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

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

#81

Post by davio » Wed, Dec 19, 2018, 9:29 PM UTC

serg_chernata wrote: post #11

codemusings wrote: post #7

Despite the fact that in my opinion this could be fixed by Universal Healthcare I'm left wondering: how is it legal to be billed these insane amounts of money without even getting a quote beforehand? Like just waiting in the ER is worth more than buying a first class airplane ticket and getting treated in another country.

> without even getting a quote beforehand Reminds me of this really good article. TLDR: Man tried to call a number of hospitals to find out how much childbirth is going to cost him and received no answers. https://www.vox.com/2016/5/5/11591592/birth-cost-hospital-bi...

I like the disconnect between this reality and the "consumer driven health plans" being offered by employers

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

#82

Post by thatswrong0 » Wed, Dec 19, 2018, 9:29 PM UTC

tgsovlerkhgsel wrote: post #62

Want to do something about it? Regulate it. Like literally, have some government body write a table: 1 pill of 400 mg paracetamol ............ $0.50 1 pill of 800 mg paracetamol ............ $0.60 prescribing medicine (once per day) ..... $4.32 base fee for an ER visit .............. $200.00 5 minutes of work by an ER physician ... $27.43 etc. and impose that as the maximum price that can be charged. It's not going t…

Shouldn't the max price of services (not things like RX of course) be different depending on the cost of living in that area? You'd need different prices in different areas otherwise the prices might be too expensive in some areas and too cheap in others. If the prices set are too cheap, you might see more people using the ER for non-emergency purposes, which would be bad for the people that need to use the ER for actual emergencies.

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

#83

Post by manfredo » Wed, Dec 19, 2018, 9:30 PM UTC

serg_chernata wrote: post #11

codemusings wrote: post #7

Despite the fact that in my opinion this could be fixed by Universal Healthcare I'm left wondering: how is it legal to be billed these insane amounts of money without even getting a quote beforehand? Like just waiting in the ER is worth more than buying a first class airplane ticket and getting treated in another country.

> without even getting a quote beforehand Reminds me of this really good article. TLDR: Man tried to call a number of hospitals to find out how much childbirth is going to cost him and received no answers. https://www.vox.com/2016/5/5/11591592/birth-cost-hospital-bi...

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

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

#84

Post by tschwimmer » Wed, Dec 19, 2018, 9:30 PM UTC

I'm surprised to see lots of people in the comments talking about line items. Line Items are irrelevant. They could include line items for oxygen and toilet paper if they wanted to. The hospital charges whatever the market (and where applicable, regulations) allow. The configuration of the line item is pretty much a customer service problem: 'how do we show what we've done in a way that will get the customer to pay it.'

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

#85

Post by gnopgnip » Wed, Dec 19, 2018, 9:30 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?

There is an out of pocket maximum of $7350 for 2018(going up to $7900 for 2019) for ACA compatible plans. Many plans have lower out of pocket maximums too. The health insurance company will negotiate and generally pay substantially less than $377k for a $377k bill.

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

#86

Post by maxxxxx » Wed, Dec 19, 2018, 9:30 PM UTC

ttcbj wrote: post #24

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…

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.

You don't need single payer. Just get some regulations about pricing. Germany doesn't have single payer but you never hear about these shenanigans.

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

#87

Post by brightball » Wed, Dec 19, 2018, 9:30 PM UTC

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…

Even out of network, you are able to bill your insurance directly. There are a lot of private practices not in network with any providers at all where insurance will still cover, you just have to do the legwork yourself usually.

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

#88

Post by landryraccoon » Wed, Dec 19, 2018, 9:30 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…

> Analyze the data

How are you going to get it? Even Google has huge regulatory issues around touching health care data. Medical records are some of the most highly regulated pieces of information around. A startup would have to have very deep pockets (or a few lawyers as founders) to have any chance IMO.

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

#89

Post by abnry » Wed, Dec 19, 2018, 9:31 PM UTC

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…

I think this is a problem orthogonal to private versus public healthcare. I think it is a problem relating to what health insurance is today. Pretty much all hospitals get all their indirectly from patients through insurance agencies. And this is for all services from checkups to bloodwork to scheduled surgeries to emergencies.

Since the insurance companies are the middle man, the cost structures become less directly correlated between patient behavior. Demand is inelastic, particularly because insurance smooths it out. The hopsital needs so much money, so why not inflate the price of advil over here, even though it doesn't directly correlate to their costs.

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

#90

Post by maxxxxx » Wed, Dec 19, 2018, 9:31 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?

Medicare seems to be able to do it even in the US.