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Majority of debtors to US hospitals now people with health insurance

theguardian.com

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Re: Majority of debtors to US hospitals now people with health insurance

#51

Post by Turing_Machine »

beaeglebeached wrote: post #8

Hospital said I owed debt. Contested claim with debt collectors. Never saw it again and not on my credit report. Know a few people who've done this.

While not great, things are a little better in this area than they were a few years ago.

1) Even if it goes to collections, a medical debt won't appear on your credit report for a full year.

2) Medical debts less than $500 won't ever appear on your credit report.

3) If you pay the debt off later, the entire thing gets expunged from your credit report (i.e, rather than showing you had a debt that went to collections, and then was paid off, it's like the whole thing never happened).

These things only apply to medical debts, though, not normal consumer debts.

(edit: list formatting)

Re: Majority of debtors to US hospitals now people with health insurance

#52

Post by freetime2 »

ahi wrote: post #31
taeric wrote: post #7

That has included me, in the past. It is stupid easy to accidentally have a debt to a hospital. For families, sensible privacy rules at clinics can mean that it is very hard to choke point bills to a single person. To the point that I asked every time if I owed money when I did checkups to be told that we did not. Only to later find that my family did, in fact, have a bill due. For a while. Recently I'm getting it wi…

I've been getting those separate bills recently and it's driving me nuts. For one small out patient procedure I have received bills from the hospital, the doctor, the anesthesiologist, anesthesiologist nursing company, and a random surgeon I have never met that the doctor asked in for a 30 second consult (I know how long the procedure took) while I was under. Seriously considering ignoring some of these whotf-are-you…

> Seriously considering ignoring some of these whotf-are-you bills out of spite.

Then they will sell your debt to a collections agency who will make it their business to harass you to the maximum extent legally allowed (and sometimes more than that). This may include impacting your credit score - although I think some states at least have protections against that.

Re: Majority of debtors to US hospitals now people with health insurance

#53

Post by tptacek »

mtlynch wrote: post #41
tptacek wrote: post #13

This is the only debt I have, because hospital payment systems are fucking impossible to navigate. Thankfully, the Biden administration is drafting plans to make it unlawful to report that debt to credit reporting agencies, so I anticipate soon giving even less of a shit about it than I do now. Figure it out with my insurer, or bill me at the time of service. I'm sure as shit not responding to an invoice.

I'd love to adopt this strategy as well, but I worry about the clinic eventually forcing me to pay somehow and adding a bunch of penalties on top. Is there a way to mitigate that risk? Or is that risk unlikely in a way I'm not considering?

I'm not a lawyer, or a financial advisor. So: they could in theory sue you. But they're doing this to everybody, so unless you think they're going to sue everybody, I think it's a pretty safe bet? This has been my stance for over 10 years. I'll gladly pay if you ask me up front (or on the way out). Otherwise, fuck off.

I get how this attitude could sound shocking. I have friends who take a similar approach to other things and get away with it; most notably, a friend who refuses on principle to pay parking tickets. I pay parking tickets, and I still get whomped every 5 years or so with some absurd backlog of missed tickets and a boot, so I don't understand how this works for them. But it does!

You probably don't want to get me started on credit scores.

Re: Majority of debtors to US hospitals now people with health insurance

#54

Post by [deleted] »

JohnMakin wrote: post #37

I have been fighting these battles for much of the last ten years and this article fails to explain a dynamic that is happening here, at least where I am (california). I'll give my most recent thing that ended up in collections (which you can easily ignore, it doesn't affect your credit at all in some states). I had a pretty intensive surgery. I had a copay, which was shown to me before the surgery. I signed it, paid…

[deleted]

Re: Majority of debtors to US hospitals now people with health insurance

#55

Post by duffpkg »

This seems like a good thread to mention the book "Never Pay The First Bill" by journalist Marshall Allen. I've worked in healthcare for 20+ years. I've been on the collecting side of many bills, it's a good book for patients. Contrary to popular belief most hospital systems are not evil profit seeking corpratons but just trying to keep the lights on, it's still a business though and as a patient you have the right and oppourtunity to negotiate. Most of the time collecting something is better than collecting nothing which is more or less the default. Of course there are exceptions and abuses.

One other point I think is important, that I see come up a lot regarding deductibles, is that your deductible is most likely double what you think it is for a lot of situations. Particularly emergencies. This is buried in the minutiae of your insurance and relates to in and out and network/facility/doctor care having seperate deductibles.

Re: Majority of debtors to US hospitals now people with health insurance

#56

Post by rincebrain »

My favorite was a reason I stopped going to a major famous hospital's outpatient clinic in my area, which was that their billing department would sell things to a debt collector that were paid, and when I called, they'd say you shouldn't be getting a notice our system says paid in full, and I'd say "well, then why do I have 12 debt collector notices with those IDs".

I suspect they were just opportunistically selling it faster than insurance paid them, but the harassment of cleaning that up every so often was exhausting (since the hospital would always say "well it's not on our end"), combined with a bunch of other shady things the place did.

The dumbest part was, they were like, $10 bills, so I can only imagine how cheaply they had to have been sold for the debt collector to think they could turn a not-loss on it...

