At least the hospital in Newport took back their coding/billing into their own hands.
What was the result?
The Company Behind Many Surprise Emergency Room Bills
51–60 of 481 posts
Re: The Company Behind Many Surprise Emergency Room Bills
#52Earlier quoted context omitted.
"Single payer is the only viable solution. " That's not true. Plenty of European systems are not single payer and work fine.
I am not familiar with these alternate systems; how do they work?
In a sense Germany works very similar to Obamacare. Private doctors, health insurances, mandatory insurance for everyone. The difference is that it's much more regulated and the insurances are non-profit as far I know.
Re: The Company Behind Many Surprise Emergency Room Bills
#53So, basically, if you visit any emergency room then your handing them a blank Check and they can write whatever number on there they want. That's egregious beyond belief. I'm never one to call for legislation and price controls, but in the face of such adversity, I think it may be our last hope. I think they should either provide a quote before they offer the services or there should be a law limiting the amount that…
> I'm never one to call for legislation and price controls, but in the face of such adversity, I think it may be our last hope.
I'm always one to call for legislation and price controls, because time and time again, without the legislation in place, situations like this arise. It's the sad reality. Regulating companies is apparently our only hope to keep people from constantly being stepped on.
Re: The Company Behind Many Surprise Emergency Room Bills
#54If you want to understand how medical billing works and why these ridiculously high bills get created, there's a lot of important context that this article unfortunately leaves out.
Large hospital systems accept patients who have a range of payers (Original Medicare, Medicare Advantage, various Medicaid plans, private insurance, and uninsured patients). On the aggregate, they want to make sure that their entire system is cashflow-positive - however, they do that in a rather roundabout way, because they only have the ability to negotiate with some of their payers, whereas the others are able to set their rates at whatever price they want.
Medicare and Medicaid set their reimbursement rates by fiat, and providers have essentially no ability to negotiate those. Except in critical access areas, Medicare actually reimburses much less than the marginal costs of care for its patients (7% in the aggregate)[0]. These rates are so low that Medicare actually has a separate program to pay extra money to hospitals that treat a lot of Medicare patients - otherwise, they would literally go under. The reason they provide this money as a separate program and don't count it in claims is entirely political.
As a result, providers present very large bills to everyone else (privately insured and uninsured patients) to make up for this loss - you can't stay in business if you're literally making a loss on every patient! Uninsured patients see the large bill and assume they have to pay the entire amount (they don't!), and private insurers end up negotiating that down to some multiple of what Medicare pays.
A typical insurer will negotiate an agreement like, "we'll pay 350% of what Medicare pays for this category of services".
[0] This is not looking at any markup that the hospital provides - we're talking about how much the hospital has to pay its suppliers. So, for a hypothetical vaccine that costs $100 wholesale, Medicare might reimburse $93, which doesn't even cover the cost of the equipment, let alone the entire hospital infrastructure (wages, etc.).
Re: The Company Behind Many Surprise Emergency Room Bills
#55Earlier quoted context omitted.
"Single payer is the only viable solution. " That's not true. Plenty of European systems are not single payer and work fine.
I am not familiar with these alternate systems; how do they work?
Germany is two-tier. Public health for the masses, private for those making over 80k or so and healthy.
The public system premiums are a % of income. The private is a flat cost, so as you make more become much more attractive (even costing less in many cases).
Doctors are sometimes private only or have separate private insurance waiting rooms. Hospitals have separate public and private rooms/beds, etc.
It's a two-tier system that works pretty well, at least in comparison to the US system.
My info is a few years dated, but is based on having been a patient in both US and German hospitals. From friends, I've heard the English system is similar in some respects to the German.
Amazingly to me, the German system was instituted under Otto von Bismark in the 1800s.
https://en.wikipedia.org/wiki/Timeline_of_healthcare_in_Germ...
Re: The Company Behind Many Surprise Emergency Room Bills
#56Earlier quoted context omitted.
Because those in the middle and upper class have employer-paid health insurance which protects from the worst of bills. You only go bankrupt if you're uninsured and usually only those in the lower-middle or lower class are uninsured. And those in the lower echelon of society economically are those least able to have the time or money to march or lobby for change.
I just logged in to say this (trying to comment less and read more) but this needed said. Even with a vanishing middle class, the middle and upper class that remains still have largely great healthcare and healthcare plans, it's the poor who are largely being screwed. Even then, they don't support universal healthcare (it's mostly us hipsters or whatever) because they are still weary of the government and we're still…
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Re: The Company Behind Many Surprise Emergency Room Bills
#57Earlier quoted context omitted.
"You only go bankrupt if you're uninsured" With copays and out of network stuff a lot of people will go bankrupt in case of a serious illness.
> With copays and out of network stuff a lot of people will go bankrupt in case of a serious illness. By law, those are capped for people with insurance. The maximum that you will have to pay out-of-pocket can be no more than about $7,000, and many private plans set the cap at a lot less. $7,000 is a non-trivial amount, but it's not a large number of people that both are insured and can't afford their out-of-pocket m…
You can easily add tens of thousands of out of network costs with some medical issues.
Re: The Company Behind Many Surprise Emergency Room Bills
#58Over here (in Europe) we get the impression that US has such a crazy healthcare system. Why aren't people marching in the streets? Is it not as crazy as it sounds for most users? If you're taken to ER how are you supposed to know if the doctors are all part of "your network" (whatever that even means)?
It is exactly as crazy as it sounds, unfortunately. But due to many years (decades!) of pre-meditated political maneuvering, one of our political parties has managed to inextricably relate any kind of desire for "single-payer" or "socialized" medical system with effectively being a communist USSR apologist. No exaggeration.
Except for Medicare.
Re: The Company Behind Many Surprise Emergency Room Bills
#59I am having problems with my insurer at this very moment. I went to an in-network hospital for an ER visit, which turned into an 8-day stay (yes, it was serious). Evidently, none of the doctors at the hospital are in-network, however, (claims from various technicians are still "in processing", so I don't know how they will turn out) despite the fact that the hospital itself is definitely in-network. I had no choice a…
You may have some recourse with the insurance company because for emergency care that leads to an admission, the hospital being in-network is supposed to be what counts. Individual doctors being out-of-network should only come into play if you have a procedure done at their practice's office. I sincerely hope it works out for you. It might not hurt to get a 1-hr consult with a lawyer and send the insurance company a nasty letter?
Re: The Company Behind Many Surprise Emergency Room Bills
#60I am having problems with my insurer at this very moment. I went to an in-network hospital for an ER visit, which turned into an 8-day stay (yes, it was serious). Evidently, none of the doctors at the hospital are in-network, however, (claims from various technicians are still "in processing", so I don't know how they will turn out) despite the fact that the hospital itself is definitely in-network. I had no choice a…
We had a similar experience about 8 months ago, but only one night in the hospital. Raise hell with everyone.
The out of network doctors were resolved the fastest for us, and the longest was the hospital stay itself, which our insurance didn't agree to pay until 8 months after the stay. It was a seriously draining experience, and luckily my wife doesn't work so I didn't have to take time off for all the phone calls and following up that was required.
I don't fault our insurer. The hospital charged more for our one night stay than another slightly further hospital recently charged us for three nights stay. It was completely ridiculous. But completely out of our hands.
I've had to deal with that and more in the last couple years. In my experience there are no "good" or "bad" guys in this fight. It's a bunch of individually rational entities that when taken as a whole are completely fucking over the rest of us.