead wrote: post #30

Earlier quoted context omitted.

>have tried to get quotes in advance, but never can. >I have been ripped off multiple times, >I think single-payer is the least bad option. Can you help me understand why if everyone is paying for everyone's healthcare in a socialize system - how that reforms the transparency and stops the abuses?

Because, then the single payer, can say "your policies/prices don't work with our system", fix it, or we won't cover any patients, effectively shutting you down.

What is stopping insurance companies from doing that now? If you're paying for insurance, it's in your insurance company's best interest to pay low prices.