Re: Majority of debtors to US hospitals now people with health insurance

#57

Post by beaeglebeached »

wing-_-nuts wrote: post #48
beaeglebeached wrote: post #24

Earlier quoted context omitted.

That will raise the price of insurance even more. Now you have to cover the cost of risk of suing your own insurance pool.

As opposed to a single 'doctor' mass denying 1000's of requests a day? That should be illegal.

Profit margins are like 4% on health insurance. Insurance companies introduce a lot of cost and waste, but there's no evidence to me these mass denials are anything but the market not bearing real insurance that covers things reasonably under current regulatory conditions.

Could it be the consumer is too poor to pay for a bloated system that covers what it does, plus the mass denials?

The whole system is fucked and the even more fucked part is mass denials may be a symptom of the madness of the inefficient rube Goldberg machine and not even a profit driver.

Re: Majority of debtors to US hospitals now people with health insurance

#58

Post by FireBeyond »

duffpkg wrote: post #55

This seems like a good thread to mention the book "Never Pay The First Bill" by journalist Marshall Allen. I've worked in healthcare for 20+ years. I've been on the collecting side of many bills, it's a good book for patients. Contrary to popular belief most hospital systems are not evil profit seeking corpratons but just trying to keep the lights on, it's still a business though and as a patient you have the right a…

A lot of this has changed with the No Surprises Act, that specifically covers Emergency situations and others where a patient would be "reasonably expected" to believe that a service was in network.

Surprise billing protections apply to most emergency services, including those provided in hospital emergency rooms, freestanding emergency departments, and urgent care centers that are licensed to provide emergency care. The federal law also applies to air ambulance transportation (emergency and non-emergency), but not ground ambulance.

It also covers non-emergency services provided by out-of-network providers at in-network hospitals and other facilities. Often, the doctors who work in hospitals don’t work for the hospital; instead they bill independently and do not necessarily participate in the same health plan networks.

Doesn't mean your insurer might not deny coverage or apply a deductible that you have to fight.

You also cannot waive certain rights. Like some hospitals will try to get you to sign waivers around balance billing, and in/out network discrepancies. Some of these will vary by state, so be aware.

> The No Surprises Act (NSA) establishes new federal protections against surprise medical bills that take effect in 2022. Surprise medical bills arise when insured consumers inadvertently receive care from out-of-network hospitals, doctors, or other providers they did not choose. Peterson-KFF and other studies find this happens in about 1 in 5 emergency room visits. In addition between 9% and 16% of in-network hospitalizations for non-emergency care include surprise bills from out-of-network providers (such as anesthesiologists) whom the patient did not choose. Surprise medical bills pose financial burdens on consumers when health plans deny out-of-network claims or apply higher out-of-network cost sharing; consumers also face “balance billing” from out-of-network providers that have not contracted to accept discounted payment rates from the health plan.

Source: https://www.kff.org/health-reform/issue-brief/no-surprises-a...

Re: Majority of debtors to US hospitals now people with health insurance

#59

Post by ddoolin »

petre wrote: post #35
devilbunny wrote: post #30

Earlier quoted context omitted.

Because historically doctors were in private practices. I still am, as an anesthesiologist. Many of the surgeons I work with are also private. So, since neither of us is employed by the hospital, we do our own billing. If we were hospital employees, we could indeed do unified billing. That's a better analogy; your chefs are expecting to be paid by the restaurant, so it collects the bill. I am not paid by the hospital…

It's still better than billing to the hospital and the hospital billing to the patient, piling up taxes and comissions. The patient is also getting more cost transparency instead of a bundled bill one can never make sense of.

I don't agree with the last point and I think this thread is evidence of that. We cannot make sense of the myriad of bills we get from all the different providers, particularly since many or all of them are also being dealt with by our insurance and may have already been negotiated by the time we get the bills in the mail.

To that point, I went to the ER a few months ago and I've probably received ten or so mailings for unpaid bills, only one of which I actually ended up owing, but my insurance didn't make the claims visible until they were settled which was months after the fact. To make matters worse, I can still log in and pay bills which were settled by my insurance. And I've received bills in the mail -- late I assume -- after they were paid by me or settled by insurance, confounding matters further.

Re: Majority of debtors to US hospitals now people with health insurance

#60

Post by FireBeyond »

wing-_-nuts wrote: post #45
taeric wrote: post #7

That has included me, in the past. It is stupid easy to accidentally have a debt to a hospital. For families, sensible privacy rules at clinics can mean that it is very hard to choke point bills to a single person. To the point that I asked every time if I owed money when I did checkups to be told that we did not. Only to later find that my family did, in fact, have a bill due. For a while. Recently I'm getting it wi…

One thing my mom has been dealing with recently is where the insurance EOB and the bill differs substantially. My mom called the hospital to ask for an explanation and poof the bill is magically lowered by a several hundred dollars. How the heck is this not criminal fraud? Why are people allowed to simply bill whatever they feel like it, and why is my mother getting 'balance billed' for random amounts? They're still…

Depending on the state you are in, balance billing can be outright illegal, and, in many cases, despite facilities potentially trying to get you to sign a waiver against your protection from balance billing, that right can't be waived except in limited circumstances.
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